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‘SWAT team’ of experts proposed to deal with unusual disease outbreaks

SINGAPORE — The taskforce looking at how to improve Singapore’s response to infectious disease outbreaks is studying the possibility of setting up a national-level “SWAT team” of experts that can be mobilised at a short notice, said taskforce chairman Chee Hong Tat today (Dec 28).

This multi-dose vial containing insulin was shown at a media briefing that shared details of a cluster of hepatitis C cases detected in a renal ward at SGH. TODAY file photo

This multi-dose vial containing insulin was shown at a media briefing that shared details of a cluster of hepatitis C cases detected in a renal ward at SGH. TODAY file photo

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SINGAPORE — The taskforce looking at how to improve Singapore’s response to infectious disease outbreaks is studying the possibility of setting up a national-level “SWAT team” of experts that can be mobilised at a short notice, said taskforce chairman Chee Hong Tat today (Dec 28).

Sharing the taskforce’s “preliminary views” for the first time since it was set up, Mr Chee, who is Minister of State (Health), said it is unfeasible for every healthcare facility to have its own full-fledged infection control response team to handle unusual and complex out-breaks.

A “SWAT team” could comprise members from both the public and private sector. A few could be full-time members while the rest could be experts from hospitals, universities and government agencies, said Mr Chee in a speech at the launch of a commemorative book and video on infectious diseases at Tan Tock Seng Hospital (TTSH) . 

The taskforce was set up by the Ministry of Health (MOH) following the release of a 79-page report by an Independent Review Committee (IRC) that investigated the hepatitis C outbreak in Singapore General Hospital, which was linked to seven deaths.

The report, among other things, flagged gaps in the national healthcare system in detecting and responding to uncommon and unusual infections. The IRC recommended designating a single team in MOH to carry out surveillance, identify and investigate potential outbreaks, and ensure there is enough expertise nationally to facilitate investigations.

Mr Chee said the taskforce will also review the list of notifiable diseases under the Infectious Diseases Act and look at the modes of notification, timelines and escalation process, as called for by members of the medical community and the public.

The taskforce will be mindful of adding to the reporting and administrative burden for healthcare institutions. “What we want is to encourage and enable medical professionals to report cases which they come across by providing clearer guidelines and simplifying the reporting process where possible,” he said, citing the example of having a direct link from laboratories to MOH on positive cases.

The taskforce also plans look into better use of data analytics to improve the detection of potential outbreaks. The current system “depends too heavily on human judgment to pro-cess large amounts of information and decide whether the risks are significant enough for escalation and further investigation,” Mr Chee noted. IT systems and data analytics could help in reporting, enhancing recognition of patterns and improve detection of “weak signals”. 

Associate Professor David Lye, Senior Consultant for the Infectious Diseases Department in the Institute of Infectious Diseases and Epidemiology (IIDE) at TTSH, who was present at the event, likened the possible “SWAT team” to the United States’ Centres for Disease Con-trol and Prevention, which responds to outbreaks in smaller hospitals and hospitals overseas via their Epidemic Intelligence Service.

He said: “It’s a fantastic idea because we’re small and we won’t have the same number of experts in every institution. This allows us to take experts from different areas very rapidly, and work together on an emergent issue.”

IIDE director Leo Yee Sin, who was at the event, said the ability to pick up signals have to be strengthened in order for the “SWAT team” to be efficient.

Professor Leo, who also led the IRC, said: “The important thing is to identify if the sig-nal we have picked up is indeed a real signal, something that we need to respond (to). And if indeed it is something we need to respond (to), we also need to analyse whether this a big event, or smaller scale event. And then from there, the local systems will need to make a decision, whether they have the capability and capacity to be able to deal with the issues.”

As for the use of data analytics, Professor Paul Tambyah, secretary-general of the Asia Pacific Society of Clinical Microbiology and Infection, said that while the private sector has not contributed to the national electronic health record, data collected from Medisave and Integrated Shield plans can be used for disease tracking, as well as outcome data in monitoring complications.

An infectious diseases physician, Prof Tambyah also urged integration in approaching animal and human health issues, citing the recent Group B Streptococcus (GBS) infections from consuming fish, as well as diseases like the Nipah virus, MERS and bird flu. By looking out for new diseases at the animal-human interface, both people and animals would benefit.

Mr Chee stressed that the taskforce agreed with the IRC that healthcare institutions already have good infection control protocols in place. “Hence, the way forward is not to simply add more rules and procedures, as that could inadvertently add to administrative workload and take time away from key operations and patient care,” he said. 

The task force will consult medical professionals to ensure recommendations can be implemented effectively. It will complete its work by middle of next year (2016).

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