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Email of appreciation to Abdullah with five proposals to fully restore public confidence in government handling of SARS outbreak - together with preparedness to accept the temporary adverse publicity and setback of Malaysia as the world's third country with the largest number of SARS cases Media Statement by Lim Kit Siang (Petaling Jaya,  Friday): I have today sent an email of appreciation to the Acting Prime Minister, Datuk Seri Abdullah Ahmad Badawi for the new Cabinet decision of full transparency on the SARS outbreak and in particular for acting on my email suggestion on Tuesday that the Health Ministry should give full and daily public updates of SARS to restore public confidence in the government handling of the new killer virus. I expressed my great sense of relief when on Wednesday I learnt of the new Cabinet policy decision of full transparency on SARS outbreak because of the intense and snowballing panic among the people over the dangerous stance for three weeks of "no SARS cases, no suspected SARS cases or deaths caused by SARS" adopted by the Health Minister, Datuk Chua Jui Meng and the Health director-general Tan Sri Tan Sri Dr. Mohamad Taha Arif, which had no credibility whatsoever. In my email, I expressed the hope that his decisive leadership in ending the three-week denial syndrome on the SARS outbreak would save the country from the international stigma of a rogue state which hides and manipulates statistics about the new killer virus to downplay its seriousness, posing a threat not only to the lives of the Malaysian people but also the international community. Furthermore, that it holds out the promise of a more open, accountable and transparent government under his forthcoming Prime Ministership and the first of a series of bold actions to eradicate the "First World Infrastructure, Third World Mentality" Malaysian malaise which he had so brilliantly diagnosed as the great impediment to Malaysia's development and progress to fully developed nation status. I made five proposals to Abdullah in my email today to ensure that the new Cabinet policy of full transparency on the SARS outbreak will not be hindered or circumvented by any rear-guard resistance action or "guerrilla tactics" by those who are too obsessed by the denial syndrome and could not envisage a new information policy in the IT era where information is the right of the people and not of the government. The Health Minister and Health director-general reported 59 "suspected" SARS cases on Wednesday and 65 "suspected" SARS cases yesterday, while strenuously declaring that there is not a single "probable" SARS case in Malaysia. These are simply untrue. There are not only "probable" SARS cases in Malaysia, the number of "suspected" SARS cases are three or four times the stated figures. Under the World Health Organisation (WHO) case definition, a "suspected" SARS case is one which meets the three criteria of firstly, high fever (more than 38C, 100.4 F); secondly, one or more respiratory symptoms including cough, shortness of breath, difficulty breathing and thirdly, recent history of travel to a SARS-infected area or close contact with a person who has been diagnosed with SARS in the past 10 days. It becomes a WHO "probable" case when there is a chest X-ray findings of pneumonia or Respiratory Distress Syndrome. As WHO has said repeatedly, "Chest X-rays showing distinctive features of SARS are presently the main tool for distinguishing suspected from probable cases". (WHO SARS multi-country outbreak - Update 8 - 24.8.2003) All the cases in Malaysia announced after the Cabinet meeting, i.e. 65 cases as of yesterday, would fall under the WHO definition of "probable" cases, as they would involve patients meeting all the four WHO criteria of high fever, respiratory symptoms, recent history of travel to SARS-infected area or contact with SARS patient in the past ten days, together with X-ray changes - or they would not have been quarantined in life-threatening circumstances to others. When the Health Minister and the Health director-general said in the past two days that there are only "suspect" but no "probable" SARS cases in Malaysia, they were not following the WHO case definitions. When doctors particularly those in government service notify the health authorities about SARS cases, they submit separate lists of "suspected" and "probable" cases in accordance with the WHO case definition. What the Health Minister and the Health director-general had done are to announce cases which meet the WHO definition of "probable" SARS cases as "suspected" cases, while ignoring the WHO-defined "suspected SARS cases" altogether. I understand that the number of WHO defined "suspected" SARS cases in Malaysia would far exceed the Health Ministry's "suspected" cases (which should properly be classified as "probable" cases according to WHO case definitions) by three to four times, or over 200 cases when taken into account the 65 "probable" (by WHO definition) cases announced yesterday. I made five proposals on the SARS "suspected' and "probable" SARS cases, bearing in mind that there is at present no "confirmed" SARS case, for the simple reason that there is no confirmatory test any where in the world for SARS. Although work is going on to try and get a test, this will take time, as even the WHO virologists and epidemiologists are still unsure of the infective agent, whether a coronavirus, a paramyxovirus or combination of both. The decision on whether a patient has SARS is a clinical decision, based on the WHO definition. My three proposals related to the SARS data are: Firstly, the Health Ministry should be directed to comply with the WHO case definitions of "suspected" and "probable" SARS cases and should make public the two sets of figures, and not to come up with its own arbitrary and self-serving definitions which seemed to be motivated more by P.R. considerations than the interests of public health protection of the people. Secondly, that the government should be prepared to accept the temporary adverse publicity and setback of Malaysia as the world's third country with the largest number of SARS cases. This is because if the number of WHO-defined "suspected" cases in the country is three or four times the 65 "probable" (by WHO definition) cases announced as of yesterday, then Malaysia would overtake Singapore as the world's third country with the largest number of SARS suspect and probable cases - with China having 1,190 cases, Hong Kong 734 cases and Singapore 100 cases. Malaysians, however, are prepared for the worst news but they want the unvarnished truth so that they could properly protect themselves. Thirdly, the Health Ministry should give a detailed breakdown of the total "suspect"and "probable" SARS cases, in states and location, chronology and dates of occurrence, gender, age and ethnicity to enable the public to better understand the SARS outbreak. My two other proposals are: Fourthly, Abdullah should appoint a special personal representative to the national SARS Inter-Ministerial Committee, headed by Chua and comprising top civil servants from the various Ministries as well as representation from the Malaysian Medical Association, Association of Private Hospitals of Malaysia and Private Practitioners Association with the unique brief to ensure that there would be no residue of the denial syndrome in the new policy of open and transparent policy on the SARS outbreak and to eliminate any rear-guard action to stonewall and to continue to deny all information about the deadly outbreak to the public. Fifthly, lift the government media blackout on information on the current dengue epidemic, where Health Ministry officials, Mentris Besar, Chief Ministers and State health officials are banned from giving the public the full, accurate and timely information about dengue cases and deaths, as it raised the fundamental question as to the credibility of the government's candidness on the SAR outbreak if it is not prepared to be candid on the dengue epidemic. In my email to Abdullah, I pointed out two bright spots about the SARS outbreak as compared to China, Hong Kong and Singapore - that no SARS death has occurred and there is no mass SARS spread as Malaysia does not have a situation where large numbers get infected in short durations by one or two persons or "Super Infectors". (4/4/2003) * Lim Kit Siang, DAP National Chairman