Let me get this right. The Health Ministry has now classified Sars cases into notified, suspected and probable cases.

The 'notified' category having developed Sars symptoms, the 'suspected' having additional feature of close contact with probable Sars patients and have travelled to highly-affected Sars country, with the 'probable' case being a suspected case with chest X-ray findings of pneumonia or Respiratory Distress Syndrome ( Ministry: Sars outbreak 'under control', 10 warded yesterday ).

It is apparent that the distinctions between 'notified', 'suspected' and 'probable' may be helpful to medical officers in their classifications and determination of approach to management of cases.

But are these distinctions however helpful from standpoint of public health in terms - not of hospital management of cases - but prevention of epidemic spread outside the hospitals?

Consider the following:

1) 'Notification' cases "need not necessarily be warded, as admission to hospitals is at the discretion of medical officers".

2) Without admission to hospitals, theoretically 'notification' cases with Sars virus (though yet unconfirmed at this stage) can transmit the virus to others.

3) Significant others in contact with, and contracting virus from 'notification cases' can in turn transmit to others ad infinitum .

I am not at all comfortable with the distinctions between 'notification', 'suspected' and 'probable' classifications, and unless I am wrong about this, they are all various gradations within a continuum, and 'notification' cases can potentially progress over time to classifications under 'suspected' and 'probable' case.

The crux of the issue is whether the ministry know enough to give the iron-clad guarantee that 'notification' cases will categorically not include persons who actually have or will eventually be proven to have the Sars virus, but who, by reason alone that it has not been shown that they have not come into contact with probable Sars patients or have not travelled to highly-affected Sars country, or have not had X-ray confirmation, are not categorised otherwise as 'suspected' and 'probable' cases - and therefore, not isolated or quarantined - and hence are free to unwittingly transmit the virus to others.

Otherwise, the situations in 2 and 3 above, if unmanaged, can aggravate transmission of the virus. In these premises, how can the Health Ministry claim that Sars management is "under control"?

So far, I assume that the statistics o­n Sars are derived from admissions to 'dedicated' government or quasi government hospitals. What is the situation in the private hospitals?

There is also another question whether dedicated hospitals' facilities alone can cope with increasing number of suspected cases.

I hope it is not because of insufficient facilities alone, the policy directive is conveniently formulated that 'notification' cases "need not necessarily be warded", with admission to hospitals being "at the discretion of medical officers".

What, may I ask, are the criteria for exercise of this discretion to admit or not admit 'notification' cases in hospitals?

Are notification cases not admitted for hospitalisation definitely free from Sars virus? If proven otherwise, can those who contracted the virus from such notification cases not hospitalised sue the hospitals for lack of duty of care in exercise of judgement?

I question here whether the classifications of 'notification', 'suspected' or 'probable' cases are helpful in the first place to assist in the containment of spread of Sars.

What do the Malaysian Medical Council and the community have to say o­n these classifications and the public measures taken thus far?