Singapore’s Success in Limiting Covid-19 Outbreak is All in the Planning, Ambassador Says

Amid the worsening Covid-19 pandemic, Singapore has won consistent praise for its response, which has included early restrictions on travel, strict quarantines, clear messaging, as well as testing and monitoring.

In an interview with Caixin, Lui Tuck Yew, Singapore’s Ambassador to China, said the Southeast Asian nation has been preparing for such an epidemic since the outbreak of severe acute respiratory syndrome (SARS), which killed dozens of people in the country.

As of Friday, the city-state has reported 345 Covid-19 cases and zero deaths.

The interview has been edited for length and clarity.

Caixin: Singapore has been successful in curbing the transmission of Covid-19. Which interventions have been most effective?

Lui Tuck Yew: We have set up multiple lines of defense to reduce the risk of imported cases and local community transmission, and we have been stepping up our efforts at each line of defense.

First, we have adopted measures that aim to minimize importation of the virus onto our shores. Travelers who meet the clinical suspect case definition are conveyed directly to the hospital while lower-risk symptomatic travelers must undergo a swab test at the checkpoint as an added measure. We monitor the global situation closely; we advise against nonessential travel to severely affected countries and impose restrictions on incoming visitors with travel history to these places. Residents and long-term pass holders returning from these regions are subject to a 14-day Stay-Home Notice enforced by law.

Second, we isolate and treat confirmed cases and carry out ‘ring fencing’ to prevent further transmission. We immediately conduct contact tracing and close contacts are quarantined and closely monitored. Singapore’s priority is therefore to detect every possible case early, contact trace and contain the spread. We work on an expanded version of the WHO’s recommended suspect case definition, and conduct surveillance on all patients with pneumonia and those in the community with influenza-like illnesses.

We have more than 800 public health clinics that provide subsidized treatment, investigation and medication. We developed our own diagnostic kit by early February and it was used extensively, thus boosting our nationwide diagnostic capability.

Third, and most importantly, we have focused our messaging on encouraging Singaporeans to play their part and exercise social responsibility to reduce the spread of the virus in the community while going about our daily lives. This includes good personal hygiene such as washing hands regularly with soap and water, as well as other good habits such as staying at home when unwell. We also urged the public not to spread unverified information or false news that can cause needless panic and fear. To address false information, we have stepped up our efforts to provide everyone with timely and accurate information, such as through daily media briefings and press releases.

Are Singapore’s measures applicable to other countries?

Public health measures must be appropriate and calibrated to risk, and to the circumstances of each country. These measures should be fair and consistent, but also sensitive to the concerns of patients and communities.

To mount a swift and effective response, it is important to adopt a “Whole-of-Government Approach” and mobilize the resources of all relevant agencies as well as to have the support of the public as we work together to fight Covid-19. We leaned on legislation and law enforcement to ensure compliance to the range of measures that we have implemented, and to counter fake news and rumors decisively to prevent disruption of our efforts. With this approach, we can implement measures in a timely, calibrated and targeted manner.

Caixin: Singapore has imposed travel restrictions — rejecting non-Singaporeans or nonresidents who have been to mainland China in the past 14 days to transit in or enter Singapore. To what extent have border control measures contributed to your success? How have China’s and Singapore’s governments interacted over borders and public health measures?

We are extra vigilant on this front because Singapore is an international travel hub with more than 68 million people using our airport last year. A virus that comes through our airport will not only impact Singapore, it can also easily spread through us to other countries in the region.

Travel restrictions are not tied to nationality and are necessary to reduce the number of imported cases as we buy time to implement necessary precautionary measures. We have also put in place travel restrictions for those coming from Iran, northern Italy and the Republic of Korea, in addition to mainland China, due to the surge in confirmed cases in these areas.

Singapore values the bilateral relations with China, and we have strong ties. Health officials from both countries remain in close communication to exchange technical expertise on managing Covid-19. But the virus is spreading around the world, so we will be exposed to new waves of infection, and it is more and more difficult to stop the virus at our borders. We also cannot shut ourselves off from the world. We will have to continually reassess and calibrate our measures appropriately.

Some have said that Singapore’s success is due to lessons learned from past epidemics like SARS, H1N1, and MERS. How has Singapore’s public health strategy evolved since 2003?

We have been preparing for the possibility of an infectious disease outbreak like this one since SARS. We have set up a whole-of-government structure for outbreak management and have developed a national pandemic preparedness plan based on our “Disease Outbreak Response System Condition” (DORSCON) framework. This enables the government to respond swiftly and appropriately to evolving outbreaks. The DORSCON framework calibrates our response measures according to the severity and spread of disease.

We set up a multi-ministry taskforce to coordinate the whole-of-government efforts even before the first imported confirmed case in Singapore. Examples of multi-agency coordination work undertaken include the police helping with contact tracing, the Immigration and Checkpoints Authority helping at checkpoints for health screening, and Ministry of National Development providing facilities for government quarantine use. The taskforce has stepped up measures accordingly.

We set up the National Centre of Infectious Diseases (NCID) in 2019, a purpose-built facility to strengthen our ability to manage the outbreak of infectious diseases. It co-locates clinical services, public health functions, teaching and training, and research capabilities and is benchmarked to international standards for treatment and safety. All public hospitals are also equipped, and their staff trained, to handle Covid-19 cases and isolate and treat them effectively. For example, public acute hospitals have Negative Pressure isolation capabilities, including capacity to surge if required.

Public acute hospitals have strict protocols, as well as trained infectious diseases clinicians and healthcare professionals to manage and isolate suspect and confirmed cases adequately. All frontline healthcare workers are trained and equipped with personal protective equipment when caring for suspect and confirmed patients with Covid-19. They have also stepped up infection control measures, which include increasing the frequency of cleaning and disinfection of premises, tightening access control at entries of hospitals, requiring temperature screening for visitors, limiting number of visitors and implementing staff fever and sickness surveillance. Our healthcare institutions also have business continuity plans in place to cater to a range of possible scenarios, including a pandemic.

We increased our isolation bed capacity in public hospitals in the past few weeks. In anticipation of a likely increase in the number of potential cases in emergency rooms, public hospitals set up temporary expanded screening areas from February 6 to cater for larger numbers of patients and implemented more streamlined patient care workflow.

The Ministry of Health is also working with polyclinic clusters to expand the triage and holding areas at smaller polyclinics. It also re-activated more than 800 Public Health Preparedness Clinics to care for patients with respiratory symptoms. Patients suspected to have pneumonia will be referred to the hospitals for further tests and care.

We have also worked with the private sector to strengthen our responses to the outbreak and coordination. For example, the health screening teams at checkpoints are from the private sector and privately-run general practitioner clinics.

We have also been increasing our testing capacity to enable us to more quickly confirm suspect cases. The National Public Health Laboratory has worked with international and academic partners to develop a better diagnostic test to identify the virus. The test has been deployed to all public hospital laboratories to boost diagnostic capabilities nationwide.

We have bolstered our research agencies to support clinical services, through curating the available evidence to recommend best practices in surveillance, diagnosis of the virus and treatment. We have had exchanges with health authorities in other countries, including Malaysia, China and Hong Kong, Japan, the rest of ASEAN and the EU, UK, U.S. CDC and WHO, to share knowledge and coordinate strategies.

2020 marks the 30th anniversary of establishment of diplomatic relations between China and Singapore. What will be your top priorities and what new areas of bilateral cooperation will there be between China and Singapore?

The 30th anniversary of the establishment of diplomatic relations not only provides both sides with the opportunity to celebrate and commemorate the past, but also provides a platform for both sides to investigate new areas of cooperation. In view of the Covid-19 outbreak, Singapore believes the current priority would be to work with China, and the international community, on epidemic prevention and control. Both sides could also assess cooperation in the healthcare sector in the long term.

In terms of high-level exchanges, President Halimah Yacob will be making a state visit to China at President Xi Jinping’s invitation.

We have planned for a series of commemorative activities in both Singapore and China. These include an exhibition of the Tang Cargo in Shanghai where thousand-year-old treasures from the ancient Silk Road will be on display.

Contact reporter Dave Yin (davidyin@caixin.com)