Bali Bombings - 2002

The 2002 Bali bombings, which occurred on 12 October 2002 resulted in the death of 202 people and injuring many more. As the local hospital was ill-equipped to deal with the scale of disaster, many of the injured were evacuated to Darwin.

Following the bombing, Fisher wrote an article titled "The Bali bombings of 12 October 2002: lessons in disaster management for physicians", which was published in 2003. Fisher's team highlighted that hospital-based physicians should see themselves as a sizeable and flexible group with the ability to contribute in a variety of ways during a disaster.^[8]

The team noted that physicians could be deployed for alternate purposes outside of hospital, such as triage and hospital liaison, and should play a central role in the overall management of inpatient care. Such arrangements could free up surgeons, enabling them to provide immediate surgical care for the wounded.

It was also opined that the incident left a great impact on the hospital, where the medical team, together with the nurses, patient-care providers, as well as the greater medical community managed an extraordinary undertaking, by handling what was considered the biggest post-war disaster to be ever met by Australian hospitals.

This event would later be identified as significant in determining Fisher's career pathway in outbreak response.

SARS - 2003

Reunion of Singapore medical staff (from left: Fisher, Paul Tambyah) on the 10th Anniversary of the SARS outbreak in Singapore

During the SARS pandemic in 2003 in Singapore, Fisher with colleagues published several articles related to "Lessons from Singapore". In these articles, it was described that SARS had demonstrated a remarkable efficiency in transmission within hospitals. In fact, 76% of SARS cases in Singapore were acquired in hospitals. They also looked at the circumstances that caused transmission within hospitals, despite the use of personal protective equipment (PPE).^[9]

The outbreak in hospitals resulted in dramatic changes in triage and infection-control policies.^[10]

In a separate article titled "Atypical presentations of SARS" published in The Lancet, Fisher and colleagues examined the difficulties of managing SARS cases without a diagnostic test.^[11] This letter described how the World Health Organization's criteria for probable or suspected SARS case had been misinterpreted. They were intended for epidemiological purposes but instead were used for triage for which they were not adequately sensitive.

Methicillin resistant Staphylococcus aureus - 2008

In dealing with the high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) within hospitals in Singapore, Fisher has participated and lead many regional and national level workgroups and committees and was key in the national rollout of universal active surveillance for acute hospital admissions.

In the article titled "Methicillin-resistant Staphylococcus aureus Control in Singapore– Moving Forward", he described how MRSA infection in hospitals could be prevented and should not be considered as an accepted tolerable by-product of healthcare. Failure to implement long-term sustainable infection control initiatives is not an option. It was also concluded that the control of MRSA in Singapore could be achieved, but it required implementation of many varied control measures across health services, and possibly would take a decade to do so.^[12]

Among many other papers on MRSA, in 2013 he published "Sustained MRSA control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore". It highlighted falls in bacteraemia, all clinical specimens as well as acquisition rates as a result of the previously described interventions.^[13]

For their efforts in reducing the rate of MRSA superbug infection from 1 in 10 patients to 1 in 40, Fisher and his colleagues were awarded the National Clinical Excellence Team Award in 2013 by the Ministry of Health, Singapore.^[14]

COVID-19

Dale Fisher with WHO Director-General Tedros Adhanom

During the ongoing COVID-19 pandemic, which began in Wuhan, China, Fisher was part of the WHO delegation that visited China to investigate technical aspects of transmission, severity and interventions preventing spread of the emerging virus. The subsequent report outlined how the world could respond to the outbreak, but warned that the world was not prepared "in capacity or mindset".^[15]

He is also involved in many pilot projects that spearhead on research and response. In his article "Q&A: The novel coronavirus outbreak causing COVID-19", Fisher shared his concerns about the emerging virus. For instance, the world's population is completely vulnerable to the novel virus as it is newly emerged in humans, and the current aim of the response muts be to flatten the epidemic curve, by interrupting chains of transmission wherever possible. It was also mentioned that while there were deaths linked to the virus, the greatest concern is the overwhelming of a health system in the wake of excessive transmission.^[16]

Fisher is now well known to the media for commentary regarding COVID-19 offered through television, radio, print and social media in dozens of countries of every continent and outlets including CNN,^[17] CNBC,^[18] BBC,^[19] ABC Australia, et cetera. In addition he undertook many webinars and other virtual speaking engagements. His philosophy was that COVID-19 can and must be contained.^[20] The key outbreak pillars of case management epidemiology, logistics and risk communication/community engagement are critical at all levels. Isolation of cases that are confirmed early by testing is particularly important in this outbreak.^[18]

As in some ways the public face of the response in Singapore, Fisher has featured in a comic series "The COVID Chronicles".^[21]