Pandemic Preparedness: Nationally-Led Simulation to Test Hospital Systems.

Introduction Cities that receive large numbers of international travellers are particularly vulnerable to outbreaks of emerging infectious disease with pandemic potential.1 Secondary transmission of Ebola virus disease (EVD) occurred when travellers from West Africa infected healthcare workers in Europe and the United States in 2014.2,3 Middle East respiratory syndrome (MERS) coronavirus has also caused secondary outbreaks due to travel by infected individuals. While most of these distant outbreaks of MERS have to date been quickly confined, South Korea experienced 185 laboratory-confirmed cases involving 5 generations of transmission over 6 weeks.4 In Singapore, the Nipah virus in 1998 to 1999, severe acute respiratory syndrome (SARS) coronavirus in 2003 and influenza A/H1N1 in 20095 not only had a major impact on the health of its population and notably its healthcare workers, but also more broadly, affected the economy. EVD outbreaks have occurred regularly in Africa. They have been invariably controlled and halted using conventional infection control practises.6 However, the 2014 to 2015 EVD outbreak was the largest and the first to leave African shores. The risk of EVD to countries outside of Africa was a concern shared by many health administrations, including those of Singapore. There is an expectation in Singapore that each healthcare facility will be prepared for the presentation of a traveller with a novel transmissible infectious disease. The cornerstone of providing safety against an infectious disease threat is early identification of a suspect case through robust triage mechanisms at potential sites of patient presentation followed by the institution of rigorous infection prevention and control precautions. Facility-level preparation is typically undertaken by individual healthcare facilities and their key stakeholders. Table 1 shows a generic checklist