Prof Dale Fisher: The current and future COVID-19 situation

Prof Fisher believes that the world may not be ready to deal with the COVID-19 crisis, but Singapore is. 

| By Professor Dale Fisher |

I first arrived in Singapore (from Australia) during the SARS outbreak in 2003. It was an extraordinary time where healthcare workers could be infected and could die. It was a severe illness where viral shedding was late and the sickest patients could spread the disease in large numbers amongst people in close contact.

Now, over 15 years later, I have been privileged to be an invited member of the WHO-China Joint Mission on COVID-19 at the request of Mr Xi Jinping, President of the People’s Republic of China and Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

On this mission we learnt a lot about transmissibility, severity and containment measures.

Internationally, I don’t believe the world is ready to deal with the COVID-19 crisis, but Singapore is. I believe we were lucky to have a ‘test run’ over the last month with imported and locally transmitted cases, together with a few transmission chains. This should be seen as the lead time to what could become massive transmission in the coming weeks and months. 

China provided this lead time to the world with extraordinary community interventions, and China continues to ramp up its own readiness efforts as still only a fraction of its 1.4 billion population has been infected.

This disease can cause explosive outbreaks as we have seen in Wuhan. When the disease runs unchecked, mortality rates climb, as health services are overwhelmed. All our efforts in Singapore are to prevent this. People will become infected, but we can best manage if infection occurs through the population slowly, and in a controlled way. The aim of the strategy is therefore to flatten the epidemic curve.

This COVID-19 crisis will go on for many months and possibly into next year. We will in time need to collectively strategise how to conduct our usual activities safely — such as our clinics, elective surgery etc. All these activities are important to the usual health needs of our patients.

The most at risk of critical illness in COVID-19 are the elderly and immune-suppressed/chronic diseases patients. Fortunately, however, children uncommonly manifest the disease and severe disease is very rare. The viral shedding data is consistent with observations that nosocomial acquisition is not common and that spread occurs early in the disease and in the community rather than late, in hospitals as we saw in SARS.

For at least a year this novel disease will interfere with the health, the economy and social activities globally. Eventually I think it will become endemic, causing sporadic respiratory illness, but currently with an immunologically naïve world we can anticipate many outbreaks, clusters and a lot of disruption in the medium term.

I feel particularly honoured to have witnessed such personal and collective support and positive feedback at all levels. Healthcare workers and indeed Singaporeans in general have a remarkable capacity to adapt and work as a team for the greater good.


About the author

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Professor Dale Fisher is from Department of Medicine at the NUS Yong Loo Lin School of Medicine. He is also Senior Consultant in the Division of Infectious Disease at the National University Hospital and Chair of the Global Outbreak Alert and Response Network (GOARN) steering committee for the World Health Organization. Recently, he has been sharing health messages about the COVID-19 crisis to the public through a comic entitled The COVID-19 Chronicles.




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