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• Main Authors: Rong-Chuan Yang, 楊榮泉
• Other Authors: Chin-Peng Chu
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/08208669674909342793

碩士 === 國立東華大學 === 公共行政研究所 === 92 === From the lesson on outbreak of the emerging severe acute respiratory syndrome （SARS） in our country last year （2003）, we knew that it not only killed 72 persons , but also deeply impacted on our medical, social and economic framework. After the three-zero’s record（zero death, zero cross-border transmission, and zero community transmission） was broken due to the initial nosocomial clustered infection of SARS occurred at Ho-Ping Hospital, events of SARS infection were subsequently reported from multiple hospitals which distributed from northern to southern Taiwan. Problems emerged from our national communicable disease prevention and control system in several aspects, such as disease detection and surveillance, case notification, nosocomial transmission control. It caused that the hygiene and medicare system of this country failed to well manage the crisis and appropriately respond to the emergent phase. In this study we try to explore and analyze the problems on the mechanism of emergency responsiveness. We took the lessons and experiences from this event and review the experiences and measures from international society. The initial SARS case was notified on March 14, 2003. In order to block the spread of SARS in our country, the government authority immediately recruited relative personnel and preventive facilities and formulated responsive plans and measures to fight SARS. The plans included： SARS prevention strategies, SARS crisis managing policies and measures, recruitment and coordination for the mechanism of crisis managing. Depended on the practical circumstances, different levels of SARS prevention and control policies were classified in accordance with the severity of SARS epidemic situation. Each level had precisely prepared measures to respond to emergency. The principal policies included：reduced sources of transmission, blocked routes of transmission, educated general publics with the correct understanding on SARS prevention. Furthermore, refered to the statistics of influenza cases by season, influenza was epidemic in autumns and winters in the past several years. Especially, cases gradually increased to peak level on the 47th to 48th weeks every year. It is difficult to distinguish the initial syndromes in patients infected with influenza from those infected with SARS. It is very important for us to correctly differentiate and diagnose the real etiological agent for patients who developed similar syndromes either infected with SARS or influenza. In order to early response to the resurging SARS, on August 15, 2003, government authority started implementing the nation’s strategies and preparedness for controlling coming SARS and influenza outbreak in winter, which included actively temperature taking, fever patients screening, influenza immunization, quarantine for fever patients, keeping alert through notification system, border controlling, preventing nosocomial infection, starting medicare network for infectious diseases, etc. In order to block the upcoming SARS outbreak, on November 15, 2003, government authority had drafted the fighting plan against SARS during the prevalent period of influenza as the responsive strategy to deal with the crisis caused by SARS outbreak. In this fighting plan included case classification and notification, outbreak investigation, extra-territory control, self health management and home quarantine, establishment and allocation the medicare network for prevention of communicable disease, transmission control, laboratory testing, management and allocation of preventive facilities for disease control, international coordination, disinfection procedure, community infection control. In other way, people knew little about this emerging communicable disease, named SARS. Nosocomial cluster infection occurred in multiple hospitals indicated that not only shortage of preventive facilities and knowledge on our disease prevention and control system, but also problems on the medicare system. In our study, we found that the role and function among different levels of medicare settings had not been clearly defined. There was no instruction for general publics. They must seek medicare attention by them-self. The patient transfer system and the medicare treatment provided in different level of hospital did not smoothly operate among hospitals for those patients who needed more proficient medical treatment. We must first teach and guide the publics with correct behavior in medicare seeking, and implement isolated medicare by district and region, and then strengthen hygiene education, patient screening，patient transfer. Medicare settings were classified to different levels that responsibilities were clearly defined and endowed. Furthermore, government authority and manufacturers could not provide sufficient protective facilities in time, and then resulted to shortage of protective facilities during the most stringent time in SARS outbreak. General publics were panic to buy protective facilities. Publics’ fear and anxiety were augmented by the circumstance on facing the uncertain disease, and then caused disorder of their daily life. It is definitely necessary to establish a facilities management and allocation mechanism. Our country have not yet been accepted as the member of the World Health Organization（WHO）. It was somewhat late for our country to receive international epidemic information, while we were suffering the challenge of SARS outbreak. In consideration of the human right on medicare issue, our human rights were intentionally neglected, even deprived. The experts from WHO could not provide adequate and sufficient supports for our country in the critical time. It definitely made Taiwan as the leaky hole for global SARS prevention and control network. Never in the world have the border become the barrier for disease transmission. Taiwan is absolutely one of the nodes in global disease prevention and control network. Troubles in any node would interfere the whole network. As a member in the global society, Taiwan needs not only a prevention system, which could operate in routine and crisis, but also international cooperation, and information exchange for disease prevention and control. We have passed the test of SARS outbreak, but no one could predict that SARS will or not resurge again. It is possible for us that challenges of new emerging diseases even powerful than SARS are waiting for us. We must remember the lessons and experiences, and examine the defects and failures from SARS prevention and control. We must keep learning, draft a more adequate strategy for crisis management, and establish a well-defined commanding mechanism for crisis management. We shall do it better in the next outbreak.