Wednesday, 5 February 2020

2019-nCoV: Singapore reports first cases of local coronavirus transmission on 4 February 2020

4 women who never travelled to Wuhan infected; more steps to contain spread
By Chang Ai-Lien, Science and Health Editor, The Straits Times, 5 Feb 2020

Singapore has recorded its first cases of local coronavirus transmission, with four women who had not travelled to Wuhan, the epicentre of the outbreak, getting infected here.

Two work at Yong Thai Hang, a Chinese health products shop in Cavan Road in Lavender which caters to Chinese tour groups.

The third is employed as a maid by one of the infected women, while the fourth is a tour guide who had taken groups to the same shop.

The tourists have since returned to China. At least two have the virus.

In addition, another two confirmed cases in Singapore were announced yesterday. The two Singaporeans were among a group of 92 people flown back from Wuhan on a Scoot flight last Thursday. Before this, the infection was confirmed in two passengers on that flight.

In total, there are now 24 confirmed cases in Singapore.

The new cases constitute "limited local transmission", the Health Ministry (MOH) said.

But Health Minister Gan Kim Yong said at a press conference: "There is, however, no evidence of widespread community transmission."

Singapore has put in place multiple lines of defence to prevent the virus from taking hold here. But Mr Gan, who co-heads a multi-ministry task force set up to combat the virus, cautioned that "despite our best efforts, Singapore could still see extensive community spread".

Should that happen, additional measures to reduce human-to-human interactions will be considered, such as cancelling mass gatherings, suspending school and paring down non-essential care services.

The country has been preparing for such clusters of cases, and efforts so far have been targeted at preventing the spread beyond such local clusters to the broader community. MOH has started contact tracing so as to ringfence the cluster and limit further spread.

The cleaning of public areas is being stepped up, and measures are being taken to lower the risk for vulnerable groups such as young children and the elderly.

To keep students safe, for instance, schools will implement staggered recess times and stop activities such as mass assemblies and school camps. Eldercare facilities will also suspend excursions and large-scale gatherings.

As an added precaution, the authorities are contacting people with profiles similar to the four local transmission cases, who have had recent close contact with individuals with a history of travel to China.

In addition, all patients with pneumonia at public hospitals are being tested for the 2019-nCoV, as the virus is called, starting last week.

Current evidence suggests the virus can be spread by droplets from infected individuals - either directly or indirectly through hands that have come into contact with the droplets - and the best way to prevent this is through personal hygiene, said MOH. Businesses and organisations are also advised to clean their premises more often, especially high-traffic areas.

The earlier 18 confirmed cases of the virus here were all imported, comprising 16 Chinese nationals and two Singaporeans who had all travelled to Wuhan. One, a Chinese national, has been discharged, said the ministry yesterday.

The update was given after a two-day lull on Sunday and Monday, when no new cases were reported.

The coronavirus has infected more than 20,000 people and claimed over 420 lives, mainly in China. The global authorities have warned of more person-to-person spread, with several countries reporting local transmission.

• Additional reporting by Timothy Goh

Coronavirus outbreak in Singapore: 4 local coronavirus transmissions but no community spread yet as source of infection is known, says Health Minister Gan Kim Yong
No widespread community infection yet but situation being monitored
By Salma Khalik, Senior Health Correspondent, The Straits Times, 5 Feb 2020

Although three Singapore residents and a foreign domestic worker here with no travel history to China have been infected by the coronavirus, it does not constitute widespread community transmission.

Health Minister Gan Kim Yong explained at a press conference yesterday that this is because the source of infection for all four people is known.

Three were infected through interaction on Jan 23 with a tour group from China - two members of whom are now known to have the coronavirus after returning home - and the fourth person, the foreign domestic worker, through close contact with her employer, who is one of the three.

Two of the three women worked at Yong Thai Hang at 24 Cavan Road, a shop that sells health products, and the third is the tour guide who took the group there.

So although it is community transmission, it is a limited transmission, Mr Gan said.

"For this particular cluster, we are able to identify all the contacts that are involved, including the source of the infection."

He added: "If you have a cluster and you know who the first patient in that cluster is, but have no idea where he got the infection from, then we have a bigger problem."

For this first local cluster, the Ministry of Health (MOH) has started contact tracing in order to ring-fence the cases so that the coronavirus does not spread to more people.

"These efforts will help reduce the risk of escalation," said Mr Gan.

He said the Government has been expecting cases with limited community transmission like this one, and it is "a scenario we are prepared for".

He said measures will be ramped up "when you have cases popping up in different parts of Singapore and we are not able to determine the source, have no idea where they come from".

Referring to his ministerial statement in Parliament on Monday, he said: "As I pointed out yesterday, despite our best efforts, Singapore could still see extensive community spread. At that point, we will need to consider measures to reduce human-to-human interactions, such as cancelling mass gatherings, suspending (classes in) schools, paring down non-essential care services and introducing further infection control and monitoring measures, to slow the spread."

This happened during the severe acute respiratory syndrome outbreak here in 2003.

"We're watching the situation very carefully, monitoring developments, and we're quite prepared to adjust our posture, our stance," Mr Gan said.

As to how the two women in the store could have caught the virus from customers who were only there to buy things, Mr Gan said there could be different modes of transmission - not just close contact that has been defined as within 2m for at least 30 minutes.

"For example, a person who is ill might have been in contact with some of the merchandise. The merchandise could have been contaminated. The salesperson could have handled the material after that, and she touches her face, her eyes and nose, she could have gotten it. So it's not necessarily through talking or sneezing."

MOH is still tracing where else the group had gone to and the hotel they stayed in, since the first of the four virus cases was confirmed only at 11pm on Monday.

The other three cases were confirmed yesterday.

Said Mr Gan: "We continue to be vigilant for more cases. There may be more with exposure to this particular travel group."

Coronavirus: First patient in Singapore discharged, some given anti-HIV drugs: MOH
By Rei Kurohi, The Straits Times, 5 Feb 2020

A man from Wuhan, China, who previously tested positive for the coronavirus has since recovered and was discharged from the National Centre for Infectious Diseases (NCID) yesterday, the Ministry of Health (MOH) has said.

Another patient could be discharged in the next few days, the ministry's director of medical services Kenneth Mak told a press conference yesterday.

The patient discharged yesterday is a 35-year-old Chinese national who arrived in Singapore on Jan 23 and stayed at Marina Bay Sands.

He developed symptoms the next day and was later warded at the NCID. He tested positive for the virus on Jan 27 and became the seventh case to be confirmed here. He is the first to be discharged.

"The patient was discharged well. All symptoms had fully resolved and he had tests over three consecutive days that were all negative," Associate Professor Mak said.

"We're quite confident that he's no longer got any infection."

Prof Mak noted that there are a number of other patients who have the virus but are well, including at least three who are not showing any symptoms. Many continue to make good progress, he added.

Two of the patients without symptoms were among the six new confirmed cases announced yesterday. There were 24 confirmed cases in Singapore as of last night.

Prof Mak said five patients required oxygen and breathing support, but added that this is "not surprising", given that they had pneumonia.

"None of the patients are in the intensive care unit and none are critically ill at this point in time," he said.

MOH's chief health scientist Tan Chorh Chuan, who was also at the press conference yesterday, said a "small number" of coronavirus patients in Singapore have been treated with a combination of antiretroviral drugs, namely lopinavir and ritonavir.

The drug cocktail is usually used to treat patients with the human immunodeficiency virus (HIV) that causes Aids. It is unclear if the patient who was discharged yesterday was given the drugs.

Professor Tan said clinical trials are under way in China to test the efficacy of the drugs in treating patients with the new coronavirus.

On Sunday, Thailand's health ministry said Thai doctors who gave the drugs to coronavirus patients have reported promising initial results.

"We are waiting to see how the trials are proceeding and we hope, in the weeks ahead, we will have some indication," Prof Tan said.

"In the meantime, among the different drugs that have been tested, these agents appear to be effective, but we can't be certain at the moment. They appear promising and the trials will help us understand how effective they can be."

Coronavirus: All 92 evacuated from Wuhan on Scoot flight being tested
By Rei Kurohi, The Straits Times, 5 Feb 2020

All 92 Singapore residents who were evacuated from Wuhan on a specially arranged Scoot flight last Wednesday are being tested for the coronavirus, and four so far have tested positive.

Two Singaporeans who flew back last week were among the six new confirmed cases announced yesterday.

The Ministry of Health (MOH) said both tested positive for the virus on Monday despite not showing any symptoms.

They are now warded in isolation rooms at the National Centre for Infectious Diseases (NCID).

The ministry's director of medical services, Associate Professor Kenneth Mak, said during a press conference yesterday that the pair were quarantined upon landing in Singapore.

"They have remained in quarantine since their return to Singapore, so there's no risk of any spread to any other individual," he noted.

Prof Mak said the ministry began testing the 92 passengers as they had a higher risk of infection given the community spread in Wuhan.

Those who did not have symptoms were also tested to see if asymptomatic travellers could carry the virus, Prof Mak added.

Two other Singaporean women on the flight, both 47, were previously confirmed to be infected on Friday and Saturday.

They were found with fever upon their return and were taken to the NCID.

All four were asymptomatic when they boarded the flight. Temperature screening was conducted at check-in and before the passengers boarded, and those found to be running a fever were not allowed to board.

It is currently unclear if the four had any close contact or interacted with one another, Prof Mak said.

Coronavirus mitigation measures: Assemblies, large group activities in Singapore schools to be suspended from 5 February 2020
Recess times to be staggered; pre-schools also stepping up precautionary measures
By Jolene Ang, The Straits Times, 5 Feb 2020

Assemblies, camps, mass celebrations and other large group and communal activities will be suspended in schools here from today after the first local transmissions of the coronavirus were reported yesterday.

The Ministry of Education (MOE) and Ministry of Social and Family Development (MSF) said in a joint statement that the suspension affects primary and secondary schools, special education schools, junior colleges and Millennia Institute.

Recess times in schools will also be staggered, although co-curricular activities and after-school programmes may continue, but in smaller groups.

These measures to minimise gatherings of students in large numbers aim to improve protection of students and staff against the coronavirus, which originated from the Chinese city of Wuhan, said MOE and MSF.

Yesterday, the Ministry of Health (MOH) confirmed that Singapore has recorded its first cases of local coronavirus transmission, with four women who had not travelled to Wuhan, the epicentre of the outbreak, testing positive for the virus.

The six new cases reported yesterday bring the total number of confirmed cases in Singapore to 24.

As for pre-schools, the Early Childhood Development Agency will also step up precautionary measures. Large group and communal activities at pre-schools, including assemblies, will also be suspended.

Health checks and temperature screening for all children, staff and visitors will continue, with the frequency of temperature-taking for children and staff increased.

These measures will also apply to certain social services for vulnerable groups of people, such as residential facilities and disability day centres. Eldercare facilities will also suspend external excursions and large-scale gatherings.

MOE and MSF said that the additional measures will allow them to mitigate the potential risks posed when students gather in large numbers, while allowing schools and pre-schools to continue with most of their usual activities.

They added that schools and pre-schools will closely monitor the health of students and staff, and advise them to see a doctor immediately if they are sick.

"We will continue to monitor the situation closely and will implement further measures should the situation escalate," the ministries said.

Parents whom The Straits Times spoke to were worried about the coronavirus situation and welcomed the latest measures.

Housewife Liew Cheng Huan, 53, who has three children in secondary school, said the virus is a real concern now that the number of cases here has gone up to 24.

While she was not completely sure if the new measures announced would make a difference, she said cancelling camps was a good move.

Madam Liew said: "The kids are still in close contact in class. The onus is on us parents to monitor our children's conditions and keep them at home if they are unwell. Schools can't police everything the kids do in and out of the school environment."

For Madam Michelle Teo, 42, whose two daughters are in pre-school and primary school, the measures by MOE and MSF are a way to reassure parents.

The housewife said she would keep her younger three-year-old daughter at home only if she is unwell or if the pre-school organises activities outside school.

"We have to trust the schools to a certain point. It is good to know they have the students' interests at heart," she said.

Coronavirus mitigation measures: Ministry of Manpower, partners issue guidelines to protect workers from infection
By Timothy Goh, The Straits Times, 5 Feb 2020

The Ministry of Manpower (MOM) and its partners issued a series of enhanced guidelines yesterday to protect workers from the coronavirus outbreak following the first cases of local transmission here.

They touch on three main areas: Stepping up cleaning, dealing with customers and measures that individual employees can take.

Enhanced cleaning of premises is part of the new guidelines that were issued by the Ministry of Trade and Industry, MOM, NTUC and the Singapore National Employers Federation.

Cleaning frequency should be stepped up in areas with high human contact, such as counters where customers are served and rooms where visitors are hosted.

The cleaning frequency of general public access areas such as lifts, handrails, pantries, toilets and bin areas should also be increased.

Workers and workplaces are further advised to adopt sanitation and hygiene advisories disseminated by the National Environment Agency (NEA).

Companies have also been advised to establish clear guidelines for frontline staff on handling customers who are unwell.

The advisory said this could include advising customers who are visibly unwell to see a doctor, or asking them to reschedule their appointments or be served via alternative means such as tele-conferencing.

If, however, it is necessary to provide urgent services to customers who are unwell, companies should establish proper procedures to safeguard their staff and premises. For example, frontline workers should wear surgical masks and serve unwell customers separately from other customers if possible.

Employees have a part to play as well, in observing good personal hygiene, avoiding close contact with people who are unwell, and staying away from the workplace and consulting a doctor if they are unwell.

"The intention of this new advisory is to provide guidance on what can be done at workplaces to preserve their cleanliness, and ensure the environment continues to be safe for workers to operate in," said Permanent Secretary for Manpower Aubeck Kam yesterday.

These guidelines come shortly after two employees at a Chinese health products shop in Lavender that caters to Chinese tour groups were confirmed to be infected with the virus.

Unlike previous cases, they did not have recent travel history to China.

Health Minister Gan Kim Yong noted that the virus may not necessarily be transmitted by direct contact with infected individuals.

"For example, a person who is ill might have been in contact with some of the merchandise... and the salesperson could have handled the material after that, and (if) he or she touches her face, her eyes and nose, she would have gotten it," he said, adding that the salesperson could have touched a contaminated surface as well.

Current evidence suggests that the likely modes of transmission are mainly through contact with droplets from infected individuals, said the Ministry of Health (MOH) yesterday.

This can take place directly or indirectly through hands that have touched these droplets or by touching contaminated surfaces.

Associate Professor Kenneth Mak, who is director of medical services at MOH, said the shop at Lavender will be inspected and cleaned by the relevant agencies.

Mr Kam said of the new guidelines: "There's obviously a very important role that individual workers can play. This coincides with the general advice we give to every Singaporean, every resident here, as to what they can do to prevent themselves from being more exposed to infection."

Coronavirus: Employers foot bill to house workers on mandatory leave of absence
By Tee Zhuo, The Straits Times, 5 Feb 2020

Six months' rent. That is the bill for Ms Laureen Goi's company to house her workers for just 14 days - the mandated leave of absence (LOA) period because of the coronavirus outbreak - after their landlords turned them away.

She is one of several employers here who now have to foot the bill for alternative accommodation so that their workers returning from mainland China are not stranded.

And they fear the situation will get worse, with the first cases of the coronavirus' local transmission announced yesterday, even though the Government has said it will take errant landlords to task.

Ms Goi, 48, general manager at Tee Yih Jia Food Manufacturing, said that six months was the minimum period the dormitory offered to her, which she accepted after being rejected by hotels.

"The support needs to be there. They are asking us to quarantine workers, but where? I hope the Government can provide a place to house the workers that are returning," she told The Straits Times.

Similarly, Trilogy Technologies' Ms Soong, 26, who wanted to be known only by one name, said the blame cannot be "100 per cent" on the landlords.

The human resource and purchasing executive for the firm, which is involved in electronics engineering servicing, said that two of her workers returning from China were not allowed back into their Housing Board (HDB) flats by landlords.

She wrote to the Ministry of Manpower (MOM) but was told they could not do anything and to contact HDB directly.

The two workers now have to stay in a hotel and this costs about $100 a night each for the two-week LOA period. Even securing a hotel room was problematic, with one hotel refusing to take any returning China nationals and another ignoring Ms Soong's request.

She said: "If a hotel did not take them, we would not know what to do. The Government should provide an alternative for workers that are not ill and just need to do the LOA."

On Monday night, MOM, the Ministry of National Development and the Ministry of Education said landlords who evict tenants on home quarantine, LOA, or based on their nationality could face restrictions and even be barred from renting to foreign work pass holders in future.

In a joint reply to queries from The Straits Times last night, the ministries said MOM may also bar addresses of errant landlords from being used for work pass applications in future.

"We understand that the affected individuals, who were residing in both public and private housing, have been able to find alternative accommodation including with the help of their employers, IHL and government agencies," they said, adding that those who could not find alternative accommodation could call 1800-333-9999 for help.

Legal experts who spoke to The Straits Times said the renting restrictions were likely meant to apply to public housing, as landlords had to obtain the consent of HDB before subletting to foreign work pass holders.

Lawyer Terence Seah said he did not think the restrictions could apply to private property.

Similarly, Mr Chia Boon Teck of Chia Wong Chambers said that HDB has an "overriding control" over the landlord as a lessee, whatever the agreement with a sub-tenant.

"HDB requires their lessees to register their occupiers through their portals, which would facilitate HDB's identification of any errant lessees," he said, adding that the agency's powers against the lessee would be provided for under the HDB Act and HDB regulations.

Private properties, on the other hand, are generally governed by the Urban Redevelopment Authority (URA), which does not have rules that are as extensive, he said.

Mr Wilbur Lua, associate director of Covenant Chambers LLC, said that to his knowledge, there was no requirement for private property owners to register tenants or obtain the consent of URA before letting.

"So, I think it would be more challenging for the Government to impose such restrictions for private property owners."

Coronavirus: All pneumonia cases in public hospitals being tested for virus
There are 500 to 600 such patients each week who will need to be tested; hospitals able to handle demand
By Timothy Goh, The Straits Times, 5 Feb 2020

All patients with pneumonia in public hospitals have been undergoing tests for the coronavirus since last week, said the Ministry of Health (MOH) yesterday.

It said this on the same day it announced the confirmation of six new cases of the virus here.

One of the cases, a 28-year-old female Singapore resident, had gone to Tan Tock Seng Hospital's emergency department on Jan 30 and was discharged as her chest X-ray did not indicate she had pneumonia.

On Monday, however, she went to the Singapore General Hospital and was diagnosed with pneumonia.

Despite having no recent travel history to China, she was classified as a suspect case and immediately isolated, before being confirmed with the virus later that night.

MOH's director of medical services, Associate Professor Kenneth Mak, said yesterday that the woman had been tested for the virus as a result of the ministry's earlier decision to screen all pneumonia patients for it.

Pneumonia was the second-largest cause of death in Singapore in 2018, accounting for over one in five deaths here. There are about 500 to 600 patients with pneumonia here each week who will need to be tested for the virus.

Prof Mak said that Singapore is able to handle the demand for tests.

"We don't think the testing capacity is going to be an issue. We in fact have sufficient capacity to test these individuals (and) those who come on as suspected cases further downstream as well," he said.

A polymerase chain reaction (PCR) test is used to screen individuals for the virus here, said Prof Mak.

This is a test which analyses a short sequence of a person's DNA by copying it multiple times.

PCR tests are used for a number of reasons, including the detecting of bacteria or viruses, the diagnosing of genetic disorders and DNA fingerprinting.

Prof Mak said such tests typically take between two and four hours, but additional time is often needed to verify the results, sometimes extending the process to 24 hours.

On Singapore's efforts to test all pneumonia patients, he added: "It's an ongoing process... As new cases come in, they will also be tested in turn."

The Straits Times understands that in addition to efforts by the public hospitals, the four private hospitals under the Parkway Pantai group will also be testing pneumonia patients for the virus. 

Additional reporting by Joyce Teo

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