Press Releases

Transcript on atypical pneumonia cases

Following is a transcript of remarks made by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong; the Chief Executive of Hospital Authority, Dr William Ho; and panels of experts -- Professor John Tam of Chinese University of Hong Kong; Professor K Y Yuen of University of Hong Kong, and Dr Dominic Tsang, Member of the Central Committee on Infection Control of Hospital Authority -- on atypical pneumonia cases at a press briefing today (March 18):

Dr Yeoh: Today I want to reinforce and update you on the figures and the position of this very unusual phenomenon that we're seeing in Hong Kong and certain parts of this region. Why we have a sub-set of atypical pneumonia patients who seem to have a very high infectivity for health care workers to take care of them. And also high infectivity to close relatives of these what we call index patients. We will update you on the figures and the current situation.

As we said yesterday, the operations of the (Prince of Wales) hospital will be based on two principles - one is on the safety to patients, and my expert advisers agree that there is currently no evidence at all that it is unsafe for patients to be seen in that hospital. As you know, the World Health Organisation has reaffirmed yesterday that this is infection spread mainly by droplets and the precautions we are taking are adequate and there's no evidence to suggest that the infection is spreading into other parts of the hospital other than those who have been in contact. So we are of the view that it continues to be safe to see patients in the hospital.

But on operational grounds because many of the medical staff are now reporting sick. (Introducing other panel members)...

The figures given to you by Professor Sydney Chung yesterday implied that there are community cases that we are not including in our presentations. And as we have mentioned before, in any community, there will always be atypical pneumonia. What we know is that we have not seen any increases in atypical pneumonia cases presenting to the hospitals. But what we do not know is what percentage of these atypical pneumonia cases are the cases that are of concern to us - that seems to infect health care workers and their families so readily. And this is ongoing research that we are doing.

I can assure the public that we are not ignorant to the fact that there are cases of atypical pneumonia in the community as we said before. What we have said is that we have not seen an outbreak of these cases in the community, but obviously they are there. Otherwise the health care worker would not have been infected because there are patients who carry this virus in the community, they are then brought into hospital because they are sick and because we are unaware of this virus, it then spreads to the health care workers and to close family contacts.

We are doing a lot of work to try to identify to see whether we can quantify among the hospitalised patients what is the potential number these are. Of course, if we don't know the virus, we would not begin to discern the number in the community. But we have certainly not seen widespread outbreaks in the community, because if they were as widespread as in the hospitals, you can imagine that we'd have large numbers of atypical pneumonia in the hospitals. So while we said that we have seen no widespread outbreaks in the community but these outbreaks are from the community spreading to healthcare workers who take care of them and to immediate family members. We do not understand completely its behaviour but as the experts here we tell you that this is partly related to the mode of infection, which is droplets. When health care workers take care of patients, they are in very close contact with them, and this is consistent with droplet infection.

The total figures are that we now have 111 individuals with pneumonia and these we suspect are clustered around six groups of patients. We have 12 additional patients that we are keeping under observation. We don't know whether they will develop pneumonia or not. So that total number is then 123. These are the results of six clusters. Dr Ho gave you two new clusters today. One is the one we suspected yesterday because this is the one from the private hospital - three new cases from the private hospital. We also have a new cluster in the Queen Elizabeth Hospital - these were four health care professionals who took care of a patient with the features of atypical pneumonia. Of the original four clusters, in three clusters there has been very little change. We had an increase of one in the cluster from the private clinic. So the main numbers are still coming from the Prince of Wales cluster.

Professor John Tam: Starting from the date of the first health care worker reporting symptoms, we went back about two weeks. We looked at Ward 8A - how many patients were admitted and how many were admitted with pneumonia. After tracing all the patients, we suspected we would probably find one case - the index case - of this particular outbreak of atypical pneumonia in the Prince of Wales Hospital. This patient suffered with respiratory tract infection on February 24 and did not seek medical treatment until March 5. At that time he presented himself at the Accident and Emergency Department at the Prince of Wales Hospital and was admitted to Ward 8A. Two days after the patient was admitted, health care workers started to complain of respiratory tract infection, progressing to pneumonia. We analysed the 50 cases of health care workers contracting the disease. All 50 patients have an identifiable link with this particular ward and at the same time some of them had very close contact with this particular patient. After that, you expected the outbreak to continue because it would take a few days for the disease to come out.

We instituted infection control for droplets on March 11. So after that, the number of cases had dropped substantially. But this is not the final - we are seeing more and more cases as we progress. Further on, we should have an update of this outbreak and see what it really looks like.

The way the virus is being transmitted is not identified yet - through droplets, through close contact with the patient. This particular patient had been under aerosol treatment, to spray drugs into the patient and this may help the virus spread within the ward.

Dr Yeoh: First the patient who was sick was not identified at an early stage to be a patient that would be at risk of giving the infection to health care staff. So it was only after that we had a large number of health care staff reporting ill, by which time the virus had already spread quite widely. The second reason was that this patient was given specific treatment that helped to spread the virus obviously without knowing, through a nebuliser. That's why we had such large numbers.

Dr William Ho(translation): Figures for today showed some increases. Let me go through the hospitals starting from Prince of Wales, altogether 44 medical staff had been admitted. Out of these 44, 36 had been confirmed to have pneumonia. That's an increase of three in total, and five over yesterday for the confirmed cases. Apart from staff of the Prince of Wales Hospital, some of the staff had been admitted to other hospitals - one in Kwong Wah Hospital, one in Princess Margaret Hospital, one in Tseung Kwan O Hospital. In Kwong Wah Hospital, apart from the staff from Prince of Wales, two of their own staff are also admitted. That's the same as yesterday for Pamela Youde Nethersole Eastern Hospital, seven had been admitted and all of them have pneumonia. And this is the same as yesterday for Queen Elizabeth Hospital, four staff members had been admitted - one has been confirmed to have been downed with pneumonia.

So, this is something new today. As you know in Mong Kok, there is a private clinic with three people admitted to the Princess Margaret Hospital. All three of them had been confirmed to have pneumonia; one of them had been transferred to Tuen Mun Hospital. All these three people come from the private clinic in Mong Kok. For the St Paul's Hospital, three staff members had been admitted to the Eastern Hospital. All three of them had been confirmed to have pneumonia. Altogether for public and private institutions, the total number of affected medical and nursing staff is 67, 55 had been confirmed to have pneumonia. So there is an increase of 11 admitted and nine in term of confirmed pneumonia cases. For medical students, Prince of Wales has admitted 17, all of them had pneumonia, which is an increase of one over the figure yesterday and two more cases of pneumonia had been diagnosed. For family members and visitors who had visited patients in hospitals and got affected, they were admitted to Prince of Wales, Princess Margaret and Kwong Wah, altogether we have 39 such patients. All 39 of them had pneumonia. That represents an increase of 16 patients and 17 confirmed cases over yesterday.

As mentioned by Dr Yeoh, pneumonia is always there and sometimes we cannot really tell whether it's typical or not atypical because we had not been able to identify the pathogen. Whether these medical staff, medical students and family members/visitors got sick because of infection, we have been talking to the hospital management, the medical faculty, the teaching staff and operation staff there. I have been spending some time on the Prince of Wales Hospital as a matter of fact. The night before last, I talked to Professor Chung, Professor Shum and other senior management staff about staffing. There is a need to adjust downwards the number of staff in service. As a result, we have to cut down on some activities of the various clinics and departments. The most affected departments are A&E, medical wards and the acute treatment wards. So for A&E patients, if they have medicine problems, they will be transferred to another hospital. After reaching this consensus with the management, we have been monitoring the situation with the staff. For the whole of this morning, I had been at the Prince of Wales Hospital discussing various operational matters with department heads and we have noticed that more staff members have come down with the disease. So, in medical wards, the staff size has been come down by as much as one-third. We have made some appeals for people not to come to Prince of Wales if they don't have to. So we have a decrease of patient visits by 40 per cent. Of course the staff members are feeling very unhappy and upset because these patients are their colleagues. We would like to suspend the operation of A&E department for some days starting from midnight tonight. We have to inform the FSD (Fire Services Department) so that their ambulances will stop going to the A&E department of the Prince of Wales Hospital. This will last for three days and then we will see what we will do after that. Why is it three days? Although the number of colleagues taken sick has increased, the rate of increase has slowed down. We hope the situation can be stabilised so that we can chart our way forward and allow colleagues to plan ahead. So this is the arrangement that we are going to put in place. We would be liaising with other hospitals because A&E patients would have to be diverted to other hospitals. So, this is more or less the new arrangements we have in mind.

Professor K Y Yuen: This is an emerging atypical agent, which is still unknown to us and therefore what we give to treatment must be based on common sense and logic. Because we don't have a test to identify whether a patient is really suffering from this emerging atypical pneumonia agent, as a result, to start with, we usually will give the patient antibiotic coverage for typical and atypical pneumonia, bacteria and viruses that are known. ... After 40 hours, if the patient is not improving, we know that he might be suffering from this emerging atypical pneumonia agent. And then, we have to think about new things because this is something which is unknown. We know that there are patients in Kwong Wah Hospital that had an open lung biopsy, so we actually take the lung out and look at it. We found that a lot of the lung damage is due to inflammation ... not directly due to the viral infection. ... We know that when we treat such patients, we need to give some drugs that would dampen the inflammation so as to decrease the damage and at the same time we would need to give a drug which is an anti-viral, which is broad enough to cover a lot of viruses, in order to keep the virus not from multiplying. ... this means these patients would not have to go on to ventilators and we hope that it would maximise the chance of survival. At the moment we are seeing good results thanks to the doctors and nurses at Kwong Wah Hospital, especially in the Department of Medicine and the Department of Intensive Care, they are doing a great job. There are three patients who are now recovering and one of the nurses is going to be discharged so you can see that there are drugs that we can try on these patients and are yielding good results at the moment. We don't know what will happen in the long run because we have so many patients, but we are doing our best.

Dr Yeoh: What Professor Yuen has said is that most micro-organisms, viruses, bacteria cause damage in two ways. One is by the organism itself, so usually if you give an anti-biotic or an anti-viral it kills the virus or the micro-organism so the patient recovers. The second reason you get sick is the body's response to the infection. The body's response is intended to kill the virus or bacteria. But sometimes it over-reacts or there are certain reactions that also harm the body itself. So then you give treatment to suppress that reaction of the body itself that is intended to do good but at the same time does harm the body. So in the treatment of these patients, we are using the two approaches.

Dr Dominic Tsang: Secretary, I think in February I explained it to you in clear term. Pneumonia is a rather common disease and you don't need to be alarmed by the figures because in February we already knew in neighbouring regions there were cases of atypical pneumonia. And our understanding after these cases is better now. We are better able to grasp the possible causes and we also see if it could help our tests and so on. We could try to identify the features. Now with a better understanding of the symptoms, I think I should be able to tell you now that in fact everyday we are monitoring all these cases. As I said at the beginning of February, pneumonia is very common. Just to give you a rough figure, there could be more than a thousand cases each month especially during winter months. But of course there could be many causes. To the disease, the most common one is probably bacteria. Bacteria could cause pneumonia but we have effective antibiotics to deal with that. But there is one type, the so-called atypical pneumonia. In other words, that is not the normal or common viruses or bacteria that we see. So then what we do with such viruses or bacteria. In some cases this could be identified through testing to see if they are caused by influenza or whatever. Of course, in these days you become very familiar with all these terms but then there are still some cases we could never identify causes. In some cases, we are unable to identify the cause, for instance, if a patient goes to a hospital and he has had treatment like antibiotic treatment, so then when we do tests, we cannot do a culture of the bacteria. Or perhaps say, in blood testing, we could not get enough samples because the patient is already cured. For those cases, we still could not identify the causes although the patient has recovered. At the Hospital Authority and all our hospitals, we do keep surveillance of pneumonia cases that result in admission to the intensive care unit or in cases where the respirators are used. We would then compare the figures with the last winter before we can tell if there is any increase in number or if there are serious pneumonia cases. I think we are confident in telling you that there are actually not many cases. We are not trying to hide anything, either we know it or we don't. Now is it possible that there are some cases that have escaped our attention? Well, it is possible because just now, as I said, we just focus on the more serious cases but you know what we need to do is that within the shortest possible span of time, with the least resources we have to come to grasp what is actually happening. That is why at the beginning of last month, we have asked all hospitals to report all serious pneumonia cases to us. Now we have some idea of the cases, we have got some understanding of the cases. We are now in a position to tell whether these are the SARS (Severe Acute Respiratory Syndrome) cases among the atypical pneumonia cases.

(Please also refer to the Chinese portion)

End/Tuesday, March 18, 2003
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