Taipei Times: When the first SARS cases surfaced in Taiwan in mid-March, the medical authorities here seemed able to bring the disease under control; no deaths, no exported SARS cases and no community transmissions were reported. But with the outbreak in Taipei Municipal Hospital, the previous well-established prevention efforts seem to have collapsed. What went wrong?
Lee Ying-yuan (李應元): When the outbreak at Hoping Hospital occurred, the government experienced difficulties in handling the crisis. We have to admit that, to some extent, there was management negligence at Hoping Hospital. The firing of the hospital's superintendent, Wu Kang-wen (吳康文), is an indication of his poor performance.
PHOTO: GEORGE TSORNG, TAIPEI TIMESN
Furthermore, the facilities and personnel management within the hospital should be designed to prevent virus dissemination by enforcing well-organized classifications of management in different sections of the hospital.
The Hoping Hospital did not promptly recognize the underlying threats. It had received SARS patients in March, but it failed to reveal the situation in a timely manner, resulting in a snowballing outbreak.
Before the Hoping Hospital incident, Taiwan's SARS situation was not serious as the number of SARS patients was limited. The NTU [National Taiwan University Hospital] then developed an effective process of treatment, which successfully cured 16 SARS patients, including a couple of Taiwanese busin-esspersons in China surnamed Chin, who were the first reported SARS cases in Taiwan.
NTU displayed an excellent performance in curing SARS patients and won international recognition after the son of an American diplomat in Vietnam was cured from SARS in NTU after being sent there for treatment.
TT: On Tuesday, NTU closed its emergency room for sterilization due to a cluster of possible SARS infections within the facility. Does that mean the hospital, Taiwan's key medical institute in fighting SARS, has also conceded to the invasion of the disease?
Lee: No. The closure of the emergency room won't affect the hospital's ability to handle patients in critical condition. The hospital was forced to temporarily shut down the emergency room because it was overloaded with all kinds of patients. It was the result of poor implementation of triage among hospitals at different levels.
Patients with mild symptoms could be treated in smaller or medium-sized hospitals and could be sent to medical centers like NTU should the illness become severe. In that case, NTU's manpower wouldn't be exhausted.
When SARS or non-SARS patients came to the hospital's emergency room, it was unavoidable that the hospital would experience internal infection. But the hospital was responsible to shut down the emergency room to stop further spread.
TT: How do we integrate national medical resources to combat SARS?
Lee: As SARS is a new and virulent disease, it is necessary to have a united system to integrate medical resources. The government should set up special clinics at a basic-level for checking initial symptoms such as fever and cough, and have upgraded SARS hospitals treat SARS patients only. Also, there should be systematic and standard operating procedures for the designation of 119 service, ambulance service and the hospital work.
TT: What's your view on the CNN report criticizing Taiwan's medical authorities for sending personnel and patients in Hoping Hospital to different locations for quarantine rather than keeping them in one area?
Lee: The CNN report, based on the advice of the US Centers for Disease Control, said the hospital should not send patients to different places, but should concentrate them in a single facility to prevent further spread. Well, the American CDC's method is the traditional way of preventing the spread of infection. But the Hoping Hospital was an exception, as the hospital had gross internal infection and there was no classification within the hospital to separate the infected patients from the healthy ones. Sending patients away to different hospitals is a way to reduce the further spread of SARS, which might otherwise be aggravated.
TT: Are the central and local governments open-minded enough to communicate with each other in laying out plans to contain the disease?
Lee: At the beginning, the communication between the two levels of government was difficult. We could see that the Taipei City Government was attempting to defy the Cabinet-level Department of Health. But now the situation has improved as both parties realized that only cooperation could help bring down the epidemic.
TT: As a candidate for Taipei City mayor last year, how do you respond to those who say the development of SARS in Taipei would have been different if you had been elected mayor? What you would have done differently?
Lee: I can't comment on this question, because I am the person involved. In hindsight, we can see that there were indeed certain things that could have been done differently, including giving training lectures to medical staff about SARS, as well as giving more prevention information to the public.
TT: Have Taiwan's chances of entering the World Health Organization (WHO) been improved as a result of the SARS outbreak?
Lee: Support from the US, Japan and Europe for Taiwan's bid to become an observer of the World Health Assembly has increased year by year. Japanese Minister of Health, Labor and Welfare Chikara Sakaguchi even showed strong support on May 11 for Taiwan's bid to join the WHA as an observer. This shows a significant improvement in the intensity and form expressed by our allies to support Taiwan's WHO bid. The wording and phrasing used by our allies have improved year by year, and this is an important index with which to gauge their support for Taiwan.
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