COVID-19: Lessons from Singapore, Taiwan and Hong Kong | Daily News

COVID-19: Lessons from Singapore, Taiwan and Hong Kong

Building management staff conduct temperature screenings of visitors and tenants of a building in the financial district of Singapore on Saturday in the wake of the spread of the COVID-19.
Building management staff conduct temperature screenings of visitors and tenants of a building in the financial district of Singapore on Saturday in the wake of the spread of the COVID-19.

COVID-19 has sent the world into a spin and challenged all assumptions. It is unreal. This article shows another angle.

Since she learned of the coronavirus outbreak, Amy Ho’s daily routine has gotten a bit more complicated. Coming home now involves sanitizing her shoes, washing her hands with soap and water, taking off her medical mask and changing her clothes. The Hong Kong resident ventures outside only by necessity. She walks to and from work. Goes to the grocery store once a week. That’s it. Her teenage daughter has only left their apartment twice since the end of January. Her precautions may sound drastic, but they’re hardly unique in a city that was among the first to be swept up in the global coronavirus crisis.

Hong Kong is desperate to avoid repeating the nightmare of a 2003 epidemic. Globally, SARS or Severe Acute Respiratory Syndrome, infected over 8,000 and killed 774, including 299 in Hong Kong.“Somewhat perversely, we can look at SARS as the dress rehearsal,” says Jeremy Lim, co-director of the Leadership Institute for Global Health Transformation at the National University of Singapore. “The experience was raw, and very, very visceral. And on the back of [it], better systems were put in place.”

Singapore, Hong Kong and Taiwan have been hailed for using those hard-won lessons to combat the new coronavirus—officially COVID-19 and a relative of SARS.

Against the odds, these enclaves have succeeded at keeping their virus numbers low, despite their links to China.

Act quickly

For Singapore, Taiwan and Hong Kong, the story could easily have been one of catastrophe. The novel coronavirus emerged just in time for Lunar New Year, when millions travel across the region in the world’s largest annual human migration. All three territories are closely interconnected with mainland China, with direct flights to Wuhan, the outbreak’s epicentre.

Yet even as the virus continues its seemingly inexorable spread—ticking upward of 132,500 cases Friday—recoveries in Singapore, Taiwan and Hong Kong are starting to outpace, or catch up with, active cases.

In Taiwan, an island of 23 million, arrivals from Wuhan were subject to health screenings before human-to-human transmission of the virus was confirmed on Jan. 20. By Feb. 1, Taiwan, Hong Kong and Singapore had all proactively implemented travel restrictions on passengers coming from the mainland, contravening the World Health Organization’s (WHO) insistence that travel bans were not necessary. The precautions came at a significant economic cost to these international hubs, which all rely on mainland China as their biggest trading partner and source of tourists.

The three destinations were also well prepared, making rapid response possible.

Following SARS in 2003, Taiwan established a central command centre for epidemics. By Jan. 20, it was coordinating the Government’s response to the coronavirus. It quickly compiled a list of 124 “action items,” including border controls, school and work policies, public communication plans and resource assessments of hospitals, according to an article in the Journal of the American Medical Association.

“If you assume that containing an epidemic is like running a 100-metre dash, Taiwan had a head start because it was prepared,” says C. Jason Wang, director of Stanford University’s Center for Policy, Outcomes and Prevention, and one of the article’s authors.

Taiwan, just 81 miles from mainland China, was expected to have among the highest number of imported cases, he adds. But it has now tallied just 50 cases—fewer than Slovenia.

“Epidemic preparedness starts years before an outbreak,” Emanuele Capobianco, director of health and care at the International Federation of Red Cross and Red Crescent Societies. “If (the) number of beds or doctors were cut over the years, for example, it will be very difficult to compensate in a short period of time.” He adds: “It is hoped that countries with strong health systems will eventually be able to manage this outbreak also, thanks to the lessons from Asia.”

Rigorous detection and strict quarantine

When the virus began crossing China’s borders in January, Singapore appeared fated for a large-scale outbreak. The tiny city-state was the third country to report cases of COVID-19, and by mid-February, had recorded over 80 infections, the highest outside the Chinese mainland.

But the tally indicated more about the thorough testing conducted on the island of 5.7 million. A study by Harvard University’s Center for Communicable Disease Dynamics estimates Singapore detects almost three times more cases than the global average due to its strong disease surveillance and fastidious contact tracing.

In order to uncover COVID-19 infections that may have otherwise evaded detection, Singapore’s health authorities decided early on to test all influenza-like and pneumonia cases. They have also spared no pains in hunting down every possible contact of those infected. The process, which operates 24/7, starts with patient interviews, and has also involved police, flight manifests and a locally developed a test for antibodies, which linger even after an infection clears. As of March 13, the city-state had 178 cases and zero deaths. Singapore is “leaving no stone unturned,” said Tedros Adhanom Ghebreyesus, Director General of the WHO.

Government advertisements carried on the front page of Singapore’s largest daily newspaper urge readers with even mild symptoms to see a doctor and refrain from going to school or work. And no Singaporean has to fear affording treatment. Testing is free, and the Government foots the hospital bills for Singaporean residents who have suspected or confirmed cases.

Social distancing and banning mass gatherings

Perched just across the border from the mainland’s health crisis, Hong Kong quickly put social distancing into practice. Schools remain closed through Easter. Normally bustling shopping streets, in some of the world’s most densely packed districts, are largely devoid of foot traffic as residents voluntarily stay sequestered at home. Many businesses have either shuttered or asked employees to work from home. Movie theatres, churches and basketball courts sit empty. Mass gatherings are canceled.

The measures appear to be working. Neighboring Guangdong province has recorded 1,356 cases, the highest number in China outside Hubei where the outbreak was first detected. But in Hong Kong, a semi-autonomous entrepot, the number of infections remains 131.

In a city deeply scarred by the SARS outbreak—and still populated with hand sanitizer stations—familiar reflexes, like proper hand hygiene, have snapped back into practice.

Effective communication

To ensure people remain vigilant, but don’t panic, experts say a Government’s communication with the public is vital. No one appears to be doing it better than Singapore’s Prime Minister Lee Hsien Loong.

After the Government raised its outbreak alert Feb. 7 to orange, one level below the maximum, Singaporeans emptied supermarket shelves. To quell the anxiety, Lee delivered an address to the nation in three of the city-state’s four official languages. “I want to speak to you directly, to explain where we are, and what may lie ahead,” he said. The speech appeared to have an immediate effect as supermarket lines soon eased.

“It’s one of the most beautiful pieces of risk communication I have ever seen,” says Claire Hooker, a senior lecturer at the University of Sydney who studies health communication.

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COVID-19: stay at home guidance

Main messages

• If you have symptoms of coronavirus infection (COVID-19), however mild, do not leave your home for 7 days from when your symptoms started.

• Ask your employer, friends and family to help you get the things you need to stay at home

• Stay at least 2 metres (about 3 steps) away from other people in your home if possible

• Wash your hands regularly for 20 seconds, each time using soap and water, or use hand sanitizer

• Stay away from vulnerable individuals, such as the elderly and those with underlying health conditions, as much as possible

• Aim to stay in a well-ventilated room with a window that can be opened. Try to keep the window open as much as possible to enable ventilation and airflow as this will help to keep clean air moving through your room.

• Use your own toothbrushes, eating and drinking utensils (including cups and glasses in the bathroom and bedroom), dishes, towels, washcloths or bed linen. Do not share food and drinks.

• If you have a garden, it is fine to use it as long as you keep 2 metres away from other members of your household. If possible they should use the outside area separately, if possible.

Use of shared spaces if you live with others

• Minimise the time you spend in shared spaces such as bathrooms, kitchens and sitting rooms as much as possible and keep shared spaces well ventilated.

• If you do share toilet and bathroom, it is important that you clean them after you have used them every time (for example, wiping surfaces you have come into contact with). Another tip is to consider drawing up a rota for bathing, with you using the facilities last, before thoroughly cleaning the bath, sink and toilet yourself.

• If you share a kitchen with others, avoid using it while others are present. Take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry your used crockery and cutlery. If this is not possible, wash them using your usual washing up liquid and warm water and dry them thoroughly, remembering to use a separate tea towel.

Singapore Budget 2020: S$4 billion support package for workers, firms amid COVID-19 outbreak

The special Stabilisation and Support Package will help workers to remain employed and aid companies with cash flow. Sectors that have taken a direct hit from the coronavirus outbreak, such as tourism, aviation, retail, and food services, will receive additional help, Heng said in his Budget statement. Heng, who is also Finance Minister, said the Government wants to help workers stay employed and will do so by helping firms to defray wage costs in two ways.

The first is through a Jobs Support Scheme worth S$1.3 billion. This aims to help firms retain local workers – more than 1.9 million Singapore citizens and permanent residents (PRs) – during this period of uncertainty.

Employers will receive an 8 per cent cash grant on the gross monthly wages of each local employee on their Central Provident Fund payroll for the months of October to December. This is subject to a monthly wage cap of S$3,600 per worker. Payment to the employers will be made by end-July.

The second is an enhancement of the Wage Credit Scheme, which supports enterprises embarking on transformation efforts and encourages them to share productivity gains with workers in the form of wage increases.

The scheme currently co-funds wage increases for Singaporean employees earning a gross monthly wage of up to S$4,000. This will be raised to S$5,000 for qualifying wage increases given in 2019 and 2020 to benefit more Singaporean workers.

The Government co-funding levels will also be increased by 5 percentage points to 20 per cent and 15 per cent for 2019 and 2020, respectively.

More than 700,000 Singaporeans employed by 90,000 enterprises will benefit from these enhancements to the Wage Credit Scheme worth S$1.1 billion, said Mr. Heng.

The outbreak of the novel coronavirus has directly affected sectors, such as tourism, aviation, retail, food services and point-to-point transport services.

To help firms in some of these sectors retain and reskill workers, the Adapt and Grow initiative will be enhanced this year, specifically through redeployment programmes.

For these sectors, the funding period for reskilling of workers will be extended from three months to a maximum of six months.

“Together with the Jobs Support Scheme, we will support employers in these sectors to retain and train more than 330,000 local workers,” said Heng. “These workers can make full use of the downtime for training and upskilling to prepare for the recovery.”

The Government will also help affected sectors with their operating costs and cash flow. 

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