Covid-19: Singapore races to regain control

Bloomberg

In the early days of the coronavirus pandemic, Singapore was a global standard bearer for taming the deadly illness. Now it’s home to Southeast Asia’s largest recorded outbreak and is racing to regain control.
One reason behind this reversal can likely be traced back to six days in February, when the earliest sign of what would become an explosion in cases among migrant labourers first appeared. It’s a cautionary tale of how even countries experienced in handling epidemics can be wrong-footed by this elusive
disease, particularly when it takes root in disadvantaged communities.
In early February, Singapore had a low-level outbreak that it was containing effectively without disruptive measures like closing schools. It was being globally lauded for its calm, measured approach to the virus. Around the same time, a 39-year-old Bangladeshi national, one of an army of almost 1 million foreign laborers in Singapore, developed symptoms of the coronavirus.
In the days after he fell ill, the labourer visited a clinic and a hospital for help, only to be sent home each time. Home for the worker was a dormitory where men sleep about 10 to a room, sharing toilets and cooking facilities. He also visited the Mustafa Centre, a 24-hour shopping mall popular with migrant labourers and locals alike. It wasn’t until February 7 that he was admitted to hospital and a day later, tested positive for the virus.
The Bangladeshi was Singapore’s patient number 42, and the first apparent case among low-wage foreign workers in the city’s dormitories. Infections among migrant labourers now account for more than 70% of the country’s 8,014 infections, and Singapore is seeing record daily increases in its tally, with new cases exceeding 1,000 for the first time on April 20.
The country didn’t record its first deaths until late March, but fatalities now stand at 11, and its less socially restrictive strategy has been replaced by a partial lockdown where the measures are being tightened and adjusted repeatedly.
Many governments have been caught out by the unexpectedly infectious pathogen, with opportunities for early containment lost as patients were sent home instead of being immediately tested and quarantined.
But unlike other Asian nations such as South Korea, some health experts say Singapore was slow to revise a response plan honed during its experience in 2003 with Severe Acute Respiratory Syndrome (Sars). That strategy saw the nation focus on hunting down people who had come into contact with an infected person, a classic public health approach known as contact tracing.
Covid-19 — highly contagious and manifesting in some with little or very mild symptoms — has turned out to be “nothing like Sars,” said Jeremy Lim, an adjunct associate professor at the National University of Singapore’s Saw Swee Hock School of Public Health. “The old playbook has to be thrown out and a new one written,” he said. “The difficulty for countries including
Singapore is that one needs to write the playbook as they execute measures. It’s like the metaphor — fixing an aeroplane’s engine while mid-flight.”
The case of Singapore’s Patient 42 shares similarities with that of a patient in South Korea who triggered a turning point
in that country’s epidemic, which has exceeded more than 10,000 cases.
Ten days passed between South Korea’s Patient 31 going to a hospital with symptoms, and when she was finally quarantined. In the days between, the woman, a member of a religious sect, attended services where people worshiped sitting on the floor, elbow-to-elbow for two hours at a time.
Until then, South Korea was — just like Singapore — testing people found through contact tracing. But faced with an explosive outbreak within a group that has more than 200,000 worshipers, Korean officials rapidly pivoted to a strategy known as community testing: it compelled church leaders to hand over a list of its members and began testing them all, regardless of whether they showed symptoms or
had had contact with an infected person.
Hong Kong also widened its virus response beyond contract tracing to include community testing as it became apparent the coronavirus was different to Sars, where those infected fell seriously — and obviously — ill.
Singapore is now entering the third week of a partial lockdown it calls a circuit breaker. Social gatherings are banned and only essential businesses are allowed to operate. Schools are now shut, as well.