Singapore’s systems-level response to COVID-19

Prof Teo (right) with UK-PHRST Director, Prof Daniel Bausch, at the event

Dean of the NUS Saw Swee Hock School of Public Health Professor Teo Yik-Ying made a trip to the UK on 9 March to speak on Singapore’s approach to COVID-19 as part of a series of seminars hosted by the UK Public Health Rapid Support Team (UK-PHRST) on the ongoing virus outbreak. Prof Teo shared and analysed the multi-prong measures that Singapore has put in place.

Singapore had the misfortune and privilege of learning from the SARS epidemic in 2003, said Prof Teo at the seminar. “We were affected quite significantly, there were some deaths, particularly among healthcare workers in Singapore. We had a number of cases — 238 and actually a lot of the responses that I will share with you today were lessons that we learnt through SARS,” he added.

Multi-disciplinary communication efforts

“It is important to highlight that Singapore treats this situation as almost a wartime scenario where we must look at the available resources we can put in place, to activate them judiciously, prudently but necessarily if the need arises,” said Prof Teo.

An example he cited was the mobilisation of the Criminal Investigation Department to use their skills gleaned in their investigations to assist in finding clues for contact tracing. He also called attention to the communications strategy that involved multiple prominent figures in a variety of roles.

“The same individuals were highlighting concerns and were the spokespersons to the society at any point in time. The Health Minister always talks about the overall health sector response, the Minister for National Development talks about all the non-health sector responses. When it comes to clinical matters, the scientific responses, and outbreak management, we have specific individuals that helm that communication,” he explained. This gave citizens a trusted face to look to for particular messages to society, what to be aware of, what are the changes in the situation.

The focus on communication extended to the Prime Minister personally making a statement to assure the country of enough supplies when Singapore’s escalation to DORSCON Orange resulted in massive panic buying. Prof Teo explained that situations such as the outbreak will always lead to social concerns. “I see this as a very classical sign of information asymmetry. We work in public health so we have a level of understanding of some of these crises. The general public may not have that information. That asymmetry of information requires them to respond in a particular way.” Consistent and accurate communication therefore becomes vital.

Clinical care and financing efforts

One of the initiatives that the Singapore government has put in place early were public health preparedness clinics. These were set up with the intention to be the first layer of triage to find out who are the people who were mildly affected. Additionally, medical certificate has been extended to five days for persons with the appropriate symptoms which is a way of social distancing with a triage mindset, added Prof Teo.

In some clinics, there is also an additional layer called the sentinel surveillance, Prof Teo added. “A fraction of our polyclinics or primary care centres routinely swab any patient with symptoms of acute respiratory infection. Through this routine swabbing, we get a sense of what is happening in the society whether it is with respect to particular strands of influenza or H1N1 and so on. Right now, COVID-19 is included. This gives us a sense of what is the prevalence of COVID-19 infection happening in the society that is not serious enough to manifest the need to go to the hospital,” he elaborated.

Encouraging social distancing and personal responsibility

Understanding that finances may result in reluctance to report their illnesses, the Singapore government took on the responsibility of paying the bills of all infected patients very early on, said Prof Teo.

In addition, as early as January, it was announced that people who are put on quarantine orders or Leave of Absence will be entitled to an allowance of S$100 per day. “This actually removes the financial barrier that may stop individuals from surfacing themselves for aid because of worry about the loss of livelihood. I see this as a very important measure meant to encourage people to report themselves when they are not feeling well,” said Prof Teo.

One other initiative that helps build personal responsibility are the national campaigns which focuses the attention of an individual towards a common cause, said Prof Teo. “Sometimes this common cause could be around a particular national event. In this instance, it is around personal responsibility towards protecting the nation against the COVID-19 infection,” he added. Some examples he cited include a special section in national newspaper The Straits Times to remind people to visit a doctor when they have mild flu symptoms, and to wear a mask only if they are sick, as well as the galvanising of social response through social media and traditional media posts including videos featuring celebrities, and comic strips by healthcare workers.

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