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The first known infection from SARS-CoV-2 (COVID-19) was discovered in Wuhan, China. On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a global pandemic. COVID-19 is a disease that is transmissible via droplets. With people moving around the world, the virus began to spread like wildfire.

As with any other country, Singapore was also affected by the pandemic. The first known COVID-19 case in Singapore is thought to have arrived via a Chinese traveller in January 2020 (1). Singapore is a small country, densely populated at approximately 8000 people per square kilometre. As such, the risk of rapid spread of any contagious disease is high. In 2003, when faced with the SARS outbreak, Singapore had built the infrastructure and developed policies to manage outbreaks in the scale of SARS. In hindsight, Singapore’s preparedness was timely to respond to the COVID-19 pandemic.

Looking into the number of total cases in densely populated countries, especially those in close proximity to China, I am fascinated by how well Singapore handled the situation. Policies involving hospital operation, management of disease spread, and the national vaccination program played crucial roles in Singapore’s success in managing the COVID-19 pandemic.

One of the most important aspects of healthcare operation that the Singaporean government looked at is the availability of hospital beds for COVID-19 infected patients. At the onset, Singapore quickly expanded its operational capacity by converting research facilities, which were previously purpose-built for use as hospitals in response to the SARS outbreak, back into hospitals (2). In addition to these hospitals, holiday resorts, exhibition centres, and convention centres were temporarily repurposed into isolation facilities for COVID-19 infected patients with mild symptoms (2). In response to a further increase in COVID-19 cases, general hospitals were also later opened to receive COVID-19 infected patients. The rapid expansion of healthcare capability and triaging patients into different facilities based on disease severity enabled Singapore to effectively cope with the pandemic without overwhelming the healthcare system.

Moreover, Singapore had also established key policies after the 2003 SARS outbreak which were useful when responding to the COVID-19 crisis. Soon after the detection of the first COVID-19 case, Singapore used its existing policies to quickly implement contact tracing and issuing directions for close contacts to immediately self-isolate (2,3). By implementing these policies, Singapore was able to trace and isolate infected individuals effectively, keeping the number of fatalities caused by COVID-19 to a minimum.

Additionally, Singapore introduced a national vaccination program as early as January 2021 with the goal of achieving herd immunity (4,5,6). As of 28 August 2021, approximately 80% of their population received both vaccine doses with peak vaccination rate reaching about 151 doses per hundred people (Figure 1) (4,5,6). Singapore currently ranks the fifth highest in the world in fully vaccinating against COVID-19.

Figure 1: Percentage of population that is fully vaccinated against COVID-19 in Singapore and Australia, compared to the world. (Adapted from Our World in Data, 6)

Collectively, these strategies were useful to break the chain of disease transmission and prevent overwhelming the healthcare system.

Turning to the shortcomings in Singapore’s COVID-19 response, deficiencies in other capacities attributed to a rise in COVID-19 numbers. There were several large and interlinked COVID-19 case clusters within the immigrant worker communities termed the ‘dormitory clusters’ (approximately 84% of the total COVID-19 cases as shown in figure 2). Densely populated dormitories, each housing up to 20 men in a single room with no sufficient space to practice social distancing, presented the perfect condition for the virus to spread rapidly. To manage the situation, the authorities decided to relocate healthy migrant workers serving in essential services who lived in the dormitories, to new accommodations. Dormitories housing infected workers were also sealed off, basic meals delivered, and occupants not allowed out of their rooms. Mass testing was also carried out and infected occupants were gradually moved to isolation facilities and treated. The remaining 16% of COVID-19 cases were also managed by rapid testing and patient isolation. Despite the shortcomings, the strategies implemented, albeit somewhat harsh, were effective in curbing COVID-19 case numbers relatively quickly and efficiently (figure 2) (7,8).

Figure 2: Number of COVID-19 cases in Singapore between 4 Jan 2020 and 26 Aug 2021. Imported (blue), community (orange) and dormitory (red) clusters and cumulative numbers (grey) are shown. (Adapted from Daily Report on COVID-19, MOH, 7)

Singapore is ranked as having the sixth-best healthcare in the world in 2021 (WHO) (9). The country uses the Beveridge Healthcare Model, ensuring excellent and affordable healthcare to each of its’ citizens. Singapore’s healthcare cost is managed with multiple protection schemes which are supplemented with private health insurance. Government healthcare subsidies are also in place to serve the poor and the disabled (10). The accessibility of quality and cost-efficient healthcare in combination with gold-standard healthcare policies provide Singapore with a strong foundation to deal with health emergencies, and more broadly allows Singapore to maintain a stable economy during a health crisis.

Although Australia was the envy of the world in 2020 with a quick response keeping the virus at bay and relatively low number of cases, that soon changed. In 2021, Covid-19 became a serious threat and Australia grappled with long periods of lockdowns exacerbated by a delay in vaccination (figure 1). Our healthcare policies and system are not set up to handle a crisis of this scale and worryingly the pandemic is far from over. Perhaps there are some things that we can learn from Singapore to improve our own health emergency response system to deal with the current ongoing Covid-19 crisis as well as any other future emergencies.


References

Karishma V. Coronavirus: The detectives racing to contain the virus in Singapore. BBC NEWS [Internet]. 2020 Mar 19 [cited 2021 Aug 15]. Available from: https://www.bbc.com/news/world-asia-51866102

2 Woo AA. Policy capacity and Singapore’s response to the COVID-19 pandemic, Taylor & Francis Online [Internet]. 2020 Jun 18 [cited 2021 Aug 13]; 39(3): 345-362, available from: https://www.tandfonline.com/doi/full/10.1080/14494035.2020.1783789

3 Policy Forum [Internet]. [place unknown]: Gwendolyn T; 2021 June 23 [cited 2021 Aug 19]. Available from: https://www.policyforum.net/how-singapore-is-handling-the-pandemic/

4 Ministry of Health Singapore. Update on Local COVID-19 Situation and Vaccination Progress (1 Sep 2021) [Internet]. 2021 Sep 01 [cited 2021 Sep 01]. Available from: https://www.moh.gov.sg/news-highlights/details/update-on-local-covid-19-situation-and-vaccination-progress-(1-sep-2021)

5 Live COVID-19 Vaccination Tracker. Singapore [publisher, date unknown] [cited 2021 Aug 28] Available from: https://covidvax.live/location/sgp

6 Statistics and Research, Coronavirus (COVID-19) Vaccination [Internet] [place unknown]. Our World in Data. 2021 Sep 01 [cited 2021 Sep 01]. Available from: https://ourworldindata.org/covid-vaccinations

7 Daily Report on COVID-19. Singapore: Ministry of Health; 2021 [cited 2021 Aug 01]. Report No.: CEG20210801 Available from: https://www.moh.gov.sg/docs/librariesprovider5/local-situation-report/ceg_20210801_daily_report_on_covid-19_cabinet.pdf

8 Representative Office for Malaysia, Brunei Darussalam, and Singapore. Coronavirus Disease 2019 (COVID-19) Situation Report. Singapore: World Health Organisation; 2021 [cited 2021 Aug 01]. Report No.: 34 Available from: https://www.who.int/singapore/internal-publications-detail/covid-19-in-singapore-situation-report-34

9 Measuring Overall Health System Performance for 191 Countries [Internet]. [place unknown]: World Health Organization; 2021 [cited 2021 Aug 13]. Available from: https://www.who.int/healthinfo/paper30.pdf

10 Roosa T. The Commonwealth Fund [Internet]. [Location unknown] Health Policy Center; 2020 Jun 05 [cited 2021 Aug 20] Available from: https://www.commonwealthfund.org/international-health-policy-center/countries/singapore

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