Singapore & Their Response to SARS | The Gold Standard They Set For The World

I'm always talking about Singapore and their amazing public health response to SARS. 

A bit of background:

The 2019 novel coronavirus (SARS-CoV-2) is a new human coronavirus which is spreading with epidemic features in China and other Asian countries; cases have also been reported worldwide. This novel coronavirus disease (COVID-19) is associated with a respiratory illness that may lead to severe pneumonia and acute respiratory distress syndrome (ARDS). Although related to the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), COVID-19 shows some peculiar pathogenetic, epidemiological and clinical features which to date are not completely understood.

COVID-19 seems not to be very different from SARS regarding its clinical features. However, it has a fatality rate of 2.3%, lower than that of SARS (9.5%) and much lower than that of MERS (34.4%). The possibility cannot be excluded that because of the less severe clinical picture of COVID-19 it can spread in the community more easily than MERS and SARS. The actual basic reproductive number (R0) of COVID-19 (2.0-2.5) is still controversial. It is probably slightly higher than the R0 of SARS (1.7-1.9) and higher than that of MERS (<1). A gastrointestinal route of transmission for SARS-CoV-2, which has been assumed for SARS-CoV and MERS-CoV, cannot be ruled out and needs further investigation.

There is still much more to know about COVID-19, especially as concerns mortality and its capacity to spread on a pandemic level. Nonetheless, all of the lessons we learned in the past from the SARS and MERS epidemics are the best cultural weapons with which to face this new global threat.

(https://pubmed.ncbi.nlm.nih.gov/32234451/)

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The Singaporean response to the SARS outbreak: knowledge sufficiency versus public trust

During the outbreak of severe acute respiratory syndrome (SARS) in Singapore from 1 March to 11 May 2003, various national prevention and control measures were undertaken to control and eliminate the transmission of the infection. During the initial period of the epidemic, public communication was effected through press releases and media coverage of the epidemic. About a month into the epidemic, a public education campaign was mounted to educate Singaporeans on SARS and adoption of appropriate behaviours to prevent the spread of the disease. A survey was conducted in late April 2003 to assess Singaporeans' knowledge about SARS and infection control measures, and their concerns and anxiety in relation to the outbreak. The survey also sought to assess their confidence in the ability of various institutions to deal with SARS and their opinion on the seemingly tough measures enforced. The study involved 853 adults selected from a telephone-sampling frame. Stratified sampling was used to ensure adequate representation from major ethnic groups and age groups. The study showed that the overall knowledge about SARS and control measures undertaken was low (mean per cent score of 24.5 +/- 8.9%). While 82% of respondents expressed confidence in measures undertaken by Tan Tock Seng Hospital (the hospital designated to manage SARS), only 36% had confidence in nursing homes. However, >80% of the public agreed that the preventive and control measures instituted were appropriate. Despite the low knowledge score, the overall mean satisfaction score of the government's response to SARS was 4.47 (out of possible highest score of 5.00), with >93% of adult Singaporeans indicating that they were satisfied or very satisfied with the government's response to SARS. Generally, Singaporeans had a high level of public trust (satisfaction with government, confidence in institutions, deeming government measures appropriate), scoring 11.4 out of possible maximum of 14. The disparity between low knowledge on the one hand and high confidence and trust in the actions of the government on the other suggests that Singaporeans do not require high knowledge sufficiency to be confident in measures undertaken by the government to control the SARS crisis.

(https://pubmed.ncbi.nlm.nih.gov/15964886/)

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National Response to SARS:
Singapore
TAN Chorh Chuan
Director of Medical Services
Ministry of Health, Singapore

In an outbreak situation

• Rapid containment of hospital clusters critical

• Intensive “wide-net” surveillance with low

threshold for mandatory quarantine & phone

surveillance

• Surveillance needs to be intensified when

chain of transmission appears to have been

broken

Singapore, unlike China and it lack of transparency, immediately (despite public outcry) closed the borders, the airports, and started quarantining people (extreme measures to contain and halt transmission) and it paid off. They also setup a website and dedicated tv channel (most everyone has a tv but not computer) with real time updates on SARS, i.e. the residents of Singapore were kept informed to reduce any concerns or fears. 

Singapore, unlike any other country, did such an amazing job that the WHO (World Health Organization) adopted their framework, highlighting the key points for containing a rapid spreading disease. As you read you'll see the same elements being used around the world with Covid-19. 

(https://www.who.int/csr/sars/conference/june_2003/materials/presentations/en/sarssingapore170603.pdf)

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Having experienced SARS in 2003, Singapore's healthcare system had drawn upon this experience to enhance its pandemic preparedness response. The emergence of COVID-19 has now put these preparations to the test. We describe the evolution of Singapore's outbreak response from the SARS crisis in 2003 to the current COVID-19 pandemic, focusing on public health measures as well as the clinical management and workflows at the National Center for Infectious Diseases, Singapore.

Singapore’s COVID-19 response

To reduce the transmission of SARS-CoV-2, Singapore has adopted a strategy of active case detection and containment through several means.

• Surveillance and containment
• Border control measures
• Community and social measures
• Management of COVID-19 in NCID
• Managing the sick healthcare worker

(https://www.mja.com.au/journal/2020/sars-covid-19-singapore-journey)

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What Singapore can teach the U.S. about responding to Covid-19

• A whole-government response
• Scaled screening using public health preparedness clinics
• The government covered costs of testing and treatment
• Aggressive but targeted quarantine measures
• An emphasis on public health communication
• Rally around health care workers

We have a lot to thank Singapore for, mostly for their public health team, their quick thinking and acting in the best interest of their residents, and being transparent with the community. The Chinese government were not transparent, actually lying to the world, putting others at risk. 

(https://www.scmp.com/comment/opinion/article/3051164/three-mistakes-chinese-government-has-made-its-mishandling)

As you navigate through your day, know that the measures taken during the Covid-19 pandemic have been used before with a positive outcome.

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https://www.facebook.com/sghealthministry/