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Statement by Chief Medical Officer, Department of Health and Children, Chair of SARS Expert Group

15 May 2003

The Minister for Health & Children requested the SARS Expert Group to give their advice on the participation in the Special Olympics of delegations from areas with recent evidence of local transmission of SARS, as defined by the World Health Organisation. That advice concerned the best options for dealing with these groups in the current circumstances that obtain under WHO guidelines regarding SARS and best public health practice.

The Group considered the matter over a number of meetings concluding with a 2 hour meeting yesterday (Wed 14 May). Dr. Richard Pebody of the World Health Organisation provided the group with technical advice in the course of their deliberations. Measures considered by the Group were grounded in a number of priority objectives to:

• Maintain the current low incidence of SARS cases in Ireland
• Maintain the highest level of Public Health in Ireland
• Minimise the disruption of normal health services
• Minimise the risk of introducing further SARS infection in Ireland
• Minimise the personal and social disruption to delegates from affected areas
• Ensure the integrity of the Special Olympics is maintained and the participation of the greatest number of delegates possible

The Expert Group also considered the nature of the event and its distinctive, unique characteristics in the context of risk assessment and risk minimisation for the importation of SARS:

• Many of the people with disability participating in the Games are at increased risk of infection - particularly respiratory infections
  
  
• The bringing together of people with these health characteristics in large numbers would further increase the likelihood of transmission of infectious diseases.

Given these objectives and the distinctive nature of the event, the Expert Group quickly concluded that the existing measures in place would not be sufficient and additional measures were required.

They next considered the issue of quarantining participants from affected areas. This involved putting each participant into quarantine, under active surveillance, for a period of 10 days prior to participation in the Games. Limiting movement and minimising social interaction along with twice daily health checks would form part of the procedure.

The Group first considered the option of this quarantining being carried out in the delegates´ home country. However, three issues arose on this:

• The desired verification by ourselves of such quarantining could not practically be achieved. It´s our policy to advise people not to travel to affected areas, therefore, we could not send Irish medical professionals to the various countries
  
  
• The Group was informed that the WHO could not provide independent verification
  
  
• Finally, the Group agreed that an individual from an affected area, despite being quarantined for the required period in their own country, would still have to be classified as a "suspect" or "probable" case of SARS if they showed the relevant symptoms, once they had arrived in Ireland.

The Expert Group then moved on to consider quarantining and screening of athletes and delegates for a period of 10 days, after arrival in Ireland, and before commencement of the Games.

We estimated the likely numbers arriving from affected areas would be in the region of 350 people.

Given the increased risk of incidence of respiratory illness amongst the delegates, the Expert Group agreed that the ideal situation would be to quarantine participants in groups as small as possible - individual accommodation where achievable. Health professionals would have to be on hand to monitor the delegates for at least 10 days - the recognised incubation period for SARS. And obviously, the necessary operations and maintenance activities associated with such accommodation would need to be put in place.

The health boards brought initial proposals to us through their representatives on the Expert Group indicating how these physical facilities and resources could be mobilised and provided satisfactorily.

The Group then considered and assessed a number of outcomes that would likely emerge in the course of quarantining:

• Critically, the Group assessed the risk of respiratory infections occurring within the delegates from infected areas, and based on the numbers involved, calculated this could be between 0 and 10 likely episodes. Any such episode would immediately require the SARS guidelines to be applied to that person, with the attendant diagnosis, management, contact tracing, and isolation of a number of delegates.
  
  
• On top of that, if the respiratory infection occurred on the 9th day of the quarantine period, for example, a further 10 days would have to be imposed, with the possibility of more infections occurring within this time. This would create further logistical and organisational problems for the Games, and potentially impede the progress of its events. Concern was also expressed about the impact that the management of "suspect" or "probable" cases arising from the quarantine system would have on the health system - and in particular on the acute hospital system - as had happened in other jurisdictions.
  
  
• The athletes concerned would be in the final stages of preparation for a major sporting event, and it would be extremely difficult to provide them with adequate training and social facilities during the quarantine period.

The Expert Group´s conclusion was that there were too many contingencies and uncertainties within this option for it to be considered sufficient to meet the Group´s objectives. Critically, these centre around the high likelihood of respiratory infections occurring, the consequent creation of suspect and probable cases, and the inevitable cycle of quarantining and possible further infections as a result.

After final deliberation, the Group concluded that the best option was to recommend that delegations from the relevant countries classified under the WHO list, be asked not to attend the Games.

The countries affected would those designated by the WHO as having local transmission of SARS, 10 days prior to the normal arrival time of delegations prior to the start of the Games.