Skip to main content
Ex: Europe, Middle East, Education

Fighting the Coronavirus Pandemic, East Asian Responses - Singapore: Anticipation, Swab Tests and Intrusive Contact Tracing

BLOG - 24 March 2020

By Institut Montaigne

Key Points
1

Centralization of executive decisions through the Ministry of Health (MOH); use of pre-existing institutions for infectious disease control (the National Centre for Infectious Diseases and the National Public Health Laboratory) and quarantine facilities that were created after the 2003 SARS outbreak.

2

Responses start 21 days BEFORE the first case is detected: the Ministry of Health requests  (January 2)  physicians to identify patients with symptoms of pneumonia and a travel history to Wuhan; regular temperature checks are instituted for incoming passengers from Wuhan.

3

Delay between the first case and strongest measures in place: 4 to 22 days.

4

Upon first case detected, public health response shifts from "preparedness" to "enhanced preparedness". Measures include contact tracing and quarantine for close contacts, entry restrictions for travelers, and reactivation of Public Health Preparedness Clinics (PHPCs).

5

Development of more fine-tuned contact tracing technologies to overhaul preparedness for communicable diseases.

6

Strict enforcement. Violation of quarantine and dissemination of false information leads to a Singapore US$6,900 fine or a 6-month jail sentence.

7

Compulsory screening for all incoming passengers. Individuals with symptoms, local or foreign, receive a swab testing.

8

Public distribution of 4 FFP2 masks per household per week, drawing from a stockpile of masks post-SARS outbreak.

9

Entry ban on foreigners adjusted over time: January 23 to passengers from Wuhan, for all short-term visitors from March 22 or permanent residents and long-term pass holders, a Stay Home Notice spanning 14 days is issued.

Implementation of "Circuit Breaker" Measures: upon a fresh wave of cases among migrant workers, the government implements a soft lockdown from April 3 onwards, spanning a month, closing all businesses and schools except essential services and economic sectors.

 

This article was updated on April 24.

Singapore is the second case study of our series "Fighting the Coronavirus Pandemic, East Asian Responses", which explores the toolbox of public policy options to contain and defeat the virus. It illustrates the lessons learned during the 2003 SARS crisis and immediately reactivated. The policies combine digital tracing of patients and their contacts, quarantine, border controls including swab tests upon arrival for individuals showing mild symptoms and up to border closure on March 23.

Timeline

  • January 2: Singaporean Ministry of Health requires physicians to identify patients with pneumonia symptoms and a history of visits to Wuhan; compulsory temperature checks put in place.
  • January 23: first case identified, a tourist from Wuhan. Public health measures shift from "preparedness" to "enhanced preparedness". Measures instituted: contact tracing, quarantine of close contacts, entry restrictions to people who traveled to China.
  • January 27: Singaporeans warned against nonessential travel to Wuhan, temperature screening expanded at Changi airport. 14-day leave imposed on people working with vulnerable populations. Teaching activities moved online.
  • January 29: Travels between Hubei and Singapore suspended. Hospital bills to be covered by the MOH for all suspected and confirmed patients.
  • February 1: All visitors with recent travel history to Mainland China within the previous 14 days are denied entry and transit through Singapore.
  • February 14: Reactivation of Public Health Preparedness Clinics (PHPCs)
  • February 18: Stay-Home notices (spanning 14 days) issued for all Singapore residents and long-term pass holders returning from China; introduction of a government stimulus package to boost affected economic sectors.
  • March 18: Introduction of a tier-system to classify passengers based on risk level, foreigners banned from entering Singapore.
  • March 21: Singapore residents returning from abroad and short-term visitors have to observe a 14-day stay-home notice and be monitored by the government through their GPS location.
  • March 22: Short-term visitors no longer allowed to enter or transit through Singapore. Work pass holders are only allowed to return if they work in essential service sectors such as healthcare and transport.
  • April 3: Partial lockdown: announcement of one-month closure of nonessential businesses, schools and universities
  • April 24: Confirming an increase of more than a 1,000 new cases for 4 days in a row, the Ministry of Health attributes them to an upsurge in clusters in migrant workers dormitories.
     

Analysis

As of mid-April 2020, Singapore had managed to contain the COVID-19 contagion by anticipating its crisis potential from late December 2019. The country is now dealing with a second wave of cases, mostly among Singaporean citizens returning home, and leading to the unprecedented border closure to almost all short-term foreign visitors. On April 9 Singapore had 1,910 cases and 6 deaths, according to Ministry of Health data.  The country experienced a second wave of infection since the end of March, as a result of Singaporean residents flying back home. Of the 54 second wave cases confirmed on March 23, 48 had been imported - a testimony to the efficiency of the country’s border control, the practice of swab tests on arrival, but also the efficiency of the active measures taken to prevent the eruption of local clusters inside Singapore.

The SARS outbreak led to the creation of the National Centre for Infectious Disease by the Ministry of Health which opened in 2019, and is equipped with 330 isolation beds.

Overall, Singapore’s relative success in containment so far can be attributed to the steps taken by the government to improve its public health infrastructure after the 2003 SARS outbreak, which caused more than 30 deaths. The SARS outbreak led to the creation of the National Centre for Infectious Disease by the Ministry of Health which opened in 2019, and is equipped with 330 isolation beds. In addition, Singapore had put in place national quarantine facilities prior to the COVID-19 outbreak.

This preparedness is accompanied by measures taken on the news that a viral new pneumonia was showing signs of spreading in Wuhan and Hubei province. In Singapore, temperature screening of incoming passengers from Wuhan starts in early January, and a complete ban on inbound flights from Wuhan is imposed on January 23, 2020. From the beginning of February, Singapore has imposed increasingly strict controls on incoming travel, broadening it to the various areas affected severely by COVID-19, and extended in mid-March to all foreigners.

A feature of Singapore’s containment strategy is the swab testing of incoming passengers showing mild symptoms. Since mid-January, the government has worked to expand screening rooms at various checkpoints. The test kits with a 99% success rate used at the checkpoints are developed in February by The Home Team Science and Technology Agency (HTX), and a Singaporean company, Veredus, to facilitate in vitro diagnosis. Tests are now conducted on the basis of a tiered system of controls classifying passengers according to risk.

On February 7, the government raised its Disease Outbreak Response System Condition (DORSCON) level to "orange"- instituting multiple precautionary measures for large-scale events, the workplace, and at the individual level, such as regular checks for fever and respiratory symptoms.

The Singaporean government also puts the emphasis on sharper contact-tracing tools, the creation of more laboratories, and higher investment levels in biomedical science and clinical research.

As other East Asian countries, Singapore emphasises the production, the availability and the wearing of masks. On February 4, the government undertakes a massive operation of distributing 4 FFP2 masks per household per week from the government-run stockpile of Personal Protective Equipment (PPEs) and masks.

An online program provides information on where and when citizens can collect these. Singapore quickly faces a shortage of masks, due to export restrictions imposed by neighboring countries and having previously no local production. It is replenishing the stockpile through collaboration with local private manufacturers such as Wellchem Pharmaceuticals. In addition, 1.6 million masks unclaimed by Singaporean households have been returned to the government. The Ministry of Trade and Industry, which manages the production and storage of masks, does not disclose the size of the country’s stockpile. Tackling a related issue, the government prevents price-gouging by issuing warnings to companies and ordering incoming travelers to declare their masks and PPEs.

Tracetogether, which records through Bluetooth other users who have been in close proximity to a smartphone user. After that user is found to be positive, individuals at risk are contacted directly.

Another major characteristic of Singapore’s crisis management is extremely intrusive contact tracing and cluster identification. Health professionals on the ground are trained to question those who test positive in order to identify potential clusters. They can use a new serological test developed by the Duke-NUS Medical School. In addition, the Ministry of Health works in tandem with hotels and companies, going as far as to consult CCTV footage to identify and track cases. The Singaporean government has developed the app Tracetogether, which records through Bluetooth other users who have been in close proximity to a smartphone user. After that user is found to be positive, individuals at risk are contacted directly.

Proactive testing and contact tracing are accompanied by strict quarantine policies. The quarantine measures adopted by Singapore range from government-mandated leave of absences to Stay-Home Notices (SHNs), first violations of which are either fined heavily (US$6,900) or given a six-month jail sentence. The stay-at-home notices come with a requirement to share GPS location with the government, thus allowing real-time tracing. In terms of advocating social distancing, Singapore has practiced "leading by example". Many Singaporean MPs have exhibited social distancing during walkabouts.

As a result of quick action, strict border control with swab tests on arrival and quarantine, proactive contact tracing, Singapore was initially able to stave off a general lockdown.

Due to a considerable panic following the first wave of cases, Singaporeans begin to empty supermarket shelves. To quell fears, Prime Minister Lee Hsien Loong delivers on February 8 an address in the four official languages, explaining the situation directly to the citizens, and this has proven effective so far. Moreover, purchase limits (ranging from US$ 20 to 35) are imposed on supermarket chains, to prevent overbuying. These limits are also a response to Malaysia, a crucial food supplier of Singapore, entering partial lockdown and closing its borders. On March 17, the Minister for Trade and Industry announced plans for stockpiling, diversification of overseas sources, and local production.

In the second half of March, a second wave of contagion occurs in Singapore, with 80% of the confirmed cases imported. As a result, from March 22, the 14-day stay-home notice system has been expanded to all permanent residents and long-term pass holders returning from any part of the world. Short-term visitors from all over the world are barred from entry or transit. The measure is also described as allowing the conservation of resources and the direction of medical focus on Singaporeans.

As a result of quick action, strict border control with swab tests on arrival and quarantine, proactive contact tracing, Singapore was initially able to stave off a general lockdown. Following a fresh wave of cases, Singapore has instituted a one-month partial lockdown from April 3 onwards, known as a "circuit-breaker" measure. Most businesses and workplaces, except for essential services are closed, having shifted to telework, and schools shift entirely to a home-based learning system. In the first wave of contagion, a majority of cases so far were young people, indicating that the elderly have either self-isolated or are protected by their kin. However, a new upsurge in cases from April 19 onwards has found clusters concentrated in dormitories inhabited by temporary workers. So far, a total of 21 foreign worker dormitories have been declared as isolation areas by the government. Following this development, on April 21, Prime Minister Lee announces an extension in its circuit breaker measures by four weeks until June 1. By way of a plan to sustain the increasingly restrictive measures the government has introduced successive economic stimulus packages of US$ 2.6 billion on February 18 and US$ 11.8 billion on March 26. A third economic stimulus plan is announced by the government on April 6, worth US$ 3.6 billion, in response to the continuing outbreak.

 


Mathieu Duchâtel, François Godement, Vasudha Rajkumar and Viviana Zhu - Institut Montaigne’s Asia Program

 

Copyright: Catherine LAI / AFP

 

 

See also
  • Commentaires

    Add new comment

    Commentaire

    • Allowed HTML tags: <a href hreflang> <em> <strong> <cite> <blockquote cite> <code> <ul type> <ol start type='1 A I'> <li> <dl> <dt> <dd> <h2 id='jump-*'> <h3 id> <h4 id> <h5 id> <h6 id>
    • Lines and paragraphs break automatically.
    • Web page addresses and email addresses turn into links automatically.
    • Only images hosted on this site may be used in <img> tags.

Envoyer cette page par email

L'adresse email du destinataire n'est pas valide
Institut Montaigne
59, rue la Boétie 75008 Paris

© Institut Montaigne 2017