INFECTIOUS DISEASES (AMENDMENT NO. 2) BILL

Order for Second Reading read.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

We are faced today with an unprecedented public health crisis. This crisis has been caused by the outbreak of Severe Acute Respiratory Syndrome or SARS. Several senior doctors told me that they have not experienced anything like this in the last 40-50 years. The SARS outbreak can destroy the capability of our national healthcare system if it is not contained. It can have wide and severe repercussions on many sectors of our economy.

The SARS outbreak can be very pernicious because SARS is likely to be more infectious when the patient is more ill. And the patient is likely to be most ill when he is in the hospital. Once a group of healthcare workers is infected by SARS in the hospital, it can spread quickly within the hospital. In Hanoi and Beijing, they have had to take the very drastic step of closing down the affected hospital, keeping everybody within the hospital, in order to stop the transmission into the community.

Even when SARS is contained, it will take a heavy toll on the healthcare system. SARS will place a disproportionate demand on ICU facilities and isolation rooms.

The Government is doing its utmost to control the SARS outbreak in Singapore. However, we need the cooperation of all Singaporeans in this battle. Until we have reliable and effective diagnostic tests, our doctors have to depend on two main criteria to assess whether a person has SARS. First, the clinical symptoms, like fever, cough, muscle aches and chills, which can be very non-specific. Second, the contact or travel history. With global travel and the complex web of interactions in a modern bustling city, establishing contact history is not an easy task unless the patient is truthful and forthcoming.

If a patient admitted to a hospital does not tell the truth about his contact or travel history, he may not be categorised as a suspect case and may not be isolated quickly. As a result, the infection can spread throughout the hospital. If a person with a fever sees a general practitioner and lies about his contact or travel history, he may not be referred to Tan Tock Seng Hospital and he goes on to infect others in the community.

The Infectious Diseases Act provides for the control and prevention of infectious diseases in Singapore. Today, I propose new amendments to the Act, to give additional and necessary powers to the Ministry of Health to control the outbreak of SARS in Singapore. The main specific provisions cover five key areas: Home Quarantine Orders, the quarantine of premises, the prevention of persons from acting irresponsibly which cause the infectious disease to spread, compliance with disease control measures and the handling of bodies of deceased persons who are suspected to have SARS.

Home Quarantine

Let me turn to the first area which is home quarantine. It is important that all persons with SARS are identified early and isolated for treatment at the Tan Tock Seng Hospital. This will minimise transmission of the disease to other people. We also impose Home Quarantine Orders on contacts of patients with SARS. Although asymptomatic contacts of SARS patients are well, the imposition of home quarantine allows us to pick up cases of SARS much earlier and prevents them from infecting others in the community. Home quarantine is therefore a key measure to prevent community transmission of SARS in Singapore. If people placed under home quarantine disregard their quarantine, they risk infecting others in the community. Clearly, this endangers the public health and we must not allow this to happen.

To begin with, the amended Act will make the legal process of issuing Home Quarantine Orders clearer. Currently, Home Quarantine Orders are issued under section 15(1) of the Infectious Diseases Act which allows any person who is or who is suspected to be a case, carrier or contact of an infectious disease to be detained and isolated in a hospital or any suitable place. Section 15(2) of the current Act that deals with the issue of home quarantine can only be applied to persons who are suffering from an infectious disease. Furthermore, we cannot compound a fine if a person breaks home quarantine.

Clause 5 of the Bill will amend the Act to allow a person who is, or who is suspected to be a case, carrier or contact of an infectious disease or has recently recovered from an infectious disease or has been treated for an infectious disease to be quarantined in his home. He will also have to follow the conditions which are applied to him with respect to his quarantine. One of these conditions will be to wear an electronic wrist tag if he breaks his quarantine.

To tighten the control on persons who are put on home quarantine, the amendment will make it an offence for persons to break home quarantine or to refuse to comply with any condition applied to the quarantine. The offence will then be compounded by my Ministry. Persons who break their quarantine may also be arrested by the police or authorised Health Officers and be detained in a hospital or other appropriate place and be required to undergo necessary medical examinations and treatment. Repeat offenders can also be referred to the courts and the courts will take his previous offences under the Act into account in sentencing.

Isolation area

Let me now turn to the second area which is the isolation area. Clause 7 of the Bill will give my Ministry new powers to quarantine any premises for the purposes of controlling or preventing the spread of an infectious disease. This will be accompanied by necessary powers to make specific orders in relation to the restriction of persons or goods within the quarantined premises as well as powers to authorise the destruction, disposal or treatment of goods, structures, water supply, drainage, sewerage system or any other matter known or suspected to be a source of infection. This section is included in the Act as a contingency to cater for a scenario like that of the Amoy Gardens in Hong Kong.

Civic responsibility

The third area that I would like to talk about is civic responsibility. Mr Speaker Sir, to prevent persons from behaving irresponsibly and endangering the health of others, the Bill proposes a new section to be added to the Infectious Diseases Act to prohibit certain acts which are liable to expose others to the risk of infection. Under this new provision, a person who knows or suspects that he is suffering an infectious disease must not expose others to the risk of the infection by his presence in a public place. The only exception to this is when he is seeking medical treatment. However, if the Director of Medical Services has designated a specific place for the medical treatment of the infectious disease concerned, then the person must seek treatment in the place specified. This provision only applies to infectious diseases which are specified in a new Fifth Schedule. SARS will be the first infectious disease listed in the Fifth Schedule.

The Prime Minister had, in an open letter to Singaporeans on 22nd April, quoted two examples of such irresponsible behaviour. The first case was the family of eight who is related to the 72-year man who works at the Pasir Panjang Wholesale Centre. Despite being instructed by the doctor to remain where they were while waiting for the ambulance to arrive, they removed their masks and wandered off to a nearby food centre and a Chinese medical hall. The other case was the man who visited a GP clinic, a polyclinic and two sinsehs before going to Changi General Hospital. He should not have gone to so many places to seek treatment.

In our battle against SARS, we need a higher level of social discipline and social responsibility. Singaporeans must have the confidence that fellow Singaporeans will not commit irresponsible acts that expose others to the risk of infection. Clause 8 sets out the provisions to ensure that this is so.

Refusal to cooperate and providing false information

The next area is on refusal to cooperate and providing false information. My Ministry's officers have encountered several instances when persons refuse to cooperate, eg, by refusing to answer telephone calls or telling our officers not to bother them. Some persons even provide misleading or false information. Clause 16 amends section 64 of the Act to make it an offence to refuse to cooperate with disease control measures and to provide false or misleading information. Under the amended Act, the first offence carries a fine of up to $10,000 and/or a prison term of up to 6 months and for subsequent offences, the fine is up to $20,000 and/or a prison term of up to 12 months.

Wakes and disposal of corpses of persons with infectious diseases

The next area is on disposal of corpses of persons with infectious diseases. To protect the public health, section 14 of the Infectious Diseases Act empowers the Director of Medical Services to impose conditions for the collection, removal and disposal of the body of any deceased person who has died from an infectious disease. Currently, we have patients who die in hospital before a diagnosis of SARS can be made. There are also some who may have died from another medical condition, eg, a heart attack or cancer, but doctors cannot totally exclude a concurrent SARS infection. This is because we now recognise that SARS can present in very atypical ways in some patients with other chronic conditions and that SARS infection can also be superimposed on other forms of bacterial infection. The diagnostic methods for coronavirus which are currently available are not sensitive enough to exclude a diagnosis of SARS.

Thus, in some cases, there is not enough clinical evidence for a diagnosis of SARS to be made but yet the doctors cannot completely rule it out. Let us consider, as an example, an elderly patient with multiple medical problems and a bronchopneumonia due to a bacterial infection, confirmed on laboratory testing. The patient also has a history of contact with a SARS patient. When such a patient dies, the cause of death will not be attributed to SARS, since bacterial bronchopneumonia is a common and well-recognised cause of death in such patients. However, in line with our very cautious approach to SARS, as a precautionary measure to minimise the risk to those who are handling the body, MOH will treat such cases as potentially infectious and the death to be treated in the same way as a SARS death.

The Infectious Diseases Act currently has no provision to empower the Director of Medical Services to issue directives for the disposal of bodies of those who are only suspected to have an infectious disease. Clause 5 will amend section 14 of the Act to allow directives to be issued by my Ministry on how the body of the deceased is to be disposed of even when the diagnosis of SARS is only suspected. In addition, the Ministry can also issue directives to disallow funeral wakes, if necessary. Failure to comply with the directive will be an offence.

Related to this, clause 4 will also amend the Act to allow the Ministry to require a post-mortem on persons who were suspected of being a carrier or contact of an infectious disease if this is deemed necessary to investigate an outbreak of an infectious disease or help to prevent its spread.

Increase in penalties

Let me now turn to the section on increase in penalties. The provisions under the Infectious Diseases Act have been enacted after careful consideration in order to protect the public health. Offences under the Act are serious and can potentially endanger the lives of many people. We want to impress upon all Singaporeans of the seriousness with which we take the protection of public health. The Bill amends the Act to raise the general penalty for those who commit an offence under the Act from $5,000 to $10,000 and/or imprisonment for a term not exceeding 6 months for the first offence upon conviction and in the case of a second conviction, the penalty has been raised to $20,000 and/or imprisonment for a term not exceeding 12 months. My Ministry will compound any offence by home quarantine breakers and the offender will be required to pay a sum not exceeding $5,000.

Sir, let me now turn to the other provisions.

Medical examination

The Ministry of Health may need to require not just persons who are suffering from an infectious disease or who are contacts of such infected persons to undergo a medical examination in order to prevent the spread of the disease. Clause 3 will amend section 8 of the Act to enable my Ministry to also require persons who are suspected to be contacts of persons with an infectious disease or carriers to undergo medical examination, if necessary. This will enable us to implement more stringent measures, if necessary, to prevent the spread of infectious diseases.

Issue of directives to health care institutions and medical clinics

The current Act only allows the Ministry of Health to issue directives for the investigation of infectious diseases and for the treatment of infected persons. This has limited the Ministry from issuing directives to healthcare institutions and clinics under the Act. Clause 4 of the Bill will amend the Act to allow such directives to be also issued to prevent the spread of an infectious disease.

Information from patients and medical practitioners

For the purpose of investigating outbreaks or suspected outbreaks of infectious disease, or in preventing the spread of such disease, clause 4 read with clause 16 will also amend the Act to allow the Director of Medical Services to require medical practitioners to obtain necessary information from his patient and transmit this information to the Ministry of Health. It will be an offence for the patient to refuse to provide the information required or to provide false and misleading information. This will help the Ministry of Health to obtain essential and accurate information when required so that control measures can be taken quickly to contain the spread of any infectious disease.

Disclosure of information

Clause 11 of the Bill will also amend the Act to allow the Director of Medical Services to disclose information obtained under the Act to any person if this is necessary to prevent the spread of the infectious diseases as specified in a new Sixth Schedule. SARS is the first disease to be included in this Sixth Schedule. I would like to reassure Members of this House that the amended Act will only allow such information to be transmitted to enable the implementation of measures which are necessary to prevent the spread of infectious diseases. These measures must also be permitted by the Director of Medical Services.

Conclusion

Mr Speaker, Sir, SARS is a clear and present danger to the health of all Singaporeans. We must be able to act swiftly and decisively to prevent and contain its spread. In the future, there may also be outbreaks of other infectious diseases, both known and new, which may again threaten the health of Singaporeans. The amendments to the Infectious Diseases Act will enable the Ministry of Health to do whatever it can to protect the health of all Singaporeans.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Jalan Besar): Mr Speaker, Sir, I stand to speak in support of the Infections Diseases (Amendment No. 2) Bill.

Severe Acute Respiratory Syndrome (or SARS) has swept over us like a hurricane leaving a trail of damage, uprooting us and having us still finding our own feet. After decades of bliss without perilous diseases and just when we are finding delight with our medical and technological advancements, our globe is suddenly seized by a new microbe having a field day disrupting our lives.

SARS is of grave concern to us as there is no treatment for it right now and there is no vaccine against it. Many people can be affected by just one afflicted person causing a ceaseless chain of reactions if left unabated. The only weapon we can have is to try and contain it. We need to stop the spread of SARS urgently and quickly before it gets out of hand. The failure in this will not only cause loss of many lives and turmoil amongst our people but also serious repercussions on our economic and social structures.

This fight against SARS involves the cooperation of the whole community in being civic-minded and courageous. The involvement of the community as stakeholders who are vulnerable cannot be over-emphasised. Sir, although I feel that the majority of Singaporeans are responsible, sensible and law-abiding citizens, this Bill to address the misdemeanor of some black sheep is necessary and very timely. This time, a few black sheep can cost us our battle against SARS. We really have no choice but to have strict enforcement of punishment upon SARS quarantine breakers for the containment of the disease and the protection of the community at large. Mr Speaker, Sir, we have to win this war at all costs for our survival as a nation.

The successful implementation of Home Quarantine Orders is important to regain the confidence of the people and let them revert to normalcy knowing their chances of getting SARS from the community is low. This will certainly give our economy a big boost and, in time, will also bring back the tourists and foreign businesses.

Sir, having said that, I welcome stricter enforcement of Home Quarantine Orders. But I would like to stress that we must ensure that undue hardship should not befall those under quarantine. We need to help them tide through the ill-effects of being quarantined. For example, their daily delivery of food or their need for any urgent errands could be facilitated. We must remember that some families may not have family members or friends to assist them. May I ask the Minister whether there are agencies that can look into these basic needs of these households?

Although those under quarantine can claim $70 a day, what considerations are we planning for those who suffer substantial direct losses, such as those from the Pasir Panjang Wholesale Centre who lost their perishable goods? Sir, in spite of the Minister for Health's announcement that financial assistance will be provided so that they can maintain their families and workers, and the announcement by the Deputy Prime Minister yesterday that they will be compensated for the loss of their goods, can we ensure that Home Quarantine Orders do not cause any bankruptcy or loss of livelihood for those quarantined?

The people under quarantine must be better equipped with knowledge on how to protect their family members and relatives from infection and on the sort of help (like availability of the free ambulances) they can get if they should fall sick themselves. Some of the quarantine cases may need urgent medical attention for other conditions such as gastritis, severe arthritis pain or even delivery of their babies. Which hospital do we advise these patients to go to?

Sir, I would like to reiterate that many are fearful of going to Tan Tock Seng Hospital thinking that they may get infected there instead of getting better. We need to allay people's fear of Tan Tock Seng Hospital, and the Ministry of Health needs to step up education in this respect.

Indeed, we need to also increase education on various aspects of SARS, reaching out to as many Singaporeans as possible. This is the hallmark of our success in our battle against SARS as many people may still be ignorant about SARS leading to unnecessary behaviour or paranoia. It is important to get knowledge about the disease, such as how it is spread and how to detect its early stages and how to seek early treatment for a better chance of recovery and so on, to everyone. We can reduce people's fear if they know how to protect themselves and their family members more rationally and effectively. The "crisis of fear" that Prime Minister alluded to would be lessened.

Sir, in view of the infectivity of SARS, any legal sanction may be ineffective as long as the actual physical movement of the quarantined individual is not rigorously curtailed. It will be poor consolation that we are able to impose a fine or even a jail sentence at some later stage. Will the Minister, therefore, consider tagging all quarantined individuals for better compliance and better monitoring to ensure success?

For those who would be jailed, it has been announced that a section of the Selarang Park Drug Rehabilitation Centre is being prepared for this purpose. We have to ensure that those who are jailed do not endanger the health of other inmates. Sir, nobody should be deprived of medical care. Therefore, should they fall sick, will they be transferred to Tan Tock Seng Hospital? Is Tan Tock Seng Hospital going to be made secure to treat them?

Sir, the successful control of SARS must be coupled with the avoidance of import of new cases. I raised the need to have the rights of implementation of compulsory statutory declaration for travellers during the Second Reading of the Infectious Diseases (Amendment) Bill last month. I had asked whether we could implement a clause on entry declaration for travellers by way of subsidiary legislation as it had not been provided in the Infectious Diseases Act. The case of the British manager who had disappeared, despite being issued with the quarantine order in Indonesia, will be an example of the importance of such a compulsory entry declaration.

On the legal sanctions in false declaration of the forms, the penalty must be backed up by law. Of course, the form must be clear and unambiguous. Will the Minister consider introducing this measure?

Sir, new section 21A(2) of the Bill is rather vague on the use of the phrase "person having the care". It reads, and I quote:

"A person having the care of another person whom he knows or has reason to suspect is a case or carrier or contact of a disease set out in the Fifth Schedule shall not cause or permit that person to expose other persons to the risk of infection by that person's presence or conduct in any such place."

May I ask the Minister to clarify if such a person comprises the family members, domestic maids, teachers, childcare personnel and all the medical professionals, such as sinsehs, nurses and doctors? Furthermore, how do these persons carry out this requirement if that is against the wish of their care? I hope the Minister could enlighten me on these points.

Mr Speaker: I will now call upon Dr Tan Cheng Bock to address this House from his home via video. Dr Tan.

Dr Tan Cheng Bock (Ayer Rajah): Thank you, Mr Speaker, for letting me participate in this debate and the trouble taken to get me connected to this House.

This is an important Bill because it seeks to amend the Infectious Diseases Act to ensure Singaporeans comply with the various measures taken to combat a disease, the spread of SARS. We must take these measures seriously or SARS will spread fast.

It is a new disease, a new virus, an unknown virus, it changes itself quickly and you do not know how, or when, or where it will strike.

Let me share with you, Mr Speaker, Sir, a personal experience. There was this man doing his usual chore of delivering vegetables to the market when he suddenly developed a fever. He never thought much about it because he never stepped out of the country. He consulted me on 15th April and I advised him to monitor his temperature daily in view of the current SARS situation. The next day, over the phone, he told my nurse, after some hesitation, his temperature was normal and told her not to worry as he has no SARS. We did not hear from him till 21st April when the Ministry of Health official called to inform me that the patient died of SARS. When I saw him, Pasir Panjang Wholesale Centre was not a SARS cluster.

Mr Speaker, Sir, every fever patient who sees a doctor is worried that he or she might get SARS. The connotation of having SARS carries with it a stigma and, worse still, that he or she is going to die. They want to avoid hospitals because getting referred there is, to them, like a death sentence. This is because our television and press coverage only shows patients in intensive care unit with tubes shoved into their noses, mouths and limbs. This is a poor image of the problem and enhances the fear factor even more.

Like yesterday in Parliament, the Health Minister informed this House the recovery rate is more than 90%. So highlighting the death case and those in ICU are not helpful in calming the anxieties of Singaporeans. With your permission, Sir, I have circulated a clinical picture of the SARS to reinforce the Minister's point and to better inform the House and the public so that they have a better understanding of this disease. In this chart, you will notice the infectivity is none, or very low, in the incubation period and the infectivity of the cases rises from low during the prodrome stage to very high during the lower respiratory stage. So Singaporeans must seek treatment to ensure 90% cure.

The fact that there are no more new healthcare workers being infected at Tan Tock Seng Hospital shows that the transmission is halted or dramatically reduced. The strict isolation and barrier nursing techniques (mask, glove, gown) have been effective and Singaporeans need not fear going to TTSH.

My concern is sometimes patients do not tell doctors the truth about their travels or about their exposure to SARS contact or even their correct temperature readings because of denial or stigmatisation. All these are borne out of fear, and the Prime Minister was right when he spoke at length about it.

I personally experienced it when I was informed by the Ministry of Health of the patient I saw who later died of SARS. I worried about my loved ones, I worried about my grandson who is so close to me and who had spent the whole Sunday playing with me, I worried about almost everything. Even my heart beat was faster than usual with a few dropped beats and my temperature even shot up to 37.6, but I soon took control of myself and decided to fight against it, if ever I get infected.

I even called MOS Ng Eng Hen when my temperature was 37.6 and he informed Dr Lim Suet Wun of Tan Tock Seng Hospital about my case. I was prepared for the worst case scenario; by then, it was not fear but the determination to fight. So far, I am symptom-free and my temperature is constantly below 37 degrees.

Mr Speaker, Sir, when we fear the unknown, we cannot think straight and we tend to do the worst. I think my patient was not truthful in telling my nurse his temperature the next day because of his hesitation and saying not to worry, "I have no SARS." On retrospect, I can see it was a clear sign of denial. As for myself, I decided to stay isolated at home and monitor myself carefully with temperature taking very frequently. This is because of social obligation I owe to my family, my friends and my colleagues.

My patients and my doctor colleagues' patients fear hospitals, they fear the nurses, the doctors who come into contact with SARS patients. Can we blame them? No. We must manage their fear and fear is the one factor that is going to work against our effort to check this disease. PM's concern on this fact was televised for all Singaporeans.

We are therefore fighting two fronts: one, the SARS itself, and, two, the psychological battle of winning the minds of the people that we must unite and isolate the virus, instead of letting the virus isolate us. Now the virus is isolating us, restricting our lifestyle, damaging the economy and causing untold damage to the tourist industry, our hotels and restaurants.

This Bill before us is to close the gaps and to reinforce our efforts to isolate the virus. It is to educate and police effectively the current measures of control taken by identifying index cases, case tracing, isolation, ringfencing and quarantine. Where are these gaps? Some of these are: not telling the truth to doctors about travel, not obeying quarantine orders, not reporting the temperature level truthfully.

Take me, for example. I isolated myself. Why? Because I want to close this gap of potential spread should I become infected. It is a social responsibility since I know that close contact and respiratory droplets spread the virus. Similarly, all Singaporeans must take their own responsibility seriously, strictly and be disciplined, and not to be angry when the nurse calls you to check. In fact, a nurse Rohana just called me to check whether I was all right when I was writing this speech. I thanked her and I praised her.

While we have achieved good results at the hospitals, the situation at the community is going to be different. This is because the community like the Pasir Panjang Wholesale Centre is not a controlled environment. We are dealing with a mixed batch of constituents. And this is where our communication must be clear, exact and precise to calm, to inform and to instruct people how to comply or we might end up punishing wrong people.

Mr Speaker, Sir, many Singaporeans are taking temperatures at schools, kindergartens, childcare centres, workplaces and even at homes. This is wise because temperature is the only certain and consistent clue that this virus gave us, so we must jump on this.

After the temperature taking lies the problem. What to do if the temperature is more than 37, more than 38, more than 39? Now, they send all these to the GPs and polyclinic doctors, but is this the right thing? SARS may be spread this way. I think we must improve the guidelines given to Singaporeans at large. The doctors know what to do because the guidelines given are very clear and good though, at the practical level, we doctors do face problems because of the confines of limited space to do a triage of our patients, who also come at different times.

If we know that, so far, temperature is the most reliable indicator, we must work on it and capitalise on it. We have a wide network of polyclinics and hospitals. I am proposing to the Minister to consider the setting up of fever screening centres close to many such institutions. These centres should be set apart from the main hospital buildings and not in the building itself. This is important, because of the fear factor of going to hospitals or polyclinics. These fever screening centres should be a stand-alone tentage, like the one I saw on television, at Alexandra Hospital. It should be convenient, with a pleasing ambience, and not hard and not too cold.

What do we do at such screening centres? Mr Speaker, at this point, I hope that the Clerk of Parliament has distributed the second chart to all the Members of Parliament. Let me also review what I am hoping the Minister would consider the fever screening centres. All Singaporeans who are involved in monitoring temperatures in the various schools, kindergartens, work places and child-care centres must know of such centres closest to their schools, etc, and must be clear as to what to do. It is no use sending all fever cases to GPs to get a letter stating that the person is free from SARS and, therefore, can attend school or work, as is what is happening. GPs do not have the ability to confirm or to detect SARS. At GP clinics, there lies a danger of spreading the virus because of the small waiting room and the air-conditioned environment.

Moreover, if a SARS case happens at the clinic, there is the unpleasant task of quarantining and disrupting their way of life. The SARS patient I saw was exposed to six other patients at the waiting room. All were under Home Quarantine Orders, and they were naturally unhappy. Therefore, sending all feverish patients to GPs is not the right thing. What we should do is to clearly tell the temperature operators:

(1) Send all those with less than 38 degrees centigrade to see their own doctor, with clear, precise referral letters given. I take 38 degrees centigrade because that is the reference temperature given; and

(2) Send all those with more than 38 degrees centigrade to a fever screening centre, again with a letter of direct referral.

At the fever screening centre, there can be a proper triage to sieve out the potential SARS and non-SARS cases. Do not have too much red tape at the screening centre, which should also be open to all who want to be screened, eg, taxi drivers, housewives, etc. There should be little or no red tape, as I said, and it should also welcome walk-in patients and serve also as a SARS information centre. Of course, the centres must be manned by doctors and nurses.

One symptom of SARS is body ache. So, many acupuncturists are treating all these body aches, without realising that they could be treating SARS patients.

Mr Speaker, Sir, to prevent the spread of SARS, we need the utmost cooperation, understanding, and action on the part of each and every Singaporean. Our personal needs have to be put aside to give way to the wider and bigger need of the general population, ie, the need to contain an unknown enemy, or the latter would disrupt and even destroy the very fabric of our society. Most, I believe, will comply; some, out of ignorance, have to be informed and helped to comply; while some will need the law to come down hard on them to make sure they comply. This piece of legislation will have all the clout to make sure that all fall in line in this battle.

Mr Speaker, Sir, I support this Bill.

Dr Michael Lim Chun Leng (Pasir Ris-Punggol): Mr Speaker, Sir, SARS has grown from a medical problem to become an economic problem. It has also grown from a regional problem to a global problem. Like most viral diseases, an effective cure for SARS is not likely to be imminent. Preventive and supportive treatment are key measures in the fight against SARS. For us to combat this SARS epidemic, the key to success is prevention and containment.

Since the SARS outbreak, the Government has put in place many precautionary measures. In the healthcare sector, several measures have been imposed, and these measures have become increasingly stringent. Many of the healthcare workers who are in the forefront of fighting SARS are people whom I have known, not just in terms of work but many of them have been doctor friends for decades or several years. And I can tell you that all these people really deserve our respect and admiration because of all the risks that they take.

It hurts the healthcare workers even more when they have to manage their own, especially those who are in the pink of health. When I was told that an ex-colleague of mine, Dr Lee in NUH, was admitted for SARS, my friends in Tan Tock Seng Hospital told me that he had difficulty breathing, and he actually requested for intubation. I was glad to hear yesterday, when I met another colleague of mine, that he had been extubated.

The problem of SARS has taken a heavy toll on the healthcare workers. Despite the strain on our healthcare workers, I wish to assure the Government that the healthcare personnel are in full support of the Government's measures. In fact, we will welcome even more draconian measures to break this cycle of the spread of infection.

I also welcome the move by the Ministry to ask healthcare workers from overseas, especially nurses, to avoid staying together with healthcare workers from other hospitals. However, some of them are bound by tenancy agreements. It is a right move. But I think the Ministry and the hospitals may want to consider offering assistance in helping them with a relocation exercise.

Secondly, in addition to healthcare measures taken in healthcare facilities, I think health education is of utmost importance in helping Singapore contain SARS. SARS is a serious disease, but I think we must not over-react. The likelihood of dying from a heart attack is much higher than the likelihood of dying from SARS when you have a heart attack and, therefore, one must put these fears in the right perspective.

I think the public should adopt preventive measures, which I would like to call the 3Hs. The first H is health. We have a responsibility to keep ourselves in good health. The second H is hygiene. We must adopt good hygiene practices like washing hands, keeping the environment clean, and avoiding indiscriminate disposal of tissues or other types of waste that may contain germs. The third H is habit. We must adopt good habits. It is time Singaporeans adopted the habit of wearing masks whenever they feel unwell, or are down with fever or cough. This is to minimise the spreading of infection to others. It is also a good habit to check one's temperature when one is unwell, so that the fever can be detected early.

However, whether it is masks, thermometers or hand washes, one must use them appropriately. A friend of mine told me that she had observed a school bus carrying pre-school children who were probably five or six years old. A few of these children in the school bus were wearing masks. They took them off to show them to each other and, subsequently, tried on each other's masks. In this instance, the masks would not only not prevent disease but would certainly help to spread infection. A friend of mine also told me about sitting next to a gentleman at the airport who was diligently wearing his mask. But, whenever he wanted to cough, he would lift up his mask and cough into other people's face. This defeats the purpose of wearing a mask in public. The main aim is actually to prevent infection to others.

Another very important public measure is screening at all entry and exit points in Singapore. Currently, those from SARS-affected countries are screened. However, if a SARS-affected person enters through a non-SARS country, he would not be screened at the entry point. One must understand that thermal screening is a very useful tool. Nevertheless, even if you have a fever and you are in an air-conditioned environment, you may not be picked up on the thermal screen and, of course, most airplanes are air-conditioned and most airports are air-conditioned too.

A patient of mine gave me another example. He attended a conference where there were delegates from Hong Kong, and this conference was held in Indonesia. The delegate from Hong Kong flew to Indonesia, and then to Singapore. The Hong Kong attendees who flew to Singapore were not screened. So he asked me whether it would defeat the whole purpose of trying to screen those from the high-incidence countries, if we did not close this loophole. I think we should protect this as well.

On quarantine, those who break their quarantine orders are irresponsible and they endanger the lives of fellow citizens. I support the Government's measures on quarantine. In fact, I am in favour of more draconian measures. The current quarantine allows people to visit those who are home quarantined, and there is a risk of spread of the disease if the person eventually turns out to have SARS. We should seriously consider having designated quarantine facilities. Perhaps even one of our off-shore islands, such as Pulau Ubin, may be made a quarantine centre. This will ensure that there will not be any visitors for those who are quarantined, and the likelihood of the disease spreading will be significantly reduced. We may even consider mandating that those on quarantine put on a mask at all times, perhaps except during meals, to reduce the likelihood of spread during the quarantine period.

Singaporeans must understand the seriousness of the impact of SARS on Singapore. If we do not take draconian measures to inconvenience a few, the economic fall-out will be so severe that all Singaporeans will have to suffer both financially and medically. I do not think we should be quibbling about how much compensation to give, but we should pull together to make Singapore a safe place. Only then can the economy improve.

Last but not least, the media plays an important role, as it has given extensive coverage on SARS, which is a step in the right direction. However, the coverage is so extensive that it appears to others that the whole country is paralysed by SARS, and that the only thing that is newsworthy and occupies the time of most Singaporeans is SARS. A friend of mine who came back from the US recently told me that when he was back in the US and he watched the American news broadcasts, it would appear to those watching that Singapore was very seriously affected by SARS and that Singapore appeared to be the main source of SARS. On the first day when he was back and he watched the news, the American news broadcast focused on SARS and Singapore. When he watched it on the second day, again, it was SARS and Singapore. When he watched it on the third day, it was SARS and Singapore and, by the way, Hong Kong also has some SARS cases. So, the impression given to viewers then was that the SARS problem appears to be mainly in Singapore and that Singapore was the source for SARS. This is certainly not the case. In fact, other relatives from the US have called their relatives here to tell them the same thing as well and, of course, fortunately, their relatives here have told them that this is not the case.

I think that the media can play an extremely important role in dispelling irrational fear and also focusing on the positive aspects of SARS, on how people have recovered successfully. And I think the media can also focus on public education messages, such us using a mask when one is sick, how to put a mask on properly and how to take temperature. You may laugh at some of these measures, but let me just tell you what one of my MP colleagues told me. At the screening at a hawker centre, he asked to look at the temperatures recorded for those who were taken at the hawker centre. The temperatures were about 33-34 degrees centigrade. If we were to believe those temperatures, all these people would be dead! So, while we want to encourage people to take temperature, it is important that we educate them as to how to take it properly so that the exercise is useful. I believe that the media can certainly play an extremely important role in this public education exercise.

SARS will become a disease that will be found in many countries throughout the world. By taking draconian but rational measures, the Singapore Government, with the full support of its people, will be able to accomplish the aim of making Singapore the safest place to live and work in in this era of SARS. 2.33 pm

Mr Chiam See Tong (Potong Pasir): Thank you, Sir, for allowing me to speak.

Sir, yesterday, the DPM and other hon. Members have paid tribute to the doctors, nurses and other healthcare workers in combating SARS. Sir, allow me now, on behalf of my Party, the Singapore People's Party, to also thank and pay tribute to the nurses, doctors and other healthcare workers of Tan Tock Seng Hospital, Singapore General Hospital (SGH), Changi General Hospital and all other hospitals and clinics in Singapore for the heroic and splendid work they are doing, and putting themselves in the frontline in detecting and caring for patients who are affected by the Severe Acute Respiratory Syndrome (SARS) disease. Sir, we thank them all.

SARS is perhaps the worst disease to have hit Singapore to-date. It has killed about 14-16 people in Singapore and caused untold sufferings, both in terms of the sickness and to our economy, especially the retail, travel and tourism business.

It is timely that this Bill is put before Parliament. I support this Bill in-principle. I say "in-principle" because, if its purpose is just to combat SARS and other similar infectious diseases, then the provisions in the Bill may have gone too far. I am referring to clause 24 of the Infectious Diseases (Amendment) Bill where it repeals the old section 55 and replaces it with a new section 55 with seven subsections comprising 20 paragraphs.

I can understand why the Director wants to enter, inspect and search any premises or any conveyance in which an outbreak or a suspected outbreak of the disease has taken place, or to take samples of substances or matter or food. But I do not understand why it is necessary for the Director to be given powers to force any person to produce for inspection any books or documents within his custody or possession. The whole exercise of looking at books and documents may lead to an income tax or custom and excise duty offence being discovered. These offences have got nothing to do with the health of the person investigated. I think the net thrown by this Act is too wide.

If people can be given the impression that the occurrence of SARS has been taken advantage of by the Government to cloak itself with more powers, then the people of Singapore can become cynical about the efforts made by the Government to combat and eradicate this disease, and this Bill may become counter-productive. I wish that this Bill could confine itself only to provisions to fight SARS and future SARS-like diseases, and not to empower the Government with more powers than necessary.

Sir, however, I agree that this Bill is necessary. But, at the same time, the Government should also approach with a softer hand to get the full cooperation of the people. I am referring to education. I believe that many Singaporeans, especially the less educated ones, do not really understand what SARS is all about. They do not apprehend the seriousness of SARS and what it can do, not only to Singaporeans, but also to the economy of Singapore. I think more can be done to teach the people at the grassroots level about SARS and, at the same time, the Government should also take care not to over-react.

For example, do not send the special ambulance to every call for an ambulance service. Only last week, I was told that in two cases, the special ambulances, with their attendants all covered up like spacemen, went to pick up a resident with suspected heart attack and a boy with only a cut arm at my constituency. The other residents there panicked and thought that residents in that block have been infected with SARS and they quickly telephoned and insisted that the Town Council go and wash the whole block again, which we did.

I have also heard that persons who died of SARS in hospitals have their corpses wrapped, not in two layers but, as reported in the press, with three layers of plastic, so much so that their relatives and next-of-kin cannot even see the faces of their deceased loved ones before their bodies were cremated. I am uncertain whether the hospitals can do something to allow the faces of the dead persons to be seen by their relatives before they are sent for cremation. I hope that the Minister will ameliorate the situation to allow relatives to be able to see their deceased patients before they are cremated.

As regards social responsibilities, I would urge all Singaporeans to help their neighbours or anyone who needs help. I am referring to the better educated Singaporeans to help and teach those Singaporeans, especially those in the lower grassroots level, who are less educated and do not really apprehend what SARS is all about. I think some of them may not even know the meaning or purpose of quarantine. They may think that they are not sick and ask why should they be quarantined. Or they may even think that quarantine is a form of punishment imposed on them by the Government like a house arrest, and not a preventive health measure.

Sir, I agree with Dr Michael Lim when he says that quarantine may not be effective and that persons who are suspected of SARS should be sent to a neighbouring island. I think that is a better solution because many Singaporeans are living in very dense areas in public housing and even the present home quarantine can still cause a spread of the disease.

Sir, in this time of crisis, all Singaporeans must play their part to help each other, as DPM Lee has said yesterday. The Government, on its own, cannot solve the SARS problem. It must have the help of all Singaporeans. Sir, this disease threatens the very livelihood of our nation and it is also a threat to our nation.

I would like to assure the people of Singapore that my Party, the Singapore People's Party - although it is an Opposition party - shall close ranks with the Government and all healthcare workers and the people of Singapore, and do our best to support all measures to prevent the spread of this deadly disease, and to help eradicate it as soon as possible.

Dr Amy Khor Lean Suan (Hong Kah): Sir, allow me again to salute our healthcare workers and the medical fraternity for their selfless deeds of sacrifice and courage. I think my heart, as well as the hearts of many Singaporeans, surely go out to them each time we see a death reported in the newspapers, particularly if it is that of a healthcare worker. I would also like to acknowledge the cooperation of all those who have not broken their quarantine orders. And indeed, as we have read from the press, these are actually the majority.

This whole SARS episode, Sir, is perhaps our equivalent of September 11th that galvanised the American nation and called for an unprecedented outpouring of civic responsibility and inspiration.

Sir, I support the amendment to the Act, though the measures would appear harsh and even draconian. But we cannot allow the reckless acts of a minority to put the lives of the majority at risk. We cannot afford to wait for this minority who appears to need time to understand the severity of the situation and to be convinced that they are endangering the lives of many others when they break the quarantine orders.

Liberals could argue that the amendment would severely curtail civil liberties, privacy of information and invest the public health authorities with immense powers that seem to have no check in place for potential abuse. However, we are facing a grave threat, perhaps in some ways, more deadly than explosive acts of terrorism because the enemy is invisible to the naked eye. Tough challenges call for tough measures, but I would further call upon all Singaporeans, while rightfully indignant at those who break quarantine rules, to spare a thought for the circumstances under which this could happen.

I suspect that not all HQO breakers are wilful. Some people may have broken quarantine orders due to sheer ignorance or a lack of understanding of the risks of infecting others. They could also have done so, as making a living may be their primary concern. I am therefore very pleased that the DPM has announced that financial assistance will be offered to affected families. But these people also need to be assured that the Government has put in place measures to help minimise their inconvenience during their quarantine period. Thus, help must not only be rendered to bring them some financial relief, but also to meet their physiological needs, such as their daily meals, groceries, etc, for example, if the entire family is quarantined, and they are unable to marshal help from their relatives and friends. We must therefore try to find out why these people have broken quarantine orders or acted irresponsibly. We can then devise better education and communication methods to help them understand the gravity of the situation and the precautionary measures and responsible behaviour they ought to take so as to minimise their urge to break quarantine orders.

Furthermore, Sir, as the Bill is draconian, imposing stiff fines and penalties, including jail terms for home quarantine offenders as well as other offenders, I would like to urge the Minister to ensure that a system of check and balance is in place. There should be a protocol for officers enforcing this Act to follow so that the Act can be administered appropriately and justly. Enforcers of the HQOs must clearly explain the requirements of the HQOs and the consequences of breaking the order to the affected individuals in the language they understand. Some HQO breakers may perhaps not even be aware of what the fuss is all about due to a lack of education or personal or family circumstances, such as age. Public health and CISCO officers who first impose HQOs should be reminded to take a more counselling approach and carefully explain the whole process to affected families and make whatever reasonable arrangements are necessary to reduce the tendency to break quarantine.

I would also like to ask the Minister for a clarification of the new section 21A of the Bill, as my parliamentary colleague, Dr Lily Neo, has alluded to. How would the person as specified in section 21A(2) be defined? Would this person include a doctor with a suspected SARS patient at his clinic, and either the patient wanders off whilst waiting for an ambulance, like in the case of the family of eight, or the patient refuses to wear a mask? Also, what happens if a suspected SARS case refuses to heed the advice of a person who is a care-giver?

This SARS war is clearly one battle that the Government, even when it mobilises every ounce of its vast and powerful machinery, cannot tackle by itself, but needs the cooperation of every Singaporean. We must, therefore, continue to impress on Singaporeans that everyone must play his part and take responsibility in this battle in order to ensure that our nation is not crippled. Yes, glimpses of what some people call the "Ugly Singaporean" have appeared. Brave and selfless nurses working in the frontline have been shunned, and there was even a vegetable panic-buying spree. However, these are initial reactions or what some people may call over-reactions to the fear of the unknown. I believe those who continue in this mode of thinking and behaviour remain the minority.

As our understanding of this pathogen grows, that knowledge will give us greater confidence and assurance. Amidst the gloom of possibly higher fatalities, increasing unemployment, rising temperatures, both on our foreheads and under our collars, falling tourist arrivals, empty taxis and airplanes, we should not lose heart. I therefore urge all Singaporeans to close ranks, bear up with the tough measures we need to take and fight this SARS war, including the amendment that has been proposed in this Bill, and to overcome our fear together.

Mr Speaker: I call upon Mr Khaw Boon Wan to address the House via video.

The Senior Minister of State for Transport and Information, Communications and the Arts (Mr Khaw Boon Wan): Thank you, Mr Speaker, for making this facility so that we can all join in the debate without causing any anxiety to our colleagues.

Early this week, I had to visit Tan Tock Seng Hospital, Intensive Care Unit, where SARS patients were being cared for. I was properly protected - N95 mask, gown and gloves. I did not have to get near any patient. There was no risk of my being exposed and infected. But, purely to allay anxiety, I decided to suspend all my activities in my constituency, including my weekly meet-the-people session. The risk of my becoming infected and, in turn, passing it on to the residents in my constituency is practically nil, but I would rather not cause any anxiety on their part. For the same reason, I decided that I should stay away from Parliament during this period. I will resume community activities from 1st of May. In fact, my first public function will be the NTUC May Day Rally, even as I continue to visit the hospitals. But I will no longer need to go inside hotspots like Intensive Care Units. By the way, I continue to go home every day to play my role as a father and husband. I take comfort in the fact that no Tan Tock Seng Hospital worker has been infected for some time now, ever since we got to know this virus better, and instituted full infection control and protection for staff and visitors.

Mr Speaker, this virus is dangerous, but actually not that scary. You can get infected only if you are near a SARS patient and unprotected. In Singapore, where we have so far managed to control its spread, the high-risk areas are mainly hospitals and the homes of SARS patients. Outside of these areas, the risk of getting infected is insignificant, although not zero. We are working hard to maintain this state of affairs, while we continue to enhance infection control in the hospitals and achieve effective protection for our hospital workers, patients and visitors. This is the top priority of our SARS combat unit. It is to eliminate in-hospital infection. If we do our job well, we will be able to reduce the risk of hospital workers, patients or visitors becoming infected while they are in hospitals to the absolute minimum. And, with some luck, perhaps, even zero in some hospitals.

How? We are focusing our efforts in five areas. First, equip our hospital workers, patients and visitors with proper protective gear, that means masks, 3Gs - gowns, goggles and gloves, and protective suits when doing procedures on patients like intubation or surgery. An unprotected or poorly protected worker handling a SARS patient is fighting a formidable enemy without weapon or shield. A few earlier cases of hospital workers being infected were due to inadequate protection.

Second, train our hospital workers on infection control and proper use of protective gear, eg, an ill-fitted N95 mask that is not 100% sealed is no protection. Training and retraining now go on repeatedly.

Third, ensure full compliance. A good infection control plan is only good if it is put into practice by all staff at all times. This calls for repeat reminders, frequent audits and peer pressure.

Fourth, pick up early onset of symptoms. Without a reliable diagnostic kit, the next best thing is to measure temperature at frequent intervals. As soon as fever is detected in staff, patient or visitor, an alarm goes off and we spring into action.

Finally, isolate immediately all those with SARS symptoms, with full protection and barrier nursing.

Together, these five components make up what I call the PDI strategy - Protect, Detect and Isolate. We are now putting it into practice in all our hospitals.

With the virus now out of the bottle and in the international community, it is no longer possible to eradicate it soon. Hospitals will now have to live with SARS. Procedures and processes will have to be re-engineered to cope with this changed environment. Infection control will have to be taken a lot more seriously than in the good old pre-SARS days. What it also implies is that, going forward, we cannot hope for no more new cases of infection. Instead, it is more likely that we will have occasional cases of infection. Hopefully, we will be able to quickly detect and isolate them before they do extensive damage, but this is something for the future. Meanwhile, I am mentally prepared for the situation to get worse, before it gets better. This is because we do not yet fully know the enemy. How is it transmitted? How long does it survive outside the human body? It is tough fighting an invisible enemy.

In the early days of the outbreak, many of our hospital workers were infected. This is because, for many decades now, modern hospitals do not have to deal with serious infectious diseases. As a result, we have relaxed on infection control standards, as it was unnecessary, and it would have been an over-kill. But after we have understood the enemy better, and put ourselves on high alert, in protective gear, the number of hospital workers becoming casualties has come down drastically. We are now busily strengthening all the hospitals, getting them up to shape. This will take some time as old habits do take time to change, but we are learning quickly day by day and getting into full swing.

A new complication for us is that some patients with other illnesses have been infected. Because of their other illnesses, the SARS symptoms are often masked. This has made early detection very difficult. That is why we may still have the occasional break-out in our hospitals, despite the best of efforts. There is no shortcut to this problem, except to keep vigilant and to close in on the enemy as soon as its identity has been exposed. That is why we await so eagerly for a good reliable diagnostic kit. Without it, we are really fighting with a major handicap. Meanwhile, we should all be mentally prepared for new cases and some setbacks. But we should not allow such occasional eruptions to reduce us to frenzy and mass panic. To win this fight, we need cooperation from all Singaporeans. To stop the spread in the community, we need cooperation from the entire community, not 80-90% but 100% of cooperation. Just a few super-spreaders who are irresponsible and we will have a major setback.

Singaporeans are not helpless in this fight. We should certainly not be mere frightened, passive spectators of this battle. We have much to do, and if we do it well, we can win this battle together, and decisively. What can you do? I suggest we focus on three areas.

First, raise our personal and public hygiene to the Japanese standard. SARS appears to be spread by droplets. So regular wiping and cleaning would help. Everyone should stop irresponsible people from spitting in public, sneezing or coughing, without covering their face, or littering. Frown on them, stare at them, make sure they get the message. I cannot help noticing that Japan, despite very intensive business and people-to-people contact with China and Hong Kong, remains unaffected by SARS. I do not think they are merely lucky. I think years of keeping high personal hygiene must have contributed to this state of affairs. So let us clean up our act in hospitals, homes, offices, hawker centres and everywhere.

Second, support our hospital workers. They are working flat out for weeks now. As I walked the hospital floor, I can see fatigue in their faces. Many are now doing extended shifts - double shifts. I worry that some may break down. They need all the support and help that we can give. Many Singaporeans are indeed doing so. I see Milos, Ovaltines, essence of chickens, vitamin Cs being sent regularly to the wards, together with flowers, lovely poems and paintings - absolutely heartwarming. Believe me, if they are able to keep their body and soul together, despite having to live with the risk and punishing work pace, it is due to this wonderful moral support that they are getting from fellow Singaporeans. Unfortunately, a small number of Singaporeans remains determined to make our lives difficult. Some lie about their history, and some break home quarantine. This Bill will directly address these deliberate acts of dishonesty.

However, there are also some Singaporeans who make our lives more difficult, perhaps without realising it. These are the visitors of patients to the hospitals, A&E Department and wards. Our staff are already busy, protecting themselves and their patients, besides rendering medical care. With visitors, they have the added responsibility to ensure their safety. This is not theoretical. There was a visitor who accompanied her husband to an A&E Department for treatment. The husband was in a trolley, closely monitored. His trolley was next to another patient who was also in a trolley, who subsequently turned out to be a SARS patient, although unknown at that time. But there was proper separation procedure and infection control. The husband never became infected. However, the lady visitor, despite constant advice and pleas by our A&E staff, insisted on hanging around in the observation ward for a good five hours, moving from trolley to trolley. She became infected by the SARS patient and is now in Tan Tock Seng Hospital.

We have cut down visits to hospitals to one visitor per patient but, really, the hospitals would strongly prefer a "No Visitor" rule during this period, except for compassionate cases, like for children, and seriously ill patients. Toronto Hospital has already imposed such a rule. This will help minimise risk of inadvertent spread through hospital visitors, besides reducing the load on the hospital workers. On the ground, we will be flexible to address the emotional needs of some patients and their loved ones. We hope Singaporeans will support this no-visitor rule.

Third, think out creative, practical ideas to help fight SARS. For example, I was most pleased to read about the taxi driver who prints his namecard and gives one to each passenger with a receipt. In this way, in the event that contact tracing has to be done, with him as a SARS suspect, his passengers will more likely be able to recall. Likewise, someone suggested that all counter staff in the shops, banks, supermarkets and hawker stalls place a bowl in which all their customers can throw in their namecards. Every day, the collections can be bagged and dated. In the event that contact tracing has to be done involving this particular outlet, the process can then be speeded up. To make it fun, we can have a monthly lucky draw of these namecards before they are discarded with prizes for the lucky winners. There are so many ways in which Singaporeans can get involved in fighting this battle.

The fun part is not to trivialise the matter, but to help raise public awareness. For example, there can be a song or jingle competition on how to remind Singaporeans to take temperature twice a day, wash hands every other hour.

Mr Speaker, this is a major crisis. We cannot duck it. But we should turn it into an opportunity to bond Singaporeans and to strengthen our spirit as one people. A few of our hospital workers have sacrificed their lives in this battle. A few are fighting for their lives. I saw them in the Tan Tock Seng Hospital's Intensive Care Unit. Many more are quietly but courageously fighting in the trenches, not knowing which patient will turn out to be SARS. As I walk the ground, talk to them, I know I am talking to true heroes and heroines. They are risking their lives every day, every hour, so that we can all be safe. The minimum we can do is not to hamper their work but to help them get on with their job.

We are now many times better prepared than when we started 43 days ago. We know the enemy better, although still not fully. We are better equipped, better trained, better protected. Preliminary diagnostic kits have arrived, and we are perfecting them. So, even if the next few days may turn out to be worse than today, we know that we will win the battle sooner rather than later.

Mr Speaker, I support the Bill.

Dr Chong Weng Chiew (Tanjong Pagar): Mr Speaker, Sir, I join my colleagues in the support of the amendment Bill. Indeed, I am so glad to hear the call of support from my parliamentary colleagues, as mentioned earlier on by Senior Minister of State, Mr Khaw Boon Wan, for healthcare providers.

I am myself a healthcare provider. I work in a hospital which is together with a restructured hospital in the fight against SARS. Every minute of the day, there are only two things in the minds of my staff and myself - SARS and infection control - and I can tell you, honestly, even in our dreams. The frontline healthcare providers - doctors, nurses, social workers, therapists, pharmacists, hospital cleaners, ambulance drivers - are all human. We too share in the fear of getting infected with SARS and I can tell you the worst fear is putting our family members and our loved ones at risk too. Despite the fear, the risk, the sacrifice, we all know that we have a job to do, and we must make sure that we do our jobs right regardless of whether our patients have SARS or not, regardless of knowing the fact that we are putting ourselves and our loved ones at our homes at risk by doing our job. We know that we have to do our jobs right. If not, our family and our country will be in trouble.

The Prime Minister had earlier highlighted two examples of black sheep within the community. I have seen for myself unreasonable visitors to my hospital verbally abusing my nurses when my nurses tell them to follow Ministry of Health's guidelines to restrict to just two visitors per day. If I could speak on behalf of all the healthcare workers in Singapore, I will support the amendment Bill wholeheartedly. We have to contain the infection. We cannot let the efforts and sacrifice of our fellow healthcare providers go to waste, just because of social irresponsibility of a few black sheep.

Let me also try to touch on three points.

(1) On the topic of quarantine, some people who have been served with Quarantine Orders question whether this is necessary. They feel that their freedom is being taken away. But in the face of SARS, let me say that Quarantine Orders are definitely necessary. As a medical doctor, in the control of any infectious disease, there are only two main approaches, and they have to be concurrently implemented. One, is in the control of the spread of the infection, by way of identification, isolation and quarantine. The other is in the treatment of those infected by the infection itself. In the case of SARS, when the diagnostic kit and the definitive treatment of the disease are not discovered yet, the only way to be on top of the situation is through the control of the spread of the infection. The amendment Bill has thus empowered the Ministry to achieve the objective of controlling the spread of the infection.

(2) We all know that Singapore is a small country. Many of us live in built-up areas. We intermingle with one another at our neighbourhood coffeeshops, marketplaces and workplaces. Thus, with this close proximity of us being with one another, in the face of an infection like SARS, if our preventive and quarantine measures are not in place and even if they are in place but not enforced, and people being non-compliant to them, then we would end up in a very sorrowful state.

(3) There is one other thing which is as important, if not more important, than the enforcement of quarantine and preventive measures in the face of SARS, and that is definitely none other than public education. I am sure the House would agree with me that, to date, the Government has done very well on this. PM, DPM and Minister Lim Hng Kiang have, time and time again, been emphasising about social responsibilities, and we all know that there are always some black sheep in the community who are socially irresponsible and selfish. Thus, in addition to the continuation of public education and the call for social responsibility, the amendment Bill would be necessary and definitely timely to safeguard the interests of socially responsible Singaporeans and definitely the general population at large.

Let me end by saying this. Laws are necessary because of seeming disregard for public health, just like smoking, drunk driving, etc. And in a situation of an infectious disease like SARS, the effects carry even more profound and severe consequences. Laws are there to support and allow public health officials to act safely, to act as deterrent, to guide human behaviour and to spell out the gravity of the situation to the few who could not care less. Nevertheless, the public must still continue to be educated. Ignorance and fear would be more deadly than SARS itself. Ignorance would be overcome by public education. Fear would be minimised by the effort of the Ministry of Health, the healthcare workers and the Ministerial Committee's effort and, definitely, by the amendment Bill. Thus, I support the amendments.

Dr Ong Seh Hong (Aljunied): (In Mandarin): Mr Speaker, Sir, in the spring of a certain year in China, there was an epidemic plague. The epidemic was so contagious that it spread very quickly and the mortality rate was very high.

China was trading with many countries at that time. Very quickly, this epidemic plague was spread to all over Asia and Europe. Through the merchant ships, it spread to Sicily in Italy and, in a few days' time, this epidemic plague had struck both the urban and rural areas of Sicily. It was said that an affected person had lunch with his friends. Yet, in the evening, he joined his ancestors in heaven for dinner!

This epidemic ravaged Europe and killed one-third of its population in a short span of five years.

Mr Speaker, Sir, fortunately, I am not talking about the SARS situation today. I am talking about the pandemic plague also known as "black death" in the 14th century. Seven hundred years later, fortunately, now our medical science is more advanced. We have better knowledge and better means to counter the various diseases and the mortality rate of SARS is not as terrible as that of the "black death". However, with our transport facilities being much more advanced now - we no longer travel by horse carriage or steamships - our people are travelling much more extensively and frequently. In the process, diseases also spread much faster and wider. In densely populated cities like Singapore, if we lower our guard, the SARS epidemic would spread to the community, and the consequences can be very serious.

Mr Speaker, Sir, for this reason, when we are fencing SARS, we should not have soft knees. We should not avail any opening to the SARS virus to spread beyond the hospital ring-fence. From the perspective of medical sciences and public health, we have to break the chain of transmission.

First of all, we must identify the source of infection and the contacts who may turn out to be suspect or probable cases. The latter may be infected with the virus, and could spread the infection in the incubation period. Following that, we have to isolate the patients and the contacts from the healthy population. Generally, the patients will be admitted to Tan Tock Seng Hospital for treatment. As for the contacts, because they do not show symptoms of the disease, they will be isolated, either at home or at other places of confinement, so as to minimise the possibility of infection to others.

The quarantine method is definitely effective in our fight against SARS. In the last six weeks, there has been no new case of any medical officer or hospital staff being infected. This shows that the isolation method is a correct one. However, in our community, when we want to ring-fence this disease, we would depend on the cooperation of everyone, particularly those people who are served with Home Quarantine Orders (HQOs). Only then can this containment exercise be effective.

Since the implementation of the HQO scheme, the majority of those served with the order have complied. Yet, there is a still a handful of people who have broken the order. They continue to go to office or participate in community activities.

Mr Speaker, Sir, such irresponsible action is like breaking a hole in our ring-fence and allowing the SARS virus to go loose. Once the SARS virus is spread to the community, our work will be made so much more difficult. Besides, there are some infected persons who would not want to disclose that they had a high temperature or symptom, for fear of being isolated. Since the implementation of the HQOs, we have been moderate in our enforcement. Now that we can see some of these people not taking the orders seriously and acting irresponsibly, we may just have to deal with them more severely.

Therefore, I support this Amendment Bill so that the law enforcers would have more muscles to deal with the violators, to fine or even imprison them. This severe punishment would serve a deterrent effect, so that those who have been served with HQOs would not dare to violate them. With this Amendment Bill, we can further show to the people all over the world our determination to fight against SARS and to enhance their confidence in us.

Mr Speaker, Sir, although I do support using harsh punishment against offenders, I hope that the Government would also work harder in public education and send the proper message to our people. If we want our people to act in a responsible manner, I think we should give them a better understanding of the matter. In a dialogue session yesterday, someone reflected that nowadays, there are a lot of rumours being spread through e-mails and SMS. Some would say, "Oh, this area was closed down because of SARS. Or so-and-so was infected with SARS and hospitalised." By spreading rumours it would only add to the fears and chaos in our society.

For this reason, I urge the Government to send a very clear signal to the people so that everybody would rather depend on the television and the media for official updates on the SARS situation in Singapore, thereby dispelling all rumours on the emails and SMS. We should also deal with these rumour-mongers more severely. Just like after the September 11 event, there were some people who were spreading rumours, and we took harsh action against them. I think we should do likewise this time round.

In public education, I think that we should make greater efforts in propagating public health knowledge and information to our people. For example, the family of eight who was asked to wait for the ambulance at a designated spot outside the clinic, ignored the doctor's instructions and wandered around the vicinity, causing the whole area to be closed down and isolated. There was another vegetable wholesaler who had been running a high fever for many days and yet refused to go to Tan Tock Seng Hospital, but went all over the places to see his family doctor and two Chinese physicians. This may perhaps be due to their ignorance.

Besides, I also observe some irresponsible action of some people. My hospital is just next to Tan Tock Seng Hospital. My colleagues told me that many people had been throwing away their used masks along the walkway between Tan Tock Seng Hospital and the Novena MRT station. We can see a lot of these discarded used masks all over the places. I presume these masks were thrown away by the people who had visited Tan Tock Seng Hospital. This is certainly very bad for public health. I think we should change our people's behaviour through public education. Perhaps our Health Promotion Board should reach out to the community and step up their efforts in public education to our people. At the same time, we should also look after the people who are not conversant with English. If possible, we may even use dialects or the minority languages to educate these people.

Mr Speaker, Sir, the fight against SARS is the responsibility of every citizen of Singapore. I, therefore, support this Amendment Bill.

Mr Speaker: I call upon Dr Balaji Sadasivan to address the House via video.

The Minister of State for Health and the Environment (Dr Balaji Sadasivan): Mr Speaker, Sir, I speak in support of the Bill.

SARS is a new disease. It hit us without warning. On March 12th, when WHO issued its warning, we were unsure what the disease pattern was going to be or how it was transmitted or what the patient outcome was going to be. Because we are dealing with the unknown, it is natural to be afraid. In this battle against SARS and the fear that SARS induces, information is power. It helps overcome our fear and puts problems in the correct perspective. In the last six weeks, we have learnt much about this disease that allows us to better assess the danger that SARS poses. I want to highlight three key points that Members of this House and Singaporeans should take note of.

The first point is that most SARS patients recover. SARS is a serious disease. There is a mortality of 5-10%. But this means that 90% do recover. Of the 192 patients diagnosed with SARS so far, 120 have recovered and have been discharged from the hospital. More will be discharged in the coming days. Since SARS is a new disease, to get a perspective of how dangerous or serious it is, let us compare SARS with other diseases. SARS is not like cancer. In cancer, even with treatment, you may not always have a cure. Cancer treatment is long and difficult and you always have to worry about the cancer coming back. SARS is not like stroke, where you may recover but you may be left with a disability for the rest of your life. In SARS, 90% of patients recover. They return to work as per normal without any disability. And because they have antibodies against SARS, they are immune from getting SARS again.

In fact, at Tan Tock Seng Hospital, there are three doctors who have caught SARS. They have been treated and have returned to work at Tan Tock Seng Hospital to look after other SARS patients. Two more doctors who are now at home will return to work next week and join them. Our research teams testing the diagnostic kits need specimens of mucus from the back of the throat. You need to be well protected to take a swab from the back of the throat of a SARS patient because when you tickle the back of the throat of a patient, he may cough into your face spraying you with a lot of SARS virus. These SARS recovered doctors can safely obtain the specimens because they are immune to the disease and cannot catch SARS again. They are helping our research teams obtain specimens from SARS patients.

Patients who have recovered from SARS are not only returning to work, they are also helping other new SARS patients fight the virus. When you recover from SARS, you have plenty of antibodies in your blood that can help kill the SARS virus. These patients donate their antibodies to new patients to help them fight the SARS virus. This is called serum therapy and new SARS patients at Tan Tock Seng Hospital are benefiting from this treatment.

The best place in the world to get treatment for SARS is Tan Tock Seng Hospital. They have the most knowledge and experience in dealing with the disease and we have given them all the resources they need.

Last week, at my meet-the-people session, a young man, a technician, saw me for help. He had lost his job. He wanted his employer to reinstate him. I asked him why he lost his job. He said he went to a neighbouring country for a week without applying for leave and his company terminated his services. I asked him why he did that. He replied he was scared of SARS and so he went to a small town to hide. I looked at him. He was young and athletic and I asked him why he was afraid of SARS. He said he had a cough. I told him lots of people have coughs. He then told me he went to Hong Kong in mid-February to participate in a sporting event and so he was afraid that he had SARS. So I asked the young man to review his actions. If he did not have SARS, he has lost his job because of his fear. But if he had SARS, would he be better off in a small town with no or little medical expertise or at Tan Tock Seng Hospital where the care is equal to the best in the world? The young man had no answer. He realised he had allowed fear to take control of him. The fear of SARS is more dangerous than the disease SARS itself.

The second point I want to highlight is that SARS is controllable. In looking at our cases, we find that our SARS cases caught their infection by having close contact with a person who was feeling unwell from SARS. If we can isolate SARS patients early, we can stop transmission. We need the help of all Singaporeans to do this. Singaporeans are, in general, a socially responsible people and are united in this battle. But we need the cooperation of every single Singaporean. One weak link and the virus will use that link to pass on to the next person. A single person with SARS, if he is the weak link in our defence and does not behave responsibly and if he is infectious, he can pass on the infection to as many as 20 persons. Hence, the need to amend the Infectious Diseases Act to get the few who may not be responsible to join us in this fight against SARS.

The third point I would like to highlight is that we are at a critical point in our battle against SARS. This week, WHO downgraded Toronto's status to that of Hong Kong, Guangdong and Beijing, that is, a place for travellers to avoid. We are at the brink. If we fail to contain the outbreak, we may end up joining Toronto, Beijing and Hong Kong as places that travellers should avoid. This will cost us many jobs. However, if we work together, we can move away from this brink and contain the outbreak. Hence the need for urgency and resolution in our actions.

Sir, I support the Bill.

Mr Speaker: Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 3.50 pm.

Sitting accordingly suspended at 3.29 pm until 3.50 pm. Sitting resumed at 3.50 pm