The severe acute respiratory syndrome (SARS) outbreak in 2003 resulted in more than 8000 cases and 800 deaths, in 26 countries. At that time, SARS was successfully controlled by means of syndromic surveillance, isolation of patients, and strict enforcement of quarantine. By interrupting all human-to-human transmission, SARS was effectively eradicated.
COVID-19 threatens to become a global pandemic that could wipe off $1 trillion from the world’s gross domestic product.
Singapore is a small, globally-connected city-state, with an estimated population of 5.6 million people (as of 2018) and population density of 7804 people per square km. Singapore is a rich nation without healthcare shortages. It has been ruled by one political party since independence.
Currently, Singapore is facing COVID-19. But it is controlling the spread of COVID-19 successfully. The local media support the government’s messaging without questioning, from washing hands to staying at home if someone is not feeling well.
The global community is much better prepared now, in comparison to the SARS outbreak in 2003.
There are many similarities between the SARS and COVID-19 (Coronavirus disease 2019). In both, the main transmission route is respiratory droplets, although viral shedding via faeces has also been reported for both viruses.
The whole genome of COVID-19 has a 86% similarity with SARS. The angiotensin-converting enzyme 2 (ACE2), found in the lower respiratory tract of humans, has been identified as the receptor used for cell entry for both SARS and COVID-19. Both have a median incubation time of about 5 days.
COVID-19 differs from SARS in terms of infectious period, transmissibility, clinical severity, and extent of community spread. By contrast, evidence from ‘exported COVID-19 cases’ suggest that transmission during the early phase of illness also contributes to overall transmission; therefore, isolation of more severe patients is too late and ‘pre-symptomatic transmission’ is making ‘temperature screening’ less effective.
Genomic analyses of the new Coronavirus have revealed that its spike protein differs from those of close relatives and the capsid protein possess a site on it which is activated by a host-cell enzyme called furin. The furin is found in lots of human tissues, including the lungs, liver and small intestines, which means that the virus has the potential to attack multiple organs.
By interrupting all human-to-human transmission, SARS was effectively eradicated but the cases of COVID-19 have been increasing with more than 3800 deaths, mostly in China.
Common symptoms of the COVID-19 disease include:
If anyone has mild flu-like symptoms like cough, runny nose, sore throat and fever, contact a doctor. During the unwell period, do not go school or work place, avoid crowds, stay at home and don’t avoid doctors. Avoid touching your face without washing your hands; your face is sacred.
According to the World Health Organisation, it is best to stay three feet from a sick person with minimum time engagement. That will carry least risk. The Coronavirus is a delicate microbe that is killed easily with disinfectant.
The New York Times in a recent article, provided all the possible answers to the questions related to transmission of COVID-19.
Case summary in Singapore (as of March 8, 2020, 1200 hours) shows zero deaths. Among the 60 ‘active cases’, 51 are stable and 9 cases are critical. All the 60 patients are hospitalised.
Real time updates may be seen here.
Despite being an international business hub, Singapore has kept infection rates down. Here are some steps taken by Singapore government to tackle with the spread of Coronavirus:
Unlike the other countries that are witnessing Coronavirus cases in travellers from China, Singapore is concerned with more human-to-human transmissions of the COVID-19 virus.
Tough laws for tracing and containing COVID-19 cases. Citizens who have travelled to infected places are quarantined. The principle is that if the person under quarantine developed illness, that person would not spread the disease.
Anyone giving false information, about their travel history, faces punitive action and faces even a ban on re-entering Singapore.
People have a strong sense of civic duty. Citizens and people living in Singapore put public interest over their own. They accept government orders to quarantine and report their location to authorities using an online system.
Singapore has a world-class health system. Health facilities in Singapore are of a high level. Recently, it has deployed a new test to track links between infected patients which will help authorities to stop the virus spreading further.
Singapore citizens returning to their homeland are placed on 14-day paid mandatory leave-of-absence (LoA) starting from the day they arrive.
The Singapore Ministry of Trade and Industry (MTI) issued notices to a number of companies engaged in profiteering from the Coronavirus situation in the country and were selling masks at a higher price to benefit from the increased demand.
Prime Minister Lee Hsien Loong reassured its citizens that the virus didn’t appear as deadly as SARS, meaning that most people would likely experience a minor illness even if they contracted it.
When there is an outbreak resulting in the spread of an infectious disease worldwide, Singapore puts in a ‘prevention and response plan.’
As part of this plan, the Disease Outbreak Response System Condition (DORSCON) becomes active. DORSCON is a colour-coded framework that shows the current disease situation and provides general guidelines on what needs to be done to prevent the spread of the disease and finally reduce the impact of infections.
DORSCON takes into account the current disease status overseas, transmission of the disease, possibility of disease arrival in Singapore and possible impact of the disease on Singapore’s community.
There are 4 statuses of DORSCON– Green, Yellow, Orange and Red, depending on the severity and spread of the disease.
During the SARS spread in Singapore, the DORSCON status was orange. It means that the disease was severe and spread easily, but still contained. During the current COVID-19 , the status of the DORSCON is the same, i.e. orange.
When suspected cases come in to the knowledge then following steps are taken in Singapore:
All suspected cases are transferred to the hospitals through ambulances to reduce their exposure to the general public. All such cases are reported to the Ministry of Health promptly.
Suspected cases are isolated in the hospitals. Many suspected cases turn out to have other mild diseases such as the common flu.
Ambulance crews who attend the suspect cases to the hospital, wear personal protective equipment, for they come into close contact with patients and are at higher risk of infection.
The risk of infection from transient contact is very low. There is no need to avoid places where suspected and confirmed cases have been.
Singapore is controlling the spread of COVID-19 through these 5 Ms:
Apart from the above suggestions, the Singapore government suggests the practice of good personal hygiene. An unwell person should cover their mouth with tissue paper when sneezing or coughing, if sick avoid crowded places, monitor temperature twice daily and stay at home, strictly follow quarantine orders, throw litter in bins, use masks and tissues, keep toilets clean and dry, keep tables clean, keep home and surroundings clean and ventilated, use private transport to the clinic, do not go near live animals including poultry and birds and do not eat raw and undercooked meats.
Singapore is showing the world that when all the stars are aligned, the virus may not be as uncontrollable as feared. India may also learn from the successful steps and approach by the Singapore government to control the spread of COVID-19 virus and related health problems.
The political will, early case detection, prompt isolation of ill people, comprehensive contact tracing, immediate quarantine of all contacts, community quarantine, and implementation of social distancing may contribute to the eradication of COVID-19 from India and world.