Saturday, 24 October 2015

More questions than answers in Hepatitis C timeline?

Review committee should examine the flow of information from SGH through the Health Ministry to the political leadership

The Singapore General Hospital (SGH) had diagnosed the infected patients between April and June, but notified the Ministry of Health only in late August.

The news was then made public at a press conference on Oct 6.

Given that the window between late August and Oct 6 contained a general election, opposition parties and some ordinary Singaporeans naturally assumed that the bad news was held back so as not to affect the ruling People's Action Party's electoral fortunes.

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MOH: Baseless allegation of political motive in disclosure of hep C cluster

I refer to Ms Rachel Chang's commentary in The Sunday Times ("More questions than answers in hepatitis C timeline?"; Oct 18).

Ms Chang suggests that public officers and medical professionals, in both the Singapore General Hospital (SGH) and the Ministry of Health (MOH), may have delayed the disclosure of information to the minister and the public for political reasons.

She offers no evidence for this serious allegation. Neither did she put the allegation to the ministry and give it a chance to respond. Instead, she quotes a scene from an American TV political comedy to lend colour to her story.

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ST column is “irresponsible” journalism: Health Ministry

If you’ve watched Veep before, you’ll know it’s an American comedy about a woman vice-president. But this comedy has made the Ministry of Health see red after it was used in a column by ST journalist Rachel Chang to discuss the delays in the SGH hepatitis C (HCV) outbreak.

In the 16-second clip, the protagonist is seen as trying to be coy about knowing or not knowing about a potential scandal that would implicate her. Ms Chang, in talking about why SGH and MOH were so late to announce the outbreak to the public, had seemed to imply that the Health Minister, like the protagonist, may have known or not known about the medical crisis.

This so infuriated the Health Ministry, that its press secretary wrote a letter in ST’s Forum pages condemning Ms Chang’s column in no uncertain terms. Said Ms Lim Bee Khim: “It is irresponsible of Ms Chang to impute improper motives to the medical professionals and public officers concerned without any evidence.
“Straits Times journalism cannot consist of repeating gossip while claiming to air opinions. Singaporeans expect higher standards of journalism from our newspapers, especially a paper of record.”
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HEALTH MINISTRY SLAMS 154 MEDIA FOR SPREADING GOSSIPS ABOUT DELAYED HEPATITIS C ANNOUNCEMENT

The Ministry of Health published a public rebuttal admonishing national newspaper The Straits Times for suggesting that the delay in Hepatitis C announcement was for political reasons. MOH claims that the allegations are completely baseless and claims that Singaporeans expect higher standards of journalism from our newspapers.

The Press Secretary for Minister of Health Gan Kim Yong, Ms Lim Bee Khim wrote:
  • "Ms Chang suggests that public officers and medical professionals, in both the Singapore General Hospital (SGH) and the Ministry of Health (MOH), may have delayed the disclosure of information to the minister and the public for political reasons.
  • She offers no evidence for this serious allegation. Neither did she put the allegation to the ministry and give it a chance to respond. Instead, she quotes a scene from an American TV political comedy to lend colour to her story.
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Ministry of Health: The Straits Times is baseless and irresponsible

The Minister for Health was first informed about the matter on 18 September. He directed that it be made public, and that a full public explanation be given. Ms Chang makes much of the Minister being “officially” informed on 18 September, implying that he knew unofficially before that. For good measure, she compares this to the situation in the American comedy. This too is totally baseless.

The timelines for key events, in SGH and MOH, have been made public. The independent Review Committee is still looking into the cause(s) of the infection, and the flow of information in SGH and MOH. As the Minister for Health has said, if there are gaps we will close them, if there are weak areas we will correct them, and if there are shortcomings, we will improve.

It is irresponsible of Ms Chang to impute improper motives to the medical professionals and public officers concerned without any evidence. Straits Times journalism cannot consist of repeating gossip while claiming to air opinions. Singaporeans expect higher standards of journalism from our newspapers, especially a paper of record.

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SGH files police report to ascertain if foul play involved in hep C spread; 2 US experts appointed to committee
SGH revealed earlier this month that 22 kidney patients had contracted hep C infections while receiving treatment at the hospital.PHOTO: ST FILE

Singapore General Hospital (SGH) filed a police report on Tuesday (Oct 20) so that the police could ascertain if there was any foul play involved in the spread of hepatitis C in the hospital.

In a statement on Tuesday (Oct 20) night, SGH said: "In response to media queries, we would like to confirm that we have filed a police report today.

"After initial internal investigation, we are still unable to determine the cause of the cluster of infection. Currently, an Independent Review Committee appointed by MOH is looking into this with the help of international advisors. The police report has been filed so that the Police may ascertain if there was any foul play."

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SGH Files Police Report Over Hep C Incident

The Singapore General Hospital (SGH) has filed a police report over the outbreak of Hepatitis C in one of its renal wards, so as to rule out any foul play. Responding to media queries, SGH said that it has still not been able to determine the cause of the infection cluster after initial internal investigations.

SGH had on 6 Oct revealed that 22 kidney patients had contracted a hepatitis C infection. Eight have died, with five deaths possibly linked to the infection. The hospital has since tightened precautionary measures at its wards and screened patients and staff who have been potentially exposed to the virus.

An independent review committee, comprising two international health experts has also been appointed by the Ministry of Health. It will investigate the cause of the cluster of infection and identify gaps or weak points that need to be improved.

related:
Independent Committee to Review Hepatitis C Cases
Measures Taken for Hepatitis C Outbreak

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SGH TO LET POLICE ASCERTAIN IF THERE WAS ANY FOUL PLAY IN HEP C OUTBREAK

The Singapore General Hospital (SGH) has filed a police report today over the disastrous Hepatitis C cluster found in its renal ward.

"After initial internal investigation, we are still unable to determine the cause of the cluster of infection. Currently, an Independent Review Committee appointed by MOH is looking into this with the help of international advisors. The police report has been filed so that the police may ascertain if there was any foul play," SGH said in its statement today.

On 6th Oct, SGH announced that 22 patients in its renal ward had contracted Hepatitis C. It also said the infection could have been a contributing factor in up to 5 deaths.

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SGH brings in police to investigate Hep C infections

The Singapore General Hospital (SGH) has filed a police report over the 22 cases of hepatitis C infection, the hospital said in a statement on Tuesday.

“In response to media queries, we would like to confirm that we have filed a police report today,” SGH said.

It explained that it has taken the step to bring in the police because “after initial internal investigation”, the hospital was “still unable to determine the cause of the cluster of infection.”

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Ministry of Health Convenes Independent Review Committee on Hepatitis C Cluster in Singapore General Hospital

The Ministry of Health (MOH) has been informed of a cluster of 22 cases of acute Hepatitis C Virus (HCV) amongst patients with kidney disease who had been admitted to Ward 64A or Ward 67 at the Singapore General Hospital (SGH) during the period from April to June 2015. The initial identification of an unusual increase in the number of HCV infections (from 2 to 4 per year on average in SGH’s prevalent pool of renal transplant patients in previous years to 5 within the space of a few weeks) was made by SGH in early June. SGH began its internal investigations in June, and took precautionary measures. SGH made an initial presentation to MOH in late August 2015 and informed MOH of the unusually large cluster of Hepatitis C patients who had been admitted to Ward 64A or Ward 67 during a period from April to June 2015. They submitted their final report to MOH late last month.

MOH has convened an independent Review Committee to provide an objective and critical review of SGH’s investigation and findings, to provide added assurance and to glean learning points for the wider healthcare system. In particular, the Review Committee has been tasked to ascertain if all possible measures had been taken to identify the possible points of infection control breach, and remedy any weak point in the overall workflow with regard to infection control.

Minister for Health Mr Gan Kim Yong said, “I am gravely concerned and disappointed with the occurrence of the cluster of Hepatitis C cases in SGH. My thoughts are with the affected patients and families.

How likely is foul play the cause?
LOCATION: Aerial view of Singapore General Hospital and its compound where 22 patients contracted hep C

Human error may be the most common reason for a hepatitis C outbreak to occur within a hospital, but it is good to explore other possibilities such as foul play, said medical and legal experts.

The news of the hep C outbreak at Singapore General Hospital (SGH) was revealed two weeks ago and on Tuesday the hospital filed a police report, "so that the police may ascertain if there was any foul play," SGH said in a statement to the media.

Dr Jarrod Lee, a gastroenterologist in private practice, told The New Paper: "This means that SGH is being transparent and wants to get to the bottom of the outbreak, even looking at foul play.


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Two more SGH patients test positive for hepatitis C

Two more patients from the Singapore General Hospital’s (SGH) renal ward which saw a hepatitis C outbreak have tested positive for the virus, although it is not clear yet whether they contracted the virus from the cluster.

Genotyping and phylogenetic studies are being carried out to determine this, said the hospital in an update today (Oct 23), adding that these two patients are well, and they and their families have been informed of the news.

Professor Fong Kok Yong, chairman of the hospital’s Medical Board, said: “Both patients (infected with hepatitis C) are currently well. While we are still in the process of determining whether they are part of the cluster, our priority is to ensure that the patients can access timely and appropriate medical care.

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2 more SGH patients test positive for hepatitis C

The Singapore General Hospital (SGH) has confirmed that two more of its patients who have passed through its renal ward between January and June have tested positive for the hepatitis C virus.

In a statement on Friday (23 October), SGH said that it has informed the patients and their families, and will arrange for appointments with its hepatologists to advise them on the treatment options.

The hospital also added that it is, however, unclear if the two are part of the cluster which was affected by the outbreak in its renal ward between April and June.

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SGH hep C cluster update: 600 patients screened, no new positives


No new cases of hepatitis C were found on Thursday, the Singapore General Hospital said, leaving the total number of patients infected at 23.

In a statement on Thursday night, SGH said that, as at 6pm, it had screened 600 patients, 539 of whom tested negative. Sixty test results are pending, and the one case that tested positive was announced on Wednesday (Oct 21).

A total of 304 staff members have been screened, the hospital said. All but one tested negative, with the last result pending.

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Hepatitis C cluster at SGH: Patient tests positive, bringing total to 23

Another patient from Singapore General Hospital (SGH) has tested positive for hepatitis C, bringing the total number of those infected to 23.

In a statement last night , SGH said one patient out of the 598 screened so far has tested positive for the hepatitis C virus.

The patient is currently well and has been informed. SGH will arrange for an appointment with a hepatologist to advise the patient and the family on treatment options.

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Hepatitis C cluster at SGH: 1 more infected

One of the 598 people screened by the Singapore General Hospital (SGH) for Hepatitis C has tested positive for the virus, the hospital announced on Wednesday (Oct 21).

Following SGH's announcement that 22 of its renal ward patients had been infected with Hepatitis C on Oct 6, the hospital started contacting patients who were admitted from January to June 2015 to wards 64A and 67 for screening.

"The patient was hospitalised during the period of April to June 2015.  We have informed the patient and family, and will arrange for an appointment with our hepatologist to advise them on the treatment options," SGH said.

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Hepatitis C could have contributed to a fifth death: SGH
AFP News/Roslan Rahman - The state-run Singapore General Hospital said 678 patients as well as 273 medical workers were being contacted to be screened for the virus

Hepatitis C virus infection could have contributed to the death of a fifth patient in the outbreak at the renal ward of Singapore General Hospital reported earlier this month.

According to media reports, the hospital said in a statement on Monday that a medical review committee led by an external senior heptalogist has concluded its investigation and found that hepatitis C infection could not be ruled out as a contributing factor in one more patient's death.

“The committee concluded that the patient passed away from end-stage renal disease and pneumonia. While the death was not caused directly by hepatitis C virus, the committee could not rule out the possibility that hepatitis C virus infection could have been a contributing factor," Fong Kok Yong, chairman of SGH's medical board, said.

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One More SGH Patient Found to Have Contracted Hepatitis C

Singapore General Hospital has announced that its screenings have found that one more patient contracted Hepatitis C during the outbreak from April to June this year.

Said the hospital in a statement:
“One patient out of the 598 screened so far was tested positive for the hepatitis C virus. The patient was hospitalised during the period of April to June 2015. We have informed the patient and family, and will arrange for an appointment with our hepatologist to advise them on the treatment options.”
This brings the total number of Hepatitis C infections to 23.

related:
4 Dead After Hepatitis C Outbreak at SGH, Drug Injections Blamed for Infections
SGH Accused of Hiding the Truth about Hepatitis C Infection Cases Last Year
Patient: “They Never Told Me I was Staying in the “Infected” Ward Until 2 Days Ago”
MOH: Delay in Disclosing Hepatitis C Outbreak Was Not Politically-Driven
Review Committee Finds One More SGH Patient Died due to Hepatitis C Infection
Nurses to Receive Pay Rise of Up to 20%, Special Payment
Give MPs and Ministers a “Bao Toh” Reward to Promote “Ownself Check Ownself”
Health Ministry’s Defensive and Arrogant Hep C Response Dodges Key Questions


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Closing in on answers about the Hep-C outbreak

A LOT has happened since we published our timeline of the hepatitis C outbreak at Singapore General Hospital (SGH). On Saturday, the Health Minister announced that the independent review committee will now investigate the Ministry of Health (MOH), as well as SGH. On Tuesday, two American experts were invited to advise the committee. And after SGH made a police report, there will now be a third investigation.

These are significant changes to how the outbreak is being investigated. First, a committee helping MOH figure out what went on at SGH is now investigating MOH itself. By expanding the remit of the committee to look at MOH as well as SGH, Health Minister Gan Kim Yong hopes it will undertake a “very thorough review”. Previously, there was no formal review of MOH procedures. Having an MOH review, in addition to an SGH one, is certainly welcome and probably overdue.

The change in committee responsibilities is no small tweak. Because the original purpose of the committee was to look into SGH exclusively, its seven members were chosen for that task. They come with solid credentials and are said to be “best in the business”:

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TMG Exclusive: Searching for answers to the Hep-C outbreak

APART from GE2015, this could be this year’s biggest story yet: An unprecedented virus outbreak at one of the country’s leading hospitals that may have led to the deaths of four of the 22 who were infected. Since the news became public on Oct 6, the Singapore General Hospital has stepped up its checks on patients, doctors and other medical staff who passed through Ward 67, the renal ward believed to be where it all began.

Media reports say the first infection was diagnosed on April 17. It has now been 182 days and still plenty of questions remain. Why did SGH delay in reporting the cases to the Health Ministry? When did SGH’s internal investigations begin? Why wait so long before screening the doctors and other medical staff?

An independent review committee has been tasked to find the answers to some of these questions. To help you get a sense of the events leading up to this investigation, we pulled together media reports and press releases from the Health Ministry and SGH to piece together this medical crisis.

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5 important questions we hope the MOH review on the Hep C outbreak can answer

Since the news of the Ministry of Health’s (MOH) announcement of a cluster of Hepatitis C virus infections that saw 22 patients testing positive — of which eight have since passed on, half with their deaths linked to Hep C — both MOH and the Singapore General Hospital (SGH), the epicentre of the outbreak, have scrambled to account to a public demanding answers.

MOH announced on Oct. 6 that it convened an independent Review Committee to look into this, and its findings will be made public in two months. The Terms of Reference of the Review Committee are “to provide an independent, objective and critical review of SGH’s report”, to “identify the possible points of infection control breach”, and “remedy any weak points in the overall workflow particularly with regard to infection control”.

Here are five important questions on our minds (and possibly ones that you might have on yours too) we are looking forward to be answered in the review:
  1. Why did SGH take so long to report the spike in Hep C cases to MOH?
  2. Why did the MOH take so long to inform the public about it after hearing from SGH?
  3. Why were the bulk of potentially-infected staff and patients not screened for Hepatitis C prior to last week?
  4. Was contact tracing done to ensure all patients and potential carriers who might have been exposed to the virus have not passed it on elsewhere?
  5. How does the hospital plan to compensate families who lost their loved ones with reasons linked to this infection?
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WP Queries Delay In Hep C Outbreak Announcement

The Workers’ Party extends its deepest condolences to the affected families and friends of the four patients who passed away since the outbreak of the Hepatitis C virus infections at the renal ward of the Singapore General Hospital (SGH) that affected 22 patients.

It was reported SGH had been aware of the infection cluster since early June 2015, but information surrounding the outbreak was only made public four months later, in October 2015. An outbreak of Hepatitis C is a potential public health risk. The knowledge of such an outbreak is relevant to all citizens as they weigh their treatment options.

The Workers’ Party would therefore like to seek clarifications from the Minister with regard to the standard protocol in releasing information on such outbreaks, whether or not they occur within a treatment facility. These questions are posed with a view to strengthen Singapore’s infection control protocols in the future.
  • Is there a timeframe within which healthcare institutions must report such incidents to the Ministry?
  • What does the Ministry believe is a permissible interval of time before the public is made aware of such incidents?
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Singapore Democratic Party puts pressure on Government to provide answers
Chee Soon Juan Just Really, Really Wants PM Lee To Answer Two Questions

Singapore General Hospital (SGH)’s Hepatitis C-related deaths were first made public last week, and the Singapore Democratic Party (SDP) were quick to demand explanations, largely on the delay in announcing the outbreak.

The Ministry of Health (MOH) were made known of the hepatitis C cluster in August 2015, but the news only broke to the public on 6 Oct. SDP first posed two questions days after the announcement of hep C cases:
  1. Why was the public not informed when the outbreak was recognised and investigations commenced in May-June 2015 despite the potential risks to other patients?
  2. Was the withholding of the information a political consideration?
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NON-TRANSPARENCY OVER HEP C OUTBREAK EXTREMELY SERIOUS

The SDP sends our condolences to the bereaved families of those who died from the recent Hepatitis C outbreak at the Singapore General Hospital (SGH) as well as to those who are infected by this serious viral infection.

We look forward to an expeditious and comprehensive investigation into how the episode occurred and, subsequently, deteriorated and what steps are being taken to prevent future mishaps.

What is disturbing, however, is the non-transparent manner in which the incident was handled by the Government. Information about the outbreak apparently first emerged between April 17 and May 14 this year when the first five cases of the hepatitis C infections were reported by the SGH to the Ministry of Health (MOH).

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Hep C-related communication must be made public: Chee Soon Juan
AFP News/Roslan Rahman - Chee Soon Juan, Secretary-General of the opposition Singapore Democratic Party, speaks to his supporters at Chua Chu Kang stadium during a rally ahead of Singapore's September 11 election, on September 3, 2015

Singapore Democratic Party (SDP) chief Chee Soon Juan has called for a "full and complete release" of all information relating to the Hepatitis C outbreak, including official correspondence such as emails and memos to address unanswered questions about the timeline of events.

This follows a letter to The Straits Forum by Health Minister Gan Kim Yong's press secretary Lim Bee Khim, which stated that Gan was only informed of the outbreak on 18 September. The letter was a response to a Sunday Times commentary which questioned if there were political motivations behind the timing of the release of the information.

Twenty-two kidney patients who were hospitalised from April to June were infected with Hep C during their stay. Eight patients died, with five deaths possibly linked to the virus. Almost 1,000 patients have also been screened for the disease. The Health Ministry has since reported the matter to the police, in order to ascertain if there was any foul play.

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SGH hep C outbreak: 2 infected patients part of affected cluster

The two Singapore General Hospital (SGH) patients who had earlier tested positive for hepatitis C have been found to be part of the affected cluster, bringing the total number of patients infected in the hospital’s hepatitis C outbreak earlier this year to 25.

“Phylogenetic studies done for the two patients who were tested positive as announced on 23 October showed that they are part of the affected cluster,” said SGH’s Chairman of the Medical Board Fong Kok Yong in a statement issued by the hospital today (Oct 26).

The patients were admitted to Wards 64A and 67 from April to June 2015.  “We will provide the patients and their family with our full support and ensure that the patients receive timely and appropriate care,” said Prof Fong.

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Full Coverage:
How likely is foul play the cause?
SGH files police report over Hepatitis C cluster
The Straits Times - SGH files police report on hepatitis C cluster
SGH files police report over Hep C cluster
More news for police report on hepatitis c
SGH files police report on hepatitis C cluster, Health News
SGH files police report on hepatitis C cluster - Singapore
SGH lodges police report over hepatitis C outbreak
SGH Files Police Report Over Hep C Incident | REACH
SGH brings in police to investigate Hep C infections | The
SGH files police report over hep C cases | My Paper | 我报
SGH files police report over Hep C cluster, AsiaOne NewsLite
SGH files police report to see if foul play was involved in
SGH files police report to ascertain if foul play involved in hep C spread
Hepatitis C could have contributed to death of 5th patient, says SGH
SGH lodges police report over hepatitis C outbreak
441 out of 485 patients tested are negative for Hepatitis C so far: SGH
SGH hep C outbreak: International experts to advise review committee
408 patients, 277 staff have tested negative for hep C: SGH
441 patients, 279 staff have tested negative for hepatitis C: SGH
SGH files police report on hepatitis C cluster
The Straits Times - SGH files police report on hepatitis C cluster
SGH files police report over Hepatitis C cluster
SGH files police report over Hep C cluster
SGH brings in police to investigate Hep C infections
Closing in on answers about the Hep-C outbreak
Morning call, October 21 2015
Hep C-related communication must be made public: Chee Soon Juan
Closing in on answers about the Hep-C outbreak
2 more patients test positive for hep C

2 more patients screened by SGH test positive for Hepatitis C
2 more SGH patients test positive for hepatitis C
Two more SGH patients test positive for hepatitis C
SGH hep C cluster update: 600 patients screened, no new positives
2 more SGH patients tested positive for hep C, test done to determine if
600 patients screened; no new cases found
539 patients, 303 staff have tested negative for hepatitis C: SGH


Hep C Outbreak
– SDP: SDP calls for release of emails regarding Hep C outbreak
– Blogging for Myself: SGH: A developing Hep C conspiracy?
– My Singapore News: Transparency and integrity of the govt and public officers
– TR Emeritus: Human error in hospitals, don’t play play
– LimpehForeignTalent: SGH: I don’t want to hear you complain, you voted for this
– New Nation: 70% of S’poreans agree SGH Hepatitis C outbreak is no one’s fault
– TOC: SGH to screen more people who passed through renal ward
– Blogging for Myself: SGH Hep C outbreak: Looking good most important
– Dewdrop Notes 露语: To Tell Or Not Tell
– The Middle Ground: Not just a medical mystery
– Six-Six News: SGH Fiasco A Systemic Failure
– TOC: Why MOH, and not just SGH, is responsible for the HCV saga
– Zit Seng’s Blog: Multi-Dose Vials But A Scapegoat
– Life of Spore: Did MSM suppress Hep C infection news for political expediency?
– Transitioning: 4 tragic Hep C-related death at SGH – a sign of over-population?
– Rise of the strawberry nation: All eyes on hepatitis C outbreak
– My Singapore News: SGH hit by hepatitis C outbreak – 4 dead

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related:
6 drug resistant TB cases in AMK
Hepatitis C: Chronic & Acute infections
Hepatitis C cluster @SGH: 22 infected, 4 have died
Three recent healthcare outbreaks in Singapore
Staff Disciplined after Hepatitis C Outbreak