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Lessons from the Past: What SARS Taught Us for COVID-19

It was 17 years ago, that Singapore successfully curbed the spread of Severe Acute Respiratory Syndrome (SARS). How can the lessons we learnt then help us in facing today's battle against COVID-19?

SingHealth Internal Medicine Residents, Dr Amar Vaswani, Dr Samantha Koh and Dr Tan Yu Bin, spoke with our SingHealth Residency Faculty, Dr Anantham Devanand and Dr Imran Bin Mohamed Noor, who were on the SARS frontlines, to find out how their experiences strengthened their calling in Medicine and prepared them to face COVID-19 today.


Dr Anantham Devanand
Senior Consultant, Department of Respiratory and Critical Care Medicine (RCCM), SGH

Dr Imran Bin Mohamed Noor
Senior Consultant, Department of Respiratory and Critical Care Medicine (RCCM), CGH

1. Where were you when SARS first appeared on the scene?

Dr Imran:

​SARS happened within my first year out of National Service, while I was doing my cardiology posting. In fact, I had just completed my Practical Assessment of Clinical Examination Skills (PACES) exams two weeks before it happened!

To be honest, no one was prepared for SARS. Its impact led to closure of schools, just a few days after the March school holidays.

​Dr Devanand:

​I was a Medical Officer (MO) at SGH when SARS broke out. My last three months of being a MO and my first few months as a RCCM registrar were affected by the outbreak.

My clinical training was affected; there were no tutorials or exams. I was just starting my respiratory training and the number of bronchoscopes done shrank tremendously. At one point, I was deeply concerned if my Advanced Specialist Training, which was equivalent to Senior Residency training, could start on time.

2. How did you feel when SARS struck?

Dr Devanand:

​It was obviously very frightening. Unlike COVID-19, it took a lot longer to identify the virus and understand its transmission. As no one really understood the science of transmission, there was always the nagging fear that we could be hit next.

A large proportion of those falling sick were fellow healthcare workers, and a significant proportion needed critical care. When the first doctor died, it was devastating. He was a cardiology MO at Tan Tock Seng Hospital. The family members and the pastor of the index case also died just before that. That meant two things: we could be next, and our families were at risk too.

The instructions and plans at the hospital and at the national level were also changing daily. Before SARS happened, we hardly used N95 masks. However, once Personal Protective Equipment (PPE) was implemented, there was a decline in the number of healthcare workers falling sick. We relied on emails and SMSes to communicate daily, unlike now where we have smartphones or Zoom.

Dr Imran:

​Being in healthcare, I told myself that I had to keep up my morale. Patients would lose faith in healthcare workers if we were seen to have a low morale. Staying positive also allowed life to carry on as per normal in my household. During SARS, the situation affected our lifestyle, unlike COVID-19 where we had to change our lifestyles to suit the situation.

3. Did SARS challenge the notion of being a doctor when you were placed on the frontline?

​Dr Imran:​I wouldn't say SARS challenged the notion as much as it enhanced it – it was like activating a ‘programme’ that had remained dormant all these years. SARS definitely played a role in my decision to become a respiratory physician today.
​Dr Devanand:

​At the time we were so stretched, there was no time to think or reflect. Some years later, when I was doing my ethics training, I wrote a paper titled “Influenza Pandemic – Physicians and Their Obligations”, explaining the need to go to work in the face of clear and present danger.

4. What have you learnt from the experience that is applicable to the current COVID-19 situation?

Dr Devanand:

Looking back, it was unwise for us to wait anxiously each day for the outbreak to end and expect everything to return to normal. The world changed with SARS and it will as well, with COVID-19. We are definitely more well-prepared this time in reacting to the situation; infection control, PPE for bronchoscopy and airways procedures have improved since SARS and are more effective now.

I also realised that my speciality was in such great demand! Three years later, when I was in Boston for the Health Manpower Development Programme, I was a content expert on matters of outbreaks just by virtue of having undergone the SARS experience! It was surreal that Harvard professors were listening to a recently graduated registrar from Singapore General Hospital on how to plan for an epidemic.

My advice to all healthcare professionals is to keep calm and not to expect a quick fix. The situation will continue to evolve with unpredictability. Make the best use of the time until we learn how to live with COVID-19. When the new normal emerges, there will be new opportunities that were least expected. Yes, there may be delays in training, but all this work may also create new job opportunities. Historically, outbreaks have led to the expansion of health budgets and health services. Administrators will have to make decisions about training to minimise disruption. More importantly, we need to continue to look out for one another.​

Dr Imran: ​I was a much more serious person back then, but the SARS experience has taught me how fragile life can be. We can decide how we live our lives and I've learnt to also find enjoyment in other aspects of life beyond work.


Written by Dr Amar Vaswani, Dr Samantha Koh, Dr Tan Yu Bin, SingHealth Residency
Supervised by Dr Malcolm Tan, Department of Gastroenterology and Hepatology, Changi General Hospital