Sunday, 22 March 2020

Singapore reports first two COVID-19 deaths on 21 March 2020

Both patients had history of heart disease; leaders stress need to adopt safe distancing
By Vanessa Liu, The Sunday Times, 22 Mar 2020

Two COVID-19 patients died at the National Centre for Infectious Diseases (NCID) yesterday morning due to complications, the first deaths Singapore has seen from the coronavirus that has taken over 10,000 lives globally.

The first patient, a 75-year-old Singaporean woman with a history of chronic heart disease and hypertension, died at 7.52am.

She was admitted to the NCID on Feb 23 for pneumonia, and was the 90th person confirmed to have COVID-19.

She had been in the intensive care unit (ICU) and developed serious complications, and was linked to the cluster at The Life Church and Missions Singapore in Paya Lebar.

The second patient is a 64-year-old Indonesian national who was admitted in critical condition to the ICU at NCID on March 13, after arriving from Indonesia the same day. He was confirmed to have the infection the next day, and died at 10.15am yesterday.

Prior to his arrival, the patient - known as case 212 - had been hospitalised in Indonesia for pneumonia and had a history of heart disease.

"While we all know that there will be fatalities in COVID-19 patients, we are deeply saddened by their passing," Health Minister Gan Kim Yong said, announcing the deaths.

"I know Singaporeans will be worried and anxious. But we must take courage, and not give in to our fears," he added.

The fatalities come as Singapore confirmed 47 new coronavirus cases yesterday, 21 March, bringing the total number of infected patients here to 432.

The new cases include 39 imported cases with travel history to Australia, Europe, North America, Asean and other parts of Asia, a surge observers had expected given the closure of borders around the world and the return of Singapore residents and long-term pass holders from overseas.

One of the new cases, case 415, is a 64-year-old Indonesian woman who was listed as a family member of case 212, the second patient who died. Three days ago, a 62-year-old Singaporean man, case 289, was also listed as a close contact of his.

Speaking to reporters at the Health Ministry yesterday, Mr Gan reiterated that safe distancing measures which have been announced must be followed.

"We must all take the necessary precautions to keep ourselves and our families safe," he said.

"We must stay united, work together, support one another, look out for one another. This way, by staying together, we will be able to prevail and overcome COVID-19."

Prime Minister Lee Hsien Loong also sent his deepest condolences to the patients' loved ones in a Facebook post, saying: "As we get more COVID-19 cases, more patients will need ICU care, and we must brace ourselves for more losses," he said.

Healthcare workers are doing their best to care for their patients, PM Lee added, noting that most of the cases are gradually improving.

"The Government is doing all we can to slow the spread of the virus, but everyone needs to support and comply with the measures we have put in place," he said. "We must work together to keep ourselves, our families and Singapore safe."

Besides strict border controls, rigorous contact tracing, quarantine and home isolation, the Government has implemented safe distancing measures such as smaller crowd sizes and the need to keep a safe space around individuals, especially vulnerable segments of the population such as the elderly.

For example, all events and gatherings with 250 or more participants are to be suspended until June 30, while the suspension of all social activities for seniors by government agencies will be extended for another two weeks until April 7.

Many religious groups have also suspended services, or implemented social distancing measures.

But the first day of tighter measures saw mixed responses as businesses and people tried to adapt.

President Halimah Yacob had a special reminder for the young, cautioning that while they may not fall as seriously ill, they could spread the infection to others who are more vulnerable.

The Public Service Division also announced that government agencies will introduce telecommuting where possible, and adopt measures such as staggered work hours and split shifts.

Overseas personal leave will not be approved across the public service unless on exceptional or compassionate reasons. Also, all social activities will be cancelled and other events involving over 250 people will be suspended.

Meanwhile, the Government Technology Agency said 500,000 people had downloaded a new contact tracing app, TraceTogether a day after its launch, and thanked them for helping stem the spread of COVID-19.

The bluetooth-based app helps contact tracers get in touch with users quicker if they have unknowingly had close contact with someone who caught the disease.

Singapore's COVID-19 deaths
By Sue-Ann Tan, The Sunday Times, 22 Mar 2020


The 75-year-old Singaporean woman who became the first patient to die of COVID-19 was linked to the cluster at The Life Church and Missions Singapore. Known as Case 90, she had no recent travel history to China.

She had reported the onset of symptoms on Feb 9 and sought treatment at a general practitioner's clinic that day, as well as on Feb 17 and Feb 23. She was taken in an ambulance to the emergency department of Tan Tock Seng Hospital on Feb 23 and immediately isolated.

Subsequent test results confirmed COVID-19 infection that afternoon. She was warded at the National Centre for Infectious Diseases (NCID) and died at 7.52am yesterday.

She had a history of chronic heart disease and hypertension.

Her church said in a statement shortly after news of her death: "As this is one of the first COVID-19 deaths in Singapore, we are not sure what can or cannot be done with regard to the funeral arrangements. Her family would make the final decision on the funeral details." The church and her family member's church may assist in the arrangements, it added.

Prior to being admitted, she had kept mostly to her home in Bishan Street 12, the Ministry of Health (MOH) said earlier.

She is linked to the second largest virus cluster in Singapore with 33 patients and which comprises two church sub-clusters. One of them, the Grace Assembly of God church, has 23 patients, including the church's senior pastor. The woman's church had 10 patients.


The 64-year-old Indonesian man died at 10.15am at the NCID.

He was recorded as Case 212 and arrived in Singapore from Indonesia on March 13. MOH had said he reported the onset of symptoms on March 9 and had been hospitalised in Indonesia for pneumonia. Upon arrival here, he sought treatment at Mount Elizabeth Hospital, and was referred to NCID that day.

Subsequent test results confirmed COVID-19 on March 14.

This case is linked to Case 289, a 62-year-old man classified as a locally transmitted case. The 62-year-old was a contact of the Indonesian and was confirmed to have COVID-19 on March 18.

Singapore Foreign Minister Vivian Balakrishnan conveyed the information to his counterpart Retno Marsudi in a call. The embassy said it "will continue to coordinate with the Health Ministry to monitor the development of other Indonesian patients with COVID-19 treated in Singapore".

Indonesian Ambassador to Singapore Ngurah Swajaya said the embassy is still coordinating matters with the deceased's family.

Coronavirus: 47 new cases in Singapore, including 39 imported on 21 March 2020
By Sue-Ann Tan, The Sunday Times, 22 Mar 2020

Singapore has confirmed 47 new coronavirus cases, the Ministry of Health (MOH) said yesterday evening. This was the same figure as the number of cases reported on Wednesday, the greatest number since the start of the outbreak. This brings the total number of infected patients here to 432.

The new cases include 39 imported ones with travel history to Australia, Europe, North America, Asean countries and other parts of Asia.

Almost all of the imported cases are returning residents and long-term pass holders, while six were short-term visitors. Of the imported cases, 15 were from Britain, with most of them under the age of 30.

Of the remaining eight cases announced yesterday which were locally transmitted, two are linked to previous cases, while six are currently unlinked.

To date, 140 cases have fully recovered from the infection and have been discharged from hospital. Of the 290 confirmed cases still in hospital, most are stable or improving. Fourteen are in critical condition in the intensive care unit.

Two patients, a 64-year-old Indonesian man and a 75-year-old Singaporean woman, have also died from the virus, MOH reported yesterday morning. The man's family member, a 64-year-old Indonesian woman, was also confirmed to have the virus yesterday.

The authorities introduced stricter safe distancing measures on Friday to reduce the risk of further local transmission. For instance, all events and gatherings with 250 or more participants are to be suspended until June 30.

Events with fewer than 250 people and operators of venues accessible to the public, such as restaurants and cinemas, are required to implement measures to ensure separation of at least 1m between patrons.

Contact tracing for the confirmed cases is ongoing. Once identified, MOH will closely monitor all close contacts. They will be quarantined for 14 days from their last exposure to the patient, MOH said.

As of yesterday, MOH has identified 7,544 close contacts who have been quarantined. Of these, 2,587 are currently quarantined, and 4,957 have completed their quarantine.

89 work passes revoked for breaching entry approval requirements or stay-home notices
By Sue-Ann Tan, The Sunday Times, 22 Mar 2020

The Ministry of Manpower (MOM) has revoked a total of 89 work passes as of yesterday for those who breached entry approval or stay-home notice requirements.

Of this number, 73 were work-pass holders who had been to countries hit by COVID-19 but did not obtain the necessary approvals from MOM before returning to Singapore.

The rules state that they must serve a 14-day stay-home notice (SHN), which means they cannot leave their homes during the time.

Another 16 work-pass holders were caught breaching the SHN or leave of absence (LOA) requirements.

An LOA is less stringent in that it allows people to leave their homes to get food and other necessities.

MOM said in a statement that some were caught at their workplaces. Others were caught leaving their place of residence during the period of their SHN or LOA, even when instructed not to do so.

"Many of these violations occurred during the first month following the imposition of the SHN requirement. In the second month, the number of violations fell to four," MOM said.

SHN was introduced last month, initially covering those with travel history from mainland China. The workers have been permanently banned from working in Singapore.

MOM said that it also has suspended the work-pass privileges of employers for periods ranging from one to three years, as they have failed to discharge their duties to ensure that their employees comply with the necessary requirements.

With stricter border requirements, entry approvals and SHN are now required for work-pass holders entering Singapore from anywhere in the world.

MOM said employers are reminded to seek approval using the online facility for work-pass holders to enter or return to Singapore.

"Employers should inform their employees not to make travel plans to Singapore until approval has been obtained from MOM," it added.

"MOM will continue to take enforcement measures against errant employers or employees who do not comply with the requirements set out above, including the revocation of work passes and suspension of work-pass privileges," the ministry stressed.

MOH advises doctors in Singapore to stop or defer accepting non-resident foreign patients
Circular points to need to conserve limited healthcare resources here
By Clement Yong and Clara Chong, The Sunday Times, 22 Mar 2020

All doctors in public and private hospitals, as well as private specialist clinics, have been advised by the Ministry of Health (MOH) to immediately stop or defer accepting new foreign patients who do not reside in Singapore.

They have also been instructed to encourage their current foreign patients to seek continued care in their home countries.

An internal circular issued by the MOH to private and public healthcare institutions on Thursday, which was seen by The Sunday Times, said it was necessary "to conserve limited healthcare resources for Singapore to cater to managing COVID-19 cases as well as the existing needs of our local patients".

The circular said the latest measures will last until further advised by the MOH. "Failure of the specialist to comply with the above may adversely impact public health and safety, and, therefore, will result in more stringent considerations of subsequent applications by MOH," the circular said.

Dr Noel Yeo, senior vice-president, hospital operations for Parkway Pantai's Singapore operations division, said that non-essential procedures were already mostly postponed after the Republic's Disease Outbreak Response System Condition (Dorscon) level was raised to orange.

However, "there were still a small number of patients who came to us for critical or essential treatment".

"Under MOH's new directive, all new cases of such patients who do not reside in Singapore will be asked to defer their appointments or seek medical care elsewhere. We are working with our doctors to ensure that these patients continue to be cared for as adequately as possible," Dr Yeo added.

Singapore reported its first two deaths from the coronavirus yesterday. Officials confirmed 47 new COVID-19 cases yesterday, bringing the total number of infected patients on the island to 432.

A carpark at the Singapore General Hospital was converted on Friday to help screen patients for fever to help alleviate the load on the National Centre for Infectious Diseases.

The contents of the circular on Thursday provided guidance on the approach doctors should take when managing foreign patients holding Asean passports who are seeking specialist medical care in the country.

The circular added that specialists who feel it is necessary for a foreign patient to remain in Singapore can apply to the MOH for a waiver.

To qualify, the patient must have healthcare needs that cannot be met in his home country and be already under the specialist's active care. The specialist must certify that delays in the treatment of the patient will lead to "serious adverse outcomes", the circular said.

Other foreign patients who live in Asean and wish to have continued specialist care in Singapore must apply for the Asean Health Clearance (AHC) prior to their medical appointment.

They must not have visited any hospital outside Singapore 14 days before the application to be eligible for the AHC.

From last Monday, the Government said that the AHC has to be submitted by all short-term visitors who are Asean nationals at least 14 to 21 days before their intended date of travel into Singapore, and should be approved by the MOH before they begin their trip to Singapore.

These approved applications will be verified by the Immigration and Checkpoints Authority at the border.

However, the circular also noted that in some cases of medical emergencies involving the evacuation of Asean passport holders, the requirement for the AHC can be waived.

The MOH had earlier announced that all travellers entering the Republic from 11.59pm on Friday will be issued a 14-day stay-home notice.

Short-term visitors who arrive in the country without the necessary approval, or proof of the place where they will serve their 14-day stay-home notice, or do not meet prevailing entry requirements, will be unable to enter Singapore.

Leaders urge Singaporeans to heed social distancing rules
By Tham Yuen-C, Senior Political Correspondent, The Sunday Times, 22 Mar 2020

Singaporeans can do a lot more to keep themselves and their families safe, national leaders said yesterday, as the Ministry of Health (MOH) announced the first two deaths here from COVID-19.

Even as they expressed condolences to the families of the two patients who died, President Halimah Yacob, Prime Minister Lee Hsien Loong and several other ministers called on Singaporeans to heed social distancing rules.

Minister for Trade and Industry Chan Chun Sing, who is in charge of the public service, also announced further initiatives to limit close contact between public servants while at work.

In a Facebook post, Madam Halimah urged people to follow the MOH's recommendations to have, for example, people seated apart at private events such as weddings.

She also said that where possible, such gatherings should be postponed "until the risk has passed".

She had a special reminder for the young to be vigilant, even if they may not fall as seriously ill from the virus, as they could spread the infection to others who are more vulnerable.

"As individuals and collectively, we could do a lot more to keep ourselves, our friends, neighbours and families safe," she added.

PM Lee too called on people to work together to keep the virus at bay. While the Government is doing all it can to slow the spread, he said that "everyone needs to support and comply with the measures we have put in place".

The Government on Friday announced the suspension of events of more than 250 people, and introduced measures for people to keep a safe distance from one another at gatherings.

However, the advice seems to have fallen on deaf ears among some at places such as hawker centres and malls.

Education Minister Ong Ye Kung, who was at Kampung Admiralty Hawker Centre with other Sembawang GRC MPs for a community event, said that although half the stools at the hawker centre were taped to signal people should not sit on them, "half of the patrons sat on the taped stools".

"So I think it's time to really take all this seriously... We really have to take a lot more precautions."

Mr Chan said public sector agencies will move to introduce telecommuting where practicable, to reduce contact between public servants at the workplace and to ease the load on the public transport system.

Among other measures being put in place are split locations for working, staggered work hours, deferment of official trips and the cancellation of all social activities regardless of size.

"Let us work together to step up these safe distancing measures so that we can collectively win this fight for Singapore," he said.

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