Post 1 of 2: Mitigation measures of a city under DORSCON Orange
Viking and De Havilland have joined other vendors and canceled plans to attend the Singapore Airshow.
Dash 8 and Twin Otter manufacturers pull out of Singapore Airshow
1. Sensible.
DORSCON Orange means the 2019-nCoV virus is probably already circulating in Singapore’s population and this affects, my family and me, directly. My family has decided not to wear masks in public, unless we are sick and have chosen to wash our hands more frequently instead. A lady teacher (Case 32) from Victoria Junior Collage (VJC) has not been to China, has caught the novel coronavirus, locally. VJC staff and students who have been in recent contact with her are put on a 14-day leave of absence. In addition, co-curricular activities have been suspended for 14 days, and the school will conduct more tutorial-size classes, rather than larger lectures. There are also 3 cases (Cases 29, 35 & 37) where the infected person(s) whose infection is not traced and have also not been to China. Other transmissions in 3 clusters, as follows:
- Yong Thai Hang health products store in Cavan Road: It was visited by a tour group from Guangxi, China, on Jan 23. So far, 10 patients have traceable links to that visit (Cases 19, 20, 21, 24, 25, 27, 28, 29, 34 & 40)
- Grand Hyatt business meeting on Jan 20-22: So far, 3 Singapore residents and 4 foreigners who have since left - at the meeting have the virus (Cases 30, 36 & 39)
- The Life Church and Missions in Paya Lebar: 5 people linked to it have tested positive (Cases 8, 9, 31, 33 & 38)
2. The total number of people infected in Singapore has grown to 40, as at 8 Jan 2020. If the number of cases of infection continues to grow, Singapore will have to reconsider its strategy,
said PM Lee Hsien Loong, as it is "futile to try to trace every contact" if the virus is widespread. Hospitals would be overwhelmed if every suspect case is hospitalised and isolated, he said. At that point,
provided the fatality rate is low, Singapore could shift its approach to encourage those with mild symptoms to see their family GP instead of going to the hospital. This way, he said, hospitals and healthcare workers would be able to focus on the most vulnerable patients instead. However, Singapore is not at that point yet, said PM Lee. "It may or may not happen, but we are thinking ahead and anticipating the next few steps," he said. "And I am sharing these possibilities with you, so that we are all mentally prepared for what may come."
3. “In this single-center case series of 138 hospitalized patients with confirmed novel coronavirus–infected pneumonia in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and [the] mortality was 4.3%.
SARS had a fatality rate of 9.6% compared to the fatality rate of 2.1% so far for this new 2019-nCoV strain of coronavirus...” wrote Quentin Fottrell of MarketWatch on 8 Feb 2020. Globally, more than 810 have been killed, mostly in China, with more than 37,000 infected worldwide. Currently, the mortality rate of the virus in China is 2 percent, but outside Hubei province, the mortality rate is 0.2 per cent.
4. During the 2009 influenza pandemic, the earliest reports listed 59 deaths from approximately 850 suspected cases, which suggested an extremely high case fatality of 7%. However, the initially reported information of 850 cases was a gross underestimate. This was simply due to a much larger number of mild cases that did not report to any health system and were not counted. After several months — when pandemic data had been collected from many countries experiencing an epidemic wave — the 2009 influenza turned out to be much milder than was thought in the initial weeks. Its case fatality was lower than 0.1% and in line with other known human influenza viruses.
5. Amongst the ASEAN-10, the Singapore Government is the best prepared to deal with a pandemic outbreak. At the heart of Singapore's response plan is the Disease Outbreak Response System (DORS), a crisis management plan which did not exist in 2003, but was drafted after SARS and refined again in the wake of the swine flu (or H1N1) pandemic in 2009.
The last SARS outbreak showed that as a country, Singapore has a disciplined population, plus we can trust systems and processes, put in place to mitigate against the spread of disease. During SARS, the Singapore Armed Forces helped to place 1,500 people under quarantine after the outbreak of Sars. Professor Ooi Eng Eong, an infectious diseases expert and virologist at the Saw Swee Hock School of Public Health, noted that a multi-ministry taskforce on the Wuhan coronavirus was formed on 22 Jan 2020, several hours before the first suspected case came to the attention of the authorities at 10pm the same day. The patient - a 66-year-old Chinese national tourist from Wuhan - tested positive the next day, becoming the first confirmed case in Singapore. “If you look at the response time, it is a fact that the ministerial committee formed before the case appeared, and we can see that a lot of systems are already in place, occurring across ministries and not as siloed as back then when SARS caught us all by surprise,” said Prof Ooi, who is also deputy director of the Emerging Infectious Diseases Programme at Duke-NUS Medical School.
6. In terms of capacity, Singapore has already beefed up its healthcare and isolation capacity since 2003. This includes the 330-bed National Centre for Infectious Diseases that opened in 2019, and new hospitals such as Khoo Teck Puat Hospital in 2010, Ng Teng Fong General Hospital in 2015, and Sengkang General Hospital in 2018. Nanyang Technological University (NTU)’s Graduate Hall 1 and Blocks 9, 10 and 11 at Hall 2, as well as Block 83 at the Prinsep Street Residences of the Singapore Management University (SMU) and the Civil Service Club@Changi were also activated as quarantine facilities. 4 blocks of Prince George’s Park Residences at the National University of Singapore (NUS) said that chaos ensued after they learnt that they had to move out to make way for quarantine facilities for the novel coronavirus outbreak. Further, there are the many enhancements to the Infectious Diseases Act over the years since 2003, which give the authorities greater powers to enforce orders that were issued in the fight against a gazetted outbreak. The Act allows people who break home quarantine orders to be arrested without a warrant and to be jailed or fined on conviction. It was amended last year to allow officers to use “physical means” to enforce the order by bringing an absconder back to the place of isolation, in lieu of arrest.
7. As a result of SARS, policies and procedures regarding risk stratification, contact mapping, contact tracing, quarantine and others were developed on the fly as the epidemic erupted, Dr Tan Yia Swam, First Vice-President of the Singapore Medical Association said. “Today, all of the above have been developed and tested before in exercises and they are now put into action. Of course, these plans, policies and procedures must be modified in line with the epidemiology of the disease, but we are not working from scratch, unlike the past experience with SARS,” Dr Tan added. Army officers have been brought in to help with contact tracing and the administration of quarantine measures. Contact tracing for the confirmed cases is ongoing in Singapore. Once identified, the
Ministry of Health (MOH) will closely monitor all close contacts. As a precautionary measure, they will be quarantined for 14 days from their last exposure to the patient. In addition, all other identified contacts who have a low risk of being infected will be under active surveillance, and will be contacted daily to monitor their health status. As of 4 Feb 2020, 12pm, MOH has identified 311 close contacts. Of the 239 who are still in Singapore, 234 have been contacted and are being quarantined or isolated. Efforts are ongoing to contact the remaining five close contacts.
8. Writing in an MOH journal on SARs, Professor Chee Yam Cheng, recalled the
Singapore Army's contributions in 2003: "They worked in shifts from 7 am to 11 pm, and their sole objective was to trace within 24 hours (and this is vitally important) of receiving the name of a SARS patient, everyone who had been in close contact with him. This meant every name (and address – in order to serve the Home Quarantine Order) of every person that the SARS patient (be he highly suspect or probable) could remember having met from the time he took ill (and maybe even while he was incubating the illness the previous 10 days, unless we can be very sure when the infectious period started in each case). "The army came to the rescue when MOH realised its battle against time to trace the 2,000 people affected by the Pasir Panjang Wholesale Centre closure could not be won without reinforcements.”
