Singapore

Dr. Light recently came across an intriguing article in the Journal of the American Medical Association (JAMA) about how the island city-state of Singapore was initially alerted and early on took proactive steps it took to limit the spread of this highly contagious virus and what we can learn as takeaways about their approach here in the West.

While it may never be known when China actually knew about the COVID-19,  it was on December 31, 2019 that the World Health Organization received word from China that the city of Wuhan was experiencing a novel viral pneumonia.

There is a lot of air travel between Wuhan and Singapore with an average of 330,000 travelers each month, so they two cities are keenly linked and Singaporean officials took note of the early news of the spread of this new Coronavirus phenomenon very seriously.

On January 2, 2020, only days after the initial reports of the Virus from China, the ministry of health (MOH) in Singapore, advised all their health care practitioners to be highly aware of and be ready for suspected COVID-19 patients. All physicians in Singapore were also warned to detect patients with pneumonia and recent travel to Wuhan.

On January 3rd, all arrivals from Wuhan were temperature screened.

It was on January 9th that the novel coronavirus was identified by the Chinese as the causative agent, on January 12th the genetic sequence was released and on January 20th human transmission of the coronavirus to healthcare workers was identified.

Singapore’s public health response was elevated to “enhanced preparedness” and the first case was diagnosed on January 23rd as a tourist from Wuhan to Singapore tested positive for the virus.

At that point, a number of public health protocols were established and quickly increased to include aggressive contact tracing and quarantine of those in close contact with those who spent extended time within two meters of confirmed cases. Travel advisories were issued and restrictions placed on travelers who had been in China in the last 14 days.

This stringent approach by Singapore was in part based on it’s recent experience with SARS which taught them that confirmed cases should be isolated until 2 consecutive samples are negative for over 2 days and those who have been in contact with infected individuals and those without symptoms need a 14 day quarantine helped them deal with the initial outbreak.

3 Key Takeaways

Singapore quickly learned there are similarities and differences in the characteristics compared with SARS. The illness seems to be similar to SARS in that patients developed pneumonia after the first week to the start of the second week of illness. Children rarely have symptomatic infections and, unlike SARS, COVID-19 has a wider range of severity from mildly symptomatic to the need for mechanical ventilation.

Singapore’s experience with SARS in 2003 had them prepare for another infectious disease outbreak by adding a National Centre for Infectious Diseases, a major buildout of negative-pressure isolation beds, building stockpiles of personal protective equipment and masks, formation of protocols to allow cross agency capabilities and major contact tracing capabilities as well as other steps to increase scientific capabilities.

7 Critical Issues Requiring Attention and Action

  1. Modes of transmission need to be better understood.
  2. Early symptoms include dry cough, low-grade fever and/or sore throat and tend to worsen several days later.
  3. Biomarkers and clinical criteria are needed to determine which individuals are more likely to become severe cases.
  4. Random trials of various drugs including trials of lopinavir/ritonavir and remdesivir are ongoing to determine the effectiveness of these treatments.
  5. There needs to be better communication methods within the medical community.
  6. Recognition of the stress healthcare workers are under. PPEs can become cumbersome, especially when performing needed procedures. Their stress includes the possibility they may become infected.
  7. A vaccine that will prove effective will become the best way to manage COVID-19. It might be a year before a vaccine is made available to the world. Until then, it is vital that containment steps are taken and there needs to be a strong effort to find ways to counteract the Coronavirus Pandemic. 

As a concerned ENT, Dr. Light feels this shows how the world’s medical community needs to share information and assist in ways to limit the continued worldwide spread of COVID-19.