How Singapore Waged War on Coronavirus
Timely preparation, aggressive testing, tracing of carriers and luck helped limit the impact of COVID-19.
WHY YOU SHOULD CARE
Because the city-state offers potential lessons for the United States and Europe.
Singaporean lawyer Iman Ibrahim was enjoying her snowboarding vacation in Italy, Switzerland and Austria this month when the coronavirus outbreak in Europe suddenly turned her trip into a race home.
With borders and mountain resorts closing around her, and her flight to Singapore canceled, Ibrahim drove to Germany and caught a plane back to the southeast Asian city-state.
“The situation was changing every few hours … but once you’re back in Singapore, you know everything is efficient and you will be looked after,” Ibrahim says.
Ibrahim did not know just how lucky she was to have made it home to Singapore, an international financial hub known for its quasi-authoritarian but effective government. Three days after her return, she tested positive for the coronavirus.
Singapore reported its first two deaths from the pathogen only this past weekend, despite being one of the first countries to be hit by the outbreak outside China two months ago. That has made it one of the safest places in the world for patients with the disease, which has already killed more than 13,000 people globally.
Singapore’s success in dealing with the outbreak is attributed to the government’s speed in imposing border controls soon after the disease first erupted in China, meticulous tracing of known carriers, aggressive testing, a clear public communication strategy and some luck.
There’s a higher degree of acceptance of being monitored by the state. That makes some of the more invasive methods for contact tracing easier.
Chong Ja Ian, National University of Singapore
“There is nothing they should be doing differently,” says Dr. Ying-Ru Jacqueline Lo, the World Health Organization representative to Singapore, Malaysia and Brunei Darussalam.
After controlling the first infections, Singapore now faces a second wave of cases from returning travelers, such as Ibrahim. Authorities tightened travel restrictions and social distancing measures after the number of cases doubled to 455 in the past week. Yet many analysts believe Singapore will also bring the second wave under control.
Some of the city-state’s advantages in confronting the coronavirus outbreak are difficult for larger Western countries to replicate, such as its small population of 5.7 million. It also learned from its experience with SARS in 2003, which forced it to strengthen its health care system.
Similar to those of some Asian neighbors, such as Taiwan, South Korea and Hong Kong, which have also managed to slow infection rates, Singapore’s example could contain lessons for the United States and Europe, which have been caught wrong-footed by the virus.
As soon as information about the disease emerged from Wuhan, the city at the center of China’s outbreak, Singapore began preparing by ramping up laboratory capacity for mass testing and developing its own test kits. This was seen as essential to contain infections and not overwhelm hospitals, a problem faced by countries such as Italy.
As of March 20, Singapore had conducted 38,000 tests, or about 6,800 examinations per 1 million people, the Health Ministry said. That rate outpaces South Korea, the region’s poster child for fast and expansive testing, which had administered about 6,100 tests per 1 million people in the same time frame.
“We used the lead time that China gave us by its massive shutdown to really refine our readiness,” say Dr. Dale Fisher, a professor of infectious diseases at the National University of Singapore. “By the time we had one of our cases, we were able to do tests, and within a week, tests were available in all major hospitals.”
Some experts say the fact that most patients in Singapore have been below the age of 65 also helps explain the low number of deaths.
But Dr. Leo Yee Sin, executive director at the National Centre for Infectious Diseases, which was set up after SARS, and who is helping spearhead Singapore’s response to the coronavirus, says: “I don’t consider us lucky. We are just giving the best of critical care to those affected.”
Leo also says that 15 percent of confirmed cases are on ventilators in intensive care units, with two undergoing extracorporeal membrane oxygenation, in which blood is drained from the patient’s body and oxygenated in a machine.
The country’s business community also moved quickly. Soon after Singapore reported its first cases, banks divided their teams among offices, home offices and emergency trading floors, many of which are in an outlying industrial area near the Changi Airport.
While government measures to contain the first wave of infections were effective, they have also raised questions about the invasiveness of the state. Surveillance cameras, police officers and contact-tracing teams have helped the government find 7,957 close contacts of confirmed cases, all of whom have been quarantined.
The government on Friday launched TraceTogether, an app that uses Bluetooth to record distance between users and the duration of encounters. People consent to give the information, which is encrypted and deleted after 21 days, to the Health Ministry. The department can contact users in cases of “probable contact” with an infected individual.
“There’s a higher degree of acceptance of being monitored by the state,” says Chong Ja Ian, an associate professor of political science at NUS. “That makes some of the more invasive methods for contact tracing easier.”
But, Chong adds, once such mechanisms are in place, “it opens the door for someone five to 10 years down the road to make use of this space in ways that are perhaps less noble.”
The government has also used a tough new online falsehoods law to correct misinformation in posts about the coronavirus, which critics argue gives authorities too much latitude to censor.
Even though Singapore has been successful so far, the battle is far from over. To deal with a potential second wave of infections, the government on Sunday banned short-term visitors from entering or transiting through the country. Returning residents will have to undergo quarantine for 14 days at home or risk a fine of up to 10,000 Singapore dollars ($6,900) and/or six months in jail.
“This is going to be a long-duration battle. We are only seeing the beginning,” Leo says.
Additional reporting by Edward White in Wellington, New Zealand
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