As the novel coronavirus (COVID-19) continues to spread around the world, governments are now being tested on their ability to respond to outbreaks in their respective countries. Fatality rates of the disease vary from place to place. This is highly dependent on how robust local healthcare systems are and the effectiveness of national crisis management strategies.
Amidst global anxieties surrounding the epidemic, Singapore has emerged as the poster child for coronavirus management, garnering praise from observers and experts globally. In mid-February, it was home to the largest number of coronavirus cases outside mainland China, with 58 cases of infection.
However, even as the number of coronavirus cases rose to over 100 as of March 4, there have been no fatalities in the city-state. Among the 110 infected patients, 78 have fully recovered. Through meticulous contact-tracing processes, the Singapore government managed to link the coronavirus cases to “infection clusters,” zeroing in on the transmission routes of the coronavirus.
VICE spoke to Dr. Dale Fisher via video chat about how Singapore is dealing with the coronavirus threat and what other countries can learn from it to manage the outbreak effectively. Fisher is a professor of infectious diseases at the National University of Singapore and the chairman of the Global Outbreak Alert and Response Network coordinated by the World Health Organisation. He is currently in quarantine in Singapore, after he returned from a WHO mission to China.
VICE: What were your first impressions of the coronavirus?
Fisher: My first impression was that this sounded like SARS. It sounded like mutterings from a distant country, and it wasn’t just chatter. There was some substance to this. You could tell it felt different.
How can you characterise the current situation in Singapore?
Singapore has a strong health system, fairly cohesive leadership with strong support, and good community engagement. It's not a big stretch to bring all that together in a time of crisis.
We’ve had six or seven transmission chains where people got infected in the community and infected others in the community, but because Singapore is so able to identify these cases early with extremely thorough contact tracing and very effective quarantine, we’ve been able to shut down all of those transmission chains to date.
You would never brag in an outbreak because you don’t know what’s around the corner for you, but to date, this formula is really the same formula as China's, just on a completely different scale. It's the same formula of traditional outbreak response measures with epidemiological approaches, strong surveillance, leadership, and teamwork.
It's under control in Singapore. Not being under control could mean that there’s free transmission, that there are people whom we don’t know how they got it, that there are infected people popping up and we’re not even comfortable allowing people to sit in restaurants together because it’s too dangerous. To me, that would mean a loss of control. We’ve had limited spread in communities, but each time it has been shut down.
Do you think Singapore’s strategy can be replicated elsewhere?
Let’s make this clear. There are no other strategies. If there was a vaccine, there would be another strategy. If there was a treatment, there could be another strategy. But if you believe that this needs to be contained — and you should believe it because non-containment means more people die — there are no other strategies.
It is simply early case detection, aggressive and thorough contact tracing, and isolation or quarantine. And if it gets out of control, that’s when you really need to rein in societal measures in stopping the gatherings and blocking the streets.
I believe you can apply Singapore’s measures in other cities. It might be more challenging depending on the relationship between the government and the community. But if they can work together, then I believe those measures will work.
So there’s nothing particularly special about the measures Singapore is taking?
There is nothing special about the measures taken in Singapore. It’s really about how you implement them. Singapore has implemented them well, stringently, and thoroughly. These measures do work if you can do it thoroughly and engage the community.
How responsive has the community been to these protocols? How crucial is that in containing the virus?
This does worry me. If there is a mistrust of the government, then these interventions are very hard to put in place. The most recent Ebola outbreak in Congo was so prolonged because of mistrust between the government and the community. If you have a government that says, “Quarantine yourself for the next two weeks” or “Don’t go out if you’ve got a flu-like illness,” if the community works with that then you’ve got a much better chance. But if they say, “I don’t believe the government, they lie to me all the time,” then, of course, these measures are not going to work.
What has the Singapore government done to gain the trust of the community?
We work very hard on community engagement. It starts with the prime minister and works its way down. It’s cross-ministerial. For the healthcare clusters in Singapore, the leadership is always communicating with people on the academic side. The fact that I’m sitting here talking with you means we regard this as critical in helping the community understand. If you give communities that information and you tell them in a way that makes sense, then they will listen. If you’re too authoritarian or dismissive or, worse still, tell them nothing, then I don’t think you’re going to get the buy-in. Responsible media is very important as well.
Do you think we’ve seen the worst of the virus?
No. I think we’re in a very immunologically naive world. I expect to see more clusters than we’ve seen. I fear a cluster in a city with a vulnerable health system that does not have the capacity to respond like other cities. I think there are challenges ahead.
Are you confident that the government is capable of containing the virus if it worsens in Singapore?
If there was a big outbreak in Singapore, I think we can handle it. Singapore has really taken advantage of this lead time.
What do you think other countries can learn from Singapore?
I think there are a few lessons. We need a whole-of-government approach. It’s not about health. It needs to be about economy, travel, and foreign affairs. It’s a disease that involves everything.
I think community engagement is crucial and you need to get the community to buy into the fact that they are the solution. Governments can say all they want, but if the community is not behind them and backing them, then it would be a challenge.
I also worry if we’re doing enough in underdeveloped health systems, and if they are getting the necessary skills to shut down clusters and treat patients. I really think they are vulnerable.
This conversation has been edited/condensed for brevity and clarity.
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