Last review and update: June 7, 2020.
Is Singapore’s COVID-19 management a success?
Singapore did not do lockdowns and life there remained normal in many aspects. Is Singapore’s COVID-19 management a success?
The curve of new daily cases of COVID-19 in Singapore seems to be tracing a plateau since mid-April 2020 with a trend towards a slow decline in new cases.
Singapore vs Switzerland vs Belarus.
The number of new cases is relatively high and proportional to what is reported by Belarus if we account for the population size. Belarus has approximately twice as many inhabitants as Singapore and the number of daily new cases during the current “high plateau” phase of the epidemic has been about 900, or twice as much as in Singapore. There were no lockdown in Belarus and “distancing” has been minimal throughout the epidemic.
Switzerland was more successful in elimination of COVID-19. Switzerland had a lockdown but draconian measures there did not last long. Switzerland is a showcase for a successful management of COVID-19.
Can we trust Singapore’s COVID-19 mortality data?
Singapore reports a very low number of COVID-19 deaths.
Can we trust Singapore’s COVID-19 mortality data?
Authoritarian Belarus also declares very low mortality numbers. Should we also trust mortality data reported from Belarus? To answer this question, we looked at the treatment guidance issued by the Belarus Ministry of Health. The guidance contains multiple questionable recommendations and its application is unlikely to result in low mortality. The reported mortality figures are probably what the authoritarian president of Belarus Mr. Lukashenko likes to see.
The IHU hospital in Marseille, France, is the reference for COVID-19 mortality.
Another reference for COVID-19 mortality is the data reported by the IHU infectious disease hospitals in Marseille, France. Among the countries with European population, the IHU Marseille produced the most reliable and coherent data on COVID-19 treatment and outcomes so far.
The competent medical team at the IHU Marseille reported a mortality rate of 0.5% of confirmed COVID-19 cases. This is the lowest COVID-19 mortality reported so far by a reliable source.
Singapore may be reporting 7.5 times less COVID-19 deaths than it really has.
If Singapore’s doctors are as good as the doctors at the IHU Marseille, France, the daily mortality figures in Singapore should be around 0.5% of the average number of the new cases over the past several weeks. The daily number of new COVID-19 cases in Singapore has been around 500. 0.5%*500=2.5. There should be 2.5 deaths a day in Singapore. Singapore reports 1 death every 3 days. This is at least 7.5 times less than what would be expected with a COVID-19 mortality rate of 0.5%.
The verdict on Singapore: the management of COVID-19 has not been exemplary so far.
The verdict on Singapore: A limited success in containing the epidemics in comparison to Switzerland and a possible under-reporting of COVID-19 mortality. The management of COVID-19 in Singapore has not been examplary so far.
Singapore’s response to COVID-19.
Below, there are several of our notes and curated citations on the different elements of Singapore’s response to COVID-19 and comparisons with other countries.
Medical practitioners were instructed to provide extended medical leave of up to 5 days for patients with respiratory symptoms.
As early COVID-19 disease is mild and undifferentiated, medical practitioners were instructed to provide extended medical leave of up to 5 days for patients with respiratory symptoms. This allowed possible COVID-19 cases to self-isolate at home to reduce the number of undetected cases seeding community transmission.
“Fever clinics”.
Australia and China set up ‘fever clinics’ to assess large volume of people for COVID-19 while minimizing risk of transmission to other patients
Designated hospitals.
While most countries managed their cases in existing hospitals, China established at least 14 temporary medical facilities designated to treat COVID-19 patients.
Schools have remained open in Singapore.
Schools have remained open, but implemented precautionary measures such as reduction of mass assemblies, inter-class and inter-school activities
No lockdown in Singapore.
Public are advised to practice social responsibility while life continues as usual with precautions.
No areas have been locked down to date in Singapore.
Wishful thinking: “Singapore’s experience suggests it is possible to avoid major social disruptions and contain the spread of COVID-19, as a sustainable approach over the long term.” (Lee et al., 2020 (1).
Lee et al., 2020 (1), understand the importance of the effective reproductive number (effective transmission rate).
Lee et al., 2020 (1):
Statistical modelling of the effective reproduction number has shown it to be consistently below 1, suggesting that containment efforts are successful.
However, if we look at the data, the statement by Lee et al., 2020 (1), that the effective reproduction number was consistently below 1 is incorrect. The effective reproductive number is oscillating around 1 and the curve of new COVID-19 cases is tracing a “high plateau” with about 500 new cases a day.
Lee et al., 2020 (1), about challenges that lie ahead in Singapore.
“Contact tracing and quarantine are resource-intensive activities and may not be sustainable in the long run.”
“With global spread, the force of infection from imported cases will be substantial, leading to new waves of infection.”
However, several challenges lie ahead. Firstly, the longer the outbreak persists, the more chains of community transmission and missed cases are present, and the more difficult it will be to link cases and contain spread. Contact tracing and quarantine are resource-intensive activities and may not be sustainable in the long run. Secondly, some individuals who continue to work or attend social functions while symptomatic are driving disease spread, leading to substantial community transmission. Thirdly, with global spread, the force of infection from imported cases will be substantial, leading to new waves of infection.
As Singapore is a travel hub with high reliance on trade, sustained border control measures may not be practical with global disease spread, and it may not be feasible to completely shut a country’s borders for a prolonged duration. These factors may result in a rise in cases, and additional measures will be required to achieve a balance between containing disease spread and reducing the overall health and socioeconomic impact due to community transmission.
Conclusions.
Singapore’s management of COVID-19 is of interest but it has had limited success so far.
Your geographical location during the COVID-19 epidemics matters for your personal safety. Reasonable literacy and preparedness should protect you from getting infected. In case you do get infected with SARS-CoV-2, a timely treatment should allow you to avoid a severe course of COVID-19 and exposure to medical errors.
It is also a good idea to interact with your local medical professionals and your local bureaucrats and elected officials to make sure there is no malpractice in the hospitals in your area.
If you need help with the above, or with other COVID-19 related questions, do not hesitate to get in contact with us.
Selected references:
1. Vernon J Lee, PhD, Calvin J Chiew, MPH, Wei Xin Khong, PhD, Interrupting transmission of COVID-19: lessons from containment efforts in Singapore, Journal of Travel Medicine, Volume 27, Issue 3, April 2020, taaa039, https://doi.org/10.1093/jtm/taaa039
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