Sunday 26 January 2020

Wuhan virus: Singapore confirms first case of novel coronavirus infection on 23 January 2020

Temperature screening, already at airport, to extend to land, sea checkpoints
By Chang Ai-Lien, Science and Health Editor, The Straits Times, 24 Jan 2020

A man from China is the first to test positive for the Wuhan virus in Singapore, with another Chinese national here in an unrelated case also likely to have contracted it.

The 66-year-old Wuhan resident arrived in the country with nine travelling companions on Monday, and stayed at Shangri-La's Rasa Sentosa Resort & Spa, the Ministry of Health (MOH) said at a briefing last night.

The announcement of Singapore's first confirmed case came amid intensified efforts here to keep the novel coronavirus at bay, including temperature screening at land and sea checkpoints starting this morning, in addition to ongoing checks at Changi Airport.

A 53-year-old woman, also a Chinese national but not with the group of 10, came up positive in preliminary tests, which were awaiting confirmation.

In addition, the man's son, 37, a suspected case, has been admitted to hospital, while the rest of the group have left the country.

All three were in stable condition, and there was no evidence that the virus had spread to the community, the ministry said.

After widening the net to include temperature screening for all air travellers from China, the number of suspected cases in Singapore went up. In total, there have been 28 suspected cases aged one to 78 years, said MOH. Seven people have been ruled out.

"All measures will be taken to contain its possible spread," said the ministry's director of communicable diseases Vernon Lee.

But more cases are expected, given the large number infected in China and high travel volume from the country to Singapore.

As for the first case here, the man was in isolation and was no longer a risk to the public, Associate Professor Lee stressed. "There is no need for the general public to panic or take any special measures."

Close contacts of confirmed cases will be quarantined.

Yesterday, in measures to shore up defences against the virus, the newly formed multi-ministry task force decided at its first meeting to enhance border control and intensify screening. Measures have also been stepped up in places such as hospitals, schools and army camps.

Health Minister Gan Kim Yong, who heads the task force with National Development Minister Lawrence Wong, said that the effort was multi-tiered.

"First, we have to ensure that we do what we can in our defensive measures in terms of our border controls, temperature screening and so on, but at the same time, we have multi-layers of defence, including our clinics, hospitals, health institutions and healthcare workers who are at the front line."

Finally, he said, it was important that everyone protected themselves by observing personal hygiene and behaving in a socially responsible way.

Speaking to reporters at the World Economic Forum in Davos, Switzerland, Prime Minister Lee Hsien Loong said that Singapore had been preparing for a new viral outbreak since severe acute respiratory syndrome hit in 2003.

This included doing a thorough review of infrastructure, hospitals, isolation wards, and scientific testing and capabilities. "And I think we are much better prepared now," he said.

China, too, had made progress in dealing with public health emergencies, he noted.

The country has taken the unprecedented move of putting extensive travel restrictions on cities at the heart of the outbreak, which has killed at least 17 and infected more than 600 people, with cases surfacing all over the world.

Singaporeans are advised to avoid travel to the whole of Hubei province, in view of the travel restrictions China has imposed on Huanggang, Chibi, Xiantao and Ezhou, in addition to Wuhan, and to be cautious and pay attention to hygiene when travelling to the rest of China.

The virus, now known as 2019-nCoV, is mutating and can now be passed from person to person. Infections are expected to spike over the Chinese New Year weekend, with hundreds of millions of travellers on the move.

• Additional reporting by Timothy Goh and Aw Cheng Wei

Why first confirmed patient is being kept in isolation at Singapore General Hospital (SGH)
All public hospitals in Singapore capable of treating confirmed patients
By Salma Khalik, Senior Health Correspondent, The Straits Times, 25 Jan 2020

Singapore's first confirmed patient with the Wuhan virus is being kept in isolation at the Singapore General Hospital (SGH) rather than the National Centre for Infectious Diseases (NCID) because all public hospitals are capable of treating such cases.

Any suspected case turning up at a public hospital - like this man did - will be treated on site.

The man is a Chinese national from Wuhan, the Chinese city at the epicentre of the outbreak of the infectious disease. He arrived in Singapore on Monday for a holiday and later felt sick.

He and his son - who is also a confirmed case now - decided to go straight to a hospital. SGH is the nearest one to their hotel - Shangri-La's Rasa Sentosa Resort & Spa.

When the severe acute respiratory syndrome (SARS) hit Singapore in 2003, Tan Tock Seng Hospital (TTSH) was designated as the treatment centre and was closed to all new non-SARS related patients. All patients with SARS were taken to TTSH for treatment.

Today, only suspected cases identified at the airport, general practitioner clinics and polyclinics are sent to the emergency department at TTSH where they are assessed.

If someone is suspected to be carrying the Wuhan virus by a TTSH emergency department doctor, the patient will be warded at NCID, which has 124 negative pressure (NEP) rooms - the largest number in any healthcare facility.

NEP rooms have air flowing in but not out. The air is sucked out of the room through Hepa filters and then treated with ultraviolet rays before being released into the atmosphere.

All major public hospitals in Singapore have isolation rooms so patients with suspected infectious diseases will not spread them to others.

Patients who turn up at other hospitals will have samples taken.

If the patient has a coronavirus infection, the swabs are sent to the National Public Health Laboratory sited at NCID, which has facilities and staff trained to deal with dangerous pathogens.

There are seven strains of coronavirus, including the new one from Wuhan, which are transmitted from person to person. The others are the ones that cause SARS, Mers and four strains of the common cold.

What you need to know about the Wuhan virus
By Clement Yong and Joyce Teo, The Straits Times, 23 Jan 2020


A Viruses are microscopic biological parasites that lack the ability to survive and reproduce outside living organisms, which include animals, humans and even bacteria.

They become active only when they come into contact with living cells, which they then try to hijack to produce more viruses.


A They belong to a large group of viruses that usually infect only animals, and are so named for the crown-like spikes on their surface.

Scientists have identified coronaviruses that affect humans, with seven types of these viruses classified to date.

Four of these typically cause mild to moderate upper respiratory tract illnesses such as the common cold. But the remaining three have more severe repercussions on human health.

The first is the SARS (severe acute respiratory syndrome) coronavirus, which killed almost 800 people in 32 countries 17 years ago.

The other two are Mers-CoV (Middle East respiratory syndrome coronavirus), which was first reported in Saudi Arabia in 2012 and later spread farther, and 2019-nCov (Wuhan virus), which killed its first victims in the Chinese city of Wuhan.


A Scientists speculate that the Wuhan virus, like the Mers and SARS viruses, evolved from coronavirus strains that previously affected only animals.

Coronaviruses generally have a single strand of genetic material called RNA, which is more easily copied or mutated than humans' double-stranded DNA, and this accounts for their virality.

The Wuhan virus has been closely linked to Huanan Seafood Market in Wuhan, which reportedly also peddled live animals like deer and animal parts, in addition to seafood.

Scientists said that such unnatural situations, where animals are brought together and often housed in poor conditions in close proximity to people, create opportunities for a virus to hop between animals. The virus could then have mutated so that it is able to infect humans, and eventually start spreading among people.

Every virus typically infects a certain type of living host organism, said Dr Sebastian Maurer-Stroh, deputy executive director of research at the Agency for Science, Technology and Research's (A*Star) Bioinformatics Institute. "Viruses can shift their host preference through mutations... Some viruses mutate much faster."


A The Wuhan coronavirus is understood to spread much like the common flu does - through the air when an infected person coughs, through close contact such as shaking hands with an infected person, or touching an object which has the virus on it before touching one's mouth and eyes.

For now, virologists say the Wuhan coronavirus is likely not as infectious as the SARS virus. But there are concerns that the Wuhan virus' current reported 2 per cent death rate - where two out of 100 infected people die - is not representative, and that the virus could further mutate to become more lethal.

There are worries that the number of infections is under-reported, with many brushing off symptoms as those of the common flu.


A It is a different strain and, for now, has reported a lower fatality rate than the SARS virus.

The World Health Organisation estimates the overall fatality rate for SARS patients to be between 14 per cent and 15 per cent, while that for Wuhan is currently at 2 per cent.

Researchers have said that the Wuhan virus shares only 76 per cent of its genetic material with the SARS virus - a big difference in genetic terms, much like "comparing a dog and a cat".

There is, however, speculation that both viruses originated from bats. Recent reports have also suggested that the Wuhan virus might be linked to snakes too.


A No, said Professor Paul Tambyah of the Department of Medicine at the National University of Singapore's Yong Loo Lin School of Medicine.

Instead, we should be concerned.

He said there are measures in place to control the outbreak here and elsewhere. The public should be concerned and thus be vigilant about maintaining good hand hygiene, seeking medical attention if unwell and staying home, he said.


A Wear a surgical mask when you have a cold or flu.

Some doctors have been wearing surgical masks as a precautionary measure at work, so some people have wondered if they should dig out their N95 masks too.

But there is no need to, said Professor Leo Yee Sin, executive director of the National Centre for Infectious Diseases. Instead, they should wear surgical ones.

"N95 masks are... very difficult to breathe in. If you find the N95 mask easy to breathe in and comfortable, you are wearing it wrongly and it is no use," she said, adding that these masks are not recommended for the public.

Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital, said everyone with respiratory symptoms must wear masks, now that there is human-to-human transmission for the Wuhan virus.


A The Ministry of Health (MOH) on Thursday said Singaporeans should avoid travelling to Wuhan, stepping up a notch from its advice on Wednesday for people to defer non-essential travel there.

The ministry said it updated the travel advisory "in view of the developing novel coronavirus situation in Wuhan and other parts of China", with confirmed cases spreading beyond Wuhan to Beijing, Shanghai, Tianjin and Guangdong, which abuts densely populated Hong Kong.

It also cited the travel halt imposed by the Chinese authorities on Thursday, as all flights out of the city were cancelled and trains, buses and ferries suspended.

The ministry also reminded the public to continue to exercise caution and pay attention to personal hygiene when travelling to the rest of China.

MOH said all travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell, and also inform their doctor of their travel history.

If they have a fever or respiratory symptoms such as a cough or runny nose, they should wear a mask and call the clinic ahead of the visit.


A Singapore is stepping up precautionary measures in anticipation of more travellers in the lead-up to the Chinese New Year holidays.

The expanded measures include temperature screening for all travellers arriving from China - not just Wuhan alone - at Changi Airport from yesterday, and issuing health advisory notices to them.


A A flu vaccine will not help protect you against the Wuhan coronavirus. There is no vaccine to protect against coronaviruses.

However, according to an advisory from Raffles Medical, you should still get a flu jab if you are travelling to places where there are suspected cases to prevent you from contracting influenza symptoms that may mislead the screening authorities at temperature checkpoints.

There is also no specific treatment to cure illnesses caused by human coronaviruses, including pneumonia caused by the Wuhan virus.

Patients typically recover on their own after some time.

6 things to know about city of Wuhan: Ground zero of new virus outbreak
By Lim Yan Liang, The Straits Times, 24 Jan 2020

The suspension of all public transport in and out of the central Chinese city of Wuhan has turned the spotlight on the historic city that has become ground zero of the new coronavirus outbreak. The Straits Times' former China correspondent Lim Yan Liang takes you through some things to know about this rising city that is the capital of Hubei province.


The most populous of the cities in central China with 11 million people, Wuhan is widely seen as the economic and financial hub of the middle reaches of the mainland.

The city has consistently made the "new first tier" list of China's metropolises outside of the traditional four (Beijing, Shanghai, Guangzhou and Shenzhen) since Chinese media began to use the term in 2013.

Long an industrial base and manufacturing city, Wuhan has in recent years been remaking itself to attract high-tech firms. Foxconn, a key Apple supplier, has a plant there.

Wuhan's GDP of 1.48 trillion yuan (S$288 billion) in 2018 put it in the top 10 of Chinese cities by GDP, with a robust 8 per cent annual growth rate.


The authorities' move to lock down Wuhan to try and contain the new virus is partly due to the city's strategic location. Wuhan's position on the confluence of the Yangtze River and the Han River means it has long been a key transport node linking the rest of China through railways and expressways, and the city is sometimes referred to as the "Chicago of China".

For instance, with the rise of high-speed rail (HSR) in China over the last decade, Wuhan is now a key intersection for two major HSR lines: the north-south Wuhan-Guangzhou line, and the east-west Shanghai-Wuhan-Chengdu line.

The Wuhan Tianhe International Airport handled more than 20 million passengers in 2016, with connections to major international destinations.


Known as one of the "four furnaces" of China, temperatures in Wuhan can soar to more than 40 deg C in summer. The oppressive humidity from being by the Yangtze River also leads to many of its residents leaving in droves in the hotter months from June to August to bishu (avoid the heat).

Come spring and autumn, tourists are drawn to Wuhan to visit landmarks such as the pagoda-like Yellow Crane Tower, immortalised in Tang dynasty poet Cui Hao's poem about a sage departing on the back of a yellow crane, one of the famous Three Hundred Tang Poems.

Wuhan also boasts the 350-year-old Guiyuan Temple that harkens back to the Qing dynasty, and the Hubei Provincial Museum, among the finest of China's public museums.


Like its weather, Wuhan is known for its spicy foods, such as shaokao, or barbecued skewered meat, and ganremian - hot-and-dry noodles coated in chilli oil and soya sauce. It is also one of the homes of the mala xiang guo, a soup-less, spicy version of the hotpot with gratuitous use of chillies and peppercorns. The city is also known for its open-air food streets, featuring stalls selling a variety of seafood, cooked meats and other street eats, served alongside easy-drinking Chinese beer.

Wuhan residents' love of exotic meats is one possible reason for the new virus outbreak: The wholesale market where the virus was first discovered was found to have sold a variety of live animals meant for the dinner table, such as crocodile, hedgehog and deer.


A little-known point is that Wuhan is the world's largest college town, boasting 53 universities, including the prestigious Wuhan University that alone accounts for some 60,000 students.

The hundreds of thousands of university students the city plays host to means that the start of each new semester in February and September sees a wave of mass migration, with traffic volume in neighbourhoods around schools swelling by more than 15 per cent.

Wuhan University is also a popular tourist destination. Situated on the picturesque Luojia hill, it commands a panoramic view of the city's East Lake scenic area. Many also flock to the campus in March and April to enjoy the cherry blossoms.


Fans of Chinese history are also drawn to Wuhan for its pivotal role throughout China's epochs. Wuhan can trace its history back to the Bronze Age and the Erligang, a civilisation that existed between 1510BC and 1460BC. Part of the city was an important port during the Han dynasty, while during the Qing dynasty, it rose to become one of China's top four merchant towns.

Echoes of that period remain in Wuhan. France, which obtained a concession in the city under the Qing, has more than 100 firms invested in Wuhan today. For instance, Renault has several plants in the area, while Peugeot-Citroen has a joint-venture project there.

Wuhan is also the birthplace of the Nationalist Era as the home of the Xinhai Revolution of 1911, and the Wuchang Uprising that led to the downfall of the Qing dynasty and the end of Imperial China.

The city is also the site of the 715 Incident, a purge of communists that led to the collapse of the alliance between the Kuomintang and the Chinese Communist Party.

Singapore sets up multi-ministry task force to deal with Wuhan virus on 22 January 2020, MOH advises against travel to Chinese city
By Timothy Goh, The Straits Times, 23 Jan 2020

Singapore is marshalling its resources against the rapidly escalating Wuhan virus outbreak, with a multi-ministry task force set up to fight the infectious disease on all fronts when - not if - it hits home.

The mystery virus, which can now be passed from person to person, has already killed 17 people and infected at least 540 throughout China, with cases also surfacing in Taiwan, Japan, Macau, Thailand, Vietnam and the United States.

"While we take all the preventive measures, it is inevitable that we will see a potential case coming into Singapore, sooner or later," Health Minister Gan Kim Yong said yesterday. "Therefore, it is important for us to ensure that we're able to mount an effective response."

The Ministry of Health (MOH) yesterday advised people not to travel to Wuhan, the epicentre of the outbreak. Likewise, the Chinese authorities have told people not to travel into or out of the capital of China's Hubei province.

MOH has also advised travellers to avoid contact with live animals and the consumption of raw or undercooked meats, and to observe good personal hygiene.

As of yesterday, temperature screening at Changi Airport was expanded to cover all inbound travellers on flights arriving from China.

Noting that MOH is at the front line of the public health issue, Minister for National Development Lawrence Wong, who is chairing the task force together with Mr Gan, said the seriousness of the situation called for a "whole-of-government, even whole-of-Singapore, response".

This would include defensive measures at schools and workplaces, and ensuring economic continuity.

The Ministry of Social and Family Development, for one, issued an advisory yesterday to various pre-schools and student care centres to take precautionary measures in order to protect children and staff.

It is also working closely with community-based and residential facilities, including welfare homes and disability homes, to ensure that the necessary precautions are taken.

The task force, which was formed in consultation with Deputy Prime Minister Heng Swee Keat, will involve several ministers from various ministries. It holds its first meeting today, just before the Chinese New Year weekend, when infections are expected to spike as a large number of travellers fly to and from China.

Singapore saw three suspected cases yesterday, with seven others cleared of having the virus.

MOH said that all travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell. They should also inform their doctors of their travel history.

The Chinese health authorities have so far been unable to determine the origin of the virus but they say the new virus, which has no vaccine, is mutating and spreading.

In a Facebook post last night, Mr Heng said: "Although Singapore has not seen a confirmed case, we must be ready to mount an effective response when it happens... Let us stay vigilant, as we roll out precautionary measures to protect our people."

Mr Gan called for Singaporeans to be supportive of healthcare workers as they carry out their duties, and to be understanding and patient.

"As we roll out many of these measures, it may create inconveniences for some, especially those who travel overseas and may be subject to temperature screenings as they return to Singapore," he said. "I hope that they will understand and bear with us because, although there are some inconveniences, it is important for us to roll out these measures to ensure that we protect Singaporeans."

The Chinese stock market reversed early losses to end higher yesterday, as Beijing vowed to contain the outbreak. The Singapore market saw a recovery too, with the Straits Times Index closing up 0.2 per cent.


Ministry of Health - Updates on 2019 Novel Coronavirus (2019-nCoV) Local Situation

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