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Singapore a Rare Lodestar in Coronavirus Fight

A security officer views a thermal screening monitor as visitors enter Gardens by the Bay nature park, in Singapore, March 14, 2020.
A security officer views a thermal screening monitor as visitors enter Gardens by the Bay nature park, in Singapore, March 14, 2020.

Crucially, health workers have joined with police for the urgent detective work of tracking down anyone a carrier has been in contact with.

On Jan. 23 Singapore became one of the first countries after China to report a case of the new coronavirus — a 66-year-old man who had brought the deadly pathogen with him three days earlier from the Chinese city of Wuhan.

Since then, the World Health Organization has labeled the speedy spread of the virus across the globe a pandemic, with major outbreaks numbering into the thousands from Iran to the United States and over much of Europe. Singapore, meanwhile, a major regional travel hub and trade transshipment point with 5.6 million tightly packed inhabitants, has reported only 345 cases as of March 19 and no deaths.

"That's a very good achievement," said Dr. Ying-Ru Jacqueline Lo, the WHO representative for Brunei, Malaysia and Singapore.

Along with Hong Kong and Taiwan, the Southeast Asian city-state has earned high praise for its early and thorough response to COVID-19. Although the number of confirmed cases continues to mount on the island daily, most new reports are still being linked to people arriving with the infection from abroad.

Authorities "were very transparent [about] what was known or unknown and what they were going to do and what the public could do, and that started very early," Lo said.

Jeremy Lim, co-director of global health at the National University of Singapore's Saw Swee Hock School of Public Health, credits that response in large measure to the country's traumatic experience with SARS, or severe acute respiratory syndrome, a deadlier relative of COVID-19.

A global SARS outbreak in 2003 infected 238 Singaporeans and killed 33, more than anywhere else besides mainland China, Hong Kong, Taiwan and Canada.

"The experience of SARS is viscerally seared into the individual as well as the collective consciousness," Lim said.

"Many of us lost friends, we have close friends, relatives who have been infected, and I think that the sentiment after SARS was, never again — we must be better prepared the next time."

And it was. Soon afterward, the government got to work scaling up both the pandemic response training of its health care professionals and the facilities to cope with future outbreaks — the National Center for Infectious Diseases opened last year — and getting other ministries and nongovernment entities in on the act.

As a result, Singapore had a multiagency task force dedicated to preparing for COVID-19 in place by early January, before authorities had even confirmed the country's first case and just ahead of the Lunar New Year, when arrivals from China typically spike.

The government had by then suspended all flights from Wuhan, where the coronavirus made its leap to humans, most likely from a bat, last year. In the weeks that followed it barred entry to those with recent travel anywhere in China, as well as South Korea, Iran, Italy, France, Germany and Spain. Arrivals from all other countries are currently being ordered to isolate themselves for 14 days, including Singapore citizens and permanent residents.

Authorities have backed up the orders with the threat of fines and jail time, and they proved they meant business when, in late February, they revoked the permanent residence status of a man who had disobeyed instructions to stay indoors after having recently returned from China.

Boasting one of the highest gross domestic products per capita in the world, Singapore also marshaled its considerable financial resources to the fight early on with free testing for anyone suspected of having the virus, no-cost treatment for confirmed cases, and payments of about $70 a day for local workers ordered to stay home, to encourage self-quarantine compliance.

Crucially, health workers have joined with police for the urgent detective work of tracking down anyone a carrier has been in contact with.

"It's this ability to mobilize resources very quickly across all of society that really provides the basis for us to have pretty effective contact tracing, quarantine, so on so forth," said Lim.

It's what those in the field call a "whole of society" approach.

"It means that when you plan interventions, for example you plan for what people can do themselves and the whole society can do," Lo said, from the state to non-government groups to private business, a big player in health care in Singapore.

She also credits the leadership's public messaging for discouraging mass gatherings and quelling an early run on facemasks, keeping supplies stable for the sick and for frontline health care workers.

"They tailored the messages together with community members, they tested them and ruled them out systematically, and they are very successful with that. Malaysia and other countries started a bit later, but they replicated that approach and it helped," Lo added.

A nine-minute speech by Prime Minister Lee Hsien Loong posted on social media Feb. 9 also helped ease an early bout of panic buying on an island heavily reliant on imports at a time of global supply chain jitters.

The address "was a pretty outstanding example of very good risk communication," Dr. Claire Hooker, a senior lecturer at the University of Sydney's Center for Values, Ethics and the Law in Medicine told the Bloomberg news agency. "It gave people very concrete actions" that "handed back a measure of control to people whose sense of control will feel threatened."

Whether the tactics and strategies of a tiny, rich city-state with an authoritarian bent can prove a model for other countries is another matter.

Lo said most countries could copy Singapore's example of engaging all ministries and the private sector and the public in fighting the coronavirus, and of communicating with citizens often and honestly.

Lim also stressed the benefits of a highly connected government and society over those of being a small country, and of acting fast. He played down the importance of one-party rule in mounting a muscular response, noting that for every China there is a Taiwan.

In addition, with much fake news swirling around the pandemic, Lim said governments must offer trusted sources of information on the virus, how they are responding and what people can do for themselves. He knows it's a luxury not all countries have.

"As the saying goes, one needs to have planted the tree 20 years ago to enjoy the shade today," said Lim. "And so governments that have not enjoyed the trust of the people cannot reasonably expect to enjoy the trust in double-quick time."