SARS suspects under surveillance
April 10, 2003 9:49 AM   Subscribe

Singaporeans under government home quarantine orders due to close contact with SARS patients will have electronic cameras installed into their homes. "These people will then be called at random intervals and asked to stand in front of the camera to show they are home. Anyone found breaking quarantine will be served a warning letter and given an electronic wrist tag."
posted by plenty (24 comments total)
Welcome to Singapore: Home of no Cosmopolitan magazine (too racy) and no chewing gum (sticks to the pavement and shoes).
posted by Mr_Spook at 9:59 AM on April 10, 2003

Can people in Singapore still smoke in restaurants?
posted by shepd at 10:16 AM on April 10, 2003

shepd apparently not. Another source indicates smoking is still legal in bars, karaokes, and outdoors, except in line at bus stands(!).
posted by whatzit at 10:29 AM on April 10, 2003

Actually, I heard chewing gum was made illegal in Singapore after some punks placed a glob of gum on the subway door sensor, holding up the subway service.
posted by reverendX at 11:40 AM on April 10, 2003

Jokes aside, this is serious stuff and not confined to Singapore. Hong Kong has just extended their quarantine and is opening "SARS camps," and Thailand has given health authorities the option to quarantine visitors for 14 days. I spoke with a friend in Australia yesterday and he reports that the entire region is gravely concerned and business/public life is almost grinding to a halt as nobody is willing to travel or in some cases, even leave their home and ride the subway.
posted by donovan at 11:41 AM on April 10, 2003

So they have the Patriot Act over there too?
posted by iamck at 12:21 PM on April 10, 2003

I live in Singapore and its true. Although not as bad in Hong Kong, the Singapore governnment is more proactive (good or bad) in reacting to this outbreak.

Malaysia no longer allows Chinese tourist in the country.

Thailand wants all passengers from effected areas to wear masks for 14 days.

In Asia, people couldn't care less about the war in Iraq, this is far closer to home and everyone is scared.
posted by AsiaInsider at 12:35 PM on April 10, 2003

View screens?

(Perhaps the first time I've felt the 1984 analogy has fit or perhaps more like Daybreak)
posted by Bag Man at 12:36 PM on April 10, 2003

In Asia, people couldn't care less about the war in Iraq, this is far closer to home and everyone is scared.

Time to break out the aluminum foil... it's conspiracy time!
posted by Eamon at 12:51 PM on April 10, 2003

I'm a Singaporean too and I'm shocked. Electronic wrist tags?? Don't they do that to convicted felons in some places?

From a country with so many stringent laws, you'd think the citizens could carry out their civic responsibilities, but obviously some choose to ignore the quarantine.

AsiaInsider: Please don't go round making sweeping statements about how people feel about the war in Asia. A lot of people are concerned.
posted by murmur at 1:51 PM on April 10, 2003

Well, those who obey quarantine rules have nothing to fear, right? *smirk*
posted by squirrel at 2:09 PM on April 10, 2003

you're right, some people do care but most people are more concerned about SARs that I'm 90% confident of.

You must be just told me not to do something. :)

I live in Singapore...I'm not a Singpaorean.
posted by AsiaInsider at 3:55 PM on April 10, 2003

Some of the responses puzzle me. What are you advocating instead? No quarantine? A quarantine that people are free to break if they want? Do you prefer a pandemic to temporary curtailment of some liberties?
posted by raygirvan at 4:56 PM on April 10, 2003

well, the government still cannot explain some cases so they figure that some people are sneaking out of quarantine.....its better than actually locking people up in a facility.
posted by AsiaInsider at 11:07 PM on April 10, 2003

What raygirvan said. Sorry to be a humorless grouch about this, but SARS is a comedy-killer for me. It's killed over a hundred people, infected thousands, and spread across the globe in a matter of weeks. It's highly infectious, perhaps as easy to spread as the common cold (of which it may be a mutated version). Quarantine is a well-established and highly-effective public health technique. It's not even that onerous: just stay home for ten days.

But some people are just ornery. Canada, too, is having problems enforcing quarantine. Note in that story that because a single guy ignored quarantine, 197 of his co-workers had to be quarantined. Is that stupid, or what? Given Singapore's known history of draconian attitudes towards personal behavior, I'd say it's treating its quarantined people with grandmotherly kindness.

SARS is just beginning. Don't be surprised if a similar program comes to your city, wherever you live. When it does, please cooperate with it. Don't wait until there have been a dozen deaths in your area to take SARS seriously.
posted by Slithy_Tove at 11:41 PM on April 10, 2003

Few question the need for quarantine measures for those who have contracted SARS or who have had extended close contact with sufferers. However, the quarantine, in Singapore at least, has been extended not only to those with the illness but to those with only the remotest likelihood of having it.

A few dozen deaths (mostly of people with a prior history of illness) and a couple of thousand infections (many of whom have recovered) in several months do not yet a global epidemic make. However, the authorities have chosen to assume the worst and public opinion, for the moment at least, is overwhelmingly in favour of such an approach.

The SARS issue illustrates how even libertarians will readily accept draconian curtailments of personal freedoms when faced with something as primal as the perceived threat of disease. Having video cameras forcibly installed at home and being required to stand to attention on demand is not exactly my idea of "grandmotherly kindness". In Hong Kong, there is public pressure on the government to reveal the names and addresses of families of sufferers. Is this a case where the end always justifies the means?
posted by plenty at 12:26 AM on April 11, 2003

plenty: your link is about foreign workers. That policy hasn't even gone into effect yet. Those are not the people who are now being quarantined. I agree, though, that quarantining only workers from SARS-affected countries and not tourists from those countries is silly. The rationale given for it in the article doesn't make any sense, medically.

You are still underestimating SARS. Take a good look at the graph at the bottom of this page. You are wrong when you say that that mostly...people with a prior history of illness have been those who died. "As of March 21, 2003, the majority of patients identified as having SARS have been adults aged 25--70 years who were previously healthy." Deaths have tended to be in those 50 and older, but certainly not everyone who is 50+ is chronically ill. Dr. Carolo Urbani was a globe-trotting infectious disease investigator for WHO, when he acquired SARS and died. Most of the 100+ patients in Prince of Wales Hospital in Hong Kong were health care workers who had merely been exposed to sick patients, not the old and infirm. This is a very different population from that which is usually killed by pneumonia: the very old, with cardiovascular disease, cancer, or advanced dementia.

Having video cameras forcibly installed at home and being required to stand to attention on demand is not exactly my idea of "grandmotherly kindness".

When compared to the alternative, which is putting people into locked hospital wards, or isolated outdoor camps, it is. That was done with TB patients, decades ago, before the development of antibiotics effective against TB. It was the only way to prevent transmission. It worked. And TB is not nearly as easy to transmit as SARS. Having to stay home and report to a video camera a couple of times a day for a week and a half? To prevent an epidemic of lethal infectious disease? Good lord. That's not being oppressed.

The SARS issue illustrates how even libertarians will readily accept draconian curtailments of personal freedoms when faced with something as primal as the perceived threat of disease.

Threat of death, not just disease. Death rate from SARS has yet to be determined, but it has ranged from 3% to 10%, with up to 20% having to go on a ventilator during the illness.

Yep, my fear of that is pretty primal. I do not wish to die. I do not wish others in my community to die. I don't see that an enforced home quarantine for a week and a half for potentially infected individuals is 'draconian'. It just isn't.

The sky isn't falling... yet. But it may, if we don't manage this disease aggressively. Not enforcing quarantine, letting infected people roam free, will cause immediate, widespread transmission, and a public health disaster.
posted by Slithy_Tove at 2:09 AM on April 11, 2003

No matter where the SARS outbreak occurs, it is a very health serious matter. Look what happened. It started from Guanzhou in China in Nov. 02 and has spread to many countries in a span of few months because of lack of prompt and effective measures that were needed to deal with an unknown, but highly infectious and deadly virus. It does appear that for the time being at least, certain drastic steps (by this I mean monitored quarantine) would have to be taken in order to effectively prevent the further spreading of the illness, which has killed young and old people who were unfortunate enough to be at the wrong places.

It may be barking up the wrong tree to think that a healthy person’s rights are being trampled upon. The complexity of the problems faced by the affected countries is not just due to the non-availablility of diagnostic tools to quickly identify SARS-sufferers or carriers, but also a lack of clinical evidence on how the spread of the virus could be avoided other than through quarantine of probable & suspect persons that fall within the definition of the WHO guidelines. The identification of persons for quarantine purposes is not arbitrary process, but is determined by doctors especially equipped to handle these cases. Professional judgment of the doctors may turn out to be wrong, and if the error is made on the side of caution and clinical uncertainty, can anyone blame the doctors? All probable and suspect persons are put under medical observation and follow-up procedures to ensure their welfare. Depending on the health condition, probable and suspect persons are promptly discharged from the home quarantine and in some cases, hospitals, to avoid strain on limited medical resources.

I think in dealing with such new illness, which doctors over the world are not yet able to pinpoint the pathogens and there are no sure ways of preventing the spread, as borne out so far by almost daily reports of new cases, taking half measures will turn out to be a case of doing too little too late.

If there ever is a good time to show a little social responsibility and restraint for the benefit of all, this is such a time.
posted by taratan at 3:27 AM on April 11, 2003

Here's a useful site on SARS : It's put up by a Singaporean or someone living in Singapore.
posted by taratan at 3:53 AM on April 11, 2003

with up to 20% having to go on a ventilator during the illness.

And that seems to me a crucial aspect. How many ventilators does an average hospital have? It wouldn't take many cases before hospitals haven't the resources to help all patients who reach this stage. People are starting to think about the numbers and the problematical decisions involved.
posted by raygirvan at 6:21 AM on April 11, 2003

Wow, raygirvan, interesting links. Terrifying links.

That second one... yep, that's the way we might wind up thinking. When you run short on ventilators, young people get the vent; people over the age of N don't. The value of N will be inversely related to the number of cases of SARS. Anyone over the age of N sinks or swims on his own. If he can breathe on his own, he lives. If he can't...

This kind of triage isn't unique to this disease, of course. All nations do it with respect to things like kidney failure and dialysis. Some nations have an upper age limit above which no one gets dialyzed. They just die.

On a less horrifying note, this might bring back the old pressure-cycled ventilators. [Pressured-cycled ventilators are much less complex, but less versatile, than the volume-cycled ventilators widely in use today.] I'll bet lots of hospitals have a bunch of twenty-year-old Birds in a back room that they could press into duty if things got tough. They're less than ideal, but they would be better than just letting middle-aged folks die.
posted by Slithy_Tove at 7:33 AM on April 11, 2003

SARS is a mutant cold virus according to the BBC. Further down comes this warning: Authorities in the UK have urged passengers on flight LH 4520 from Frankfurt to London on 2 April and flight LH 4671 from London to Munich on 3 April, to seek medical advice. So much for containment. I'm amazed that there's not more discussion and alarm about this, particularly for those who are HIV+. Has the penny just not dropped or have people perhaps correctly concluded that there's no point worrying since nothing can be done?
posted by grahamwell at 12:15 PM on April 11, 2003

no point worrying

Aaronovitch is an idiot. None of the diseases he cites have spread to the extent of this SARS outbreak. Something can be done, but only if governments are prepared to do it, now.

Slithy_Tove I'm prepared to be corrected on my estimates, but I'd guess that the average small-city hospital has maybe a couple of dozen ventilators. If so, we don't need a pandemic; all it would require is 100+ cases within the catchment area for resources to be swamped. Has anyone got any better estimates?
posted by raygirvan at 4:10 PM on April 11, 2003

We may do okay. Hong Kong was blindsided by the disease, and even so, they never ran out of ventilators. Everyone else is now ready and armed. Everyone will use major precautions (N95 masks, gowns, gloves, headcovers, locked-down wards, etc.). The spread will never again be as unchecked as it was in Hong Kong at the beginning.

Many hospitals own only a minimum number of ventilators, and rent any more they need from commercial agencies. These do business over a wide area. (I've been in hospitals in Philadelphia which have brought in rent-a-vents from Allentown.) For there to be a true shortage of vents, you would have to have pretty much of a full-blown nationwide epidemic. That could still happen... but because vents are borrowed and rented freely, if we run out of them, the whole world will run out at about the same time.
posted by Slithy_Tove at 7:59 PM on April 11, 2003

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