On Tuesday, Singapore General Hospital (SGH) called a press conference to inform the media and the public that 22 patients had been diagnosed with hepatitis C between April and June while they were in its renal ward. One was likely the index patient who brought the virus into the hospital. The other 21 must have been infected there.
The first case was diagnosed on April 17, and by the end of May, eight of its kidney patients were confirmed to have this virus, which could lead to liver disease.
Why did it take so long before the public was informed?
First, a bit of background.
Hepatitis C is a serious viral disease that can lead to liver failure, so it is obligatory for doctors and laboratories to inform the Ministry of Health (MOH) of all diagnoses within 72 hours. Such infections are also rare, with only six cases last year and two in 2013.
MOH explained that it lists only acute cases, that is, when someone has symptoms; and not chronic cases where they show up only in blood tests. This was why it had not reacted to the earlier reports of hepatitis C that it received from the SGH laboratory - they were classified as chronic. But the MOH now says that it will reclassify them as acute infections.
However, none of this explains SGH's slow reaction since the first case was diagnosed.
The hospital had told the media: "Full investigations and involvement of our infection control team started the moment we noticed a clustering of seven cases within four weeks, which is unusual."
According to MOH, SGH gets two to four cases of hepatitis C infections among its renal patients in one year. It took seven cases in one month to trigger alarm bells. A little slow, but these patients were seen by different doctors, making connecting the dots difficult.
Doctors knew something was wrong in mid-May. But its infection control team was activated only in June. If action had been taken earlier, could some patients have been saved from an infection that is expensive to treat and can be deadly?
Also, why did it take another four months and many more infections before the hospital informed MOH's Director of Medical Services (DMS) in late August?
It seems SGH has not learnt its lessons from the outbreak of severe acute respiratory syndrome (Sars).
In early April in 2003, the media heard rumours that some SGH staff had been infected with Sars. MOH was asked during the daily media briefing, and was told by the then DMS that there was no such thing. Senior SGH staff were present at that briefing.
The very next day, the ministry announced that 21 SGH staff were suspected to have contracted Sars.
It later transpired that SGH did not think there was any urgent need to inform the ministry about the cases, even as the number of its staff suspected to have contracted the deadly bug grew.
Yes, hospitals need some autonomy - but when there is a serious outbreak of disease, they must also be proactive and responsible in notifying the ministry.
Having more hepatitis C cases diagnosed in one month (seven) in one hospital than the whole country had in the previous year (six) should be classified as serious.
Singapore's highest medical authority should have been told of the big spike in numbers immediately.
Waiting until more than 20 patients were diagnosed before telling MOH in late August is tantamount to dereliction of duty.
After that, DMS Benjamin Ong met SGH doctors, roped in the Agency for Science, Technology and Research (A*Star) laboratory to verify that the cases came from the same source, and told Health Minister Gan Kim Yong about the outbreak on Sept 18.
In this case, it is fortunate that all the infections took place within SGH's ward 67. But what if the infections were occurring outside of the hospital?
What if the infections were taking place in every hospital, and no one told the ministry? The question on many minds is this: Is there a timeframe within which healthcare institutions must report such incidents to the ministry?
If there isn't, perhaps it is time to institute such a practice. Lapses in reporting undermine the country's ability to keep a lid on the spread of deadly diseases.
With Ebola, the Middle East respiratory syndrome and other emerging infectious diseases a constant threat, the MOH needs to strengthen its defence. Access to timely information is paramount.
This article was first published on Oct 9, 2015.
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