March 2003

Ten years ago, in March 2003, the Hong Kong Special Administrative Region (HKSAR) suffered from the attack of a new deadly virus.  Around 1750 people contracted the disease.  Sadly, among them, about 300 patients died.  A significant proportion of the patients and the diseased were healthcare workers.  After a few months, the virus was identified to be a corona virus; and the disease named as Severe Acute Respiratory Syndrome, SARS, or the SAR Syndrome.

Now is March 2013, while we pay our respects and salute to the sufferers, we might want to review the tragedy.  Luckily SARS was unheard after 2003, though there are now sporadic cases of a new corona virus.  But can we handle another outbreak of severe infectious disease?

There have been quite a number of reviews in the media.  I have gone through some of them, and I have chatted with some colleagues.  On an individual level, since the causative agent is a virus, we do not have a magic bullet for it.  Ribavirin is out.  Steroid is for the immune response.  It is doubtful if the aged anti-SARS serum is effective.  We do have better supportive treatment now, such as better ventilators and Extra-corporeal Lung Support (ECLS).  On infection control level, we now have the quick screening test for SARS, allowing prompt identification of probable subjects.  We have better protective equipment, which is regularly used by healthcare professions.  We have better ward facilities such as negative pressure wards.  We have the precedent of quarantining a hotel during the swine flu period in 2009.  We have better action plans and we have trained people for strategy execution.

However, are we prepared psychologically for an outbreak?  For those who experienced SARS ten years ago, do you still remember how you felt at that time?  For those younger doctors, have you ever thought of the life as a doctor in the period of a disaster?  I try to recall my feelings ten years ago.  Although I was by no means in close contact with SARS patients, as a family doctor I was still a frontline worker.  Every patient with fever was a potent sufferer of SARS.  I had to wear protective gears.  I could not play with babies and kids and I could not hold them in my arms.  I did not eat at my clinic, and I dined alone in open areas during lunch.  I avoided lifts as far as possible.  I went straight for a bath when I reached home.  I heard story from patients about how their friends and relatives got infected.  I knew that some of my colleagues were affected.  I read in newspaper that the number of casualties increased every day.

I then realize that I would have to prepare to face “losses” if there were another outbreak.  In the worst case, I might lose my life.  More likely, I might lose my freedom, which includes the freedom to travel, the freedom of not being isolated, the freedom to meet and chat and dine with friends without worry.  Surely, I would lose the trust of breathing in without the filter of a mask, maybe at the same time losing the trust on my patients.  Others would suffer similar losses, to a greater or lesser extent.  Apart from physical and psychological aspects, the economy of Hong Kong, maybe the whole world, would be affected.

Reviewing the tragedy ten years ago, and contemplating what would happen if I were to face it again, a saying keeps ringing in my mind.  It says that the most delicious food is just dumplings; and that the most comfortable thing (to do) is just lying down.  最好吃不過是餃子；最舒服不過是躺下。 In some northern provinces of China, dumplings are the staple food, just like our rice or the Caucasians’ bread.  After experiencing major events, be they good or bad, one would likely come up with the conclusion that uneventful lives are most valued and longed for.  Just like a commercial advertisement of an airline years ago, after travelling around the world and tasting cuisines from different countries, what the traveler misses most is a bowl of rice.

It might be enlightening while you compare your troubles now and your anticipated losses if there were SARS again.  You might be troubled by the continuous rise in real estate prices, a fall of stock market, your rival getting promoted, failure to gain the love of the one you admired, and so on, and so forth.  But looking back at the list of losses you do not want to encounter, they are mostly mundane things that we have forgotten, or failed to notice.  They are: freedom, trust, or even the down-to-earth things as breathing and being able to live.

In March 2013, here I again pay tribute to the diseased and the sufferers from SARS.  I pray for Hong Kong that no tragedies will happen in the future.  I treasure the bowl of rice I am going to have for dinner, after which I would lie down, and sleep through the night.

(Source: HKMA News March 2013)