Sunday, 9 February 2020

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

He urges Singaporeans to stay united and resolute, adding that nation is much better prepared to deal with situation than it was 17 years ago with SARS
By Linette Lai, Political Correspondent, The Sunday Times, 9 Feb 2020

The coronavirus outbreak is a test of Singapore's social cohesion and psychological resilience, said Prime Minister Lee Hsien Loong, as the country announced seven new confirmed cases yesterday.

It is the biggest jump reported in a single day, bringing the total number of people infected here to 40. Four are in critical condition, the Ministry of Health (MOH) said in an update last night.

A possible new cluster has also been identified, linked to The Life Church and Missions Singapore in Paya Lebar, the third after a medical products shop in Lavender and the Grand Hyatt Singapore.

Among the new confirmed cases are a taxi driver and a private-hire car driver. MOH added that for the general public, the risk of infection from transient contact, such as on public transport or in public places, is assessed to be low.

In a recorded video message released earlier in the evening, PM Lee urged Singaporeans to take courage and see through the current stressful time together.

"Fear and anxiety are natural human reactions. We all want to protect ourselves and our families from what is still a new and unknown disease," he said.

PM Lee added: "But fear can do more harm than the virus itself. It can make us panic, or do things which make matters worse, like circulating rumours online, hoarding face masks or food, or blaming particular groups for the outbreak."

Instead, he held up as positive examples those who have gone the extra mile by volunteering to distribute masks to households, or delivering food to schoolmates on leave of absence.



Healthcare workers are on the front line treating patients, while others - including business federations, unions and public transport workers - are keeping Singapore running, he said.

"They are inspirations to all of us," said PM Lee, who also delivered his message in Mandarin and Malay. "This is what it means to be Singaporean. This is who we are."

Singapore is much better prepared to deal with the new coronavirus than it was 17 years ago, when the severe acute respiratory syndrome (SARS) outbreak occurred, PM Lee said.

It has stockpiled adequate supplies of masks and personal protective equipment, and expanded and upgraded medical facilities, including the new National Centre for Infectious Diseases.

It also has more advanced research capabilities to study the virus, and its doctors and nurses are better trained to deal with the situation.

"We are psychologically better prepared too," PM Lee added. "Singaporeans know what to expect, and how to react. Most importantly, having overcome SARS once, we know that we can pull through this too."

He pointed out that although the new virus is more infectious than SARS - and therefore harder to stop from spreading - it is much less dangerous.

About 10 per cent of those who contracted SARS died. But outside Hubei, the epicentre of the coronavirus outbreak, the death rate is only 0.2 per cent so far.

In comparison, seasonal influenza has a death rate of 0.1 per cent.

In Singapore, MOH said that among the 40 confirmed cases, two have been discharged, and most of the rest are stable or improving.

As of noon yesterday, 438 of the suspect cases have tested negative, while test results for the remaining 181 cases are pending.

MOH has so far identified 758 close contacts. Of the 663 who are still in Singapore, 647 have been contacted and are being quarantined or isolated.

Efforts are ongoing to contact the remaining 16 close contacts.



"But the situation is still evolving. Every day brings new developments, and we have to respond promptly and dynamically," PM Lee said. On Friday, Singapore raised the outbreak alert level to orange as more cases emerged with no known links to previous cases, or travel history to China.

Alongside moves to tighten access to hospitals and take extra precautions at large public events, PM Lee said he has postponed this year's Chinese New Year Istana Garden Party for grassroots leaders, which was to be held today.

If the numbers keep growing, Singapore will have to reconsider its strategy at some point, PM Lee said. This could mean encouraging those with mild symptoms to see a GP and stay at home, letting hospitals and healthcare workers focus on the most vulnerable patients.

He urged Singaporeans to stay united and resolute.

"Take sensible precautions, help one another, stay calm, and carry on with our lives," he said.


















Coronavirus: Singapore to review strategy if cases climb, says Prime Minister Lee Hsien Loong
Hospitals should be able to focus on most vulnerable patients, says PM Lee
By Linette Lai, Political Correspondent, The Sunday Times, 9 Feb 2020

Singapore will have to reconsider its strategy if the number of coronavirus cases continues to grow, said Prime Minister Lee Hsien Loong yesterday.

"If the virus is widespread, it is futile to try to trace every contact. If we still hospitalise and isolate every suspect case, our hospitals will be overwhelmed," he said in a statement on the outbreak.

"At that point, provided that the fatality rate stays low like flu, we should shift our approach."

In such circumstances, those who have only mild symptoms should see a general practitioner and rest at home instead of going to the hospital, Mr Lee said.

Hospitals and healthcare workers will then be able to focus on the most vulnerable patients - the elderly, young children and those with medical complications.

"We are not at that point yet," PM Lee added. "It may or may not happen, but we are thinking ahead and anticipating the next few steps. And I am sharing these possibilities with you, so that we are all mentally prepared for what may come."

Outside the epicentre of China's Hubei province, the death rate for the new virus has stood at 0.2 per cent so far.

In comparison, seasonal influenza has a death rate of 0.1 per cent, while that of the severe acute respiratory syndrome (SARS) virus is around 10 per cent.

"So in terms of mortality, the new virus is much closer to influenza than SARS," PM Lee said.

Last Friday, Singapore raised its disease outbreak alert level to orange, meaning that the outbreak is deemed to have moderate to high public health impact.



It is an acknowledgement that there is local spread, with a possibility that the disease may spread even more widely across the country. But in spite of the increased spread, the situation is still considered to be under control.

"In the last few days, we have seen some cases which cannot be traced to the source of infection. These worried us, because it showed that the virus is probably already circulating in our own population," PM Lee said.

He added that this is why the outbreak alert level has been raised to orange and the Government is stepping up measures.

These include reducing mingling in schools, tightening access to hospitals, and taking extra precautions at large public events.

The last time the outbreak alert status was raised to orange was in 2009, for the H1N1 swine flu outbreak.

"So there is no need to panic. We are not locking down the city or confining everybody to stay at home. We have ample supplies, so there is no need to stock up with instant noodles, tinned food or toilet paper, as some people did yesterday," PM Lee added, referring to Friday.



Professor David Heymann of the London School of Hygiene and Tropical Medicine, who headed the World Health Organisation's global response to SARS in 2003, said that much is unknown about the disease. For instance, the current understanding of the virus' mortality rate is "skewed" because until recently, China was looking only at people with pneumonia.

However, many more probably have the disease in a milder form, so the base number of patients could be much larger, he said.

The experts are also still unclear about how transmissible the virus is, Prof Heymann said, adding that there is no lifelong immunity for coronavirus infections.

Additional reporting by Salma Khalik















PM Lee Hsien Loong on the Novel Coronavirus (nCoV) Situation in Singapore on 8 February 2020

'Whatever the situation, we can each do our part'
Prime Minister Lee Hsien Loong spoke yesterday about the coronavirus situation in Singapore. Here is his statement in full.
The Sunday Times, 9 Feb 2020

We have faced the new coronavirus (nCoV) situation for about two weeks now.

The Ministerial Task Force, advised by Deputy Prime Minister Heng Swee Keat, has been leading the Government's response to this outbreak. They have been dealing with new developments every day, and holding regular press briefings to keep Singaporeans informed every step of the way.

Today, I want to speak to you directly, to explain where we are, and what may lie ahead.

We went through severe acute respiratory syndrome (SARS) 17 years ago, so we are much better prepared to deal with nCoV this time. Practically, we have stockpiled adequate supplies of masks and personal protective equipment. We have expanded and upgraded our medical facilities, including the new National Centre for Infectious Diseases. We have more advanced research capabilities to study the virus. We have more well-trained doctors and nurses to deal with this situation. We are psychologically better prepared too. Singaporeans know what to expect, and how to react. Most importantly, having overcome SARS once, we know that we can pull through this too.



The new coronavirus is similar to SARS, but with two important differences. First, the new virus is more infectious than SARS. Therefore it is harder to stop it from spreading. Second, the new virus is much less dangerous than SARS. About 10 per cent of those who caught SARS died. With the new virus, outside of Hubei province, the mortality rate is so far only 0.2 per cent. In comparison, seasonal influenza has a death rate of 0.1 per cent. So in terms of mortality, the new virus is much closer to influenza than SARS.

But the situation is still evolving. Every day brings new developments, and we have to respond promptly and dynamically. So far, most of our cases have either been imported from China, or can be traced to imported cases. When we discover them, we have isolated the patients, done contact tracing and quarantined close contacts. This has contained the spread and helped stamp out several local clusters. But in the last few days, we have seen some cases which cannot be traced to the source of infection. These worried us, because it showed that the virus is probably already circulating in our own population. This is why we raised the Dorscon (Disease Outbreak Response System Condition) to orange yesterday, and are stepping up measures. We are reducing mingling in schools. We are tightening up access to our hospitals. We are taking extra precautions at large public events. I have already postponed my Chinese New Year Istana Garden Party for grassroots leaders, which was to be held tomorrow. We have raised Dorscon to orange before. You may not remember, but this was in 2009, for the H1N1 swine flu. So there is no need to panic. We are not locking down the city or confining everybody to stay at home. We have ample supplies, so there is no need to stock up with instant noodles, tinned food or toilet paper, as some people did yesterday.

Whatever the situation, we can each do our part. One, observe personal hygiene - wash your hands often, and avoid touching your eyes or face unnecessarily. Two, take your temperature twice daily. And three, if you are not well, please avoid crowded places and see a doctor immediately. These simple steps do not take much effort, but if we all do them, they will go a long way towards containing the spread of the virus.

Right now, we are continuing to do contact tracing and to quarantine close contacts. But I expect to see more cases with no known contacts in the coming days.

If the numbers keep growing, at some point we will have to reconsider our strategy. If the virus is widespread, it is futile to try to trace every contact. If we still hospitalise and isolate every suspect case, our hospitals will be overwhelmed. At that point, provided that the fatality rate stays as low as the flu's, we should shift our approach. Encourage those who have only mild symptoms to see their family GP, and rest at home instead of going to the hospital, and let hospitals and healthcare workers focus on the most vulnerable patients - the elderly, young children and those with medical complications.

We are not at that point yet. It may or may not happen, but we are thinking ahead and anticipating the next few steps. And I am sharing these possibilities with you, so that we are all mentally prepared for what may come.

I am confident of the medical outcome of this outbreak. Most Singaporeans should remain well, and of those who get ill, most should expect to recover. Among those who have been hospitalised so far, most are stable or improving. Several have already recovered and been discharged, although a few remain in critical condition.

But the real test is to our social cohesion and psychological resilience. Fear and anxiety are natural human reactions. We all want to protect ourselves and our families from what is still a new and unknown disease. But fear can do more harm than the virus itself.

It can make us panic, or do things which make matters worse, such as circulating rumours online, hoarding face masks or food, or blaming particular groups for the outbreak. We should take courage and see through this stressful time together.

That is in fact what many Singaporeans are doing. Grassroots leaders and Team Nila volunteers have stepped forward to help distribute masks to households. University students are delivering food daily to schoolmates confined to their dormitories on leave of absence. Healthcare workers are on the front line, treating patients in hospitals and clinics and helping them get well again.

Business federations, unions and public transport workers are going the extra mile to maintain services, take care of workers and keep Singapore running.

They are inspirations to all of us. This is what it means to be Singaporean. This is who we are.

Let us stay united and resolute in this new coronavirus outbreak. Take sensible precautions, help one another, stay calm and carry on with our lives.















Singapore doing it right with measures, says expert who led WHO's fight against SARS
By Salma Khalik, Senior Health Correspondent, The Sunday Times, 9 Feb 2020

Singapore is doing what is needed to try to contain the coronavirus outbreak, said an infectious diseases expert who headed the World Health Organisation's (WHO) global response to SARS in 2003.

Professor David Heymann of the London School of Hygiene and Tropical Medicine said this may make things inconvenient for people, but "you have to put precautionary measures in until you understand what the potential of this outbreak is".

"So every precautionary measure based on national assessment should be followed," he added.

Prof Heymann currently chairs the Strategic and Technical Advisory Group for Infectious Hazards, which provides independent advice to WHO on potential threats to global health security.

He said Singapore "is not overdoing it" with the measures it has introduced.

Singapore moved to code orange on Friday and new measures include cancelling large-scale events if possible.

Earlier measures include not allowing non-residents who had been in Hubei in the past fortnight, or people holding passports issued in Hubei, from entering.

In a telephone interview from London with The Sunday Times, he said: "Singapore has been identifying cases, isolating them, done contact tracing, everything that's necessary to do to stop the outbreak."

This is what the WHO is recommending - to try to ring-fence or contain the disease.

But he added: "It's very difficult when before the disease is known, it's already out in the community. Some of the people coming in to China were exposed."

Singapore is now the country with the most number of coronavirus patients outside of China. This excludes the cruise ship docked in Japan which is classified as an international conveyance.

Prof Heymann said the high number is probably due to "multiple introductions" given the high number of visitors from China.

A major problem is that too much is unknown about the disease, which surfaced only at the end of last year.

Among the unknowns, which may even be more important in fighting a disease, he said, is "we don't yet fully understand the spectrum of the disease, how many cases are mild, like a cold, how many cases are severe".

"It looks like this is a relatively mild outbreak compared with SARS. But there is mortality, especially in the elderly, and those with diabetes, chronic diseases, et cetera."

Early indications point to less serious illness in children, but he added that more data is needed.



Prof Heymann also said that the current understanding of the virus' mortality rate is "skewed", because, until recently, China was only looking at people with pneumonia, in other words, those who are seriously ill.

But there are probably many more with the disease in a milder form who are not picked up, so the base number of patients could be much larger.

It is only recently that China is starting to pick up less severe cases.

Experts are still not clear about how transmissible the virus is. Early data points to droplets, he said. If it is airborne, the infection rate could be 10 times worse.

He said how severe the illness in a person is depends both on the person's own immune system, as well as how large the viral load is when the person is infected.

If someone who is very sick sneezes or coughs in the person's face, the viral load could be high.

If the infection is passed by someone with a mild illness, much like the common cold, the viral load would be low. But if the person getting infected has other medical conditions, he could still get seriously ill even with a low viral load, said Prof Heymann.

On how long the virus remains infective on surfaces, he said it can be transmitted so long as it remains moist. Once it dries up, it is no longer infective.

As to whether someone who recovers can get the infection again, he said it is not clear how long the antibodies last, but there is no lifelong immunity for coronavirus infections.

But he said infection controls everywhere, and definitely in Singapore, are at a standard where there should not be any hospital transmission.















Discharged patient thanks medical team's 'hearts of gold'
2nd person confirmed to have coronavirus is also given clean bill of health by hospital
By Salma Khalik, Senior Health Correspondent, The Sunday Times, 9 Feb 2020

For some years now, Ms Jiang, 53, who wants to be known only by her surname, had been hearing about how clean Singapore is and how friendly the people here are.

She yearned to visit, and her daughter, who had been to Singapore with a classmate some years back, saved from her salary to give her mother a treat.

Little did Ms Jiang expect to become Singapore's second confirmed coronavirus patient, just three days after she arrived for a holiday.

But one thing has panned out - she has found people here as friendly as she had been told, though much of the friendliness she experienced was from the medical staff who cared for her.

She has recovered and was discharged last Friday - the second patient to get a clean bill of health out of 40 identified so far.

"The medical team really have hearts of gold," she said in Mandarin. She said they had taken good care of her even though she is a foreigner. When she thanked them, they replied: "It is our job."

She added: "I was not afraid, because of the wonderful medical team you have here. I am but an ordinary mother, but I was brave and overcame it. From the experience, I also became stronger."

Ms Jiang arrived in Singapore on the morning of Jan 21, but started feeling unwell that afternoon. She did not think much of it till the following day, when she started coughing and was running a temperature.

She went to Raffles Hospital, but since she had come from Wuhan - the epicentre of the outbreak - the hospital sent her to Tan Tock Seng Hospital's (TTSH) Emergency Department at 9pm in an ambulance.

She was transferred to the National Centre for Infectious Diseases (NCID) on Jan 23 at 1am, and was immediately warded in an isolation room.

She said: "I thought I had the common cold. I have had such symptoms before, which were like the common cold."

Even after she was sent to TTSH, she said: "I didn't believe I caught the coronavirus infection, I comforted myself, thinking it was just the typical pneumonia."

But the following day, her worst fears were confirmed when she was told she had the coronavirus.



In the two days of sightseeing she managed to get in before she sought medical care, she had taken the MRT and taxis to Orchard Road, Marina Bay Sands and Gardens by the Bay. Now, she would very much like to go home as soon as possible.

"To be honest, Singapore is a wonderful country, in terms of its climate and in other areas too. But this is not my homeland after all.

"I understand that there was a chartered flight on Feb 5 for Wuhanese to return to China," she said. But she missed it as she was still in hospital.

All commercial flights between Singapore and Wuhan have been suspended because of the outbreak.

The doctor caring for her at the NCID had apologised that he could not discharge her in time for the chartered flight. He had explained that she still had some strain of the virus in her then, so it was not safe for her to be discharged.

She told him: "I should thank you. You are being responsible to me, to others and your profession by not discharging me. There is no need for you to apologise to me, I should thank you instead."

She said if the doctor had discharged her earlier, before she was fully well, she might have spread the disease to others.

"This is definitely unacceptable. I must be cleared of my virus thoroughly and be given a clean bill of health before I can go home."














Made-in-Singapore diagnostics test implemented in hospitals here
By Audrey Tan, Science and Environment Correspondent and Timothy Goh, The Sunday Times, 9 Feb 2020

A made-in-Singapore diagnostic test kit that detects the presence of the novel coronavirus (2019-nCoV) with high accuracy has been rolled out at some public hospitals here.

Plans are in place to scale up production so the kits can be deployed at other hospitals and laboratories which are not offering 2019-nCoV tests, said the Agency for Science, Technology and Research (A*Star), whose scientists developed the pre-packed reagents.

This will widen the network of facilities in Singapore that can accurately screen patients for the coronavirus, reducing the wait time for results and allowing those infected to be treated quickly.

The test kit was developed by scientists at A*Star's Experimental Drug Development Centre and Bioinformatics Institute.

A number of public hospitals here last weekend received 5,000 test kits in total, and Singapore has the capability to produce more, A*Star said. Singapore also sent 10,000 of the test kits to China to help prevent further spread of the coronavirus.



Currently, to determine if someone has been infected with 2019-nCoV, samples are first taken from the patient. These are then processed by laboratory technologists at the hospitals. The technologists mix reagents together in a tube before placing the sample in it, then feed it into a machine which can take between two and four hours to register a reading.

But the entire process could take up to a day, said Prof Lin, highlighting factors such as the time to transport the sample, and sort the data.

However, a test kit could expedite this process at some laboratories by reducing the time required for preparing the reagent mix.



Such tests are pre-packed with reagents mixed in the right quantities, and with quality control tubes included. All that is required is for technologists to place the patient's sample in the tube before feeding it to the machine.

The diagnostics test kit also makes the procedure easier, allowing more laboratories in Singapore - including those with less experience working with reagents required to test for 2019-nCoV - to conduct them as well, without compromising accuracy.




 





How contact tracers track down the people at risk of infection
By Salma Khalik, Senior Health Correspondent, The Sunday Times, 9 Feb 2020

There are seven teams comprising 10 people here, working in two shifts from 8.30am till 10pm, seven days a week. Their job - calling people to check if they are "close contacts" of coronavirus patients.

This group of contact tracers was activated when Singapore confirmed its first case of coronavirus infection last month.

Their job is a critical part of ring-fencing the virus by rounding up patients who may have been infected.

Close contacts are people who have had prolonged physical contact with or stayed in the same place as the patient.

It could include, for instance, someone driving the patient from the airport to a hotel, at a time when the person does not yet seem sick.

Any close contact must be quarantined for 14 days from their last contact with the patient.

But contact tracing does not start with these teams.

It begins in the hospital.

Dr Olivia Oh, assistant director in the Communicable Diseases Division of the Ministry of Health (MOH), said the hospital where the patient is warded would do an activity map - this refers to everything the patient has done and the people he has been with over the previous two weeks.

Her colleague, Mr Pream Raj, also an assistant director in the division, added: "The mapping is detailed, 24 hours, minute by minute, with no gaps."

If there are gaps, then the contact tracing team would call a patient to try and jog his memory. And if the patient is too sick, they would approach his next of kin instead.

He said although 14 days may seem like a long time ago, most people have routines, so it is not that difficult to recall what they had been doing.

If they had meals with people, and because of Chinese New Year many did, they need to remember who was there. If it was at a restaurant, they need to recall if any of the serving staff spent much time with them, or if the contact was casual.



For the 17 patients from China who were confirmed with the virus here, Dr Oh said they would start the contact tracing from the time they arrived in Singapore, assuming that they had caught the virus while still in China.

They would get the list of passengers sitting in the same row, as well as two rows in front and two rows behind the patient, from the airline, and get in touch with them.

Mr Raj said the airlines, taxi companies and Grab, since quite a number of the visitors use that service, have all been very cooperative - they are obliged to provide all information required under the Infectious Diseases Act.

Sometimes, patients have no taxi receipt, remembering only that they were in a blue cab. The contact tracers would go through the closed circuit television footage at the hotel driveway to identify the taxi.

He added that they try to identify and get in touch with all possible close contacts of a patient to verify that what the patient had said was correct within 24 hours.



If the person is deemed at risk of infection, an MOH officer, together with a Certis guard, would serve notice of quarantine to the person, who will then be given the choice of staying at home or going to a government quarantine facility if his home premises are not suitable.

For home quarantine, the person must have a room and toilet that is not shared with anyone else.

The locations of where individual patients had been is also cross-referenced with other patients' activity maps to see if there are any overlaps.

These are analysed by another team and any links are flagged, and further cross-checks made.

Mr Raj said several such links have been found.

It could be anything from both patients attending the same event to meeting the same person.












































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