World Health Organization (WHO) experts in Taiwan have again raised concerns about the community spread of SARS and the infection-control measures in hospitals. At the same time, the news media report daily on the people who willfully disregard quarantine orders and others who are resorting to do-it-yourself masks because of a reported severe shortage of medical masks.
Taken together, these stories suggest that the biggest problem in the government's handling of the SARS epidemic thus far has been the lack of effective and coordinated enforcement and implementation mechanisms.
It is true that -- with ever-changing developments in the spread of the disease -- ?this is not the time to point fingers and cast blame. Cooperation and unity among all levels of the government are imperative to get the job done.
However, that does not mean that scrutiny and examination of what has gone wrong can wait until later. After all, only by first recognizing and identifying mistakes can one learn to improve. If these errors are not pointed out, the government will only repeat the mistakes over and over again, and all hope of a victory in the battle against SARS will be lost.
Many agree that the Taipei Municipal Hoping Hospital was where the first major defeat in the fight against SARS was suffered and from where things went rapidly downhill. Because the hospital did not adopt strict measures to prevent infection, members of the medical staff were infected by SARS patients. For the same reason, infected personnel further spread the disease within the hospital. This reveals a major shortcoming in the disease-control measures of the hospital.
Worse yet, the hospital allegedly had failed to issue proper alerts and notifications to hospitals where suspected SARS patients were transferred to. As a result, other hospitals did not have the opportunity to adopt extra precautions in treating these patients, thereby exposing their medical staff to the risk of infection.
For example, the National Taiwan University Hospital's zero-death record was spoiled by the death of a SARS-infected man who had previously sought medical treatment at the Hoping Hospital. Yet, the univeristy hospital was clueless about the man's contact with Hoping -- which would have alerted them about potential SARS infection -- until they checked his National Health Insurance card. This reveals major loopholes in the mechanism for tracing and reporting SARS infections.
The enforcement of quarantine is another major problem. For example, in the case of the Hoping Hospital, people sealed off in the hospital were allegedly at serious risk of cross-infection among themselves as a result of a shortage of protective gear and a lack of internal segregation based on the level of their exposure and potential exposure to the SARS virus.
In addition, many people who were place under home quarantine defied their quarantine orders and simply went about their usual business.
Minister of Interior Yu Cheng-hsien (