Spillover - By David Quammen Page 0,72

picture. Someone from the ministry seems to have called the CEO of Tan Tock Seng, whereupon a meeting of senior hospital staff was convened. The CEO, the chairman of the medical board, the nursing director, Ang herself as head of infection control, and others—they all came to this room, Ang said, to discuss what was happening.

“Came to this room?” I asked.

“This room,” she said. “Same room.” That’s when the CEO told them: “I think we’ve got an outbreak on our hands. And we need to organize.”

A doctor named Leo Yee Sin, with previous experience of handling a Nipah outbreak, was charged with mobilizing special measures of response. The Ministry of Health advised Tan Tock Seng’s leadership: Get ready to accept cases, because we’re starting to see more—friends and relatives of the first group, now showing symptoms. Leo Yee Sin got people moving. They set up a tent outside one ward, for screening patients, and brought down an X-ray machine to check possible cases for lung involvement. Most of the patients were admitted to general wards, but the sicker ones went to Intensive Care. As the first Intensive Care Unit filled up, two others were converted into SARS ICUs, exclusively for handling additional cases. Isolation and barrier nursing were important control measures, though Ang and her colleagues still didn’t know what they were isolating. “Remember,” she told me, “all this time there are no diagnostic tests.” No tests, she meant, that detected presence or absence of the culpable infectious agent—because no one had yet identified that agent. “We are going purely based on epidemiology—whether there is contact with some of the source patients.” It was blind man’s bluff.

On Friday of that week, March 14, the hospital’s annual dinner and dance, long planned and anticipated, would occur at the Westin Hotel. It went ahead as scheduled, more or less, although Brenda Ang and some colleagues sat at half-empty tables wondering, Where’s Leo Yee Sin, where’s this colleague, where’s that one? Well, they were absent in extremis—back at the hospital, shifting beds and other furniture to put the place on an emergency footing. Ang herself rejoined the scramble on Saturday morning.

In her capacity as head of infection control, Ang started getting all staff members into gowns, gloves, and high-filtration N95 masks, the kind that fit more snugly than mere surgical masks. But she faced a shortage of those supplies, and then also black-market inflation; N95 masks in Singapore went from $2 to $8 apiece. Still, they were doing the best that could be done. On March 23, by which point the disease had an internationally recognized name, Tan Tock Seng became the designated SARS hospital for Singapore, with all patients to be transferred there from other hospitals. Visitation was restricted. Staff members were masked, gloved, and gowned.

Before the isolation and protection measures were fully implemented, though, another superspreader event occurred, this one in the hospital’s Coronary Care Unit. A middle-aged woman with multiple health problems, including diabetes and heart disease, had been admitted to one of the open wards; she was infected there by a health-care worker, who had in turn been infected by Esther Mok. Then the older woman suffered a heart attack and was moved to the CCU. Her atypical pneumonia symptoms hadn’t yet ­manifested—not enough, anyway, to be weighed against her coronary crisis. In the CCU she was intubated by the attendant cardiologist, with assistance from a cardiology resident. Again, as with the Poison King in Guangzhou, intubation seems to have been an occasion for transmission. Eventually twenty-seven people became infected in the CCU, including five doctors, thirteen nurses, one ultrasound technician, two cardiac technicians, one attendant, and five visitors. I found that tally in a later report. Brenda Ang’s account was more personal. She recollected that the cardiologist, a pregnant woman, had worn a mask while performing the intubation, and though that doctor got ill afterward, she recovered. The resident, standing nearby, had worn no mask. “It was a guy. He was sick for a while and brought it home. His mother,” Ang said. “His own mother nursed him and she became sick.”

“Did they survive?”

“No.”

“Neither one of them,” I said.

“It was one of the most painful things. Because he was a young, twenty-seven-year-old doctor. And his mother also died.”

Another young doctor who faced similar exposure was Brenda Ang’s registrar—remember him?—who had taken a throat swab from Esther Mok. His story reflects the dawning awareness that this syndrome was caused by some highly infectious bug, maybe a bacterium, maybe a

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