Dale Andrew Fisher
1960 (age 60–61)
Dale Andrew Fisher FRACP (born 1960) is an Australian physician who specialises in Infectious Diseases and is a Senior Consultant in the Division of Infectious Diseases at the National University Hospital, Singapore.He is also a Professor of Medicine at the Yong Loo Lin School of Medicine, National University of Singapore (2004 -), the chair of the National Infection Prevention and Control Committee through the Ministry of Health, Singapore (2013 -), and chair of the steering committee of the Global Outbreak Alert and Response Network (2017 -) hosted by the World Health Organization.
Fisher has written numerous peer-reviewed articles in medical journals. In addition, he is involved in numerous international medical committees and groups dealing with infectious diseases and outbreak response. He has published on various diseases, including melioidosis, Outpatient Parenteral Antibiotic Therapy (OPAT), Severe Acute Respiratory Disease (SARS), infection control in hospital settings especially as it relates to multi-drug-resistant pathogens and most recently COVID-19.
During the 2019-2020 coronavirus pandemic, which began in China, Fisher was part of the World Health Organization's team that visited China to understand about the virus, and to guide the global response to the pandemic.
Fisher was born in Melbourne in 1960 but moved to Hobart, Tasmania in 1973 when his father (1926-2013) was appointed the Registrar of Motor Vehicles. His mother (1929-) was a nurse who worked shifts, in order to bring in a second income throughout Fisher's schooling years.
In 1976, he attended United World College of South East Asia in Singaporeunder a scholarship provided by the State and Federal Governments.
Fisher received his Bachelor of Medicine and Bachelor of Surgery (MBBS) degree from the University of Tasmania in 1985 and became a Fellow of the Royal Australasian College of Physicians (FRACP) in 1992, doing most of his training at the Royal Prince Alfred Hospital, Sydney. His final year of training was in Darwin under the supervision of Professor Bart Currie.
He moved to Singapore in 2003, after working more than a decade at the Royal Darwin Hospital in infectious diseases and general internal medicine.
He has three daughters, Amy, Emma and Ally.
Fisher began his career as a Staff Specialist Physician at the Royal Darwin Hospital (RDH) in 1993 specialising in Infectious Diseases, before progressing to become the Director of Division of Medicine. He came to Singapore in 2003, after responding to a call to assist with the SARS epidemic in Singapore. In 2006, he was appointed Clinical Director of Medicine at the National University Hospital, Singapore, where he maintained his strong commitment to general medicine as a clinician and a teacher, despite his work and experience as an infectious disease physician.
In addition to his career in hospitals, Fisher is actively involved in the international medical community. He began his involvement in the Global Outbreak Alert and Response Network (GOARN) in 2009 as a training faculty in Laos, and has undertaken numerous operational and training missions as well as consultations in many countries through GOARN as well as bilateral arrangements.
In response to H1N1 2009 outbreaks, he undertook missions as requested at the National level deploying to Malaysia, Mongolia, China and Myanmar. Likewise at the request of WHO and the Liberian Government he undertook missions for the Ebola response through 2014-5 which lead to a number of published reviews and commentaries relating to clinical care and infection prevention and control. He has participated in several WHO Guidelines Development Groups in infection control, including related to Ebola, measles and COVID-19. He currently sits as Chair of the GOARN Steering Committee and Chair of the National Infection Prevention and Control (NIPC) Committee in Singapore, and chairs the OPAT workgroup of the International Society of Antimicrobial Chemotherapy.
In February 2020, Fisher was on the World Health Organization-led team that visited China to understand technical aspects of the COVID-19 virus; the severity, transmissibility and interventions that could guide the global response to the pandemic outbreak.
He has published a little under 200 peer-reviewed papers in the medical literature and given around 100 plenary and invited presentations to scientific audiences.
Fisher was also the infectious disease physician who attended to comedian Jerry Lewis, when the late comedian was admitted to hospital for meningitis while on tour in Darwin.Lewis, when interviewed by Larry King, said “God must have put him in “the bush” (aka Darwin) because Dr Fisher was the world's best infectious disease physician.”
The 2002 Bali bombings, which occurred in 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.
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. In addition, the team also found that heads of departments of Royal Darwin Hospital were adopting a military style of operation themselves, with those receiving the instructions accepted the directives willingly.
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.
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).
The outbreak in hospitals resulted in dramatic changes in triage and infection-control policies. For instance, healthcare workers were required to monitor their temperatures three times a day. Those with a temperature of more than 37.5c would be removed from duty pending further evaluation. In addition, all patients with respiratory complaints or chest x-ray abnormalities would be isolated, screened for SARS contacts, and managed with full PPE.
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.This letter described how the World Health Organization's criteria for probable or suspected SARS case had been misinterpreted. It was intended for epidemiological purposes but instead were used for triage for which they were not sensitive enough. The article concluded that the atypical presentations of SARS pose a threat to patients, staff and visitors, and while the WHO's definition is a useful guide, it does not substitute for a thorough clinical, laboratory and radiological assessment of patients.
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.
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.
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.
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”.
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 global response is to flatten the epidemic curve, by interrupting chains of transmission wherever possible. It was also mentioned that while there are deaths that are linked to the virus, the greatest concern right now is the overwhelming of a health system in the wake of excessive transmission.
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,CNBC, BBC, ABC Australia et cetera. In addition he undertakes many webinars and other virtual speaking engagements. His philosophy maintains that the coronavirus can and must be contained. 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.
As in some ways the public face of the response in Singapore, Fisher has featured in a comic series “The COVID Chronicles".
In addition, Fisher has particular expertise (and publications) in melioidosis and Outpatient Parenteral Antibiotic Therapy,
Other selected publications by Fisher include:
Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. Antibiotic resistance is a subset of AMR, that applies specifically to bacteria that become resistant to antibiotics. Infections caused by resistant microbes are more difficult to treat, requiring higher doses of antimicrobial drugs, or alternative medications which may prove more toxic. These approaches may also be more expensive. Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR).
Staphylococcus aureus is a Gram-positive round-shaped bacterium, a member of the Firmicutes, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive for catalase and nitrate reduction and is a facultative anaerobe that can grow without the need for oxygen. Although S. aureus usually acts as a commensal of the human microbiota it can also become an opportunistic pathogen, being a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning. Pathogenic strains often promote infections by producing virulence factors such as potent protein toxins, and the expression of a cell-surface protein that binds and inactivates antibodies. The emergence of antibiotic-resistant strains of S. aureus such as methicillin-resistant S. aureus (MRSA) is a worldwide problem in clinical medicine. Despite much research and development, no vaccine for S. aureus has been approved.
Vancomycin is an antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also recommended by mouth as a treatment for severe Clostridium difficile colitis. When taken by mouth it is very poorly absorbed.
Methicillin-resistant Staphylococcus aureus (MRSA) is a group of Gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. MRSA is any strain of S. aureus that has developed or acquired a multiple drug resistance to beta-lactam antibiotics. Beta-lactam (β-lactam) antibiotics are a broad-spectrum group that include some penams and cephems such as the cephalosporins. Strains unable to resist these antibiotics are classified as methicillin-susceptible S. aureus, or MSSA.
Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by severe acute respiratory syndrome coronavirus, the first identified strain of the SARS coronavirus species severe acute respiratory syndrome–related coronavirus (SARSr-CoV). The syndrome caused the 2002–2004 SARS outbreak. Around late 2017, Chinese scientists traced the virus through the intermediary of Asian palm civets to cave-dwelling horseshoe bats in Xiyang Yi Ethnic Township, Yunnan.
Bloodstream infections (BSIs), which include bacteremias when the infections are bacterial and fungemias when the infections are fungal, are infections present in the blood. Blood is normally a sterile environment, so the detection of microbes in the blood is always abnormal. A bloodstream infection is different from sepsis, which is the host response to bacteria.
Linezolid is an antibiotic used for the treatment of infections caused by Gram-positive bacteria that are resistant to other antibiotics. Linezolid is active against most Gram-positive bacteria that cause disease, including streptococci, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). The main uses are infections of the skin and pneumonia although it may be used for a variety of other infections including drug-resistant tuberculosis. It is used either by injection into a vein or by mouth.
Melioidosis is an infectious disease caused by a Gram-negative bacterium called Burkholderia pseudomallei. Most people infected with B. pseudomallei experience no symptoms, but those who do experience symptoms have signs and symptoms that range from mild, such as fever, skin changes, pneumonia, and abscesses, to severe with inflammation of the brain, inflammation of the joints, and dangerously low blood pressure that causes death. About 10% of people with melioidosis develop symptoms that last longer than two months, termed "chronic melioidosis".
Azithromycin is an antibiotic medication used for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, and certain other intestinal infections. Along with other medications, it may also be used for malaria. It can be taken by mouth or intravenously with doses once per day.
Trimethoprim/sulfamethoxazole (TMP/SMX), also known as co-trimoxazole among other names, is a combination antibiotic used to treat a variety of bacterial infections. It consists of one part trimethoprim to five parts sulfamethoxazole. It is used for urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) skin infections, travelers' diarrhea, respiratory tract infections, and cholera, among others. It may be used both to treat and prevent pneumocystis pneumonia and toxoplasmosis in people with HIV/AIDS and other causes of immunosuppression. It can be given by mouth or intravenously.
Carbapenems are a class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections. Similar to penicillins and cephalosporins, carbapenems are members of the beta lactam class of antibiotics, which kill bacteria by binding to penicillin-binding proteins, thus inhibiting bacterial cell wall synthesis. However, these agents individually exhibit a broader spectrum of activity compared to most cephalosporins and penicillins. Furthermore, carbapenems are typically unaffected by emerging antibiotic resistance, even to other beta-lactams.
An emerging infectious disease (EID) is an infectious disease whose incidence has increased recently, and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics. Their many impacts can be economic and societal, as well as clinical.
The Infectious Diseases Society of America (IDSA) is a medical association representing physicians, scientists and other health care professionals who specialize in infectious diseases. It was founded in 1963 and is based in Arlington, Virginia. As of 2018 IDSA had more than 11,000 members from across the United States and nearly 100 other countries on six different continents. IDSA's purpose is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases. It is a 501(c)(6) organization.
Enterococcus faeciu is a Gram-positive, gamma-hemolytic or non-hemolytic bacterium in the genus Enterococcus. It can be commensal in the gastrointestinal tract of humans and animals, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.
Carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae (CPE) are Gram-negative bacteria that are resistant to the carbapenem class of antibiotics, considered the drugs of last resort for such infections. They are resistant because they produce an enzyme called a carbapenemase that disables the drug molecule. The resistance can vary from moderate to severe. Enterobacteriaceae are common commensals and infectious agents. Experts fear CRE as the new "superbug". The bacteria can kill up to half of patients who get bloodstream infections. Tom Frieden, former head of the Centers for Disease Control and Prevention has referred to CRE as "nightmare bacteria". Examples of enzymes found in certain types of CRE are KPC and NDM. KPC and NDM are enzymes that break down carbapenems and make them ineffective. Both of these enzymes, as well as the enzyme VIM have also been reported in Pseudomonas.
Antimicrobial stewardship is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antibiotic overuse, and thus antimicrobial resistance. AMS has been an organized effort of specialists in infectious diseases, both in Internal Medicine and Pediatrics with their respective peer-organizations, hospital pharmacists, the public health community and their professional organizations since the late 1990s. It has first been implemented in hospitals. In the U.S., within the context of physicians' prescribing freedom, AMS had largely been voluntary self-regulation in the form of policies and appeals to adhere to a prescribing self-discipline until 2017, when the Joint Commission prescribed that hospitals should have an Antimicrobial Stewardship team, which was expanded to the outpatient setting in 2020.
Sharon Peacock is a British microbiologist who is Professor of Public Health and Microbiology in the Department of Medicine at the University of Cambridge. She is known for her work on the use of microbial whole genome sequencing in diagnostic and public health microbiology, particularly on the bacterium Burkholderia pseudomallei and on methicillin-resistant Staphylococcus aureus (MRSA).
Daniel R. Lucey is an American physician, researcher, senior scholar and adjunct professor of infectious diseases at Georgetown University, and a research associate in anthropology at the Smithsonian National Museum of Natural History, where he has co-organised an exhibition on eight viral outbreaks.
Kerry L. LaPlante is an American pharmacist, academic and researcher. She is a Professor of Pharmacy and the Chair of the Department of Pharmacy Practice at the University of Rhode Island, an Adjunct Professor of Medicine at Brown University, an Infectious Diseases Pharmacotherapy Specialist, and the Director of the Rhode Island Infectious Diseases Fellowship and Research Programs at the Veterans Affairs Medical Center in Providence, Rhode Island.