Why we can learn from Singapore’s coronavirus response

22 Mar, 2020 - 00:03 0 Views

The Sunday Mail

Prof Dale Fisher

SINGAPORE’S response to the coronavirus has been held up by many around the world as a model.

As of tlast week, the country had 266 total cases (with zero deaths), and its infection rate is much slower than the rest of the world.

The first thing that helped with its response was it was ready before the outbreak even occurred because of the SARS outbreak of 2002-03.

It was aware then that its infrastructure was not ready for an outbreak of this kind. So, in the years since, isolation hospitals were built, more negative pressure rooms were created and legislation was put in place.

Then, on December 31 2019, when the world first became aware of the coronavirus in China, Singapore started to get prepared.

By the time the World Health Organisation (WHO) declared a public health emergency at the end of January, it was ready.

In February, Singapore made it clear again that this virus had the potential to have major health, social and economic consequences.

We knew that because we saw what happened in China.

The virus brought a country of 1,4 billion people basically to its knees. The rest of Asia was clearly frightened and scampering to get ready, too — Taiwan, Hong Kong, South Korea.

There was no confusion in the minds of these countries what this virus could do. Yet, still other parts of the world were not preparing.

Keeping positive patients in hospitals

Looking at what we do differently today, I think the biggest one is Singapore did not let positive patients back into the community.

China also did not do that. Wuhan created 50 000 hospital beds in two big temporary hospitals.

These were not hospitals for sick people, these were all the mild cases that Australia, Europe and US sends home.

Home quarantine is not easy.

You are not supposed to mix with your family, you are supposed to have your own toilet, you are not supposed to have visitors. If you are going to keep people at home, you need to be really sure they are not transmitting it.

In Singapore, we think it is better to hive those people off and look after them elsewhere until the virus is clear.

People with mild cases are kept in hospitals — we have enough space to put all the positives together.

If you are going to look after people at home, how do you know they are complying with self-isolation rules? Are you doing phone tracking? Are you doing random checks regularly enough? Are there harsh enough penalties to frighten people from disobeying?

Singapore has contact tracing teams, who identify all the contacts of an infected person and ring them up.

Often these people have early symptoms and we will arrange for them to be picked up and tested.

In Singapore we are very liberal with our testing. Less than one percent of our tests are positive, so that reflects just how many tests we are doing.

If people do not have symptoms, they are put in home quarantine. And home quarantine is very strict. A couple times a day, you will get an SMS and you have to click on a link that will show where your phone is.

In case you cheat and leave your phone at home with someone else, the government has people knocking on doors now and then. The penalties are pretty  harsh.

Consistent, regular communication

We have been very strong on community engagement. The messages we send are: if you are sick, stay home. If you are sick and have had contact with a Covid-19 patient, come in for a test.

If you cannot stay home and you have to go out, wear a mask. If you cough, cough into your elbow. Avoid crowds, particularly indoors.

To everyone else, we say social distancing. For restaurant and bar owners, try and reduce the number of people in your businesses.

People know what to do and they know if there is a lockdown, they are going to be closed.

There is a lot of business and revenue to be lost. Everyone understands and adapts.

You know what happens when people do not adapt — we end up closing things down.

The messaging has also been very strategic. There is a cross-ministerial task force — we regard this as a whole of government issue, not just a health issue.

The prime minister comes on television every couple of weeks, the chair of the task force is now a well-known face.

Messaging is generally limited to a small number of authoritative people.

There is great transparency.

There is already great faith in government, so that helps quite a bit.

The messaging from the government is also consistent — they provide the latest numbers and say what is happening in other countries and what might need to be done in Singapore.

We also created a public awareness campaign with cartoons.  This is an alternative medium people might connect with.

They are very popular, with over one million viewings online. WHO is now translating them into other languages.

Why Singapore is not in lockdown

It is pretty well-known that children are asymptomatic or only have mild disease, so there was no real reason to close  schools.

If you close schools, what is the trigger to reopen them?

In Singapore, we want life to go on as normal. We want businesses, churches, restaurants and schools to stay open.

This is what success looks like. Everything goes forward with modifications as needed, and you keep doing this until there is a vaccine or a treatment.

On testing, the threshold for getting a test is pretty low.

For the first week, we tested only people from Wuhan or Hubei province, then we tested anyone who had been in China within the last 14 days.

By the end of January, all of our public hospitals could do tests.

Then we moved to enhanced screening — we tested anyone coming to a hospital with a respiratory illness, anyone who had been in contact with a Covid-19 patient.

Now, it has even become more liberal.

If you are a hospital staff member with a mild cold, we will give you a test.

But if you are a normal person with no contacts with anybody and mild symptoms, we will just send you home.

You can get a medical certificate that allows you to stay home from work for five days.

If you are a casual worker, there is financial help with that, too.

Leadership needs to be organised

It is nothing really fancy.

We do not have the magic answer here, we just do it well and efficiently.

It is certainly more challenging to put these things in place in bigger countries with different political systems, but it just means people need to know their roles.

For instance, communicating to the nation should come from the national government, but the state level should talk about state-relevant things.

It is really about leadership being organised enough to get the messaging right as a team. Then people will feel more comfortable and are much more likely to follow the rules.


Prof Dale Fisher is the chair of infection control at the National University Hospital, National University of Singapore.


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