Singapore sees record 47 new coronavirus cases on 18 March 2020
33 of the 47 new cases confirmed were imported cases, with a large majority of them returning residents and long-term pass holders
Plans to raise capacity to treat COVID-19 patients
Singapore measures meant to ensure healthcare system copes at peak: Gan Kim Yong
Without tough steps, Singapore might have 5,000 cases by now
Singapore residents told to defer all overseas travel
Self-isolation for all entering here from 11.59pm, 20 March 2020; 33 of the 47 new cases are imported
By Chang Ai-Lien, Science and Health Editor and Lim Min Zhang, The Straits Times, 19 Mar 2020
Singaporeans have been told to put all travel on hold, and those who return from abroad will have to stay at home for 14 days to prevent any further spread of Covid-19.
The tough new measures were announced yesterday as the country reported 47 new cases (18 March) - a new high - and most of them were imported.
This brings the total number of cases here to 313.
In line with recent trends, 33 of the new cases are imported, and 30 of them involve Singapore residents returning from abroad.
The new, broader measures to contain the coronavirus come as the country braces itself for a spike in infections.
The travel advisory takes immediate effect.
From 11.59pm, 20 March, all Singaporeans, permanent residents, long-term pass holders and short-term visitors entering Singapore will be served with a 14-day stay-home notice - they have to remain in their place of residence at all times.
As more Singaporeans, such as students and workers, return home, the country has to be mentally prepared that numbers could continue rising in the coming days, said National Development Minister Lawrence Wong, who co-chairs the multi-ministry task force set up to deal with the outbreak.
The rise in the number of infections revealed yesterday and in recent days was a cause for concern for all, Mr Wong said at a news conference yesterday.
"We cannot afford to take further risks if the number of imported cases continues to rise. That is why we are imposing additional border controls and travel restrictions today."
As far as Singapore residents are concerned, they have been told to defer all travel - a more stringent requirement than the earlier advisory to put off non-essential travel.
As for those returning to Singapore, Mr Wong said: "This means a Singaporean coming back from anywhere in the world will have to serve a full 14-day self-isolation period."
As part of the more stringent measures, the Manpower Ministry said that from 11.59pm tomorrow, all new and existing work-pass holders planning to enter or return to Singapore from any country will have to obtain approval before they commence their journeys.
New measures are also being planned to increase distancing among people, especially among seniors and vulnerable people in the local community, to further reduce the risk of local transmission.
In addition, there will be extra precautions in place for children who have gone overseas during this period, with children having to stay at home for 14 days, even if this is before tomorrow's deadline.
This comes amid a sharp increase in the number of cases and widening spread of the virus across the world. There are now more than 208,000 Covid-19 cases across about 170 countries, and more than 8,200 deaths, with many countries experiencing an exponential rise in cases.
The number of new cases daily in Singapore has been on an uptick, with 14 on Sunday, 17 on Monday, 23 on Tuesday, and 47 yesterday, all of which were new daily highs.
Over the past three days, about 70 per cent of the new cases here were imported, and most of these were Singapore residents and long-term pass holders returning to Singapore after travel abroad, the Health Ministry said yesterday.
Task force co-chairman and Health Minister Gan Kim Yong said yesterday: "Today, we have 47 cases, we do expect to see higher numbers than this in time to come."
And the country has prepared for an increase in the number of imported cases over the next few weeks.
Mr Gan stressed that while healthcare capacity was still sufficient to deal with the current case load, with a sufficient buffer to manage new cases, the number of cases must be managed so as to reduce the peak case number in any day.
"We hope to have fewer cases, but that means the infection as a whole, the outbreak as a whole, may last a bit longer, so we have to be prepared for that, and this is part of the strategy that we are putting in place."
33 of the 47 new cases confirmed were imported cases, with a large majority of them returning residents and long-term pass holders
Plans to raise capacity to treat COVID-19 patients
Singapore measures meant to ensure healthcare system copes at peak: Gan Kim Yong
Without tough steps, Singapore might have 5,000 cases by now
Singapore residents told to defer all overseas travel
Self-isolation for all entering here from 11.59pm, 20 March 2020; 33 of the 47 new cases are imported
By Chang Ai-Lien, Science and Health Editor and Lim Min Zhang, The Straits Times, 19 Mar 2020
The tough new measures were announced yesterday as the country reported 47 new cases (18 March) - a new high - and most of them were imported.
This brings the total number of cases here to 313.
In line with recent trends, 33 of the new cases are imported, and 30 of them involve Singapore residents returning from abroad.
The new, broader measures to contain the coronavirus come as the country braces itself for a spike in infections.
The travel advisory takes immediate effect.
From 11.59pm, 20 March, all Singaporeans, permanent residents, long-term pass holders and short-term visitors entering Singapore will be served with a 14-day stay-home notice - they have to remain in their place of residence at all times.
As more Singaporeans, such as students and workers, return home, the country has to be mentally prepared that numbers could continue rising in the coming days, said National Development Minister Lawrence Wong, who co-chairs the multi-ministry task force set up to deal with the outbreak.
The rise in the number of infections revealed yesterday and in recent days was a cause for concern for all, Mr Wong said at a news conference yesterday.
"We cannot afford to take further risks if the number of imported cases continues to rise. That is why we are imposing additional border controls and travel restrictions today."
As far as Singapore residents are concerned, they have been told to defer all travel - a more stringent requirement than the earlier advisory to put off non-essential travel.
As for those returning to Singapore, Mr Wong said: "This means a Singaporean coming back from anywhere in the world will have to serve a full 14-day self-isolation period."
As part of the more stringent measures, the Manpower Ministry said that from 11.59pm tomorrow, all new and existing work-pass holders planning to enter or return to Singapore from any country will have to obtain approval before they commence their journeys.
New measures are also being planned to increase distancing among people, especially among seniors and vulnerable people in the local community, to further reduce the risk of local transmission.
In addition, there will be extra precautions in place for children who have gone overseas during this period, with children having to stay at home for 14 days, even if this is before tomorrow's deadline.
This comes amid a sharp increase in the number of cases and widening spread of the virus across the world. There are now more than 208,000 Covid-19 cases across about 170 countries, and more than 8,200 deaths, with many countries experiencing an exponential rise in cases.
The number of new cases daily in Singapore has been on an uptick, with 14 on Sunday, 17 on Monday, 23 on Tuesday, and 47 yesterday, all of which were new daily highs.
Over the past three days, about 70 per cent of the new cases here were imported, and most of these were Singapore residents and long-term pass holders returning to Singapore after travel abroad, the Health Ministry said yesterday.
Task force co-chairman and Health Minister Gan Kim Yong said yesterday: "Today, we have 47 cases, we do expect to see higher numbers than this in time to come."
And the country has prepared for an increase in the number of imported cases over the next few weeks.
Mr Gan stressed that while healthcare capacity was still sufficient to deal with the current case load, with a sufficient buffer to manage new cases, the number of cases must be managed so as to reduce the peak case number in any day.
"We hope to have fewer cases, but that means the infection as a whole, the outbreak as a whole, may last a bit longer, so we have to be prepared for that, and this is part of the strategy that we are putting in place."
Singapore measures meant to ensure healthcare system copes at peak
But this would also mean outbreak may last longer, and Singapore has to be prepared for that, says Health Minister Gan Kim Yong
By Lim Min Zhang, The Straits Times, 19 Mar 2020
Many of Singapore's measures are aimed at ensuring that when coronavirus cases hit their peak, it is at a lower level, is deferred for as long as possible and the system still has capacity to spare, Health Minister Gan Kim Yong said yesterday.
But this would also mean that the outbreak may last longer, and Singapore has to be prepared for that, he added at a news conference to announce new measures to arrest the spread of the virus.
Mr Gan, who is co-chairman of a multi-ministry task force set up to deal with the coronavirus, was responding to a question about whether there was a risk that Singapore's healthcare system would not be able to cope with a large increase in the number of confirmed Covid-19 cases.
The Ministry of Health reported a record 47 confirmed cases yesterday, bringing the total number here to 313. Of the 47, 33 were imported cases.
The task force also announced that from 11.59pm tomorrow, all Singaporeans, permanent residents, long-term pass holders and short-term visitors entering Singapore will be issued a 14-day stay-home notice.
Mr Gan said: "Many of the things we have put in place... are aimed at reducing the peak number, and also to defer as long as possible so that we have sufficient capacity for the cases, and we do want to preserve as much buffer capacity as possible.
"So, it is in our interests to ensure that we reduce it as much as possible and to defer it as long as possible. By deferring the peak, it also may mean that the outbreak might last longer because, instead of everyone coming down with Covid-19, we stretch it out."
He added that this was part of the strategy that Singapore has put in place, which includes reducing both imported cases and the risk of local transmissions.
Director of medical services Kenneth Mak, who was also at the news conference, along with National Development Minister Lawrence Wong, said that the healthcare system being possibly overwhelmed was a scenario that they were prepared for.
Associate Professor Mak said: "This is something that we are always mindful of, that there is a possibility that the number of cases will continue to rise. And there is always a potential that if numbers rise very significantly over a short period of time, that they may potentially overwhelm our capacity and capability.
"That has not occurred yet, and we do have plans that allow us then to expand our capacity and capability accordingly as needed."
Prof Mak also said that the travel restrictions announced yesterday were aimed at cutting the number of imported cases.
He said the aim was to detect and ring-fence cases early so that there were fewer imported cases generating new clusters.
Mr Wong, who is also co-chairman of the task force, said that the Ministry of Education (MOE) will announce new measures to complement the travel restrictions that the task force has in place.
"They are indeed going to take extra precautions for family members and children who have gone overseas during this period, and when the family members return, even if they had returned before the deadline that we have put in place, MOE will want the children to stay at home for 14 days just to have extra precautions," said Mr Wong.
He added that Singaporeans should not rush to come back home to meet the deadline, but that the responsible thing to do would be to self-isolate at home for a few days.
"You never know what can happen because, especially if you are overseas and given the way the virus is spreading everywhere in the world, the best precaution you can take to protect yourself and your family members is just to spend some time self-isolating at home," he said.
But this would also mean outbreak may last longer, and Singapore has to be prepared for that, says Health Minister Gan Kim Yong
By Lim Min Zhang, The Straits Times, 19 Mar 2020
Many of Singapore's measures are aimed at ensuring that when coronavirus cases hit their peak, it is at a lower level, is deferred for as long as possible and the system still has capacity to spare, Health Minister Gan Kim Yong said yesterday.
But this would also mean that the outbreak may last longer, and Singapore has to be prepared for that, he added at a news conference to announce new measures to arrest the spread of the virus.
Mr Gan, who is co-chairman of a multi-ministry task force set up to deal with the coronavirus, was responding to a question about whether there was a risk that Singapore's healthcare system would not be able to cope with a large increase in the number of confirmed Covid-19 cases.
The Ministry of Health reported a record 47 confirmed cases yesterday, bringing the total number here to 313. Of the 47, 33 were imported cases.
The task force also announced that from 11.59pm tomorrow, all Singaporeans, permanent residents, long-term pass holders and short-term visitors entering Singapore will be issued a 14-day stay-home notice.
Mr Gan said: "Many of the things we have put in place... are aimed at reducing the peak number, and also to defer as long as possible so that we have sufficient capacity for the cases, and we do want to preserve as much buffer capacity as possible.
"So, it is in our interests to ensure that we reduce it as much as possible and to defer it as long as possible. By deferring the peak, it also may mean that the outbreak might last longer because, instead of everyone coming down with Covid-19, we stretch it out."
He added that this was part of the strategy that Singapore has put in place, which includes reducing both imported cases and the risk of local transmissions.
Director of medical services Kenneth Mak, who was also at the news conference, along with National Development Minister Lawrence Wong, said that the healthcare system being possibly overwhelmed was a scenario that they were prepared for.
Associate Professor Mak said: "This is something that we are always mindful of, that there is a possibility that the number of cases will continue to rise. And there is always a potential that if numbers rise very significantly over a short period of time, that they may potentially overwhelm our capacity and capability.
"That has not occurred yet, and we do have plans that allow us then to expand our capacity and capability accordingly as needed."
Prof Mak also said that the travel restrictions announced yesterday were aimed at cutting the number of imported cases.
He said the aim was to detect and ring-fence cases early so that there were fewer imported cases generating new clusters.
Mr Wong, who is also co-chairman of the task force, said that the Ministry of Education (MOE) will announce new measures to complement the travel restrictions that the task force has in place.
"They are indeed going to take extra precautions for family members and children who have gone overseas during this period, and when the family members return, even if they had returned before the deadline that we have put in place, MOE will want the children to stay at home for 14 days just to have extra precautions," said Mr Wong.
He added that Singaporeans should not rush to come back home to meet the deadline, but that the responsible thing to do would be to self-isolate at home for a few days.
"You never know what can happen because, especially if you are overseas and given the way the virus is spreading everywhere in the world, the best precaution you can take to protect yourself and your family members is just to spend some time self-isolating at home," he said.
Coronavirus: Over 70% of 47 new cases in Singapore had returned from abroad
By Clara Chong, The Straits Times, 19 Mar 2020
Over 70 per cent of Singapore's largest single-day surge in Covid-19 cases comprised people coming into Singapore from overseas.
The Ministry of Health (MOH) said yesterday that 33 of the 47 new cases confirmed were imported cases, with a large majority of them returning residents and long-term pass holders. Only three were short-term visitors.
Yesterday's numbers add to what has been a sharp increase in the number of imported cases in the past week. There were 101 cases from overseas in just the past week, compared with 34 in the nearly two months prior.
In total, 135 of the 313 cases in Singapore are imported cases.
The rising numbers are a reflection of the global nature of the outbreak, Health Minister Gan Kim Yong said at a news conference yesterday.
Singapore should expect the number of imported cases to continue to rise, he said.
"We have to take into consideration what is happening to the rest of the world... Because we are connected to the rest of the world, even though we have travel restrictions, we have travel advisories, there will still be Singaporeans who will make necessary trips overseas and will (still) have a risk of importation."
Of the cases confirmed yesterday, a total of 11 patients had been to the United Kingdom, and seven to the United States. There were also cases with a travel history to India, Switzerland, Croatia, France, Germany, Austria, Thailand, the Philippines, Indonesia and Turkey.
Associate Professor Kenneth Mak, director of medical services at MOH, said: "It is clear that in terms of cases with travel history, the countries that our imported cases have an association with goes well beyond the countries we currently have travel restrictions on."
Of the locally transmitted cases, two are linked to the clusters at Church of Singapore (Bukit Timah) and boulder+ gym, while one is linked to the Masjid Al-Muttaqin cluster.
Six others are linked to previous cases, while contact tracing is taking place for another five.
Three more patients were discharged yesterday, bringing the total number of those who have recovered to 117. Of the 196 patients still in hospital, most are stable or improving, while 15 are in critical condition in the intensive care unit.
As of noon yesterday, MOH has identified 6,250 people who are close contacts of confirmed cases. Of these, 2,221 are still in quarantine.
By Clara Chong, The Straits Times, 19 Mar 2020
Over 70 per cent of Singapore's largest single-day surge in Covid-19 cases comprised people coming into Singapore from overseas.
The Ministry of Health (MOH) said yesterday that 33 of the 47 new cases confirmed were imported cases, with a large majority of them returning residents and long-term pass holders. Only three were short-term visitors.
Yesterday's numbers add to what has been a sharp increase in the number of imported cases in the past week. There were 101 cases from overseas in just the past week, compared with 34 in the nearly two months prior.
In total, 135 of the 313 cases in Singapore are imported cases.
The rising numbers are a reflection of the global nature of the outbreak, Health Minister Gan Kim Yong said at a news conference yesterday.
Singapore should expect the number of imported cases to continue to rise, he said.
"We have to take into consideration what is happening to the rest of the world... Because we are connected to the rest of the world, even though we have travel restrictions, we have travel advisories, there will still be Singaporeans who will make necessary trips overseas and will (still) have a risk of importation."
Of the cases confirmed yesterday, a total of 11 patients had been to the United Kingdom, and seven to the United States. There were also cases with a travel history to India, Switzerland, Croatia, France, Germany, Austria, Thailand, the Philippines, Indonesia and Turkey.
Associate Professor Kenneth Mak, director of medical services at MOH, said: "It is clear that in terms of cases with travel history, the countries that our imported cases have an association with goes well beyond the countries we currently have travel restrictions on."
Of the locally transmitted cases, two are linked to the clusters at Church of Singapore (Bukit Timah) and boulder+ gym, while one is linked to the Masjid Al-Muttaqin cluster.
Six others are linked to previous cases, while contact tracing is taking place for another five.
Three more patients were discharged yesterday, bringing the total number of those who have recovered to 117. Of the 196 patients still in hospital, most are stable or improving, while 15 are in critical condition in the intensive care unit.
As of noon yesterday, MOH has identified 6,250 people who are close contacts of confirmed cases. Of these, 2,221 are still in quarantine.
Plans in place to turn normal wards into isolation wards, quarantine facilities into care centres for patients, says Gan Kim Yong
By Lester Wong, The Straits Times, 19 Mar 2020
There are plans to convert normal wards into isolation wards, and quarantine facilities into care centres for Covid-19 patients with less severe symptoms or those who are recovering.
These are some of the options available if the number of cases here continues to rise, Health Minister Gan Kim Yong said yesterday. Non-Covid-19 patients could also be transferred to private hospitals to free up capacity at public hospitals, he said.
"Today, I visited Tan Tock Seng Hospital and the National Centre for Infectious Diseases. They have contingency plans to turn normal wards into isolation wards," Mr Gan said.
Singapore announced 47 new cases yesterday, its highest single-day increase, bringing the total number of cases here to 313.
Mr Gan outlined the plans when asked during a news conference if Singapore's healthcare system was close to hitting the limit of its capacity.
He said any adjustments made to Singapore's strategy to deal with the virus would have to be progressive and gradual. "We have a few options. Currently, close to 80 per cent of the cases we see that do not need much support or medical attention are kept in hospitals for various reasons... The bulk of these can be housed elsewhere."
"One possibility is to look at some long-term care facilities that come with sufficient safeguards because they are medical facilities, or converting quarantine facilities that can provide minimal medical care, including swabs and some attention to medical needs," Mr Gan added. Quarantine facilities are currently used to house suspect cases. He said arrangements can be made to move patients back to nearby hospitals if their conditions worsen.
There are also collaborations with private hospitals "to see if we can send some non-Covid patients to them". Mr Gan said: "Some of these can be stepped up so that we can preserve capacity in our public hospitals. Some private hospitals also are equipped to handle Covid patients... We must underline the emphasis on one healthcare system."
Even as various options are being considered, Singapore must not be complacent, he stressed. "Although we have a buffer and there are plans to expand this buffer, we must do all we can to reduce the number of new cases and flatten the curve."
Coronavirus: Without tough steps, Singapore might have 5,000 cases by now
Research don says cases would have soared without measures to slow down the spread
By Salma Khalik, Senior Health Correspondent, The Straits Times, 19 Mar 2020
If Singapore had not initiated measures such as contact tracing and quarantines, more than 5,000 people here would have been infected with Covid-19 by now, instead of 313 as of yesterday.
The outbreak would have hit its peak by July, after which the number of infections here would start going down, said Associate Professor Alexander Cook, vice-dean for research at the NUS Saw Swee Hock School of Public Health.
But Prof Cook explained that for Covid-19 to reach its peak when there is no vaccine available means that half the population - or about 2.9 million people - would have been infected.
Covid-19 is more transmissible than influenza, he said. In the case of flu, one infected person generally passes it to 1.2 to 1.5 other people. For Covid-19, one person transmits it to two to 2.5 people.
Prof Cook is the school's domain leader for biostatistics and modelling, and has been helping the Government with projections of various scenarios in the current crisis.
He said modelling is a simplified representation of reality. But he was quick to add that a model of what has happened so far may not be an indication of what will happen in the future.
Based on the premise of one Covid-19 patient transmitting the infection to another two, the number of people infected doubles every week if nothing is done to disrupt the transmission.
By July, half the population would have been infected. After that, the rate of transmission would naturally slow as there would be fewer people left to infect.
In medical jargon, this is known as herd immunity. That happens when a large number of people recover from a disease and become immune to contracting it again. This serves to break the chain of transmission to others.
But it can be a risky affair.
It is fine to rely on herd immunity to protect segments of the population for a mild disease that rarely kills, such as the H1N1 flu pandemic in 2009.
But for Covid-19, the global case fatality rate now hovers around 4 per cent. The case fatality rate varies, at more than 7 per cent in Italy to under 1 per cent in South Korea.
These rates suggest that relying on herd immunity could result in a large number of deaths before the disease is reined in. That is why, Prof Cook said, Singapore should continue to try to contain the disease for as long as possible.
"Right now, cases are sufficiently low, so the Government is able to put a lot of effort into contact tracing," he said.
This, together with other measures such as border checks, has reduced the transmission rate of the disease from the global average of one person spreading it to two to 2.5 other people, to a patient spreading it to just one other person here, he said.
Every day's delay in quarantining someone who is infected can increase the number of cases by 0.15 to 0.2, said Prof Cook.
"It is not much, but it all adds up. If your transmission rate is just above one, you will still get quite a big outbreak."
This is why Singapore tries to identify all the close contacts of an infected person within 24 hours.
Prof Cook said contact tracing to contain a disease is possible with 20 to 30 new cases a day, but added: "You won't be able to do the same level of contact tracing if you have 1,000 cases a day."
Even at that point, he said, contact tracing and quarantining can reduce the overall numbers.
"If we stop our measures, it will go on to the trajectories of other countries. It is going to grow, no way we are going to stop that," he said. "The success is dependent on both the Government and the people acting socially responsible."
This means people observing precautions and the Government continuing with its measures such as contact tracing.
"It is a lot of work," Prof Cook said. "If you miss some, that is okay. Even if you are missing a lot, contact tracing will still bring down the number of cases."
He added: "For sure, we are missing cases." But that does not mean that the people infected by these missing cases will also be missed.
Using contact tracing, it is possible to backtrack and isolate as many close contacts of all those in the cluster. That will minimise the spread and hopefully keep the total number of infections at any one time within manageable limits for the healthcare system.
For now, it is not known exactly how many people have been infected but not identified. This can change the picture as the case fatality rate is different from the infection fatality rate.
Case fatality refers only to identified patients. Infection fatality refers to everyone who has been infected, including those who were not identified when they were sick, or were infected but did not become sick, but are now protected from the virus and will not pass it on.
A team from Duke-NUS Medical School has developed an antibody test that can check if people have been infected and recovered.
Prof Cook said Singapore plans to do a serology study to find out if there are many unidentified people who have had Covid-19.
Looking beyond Singapore's shores, Prof Cook touched on Britain's announcement last week that it was going to allow herd immunity in the population to deal with the outbreak. Britain has done a U-turn since, but the Netherlands has recently indicated it might consider this approach.
The virus appears more deadly to older people and those with underlying diseases. So, Britain wanted this group to self-isolate while enough healthier young people got infected and recovered to provide herd immunity to protect the rest.
Prof Cook said Britain's healthcare system struggles every winter with influenza.
The idea was to overcome Covid-19 in summer. Otherwise, it could push up the number of people dying in winter when those hit with influenza and those infected with Covid-19 fight for the limited healthcare resources.
The plan was "either extremely pessimistic or realistic", Prof Cook said.
By Lester Wong, The Straits Times, 19 Mar 2020
There are plans to convert normal wards into isolation wards, and quarantine facilities into care centres for Covid-19 patients with less severe symptoms or those who are recovering.
These are some of the options available if the number of cases here continues to rise, Health Minister Gan Kim Yong said yesterday. Non-Covid-19 patients could also be transferred to private hospitals to free up capacity at public hospitals, he said.
"Today, I visited Tan Tock Seng Hospital and the National Centre for Infectious Diseases. They have contingency plans to turn normal wards into isolation wards," Mr Gan said.
Singapore announced 47 new cases yesterday, its highest single-day increase, bringing the total number of cases here to 313.
Mr Gan outlined the plans when asked during a news conference if Singapore's healthcare system was close to hitting the limit of its capacity.
He said any adjustments made to Singapore's strategy to deal with the virus would have to be progressive and gradual. "We have a few options. Currently, close to 80 per cent of the cases we see that do not need much support or medical attention are kept in hospitals for various reasons... The bulk of these can be housed elsewhere."
"One possibility is to look at some long-term care facilities that come with sufficient safeguards because they are medical facilities, or converting quarantine facilities that can provide minimal medical care, including swabs and some attention to medical needs," Mr Gan added. Quarantine facilities are currently used to house suspect cases. He said arrangements can be made to move patients back to nearby hospitals if their conditions worsen.
There are also collaborations with private hospitals "to see if we can send some non-Covid patients to them". Mr Gan said: "Some of these can be stepped up so that we can preserve capacity in our public hospitals. Some private hospitals also are equipped to handle Covid patients... We must underline the emphasis on one healthcare system."
Even as various options are being considered, Singapore must not be complacent, he stressed. "Although we have a buffer and there are plans to expand this buffer, we must do all we can to reduce the number of new cases and flatten the curve."
Coronavirus: Without tough steps, Singapore might have 5,000 cases by now
Research don says cases would have soared without measures to slow down the spread
By Salma Khalik, Senior Health Correspondent, The Straits Times, 19 Mar 2020
The outbreak would have hit its peak by July, after which the number of infections here would start going down, said Associate Professor Alexander Cook, vice-dean for research at the NUS Saw Swee Hock School of Public Health.
But Prof Cook explained that for Covid-19 to reach its peak when there is no vaccine available means that half the population - or about 2.9 million people - would have been infected.
Covid-19 is more transmissible than influenza, he said. In the case of flu, one infected person generally passes it to 1.2 to 1.5 other people. For Covid-19, one person transmits it to two to 2.5 people.
Prof Cook is the school's domain leader for biostatistics and modelling, and has been helping the Government with projections of various scenarios in the current crisis.
He said modelling is a simplified representation of reality. But he was quick to add that a model of what has happened so far may not be an indication of what will happen in the future.
Based on the premise of one Covid-19 patient transmitting the infection to another two, the number of people infected doubles every week if nothing is done to disrupt the transmission.
By July, half the population would have been infected. After that, the rate of transmission would naturally slow as there would be fewer people left to infect.
In medical jargon, this is known as herd immunity. That happens when a large number of people recover from a disease and become immune to contracting it again. This serves to break the chain of transmission to others.
But it can be a risky affair.
It is fine to rely on herd immunity to protect segments of the population for a mild disease that rarely kills, such as the H1N1 flu pandemic in 2009.
But for Covid-19, the global case fatality rate now hovers around 4 per cent. The case fatality rate varies, at more than 7 per cent in Italy to under 1 per cent in South Korea.
These rates suggest that relying on herd immunity could result in a large number of deaths before the disease is reined in. That is why, Prof Cook said, Singapore should continue to try to contain the disease for as long as possible.
"Right now, cases are sufficiently low, so the Government is able to put a lot of effort into contact tracing," he said.
This, together with other measures such as border checks, has reduced the transmission rate of the disease from the global average of one person spreading it to two to 2.5 other people, to a patient spreading it to just one other person here, he said.
Every day's delay in quarantining someone who is infected can increase the number of cases by 0.15 to 0.2, said Prof Cook.
"It is not much, but it all adds up. If your transmission rate is just above one, you will still get quite a big outbreak."
This is why Singapore tries to identify all the close contacts of an infected person within 24 hours.
Prof Cook said contact tracing to contain a disease is possible with 20 to 30 new cases a day, but added: "You won't be able to do the same level of contact tracing if you have 1,000 cases a day."
Even at that point, he said, contact tracing and quarantining can reduce the overall numbers.
"If we stop our measures, it will go on to the trajectories of other countries. It is going to grow, no way we are going to stop that," he said. "The success is dependent on both the Government and the people acting socially responsible."
This means people observing precautions and the Government continuing with its measures such as contact tracing.
"It is a lot of work," Prof Cook said. "If you miss some, that is okay. Even if you are missing a lot, contact tracing will still bring down the number of cases."
He added: "For sure, we are missing cases." But that does not mean that the people infected by these missing cases will also be missed.
Using contact tracing, it is possible to backtrack and isolate as many close contacts of all those in the cluster. That will minimise the spread and hopefully keep the total number of infections at any one time within manageable limits for the healthcare system.
For now, it is not known exactly how many people have been infected but not identified. This can change the picture as the case fatality rate is different from the infection fatality rate.
Case fatality refers only to identified patients. Infection fatality refers to everyone who has been infected, including those who were not identified when they were sick, or were infected but did not become sick, but are now protected from the virus and will not pass it on.
A team from Duke-NUS Medical School has developed an antibody test that can check if people have been infected and recovered.
Prof Cook said Singapore plans to do a serology study to find out if there are many unidentified people who have had Covid-19.
Looking beyond Singapore's shores, Prof Cook touched on Britain's announcement last week that it was going to allow herd immunity in the population to deal with the outbreak. Britain has done a U-turn since, but the Netherlands has recently indicated it might consider this approach.
The virus appears more deadly to older people and those with underlying diseases. So, Britain wanted this group to self-isolate while enough healthier young people got infected and recovered to provide herd immunity to protect the rest.
Prof Cook said Britain's healthcare system struggles every winter with influenza.
The idea was to overcome Covid-19 in summer. Otherwise, it could push up the number of people dying in winter when those hit with influenza and those infected with Covid-19 fight for the limited healthcare resources.
The plan was "either extremely pessimistic or realistic", Prof Cook said.
Lockdowns need to be timed well: Experts
By Salma Khalik, Senior Health Correspondent, The Straits Times, 19 Mar 2020
Lockdowns appear to be the preferred way to deal with the coronavirus outbreak globally, but they need to be timed well and complement other strategies, experts say.
China has sharply checked its coronavirus infections - reporting just 39 new cases on Tuesday - after locking down Hubei province, the pandemic's original epicentre.
"But the cases have not peaked in China and there is nothing to stop another wave of outbreak being as bad as the first phase," said Associate Professor Alex Cook, NUS Saw Swee Hock School of Public Health's vice-dean of research. Cases peak when half the country has been infected or immunised, halving the rate of transmission.
Yesterday, a lockdown began in Malaysia that will last until the end of the month. In Europe, the pandemic's current epicentre, Italy, Belgium and Paris have also locked down in a bid to curb the spread.
National Development Minister Lawrence Wong, who co-chairs the multi-ministry Covid-19 task force, said a lockdown in Singapore remains an option, but it will not be in place yet.
Prof Cook, the school's domain leader for biostatistics and modelling, said stringent measures must be timed for best effect because they put stress on people and the economy. But they can give countries much-needed breathers. Timing is important "as once the measures are relaxed, the epidemic happens again, but is delayed", he said.
Professor Teo Yik Ying, the school's dean, said lockdowns serve two purposes. "They prevent further importations, especially as Covid-19 is now spreading in many countries and it becomes a real challenge to enforce travel advisories or bans that are specific to individual countries," he said.
"And it is socially responsible to prevent exporting to other countries, and to contain any further spread to within the country."
But a lockdown cannot be a country's only strategy, he said. It must co-exist with other measures like active contact tracing and mandatory social distancing. "Judiciously applying a lockdown as well as timing it carefully can indeed be effective," said Prof Teo, citing China's success.
Prof Cook said a two-week lockdown is not enough as the spread will start again after the shutdown ends. This is because people can still pass the virus to family members and others, who may get sick after the lockdown is lifted - and start the spread all over again.
If such measures flatten the curve by reducing the number of new infections, that would be good, he said.
Both experts agree it is critical to keep numbers below the threshold at which a country will run out of intensive care unit (ICU) beds - as more than one in 10 Covid-19 patients require ventilators to help them breathe.
Prof Cook said in theory, a good approach is to let the number of infections "grow at a rate that is still comfortable, when you still have ICU beds. When it gets near full, implement measures to bring it down". He quickly added: "But I would be anxious about trying to game an epidemic. It may not work out that way in reality."
Until a vaccine is available, even if countries succeed in keeping infections low, there is the risk of imported cases starting another major outbreak. The real worry, said Prof Cook, is less developed countries with poorer healthcare systems where infections could spike, reviving the spread elsewhere.
He said a socially responsible population, where people who are sick self-isolate, can do a lot to reduce transmission. "That will have a big impact on the infection rate."
By Salma Khalik, Senior Health Correspondent, The Straits Times, 19 Mar 2020
Lockdowns appear to be the preferred way to deal with the coronavirus outbreak globally, but they need to be timed well and complement other strategies, experts say.
China has sharply checked its coronavirus infections - reporting just 39 new cases on Tuesday - after locking down Hubei province, the pandemic's original epicentre.
"But the cases have not peaked in China and there is nothing to stop another wave of outbreak being as bad as the first phase," said Associate Professor Alex Cook, NUS Saw Swee Hock School of Public Health's vice-dean of research. Cases peak when half the country has been infected or immunised, halving the rate of transmission.
Yesterday, a lockdown began in Malaysia that will last until the end of the month. In Europe, the pandemic's current epicentre, Italy, Belgium and Paris have also locked down in a bid to curb the spread.
National Development Minister Lawrence Wong, who co-chairs the multi-ministry Covid-19 task force, said a lockdown in Singapore remains an option, but it will not be in place yet.
Prof Cook, the school's domain leader for biostatistics and modelling, said stringent measures must be timed for best effect because they put stress on people and the economy. But they can give countries much-needed breathers. Timing is important "as once the measures are relaxed, the epidemic happens again, but is delayed", he said.
Professor Teo Yik Ying, the school's dean, said lockdowns serve two purposes. "They prevent further importations, especially as Covid-19 is now spreading in many countries and it becomes a real challenge to enforce travel advisories or bans that are specific to individual countries," he said.
"And it is socially responsible to prevent exporting to other countries, and to contain any further spread to within the country."
But a lockdown cannot be a country's only strategy, he said. It must co-exist with other measures like active contact tracing and mandatory social distancing. "Judiciously applying a lockdown as well as timing it carefully can indeed be effective," said Prof Teo, citing China's success.
Prof Cook said a two-week lockdown is not enough as the spread will start again after the shutdown ends. This is because people can still pass the virus to family members and others, who may get sick after the lockdown is lifted - and start the spread all over again.
If such measures flatten the curve by reducing the number of new infections, that would be good, he said.
Both experts agree it is critical to keep numbers below the threshold at which a country will run out of intensive care unit (ICU) beds - as more than one in 10 Covid-19 patients require ventilators to help them breathe.
Prof Cook said in theory, a good approach is to let the number of infections "grow at a rate that is still comfortable, when you still have ICU beds. When it gets near full, implement measures to bring it down". He quickly added: "But I would be anxious about trying to game an epidemic. It may not work out that way in reality."
Until a vaccine is available, even if countries succeed in keeping infections low, there is the risk of imported cases starting another major outbreak. The real worry, said Prof Cook, is less developed countries with poorer healthcare systems where infections could spike, reviving the spread elsewhere.
He said a socially responsible population, where people who are sick self-isolate, can do a lot to reduce transmission. "That will have a big impact on the infection rate."
New coronavirus study compels US and Britain to ramp up responses
The Straits Times, 19 Mar 2020
A scientific paper on the new coronavirus published this week has been credited for influencing the British and American governments' response to the pandemic.
Following the report's advice, British Prime Minister Boris Johnson urgently imposed unprecedented peacetime measures on the population after earlier holding them off. American officials said the report also shaped the White House's response, prompting the authorities to strengthen their social distancing measures.
What did this scientific paper say that so compelled the authorities to act, and why was it so influential?
WHAT IS THIS SCIENTIFIC PAPER AND WHO IS BEHIND IT?
The paper, titled "Impact of non-pharmaceutical interventions to reduce Covid-19 mortality and healthcare demand", was published on Monday. The study was led by epidemiologist Neil Ferguson and compiled by 31 members of Imperial College London's Covid-19 response team.
Professor Ferguson advises the British government's Scientific Advisory Group for Emergencies, which is helping to coordinate the country's coronavirus response. Prof Ferguson said yesterday that he was in self-isolation after developing a dry cough and a fever.
WHAT DOES THE REPORT SAY?
The report referred to the Covid-19 disease as the most serious public health threat seen in a respiratory virus since the 1918 Spanish flu pandemic. The 1918 pandemic killed between 50 million and 100 million people around the world.
The researchers studied the potential effectiveness of several public health strategies to counter the virus, dividing their aims into two broad categories: mitigation and suppression. Mitigation focuses on slowing, but not necessarily stopping epidemic spread. Suppression aims to disrupt transmission so dramatically that each case generates less than one additional infection and the disease is stopped in its tracks.
They concluded that suppression was the "preferred policy option".
The major challenge of suppression, the British scientists concluded, is the length of time that intensive interventions would be needed, given that "we predict that transmission will quickly rebound if interventions are relaxed".
The authors said mitigation policies alone - isolating people suspected of having the virus at home, quarantining their contacts and separating the most vulnerable people from others - might reduce the peak demand on the healthcare system by two-thirds and deaths by half if applied for three months. But that would still result in hundreds of thousands of deaths and in health systems "overwhelmed, many times over", they said.
HOW DID THE SCIENTISTS ARRIVE AT THEIR CONCLUSIONS?
The researchers analysed data from Italy and China to mathematically model how the spread of the coronavirus would affect Britain and the United States in an uncontrolled social environment. The study predicted that 81 per cent of the British and American populations would be infected, with 510,000 deaths in Britain and 2.2 million in the US. The death rate was expected to peak after three months.
Prof Ferguson told BBC on Tuesday that there was no other way than to adopt the suppression strategy, and that it was becoming increasingly clear that the study's predicted death rate is "the most likely scenario".
WHY IS THE REPORT SO INFLUENTIAL?
A report in The New York Times has argued that it was probably not so much about what the report said but who was saying it. Imperial College London has ties to the World Health Organisation, and has advised the British government in several epidemics, including severe acute respiratory syndrome (Sars), avian flu and swine flu.
With additional reporting from Agence France-Presse and NYTimes
The Straits Times, 19 Mar 2020
A scientific paper on the new coronavirus published this week has been credited for influencing the British and American governments' response to the pandemic.
Following the report's advice, British Prime Minister Boris Johnson urgently imposed unprecedented peacetime measures on the population after earlier holding them off. American officials said the report also shaped the White House's response, prompting the authorities to strengthen their social distancing measures.
What did this scientific paper say that so compelled the authorities to act, and why was it so influential?
WHAT IS THIS SCIENTIFIC PAPER AND WHO IS BEHIND IT?
The paper, titled "Impact of non-pharmaceutical interventions to reduce Covid-19 mortality and healthcare demand", was published on Monday. The study was led by epidemiologist Neil Ferguson and compiled by 31 members of Imperial College London's Covid-19 response team.
Professor Ferguson advises the British government's Scientific Advisory Group for Emergencies, which is helping to coordinate the country's coronavirus response. Prof Ferguson said yesterday that he was in self-isolation after developing a dry cough and a fever.
WHAT DOES THE REPORT SAY?
The report referred to the Covid-19 disease as the most serious public health threat seen in a respiratory virus since the 1918 Spanish flu pandemic. The 1918 pandemic killed between 50 million and 100 million people around the world.
The researchers studied the potential effectiveness of several public health strategies to counter the virus, dividing their aims into two broad categories: mitigation and suppression. Mitigation focuses on slowing, but not necessarily stopping epidemic spread. Suppression aims to disrupt transmission so dramatically that each case generates less than one additional infection and the disease is stopped in its tracks.
They concluded that suppression was the "preferred policy option".
The major challenge of suppression, the British scientists concluded, is the length of time that intensive interventions would be needed, given that "we predict that transmission will quickly rebound if interventions are relaxed".
The authors said mitigation policies alone - isolating people suspected of having the virus at home, quarantining their contacts and separating the most vulnerable people from others - might reduce the peak demand on the healthcare system by two-thirds and deaths by half if applied for three months. But that would still result in hundreds of thousands of deaths and in health systems "overwhelmed, many times over", they said.
HOW DID THE SCIENTISTS ARRIVE AT THEIR CONCLUSIONS?
The researchers analysed data from Italy and China to mathematically model how the spread of the coronavirus would affect Britain and the United States in an uncontrolled social environment. The study predicted that 81 per cent of the British and American populations would be infected, with 510,000 deaths in Britain and 2.2 million in the US. The death rate was expected to peak after three months.
Prof Ferguson told BBC on Tuesday that there was no other way than to adopt the suppression strategy, and that it was becoming increasingly clear that the study's predicted death rate is "the most likely scenario".
WHY IS THE REPORT SO INFLUENTIAL?
A report in The New York Times has argued that it was probably not so much about what the report said but who was saying it. Imperial College London has ties to the World Health Organisation, and has advised the British government in several epidemics, including severe acute respiratory syndrome (Sars), avian flu and swine flu.
With additional reporting from Agence France-Presse and NYTimes
108,000 affected workers to each get one-time payment of up to $300: NTUC
By Clement Yong, The Straits Times, 19 Mar 2020
A one-time payment of up to $300 will be given to about 108,000 workers who lose their jobs or suffer income losses due to the Covid-19 outbreak, the National Trades Union Congress (NTUC) said yesterday.
It will be funded by $25 million set aside by NTUC, unions and the Government, and is for union members only.
Self-employed union members are also eligible for the NTUC Care Fund (Covid-19).
"NTUC, its affiliated unions and associations, together with the Singapore Government, are banding together in a show of support to help our workers by providing them with temporary cash relief which will help to ease their daily expenses during this period of hardship," NTUC said.
Existing union members with dependants living in the same household will get $300. Those without dependants in the same household can get $100.
New union members who joined after March 1 get $200 if they have dependants in the same household, and $50 if they do not.
Those with dependants must have initially earned $3,400 or less monthly, while those without must have earned $1,500 or less.
Their earnings should also have fallen by at least 30 per cent.
Self-employed people whose incomes have been "adversely affected" by job or event cancellations due to the outbreak can apply, as can those retrenched with benefits of not more than $6,500.
NTUC secretary-general Ng Chee Meng, who visited Gardens by the Bay to hand out care packs to workers including cleaners and cab drivers, said workers have shared that "their biggest concerns centre around sustaining their livelihoods and caring for their loved ones".
Union members can apply for assistance from their unions or via NTUC from March 25 to Sept 30.
Meanwhile, private-hire car drivers who did not qualify for an initial aid package announced last month can apply for a new Driver Care Fund set up by NTUC and the Government.
Drivers in need of help due to hardship can apply from now until April 17. Successful applicants get a one-off support package of $300. They can check www.ntuc.org.sg/drivercarefund for information.
By Clement Yong, The Straits Times, 19 Mar 2020
It will be funded by $25 million set aside by NTUC, unions and the Government, and is for union members only.
Self-employed union members are also eligible for the NTUC Care Fund (Covid-19).
"NTUC, its affiliated unions and associations, together with the Singapore Government, are banding together in a show of support to help our workers by providing them with temporary cash relief which will help to ease their daily expenses during this period of hardship," NTUC said.
Existing union members with dependants living in the same household will get $300. Those without dependants in the same household can get $100.
New union members who joined after March 1 get $200 if they have dependants in the same household, and $50 if they do not.
Those with dependants must have initially earned $3,400 or less monthly, while those without must have earned $1,500 or less.
Their earnings should also have fallen by at least 30 per cent.
Self-employed people whose incomes have been "adversely affected" by job or event cancellations due to the outbreak can apply, as can those retrenched with benefits of not more than $6,500.
NTUC secretary-general Ng Chee Meng, who visited Gardens by the Bay to hand out care packs to workers including cleaners and cab drivers, said workers have shared that "their biggest concerns centre around sustaining their livelihoods and caring for their loved ones".
Union members can apply for assistance from their unions or via NTUC from March 25 to Sept 30.
Meanwhile, private-hire car drivers who did not qualify for an initial aid package announced last month can apply for a new Driver Care Fund set up by NTUC and the Government.
Drivers in need of help due to hardship can apply from now until April 17. Successful applicants get a one-off support package of $300. They can check www.ntuc.org.sg/drivercarefund for information.
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