Saturday, 15 February 2020

COVID-19: Clinics roped in to help detect and manage coronavirus cases from 18 February 2020

Public Health Preparedness Clinics re-activated to reduce risk of COVID-19 spread

MOH activates 900 clinics; doctors advised to give 5-day medical leave to patients with respiratory symptoms

Citizens and permanent residents will pay a flat rate of $10 for consultation and treatment, while the Pioneer and Merdeka Generation seniors will pay $5
By Linette Lai, Political Correspondent, The Straits Times, 15 Feb 2020

People with respiratory symptoms such as cough, fever and sore throat will pay a maximum of $10 when they seek treatment at polyclinics and about 900 designated clinics as the Government steps up its response to the coronavirus outbreak.

The Ministry of Health (MOH) is also re-activating the Public Health Preparedness Clinics (PHPCs) - previously used to deal with the haze and the H1N1 pandemic - to better detect and manage the disease now named COVID-19.

Doctors at all clinics, even those not designated as a PHPC, have also been advised to give five days of sick leave to patients with such respiratory symptoms.

In announcing these moves yesterday, Health Minister Gan Kim Yong said at a news conference that the PHPC clinics are an important line of defence during public health outbreaks.

They provide subsidised treatment, investigations and medication during outbreaks. Staff at these general practitioner clinics have been guided on "the appropriate care protocols according to the assessed risk and diagnosis of each patient", and will be supplied with personal protection equipment.

The network of clinics will be progressively activated from Tuesday, 18 February. Citizens and permanent residents will pay a flat rate of $10 for consultation and treatment, while those belonging to the Pioneer and Merdeka generations will pay $5.

Those with respiratory symptoms can also go to polyclinics, where the same subsidies will apply.

On the guidance to doctors to give five-day medical certificates for patients with respiratory symptoms, Mr Gan said the authorities noticed that many confirmed cases had not isolated themselves even after falling ill.

"We are quite concerned that many of the local confirmed cases had remained in the community, and some had gone back to work even when they were ill, after they had seen a doctor," Mr Gan said.

"This is not helpful in our efforts to reduce the risk of community transmission."

The five-day duration will also help separate the genuine coronavirus cases from those with other ailments. People who do not recover within five days will be referred for further medical assessments and tests. They are encouraged to return to the same doctor when they seek further treatment.

In a separate statement, MOH noted that although most people with respiratory symptoms do not have the coronavirus, they should still seek medical treatment early and stay home throughout their illness.

Members of the public can refer to for the updated list of preparedness clinics. They can also identify the preparedness clinics from the PHPC decal at these clinics.

Singapore has no plans to go to DORSCON red, says Health Minister Gan Kim Yong
By Fabian Koh, The Straits Times, 15 Feb 2020

There are currently no plans to escalate the national disaster alert response level in relation to the coronavirus outbreak, Health Minister Gan Kim Yong said yesterday.

The Disease Outbreak Response System Condition (DORSCON) level was raised from "yellow" to "orange" on Feb 7 amid indications that the disease, now known as COVID-19, was spreading in the community.

Mr Gan, who co-chairs the multi-ministry task force tackling the coronavirus, said at a news conference that rumours going around that the DORSCON level will be raised from "orange" to "red", its highest level, impedes the Government's efforts in helping patients.

"I want to say categorically that we have no plans to go to DORSCON red. So, please help me stop these rumours going forward so that we can focus our efforts on dealing with our patients and support them."

Mr Gan said the battle to stop the spread of the virus is already challenging enough. "We don't really want to have to spend efforts stopping the spread of rumours."

The Ministry of Health has said the DORSCON categories are not cast in stone, but are general guidelines for action.

In the colour coding system, "green" means the disease is mild or it is severe but does not spread easily. "Yellow" refers either to a disease that is spreading but is a mild infection or being contained, or a severe infection that spreads easily but is occurring outside Singapore.

"Orange" means the disease is severe with transmission, but is generally contained, and has moderate to high public health impact. "Red" signifies a severe disease that is spreading widely.

Yesterday, Mr Gan said that having the DORSCON level downgraded to "yellow" or "green" involves taking into account many factors beyond just the Government changing its management strategy in this crisis.

"The measures... are not necessarily so closely tied to the DORSCON level. Some of the measures that we were taking when we were in 'yellow' were already (for those should we be) in 'orange'.

"And if the situation evolves such that some of the measures (can be) rolled back, we may roll back before we downgrade the DORSCON," he said.

Mr Gan added that moving the DORSCON level is a judgment call "to a very large extent", which also takes into account advice and expert inputs from professionals, and a general assessment of the situation.

"It is not an easy thing to list out 'these are the conditions' and if you tick all the boxes, it will be downgraded," he said.

Strategies to be updated as more is known of coronavirus: Lawrence Wong
Research shows its transmission is different from Sars, more like H1N1 flu
By Fabian Koh, The Straits Times, 15 Feb 2020

As more information on the coronavirus surfaces, Singapore will reassess and update its strategies to deal with the evolving situation, National Development Minister Lawrence Wong said yesterday.

One potential strategy if widespread community transmission happens here would be to discontinue contact tracing for every individual, he said.

"Instead, we will look at the patients who come forward," he added. The majority of those with mild symptoms can visit GPs and, with necessary precautions, will recover in due course, he said.

The more severe cases will be referred to hospitals, where they can get more specialised treatment.

Mr Wong said the Government used the same strategy to handle the H1N1 situation in 2009.

"We are not saying we are there yet. This is not our strategy today, which is still to contain the spread of the virus," he emphasised.

"That is the strategy that countries everywhere are still adopting."

Giving an update on the latest research, Mr Wong said it is now clear the transmission mechanism of the disease known as COVID-19 is different from the severe acute respiratory syndrome (Sars) which struck in 2003, and more similar to the H1N1 influenza which struck in 2009.

Mr Wong said this has been confirmed by researchers at the National Centre for Infectious Diseases (NCID), who looked at the Singapore cases and found that like influenza, the coronavirus is infectious when the symptoms are mild.

"With our mild symptoms, we sometimes let our guard down - we continue going out even though we don't really feel well, and that is how the virus transmits," he added.

He noted that the coronavirus is less severe than Sars. The mortality rate in China, and more so globally, is lower than it was for Sars.

Mr Wong, who co-chairs the Multi-Ministry Taskforce on the coronavirus, added that various studies are being done and cited one by the World Health Organisation (WHO) of 17,000 patients.

They found that 82 per cent of the patients have mild symptoms, 15 per cent have severe symptoms and 3 per cent have critical symptoms.

"It is not a mild illness at all, but certainly not of the severity of Sars," he said of COVID-19. "It is less severe; it is more infectious than Sars; it is different from Sars. That is why because of the higher degree of infection, various experts have also projected that the disease may well spread at a much faster rate - closer, more akin to H1N1."

Mr Wong also highlighted a study by Harvard University's school of public health on airline travel volume, which concluded the virus may well have spread undetected to various countries in the region, including Indonesia and Thailand.

Public health experts globally have also said the number of people infected with the coronavirus outside of China "cannot possibly remain at current levels", he added.

"It is a matter of time before you see a lot of people around the world getting the disease," he said.

Mr Wong noted how during the H1N1 and flu pandemic in 2009, 10 per cent to 20 per cent of the global population contracted the illness. "In Singapore alone, more than 400,000 people got ill from H1N1 in less than a year. We are not saying that this will happen for COVID-19. It is a different disease than H1N1, so the patterns of transmission and the number of people contracting the disease will be different," he said.

"But because the transmission patterns are similar to H1N1, we should be prepared for a scenario where you get wider transmission around the world."

He also noted while Prime Minister Lee Hsien Loong spoke about a possible change in approach should the virus become more widespread, "we are not there yet". Mr Wong said there is no widespread community transmission of the virus here or elsewhere at this stage. "All of us are doing everything we can to reduce the risk of further spread."

But new information on the virus is also being discovered every day. "As we get more of this information, we will share it with everyone so that everyone is informed and updated on the latest understanding of this virus," he said.

Mr Wong noted that four coronaviruses already form part of the common flu family, so the latest one is not unusual in that sense. "Will COVID-19 be the fifth? I don't know. The fact of the matter is, this will not be the first coronavirus to form part of the common flu that we get."

He said that what is key now is understanding the new virus, and for that, Singapore has to continue working with scientists and researchers from other countries.

"Our database is very small. We are dealing with the cases we have, but you need to look at a larger sample... to get some better sense of the patterns and the kinds of severity for different patients," he added.

No plans to close schools yet, says Education Minister Ong Ye Kung
Extra precautions taken but situation will be monitored closely, he says
By Jolene Ang, The Straits Times, 15 Feb 2020

There are no plans to close schools yet, Education Minister Ong Ye Kung said yesterday. It is a big and difficult decision with pros but also significant cons, he said.

"For many parents, the pro is that 'I can keep my child at home, I can look after my child and I feel a sense of safety'," he said.

But there are three downsides to closing schools in the light of the coronavirus outbreak, he told reporters during a visit to First Toa Payoh Primary School.

The first is that infections can happen even in homes, for example, if parents bring back germs from work outside. But schools have cleaning and disinfection routines to keep a school environment safe.

Mr Ong said the second disadvantage of shutting schools is that children may not stay at home all the time during a school closure.

He said: "So, they will go out, which is good... You get out in the open, you exercise, you get under the sun, which raises their resilience and immunity. But at the same time, they are also mingling in public spaces.

"In school, they are kept within this environment with a protocol, with teachers repeatedly reminding and bringing them to wash their hands, reminding not to touch their face, making sure that those who come in with a fever or are not feeling well are asked to rest at home.

"So, today in school, it is a much more regimented and cleaner environment."

The third disadvantage is one that is often underestimated, the minister said. "It is a big disruption to many parents and students' lives. At the beginning, we may feel safe, but as schools continue to be closed, after a while, normalcy is disrupted."

Parents who are working may have to make alternative childcare arrangements, and prolonged closure can also instil a sense of fear and despair, he added.

Closing schools would be "a big decision", said Mr Ong, adding: "We will consider and monitor the situation closely. As of now, I think we should keep schools going, but take extra precautions, as we have already done."

Some measures taken include suspending large gatherings or communal activities such as mass assemblies and school camps, and staggering recess timings.

Mr Ong noted that schools were closed for a while during the severe acute respiratory syndrome (Sars) period to "beef up our systems".

"That was when we made sure every child had a thermometer, every school gate had temperature checks and all the school protocols were put in place... but all those systems are in place today."

Mr Ong was at First Toa Payoh Primary School to launch a campaign to rally pupils against the coronavirus, ahead of Total Defence Day today. The campaign's objectives include helping pupils to develop good personal hygiene habits and practise social responsibility.

The minister also joined a lesson at MK @ First Toa Payoh, a Ministry of Education kindergarten, where the children learnt a song that taught them how to wash their hands properly.

He also visited a Primary 6 class and learnt a rap song, created by MOE, with the pupils. They were introduced to five superhero characters, such as Hands Down Hana who reminds pupils not to touch their face, while Mask Up Mei Mei tells those unwell to wear a mask.

Primary 3 pupil Shen Yi Ping said his teacher has been teaching his classmates to wash their hands regularly with soap and water and not to touch their faces unnecessarily.

Added the nine-year-old: "Now, the school is very strict, and we have to do a health check every time we come to school."

Ministry of Health - Updates on COVID-19 (Coronavirus Disease 2019) Local Situation 2019 - COVID-19 (Coronavirus Disease 2019) situation in Singapore

2019 Novel Coronavirus: Ministerial Statement on Whole-of-Government Response

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

Wuhan virus: Singapore has to stay vigilant, but has every reason to be confident, says PM Lee Hsien Loong

Wuhan virus: Each Singapore household to get 4 free masks for contingencies; collection starts on 1 Feb till 9 Feb 2020

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

2019-nCoV: Singapore employers will receive $100 a day for each worker serving the 14-day Leave of Absence (LOA)

DORSCON Orange: Singapore raises coronavirus outbreak alert on 7 February 2020; Singaporeans clear supermarket shelves in panic buying of essentials

Fear and panic can do more harm than coronavirus: PM Lee Hsien Loong

Singapore to work closely with China to battle novel coronavirus threat: Deputy Prime Minister Heng Swee Keat

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