Dale Fisher

Dale Andrew Fisher FRACP (born 1960) is an infectious diseases physician who specialises in Infectious Diseases and 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 -), and the chair of the National Infection Prevention and Control Committee through the Ministry of Health, Singapore (2013 -). In 2020, he became group chief of Medicine for National University Health Systems.

Fisher first practiced medicine in Singapore in 2003, and soon afterwards relocated permanently from Darwin, Australia. He has written numerous peer-reviewed articles in medical journals, publishingon 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.

In addition, he is involved in numerous international medical committees and groups dealing with infectious diseases and outbreak response. He has had many leadership roles in international outbreak missions and outbreak response training across Africa and Asia and worked on many Guideline Development Groups at WHO. He was chair of the steering committee of WHO’s Global Outbreak Alert & Response Network (2018-2022) and was one of 12 international technical experts on the WHO mission to China in February 2020 to investigate the COVID-19 outbreak. In 2022, he was given a certificate for outstanding leadership by the Director General of WHO.

Early life and education

Fisher was born in Melbourne in 1960 but moved to Hobart, Tasmania in 1973 when his father (1926-2013) Alfred Leopold, known as Ron, 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 Singapore under an Australian government scholarship.

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.

Career and research

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.

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 over 200 peer-reviewed papers in the medical literature and given almost 200 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."

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.

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

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.

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. 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.

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.

COVID-19

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 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.

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 undertook many webinars and other virtual speaking engagements. His philosophy was that COVID-19 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".

References

{{DEFAULTSORT:Fisher, Dale
Living people
COVID-19 researchers
1960 births
Academic staff of the National University of Singapore
Fellows of the Royal Australasian College of Physicians
People educated at a United World College
People educated at The Hutchins School