Thinking Aloud

Fighting the coronavirus, with openness and information

Fostering confidence and trust in public institutions over the years has helped enable Singapore to respond sensibly to the present outbreak

It was just before noon, but The Straits Times newsroom was deserted.

The multimedia hub - the operational nerve centre of the revamped ST newsroom - usually abuzz with activity, had fallen silent. Only a handful of my colleagues were about, staring intently at their screens.

Like in many organisations across the island, most of our staff had been told to stay at home, after we made a decision to move into a virtual, distributed mode of operations.

The purpose: To ensure that ST would be able to continue to serve our readers, with the latest news and analysis, across all our platforms, come what may, as the coronavirus outbreak unfolds.

If you have not noticed any difference to your paper or our website, that is thanks to the efforts of the ST team, working doubly hard to stay connected despite the disrupted operations, through a flurry of phone calls and Google Hangout sessions. Reporters continue to do their jobs, with precautions, filing remotely from the field.

In times like these, with so much fake news swirling about, people look to trusted sources of information to help them make sense of developments and how to respond. Indeed, ST's page and video views have seen a surge these past weeks.

Information - timely, reliable and trusted - might be the best antidote to an outbreak, both of viruses and viral rumours, and the panic and anxiety these can engender.

In the absence of this, the vacuum is inevitably filled by falsehoods and misinformation, spread deliberately or otherwise.

To try to counter these, Health Minister Gan Kim Yong and National Development Minister Lawrence Wong, who co-chair the Covid-19 response task force, have been tireless in addressing queries from the media, openly and transparently, with briefings held almost daily in recent weeks.

Singapore's multi-ministry task force tackling the coronavirus addressing a press conference on Jan 27. The Republic has managed to foster trust in its key institutions - the political leadership, public services and also the media - in large part because of the open and transparent way it has dealt with such crises in the past. PHOTO: LIANHE ZAOBAO

Their explanations have been detailed and nuanced, rather than trying to oversimplify the complexities of the situation.

Take, for example, the burning question of whether to wear a mask or not.

Now, the idea that donning a mask might help keep the bug at bay seems intuitive. After all, some barrier should be better than none.

Yet, the authorities here have taken the harder line to explain - that while a mask might be useful in some circumstances, such as when you are sick, wearing one when you are not does not provide all that much of a defence, since the virus is more likely to be picked up when you touch your face with your hands, which might have come into contact with droplets of the virus left on surfaces around you.

The stocks of masks, which can't possibly be infinite, might then be better used by those who need them most - healthcare workers and those who are ill.

To my mind, while this might be harder to communicate, it makes for greater credibility in our public health officials' statements. Similar positions have been taken by top medical officials in the United States, Australia and elsewhere.

Then, there is Prime Minister Lee Hsien Loong, who drew attention from the foreign media for the frank and direct way in which he addressed Singaporeans on the outbreak recently.

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A report by the Bloomberg news agency, titled "As Asia panics, one country wins praise for approach to virus", said: "The speech, posted on social media in three languages, appeared to have an immediate impact: The long queues at supermarkets throughout the city-state on Friday night returned to normal levels as of Sunday.

"That alone proved notable in a region where governments have struggled to get the message right, spurring panic buying and confusion over how to protect themselves from the outbreak."

In his video message, PM Lee went on to alert Singaporeans to the possibility that the present approach of trying to contain the virus might need to be changed at some point if it was found to be spreading widely in the community, without traceable sources.

An alternative stance of mitigation might then be more appropriate, with mild cases sent home to recuperate, allowing hospitals to focus on those who were most at risk. But this depended on the mortality rate of the virus remaining relatively low, closer to the seasonal flu rather than the higher rates seen during the Sars outbreak, he made plain.

This tell-it-like-it-is-to-the-grown-ups approach prompted Professor Thomas Abraham, author of Twenty First Century Plague, The Story Of Sars, and a risk communication consultant for the World Health Organisation, to note in the Bloomberg report: "Prime Minister Lee does not hide any facts. Nor does he hesitate to talk about how the situation might worsen."

Now, set this against the recent study by Harvard University, which modelled how the outbreak might be expected to play out, given the region's strong business and travel links to China.

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Alarmed by what they saw, they warned that there might be further waves of the current outbreak as countries such as Indonesia, Cambodia and Thailand had reported lower number of cases than might be expected.

"Indonesia has reported zero cases and you would expect to have seen several already," said Professor Marc Lipsitch of Harvard's T.H. Chan School of Public Health, who co-authored the study, which Indonesian officials dismissed as "insulting".

Similarly, in Japan, experts are warning of a "stealth outbreak" with patients having been infected by some whom they are unable to trace, as all efforts to do so run into a dead end for a lack of information on possible sources, including perhaps those from abroad.

Then, there is China, which has drawn much flak for its initial efforts to downplay the severity of the outbreak.

For weeks, experts said they feared that the numbers of infections and deaths being reported were a gross underestimate - perhaps by as much as tenfold - with reports emerging of sick patients being sent home because of a lack of facilities to test them, potentially spreading the disease to their families and those around then.

Then, out of the blue, came news on Thursday that some Chinese provinces had decided to revise their numbers. One, near Russia, is reported to have cut its numbers by reclassifying patients who had tested positive for the coronavirus but did not have symptoms, taking them out of the total count of confirmed cases.

"The documents offered little detail or explanation, and scepticism was immediate. A Hong Kong newspaper called the decision a 'disguise'," reported The New York Times.

Meanwhile, in Hubei, the epicentre of the current outbreak, officials went the other way. They announced that nearly 15,000 new cases and 242 new deaths were recorded in a single day. This was largely because the authorities decided to accept doctors' "clinical confirmation" of cases suspected to have the virus, without the need for a lab test, since these were in short supply.

While many experts from around the world welcomed the move since it enabled patients who needed medical care to receive it, doubts were inevitably raised about the numbers and the motives behind these sudden revisions.

"It's pretty clear that there is an issue with trust about whatever the Chinese government comes out with at the moment," Professor Kerry Brown, director of the Lau China Institute at King's College, London, was quoted as saying.

"That may be terribly unfair," he said, adding: "To redefine things - even legitimately - at a moment like this is always going to be a presentational challenge, because people are going to be very sensitive, and they're going to suspect there's another agenda."

For its part, Singapore's Health Ministry has said it sees no reason to change its protocols and will continue to classify people as having coronavirus only after a lab test, given that its capacity to carry out such tests remains robust.

The upshot of this is clear: trust is critical, especially in a crisis, which could be exacerbated if the public loses confidence in those charged with managing it.

But trust cannot be whipped up on demand, nor can it be mandated or handed down. As in a bank account, trust has to be earned, painstakingly chalked up over the years, to be available to be drawn on when the chips are down.

And let's be clear: The main beneficiaries of such high-trust societies or systems are not just the political players or public officials, but also the community itself, as it enables everyone to take practical steps on the basis of what is most sensible and sound.

Those who seek to undermine that trust, for whatever reasons, and beat the "drums" - as Defence Minister Ng Eng Hen put it, spreading distortions, rumours, untruths, misinformation and smears - are the ones that society most needs inoculation against, in good times and in bad.

Thankfully, by most accounts, Singapore has managed to foster trust in its key institutions - the political leadership, public services and also the media - in large part because of the open and transparent way it has dealt with such crises in the past.

This was on display, for example, during the Sars outbreak in 2003, when many of us journalists would recall how then Health Minister Lim Hng Kiang would sit patiently answering each and every question reporters threw at him late into the evening, until everyone in the room ran out of steam.

"There was nothing to hide, so it's best to be open," he said with a laugh, when I asked him about his approach some time afterwards.

Wittingly or otherwise, Mr Lim and his successors have been drawing on an old playbook that was first framed by Singapore's founding Prime Minister Lee Kuan Yew.

Indeed, some years ago, when my colleagues Han Fook Kwang, Sumiko Tan and I were working on the book, Lee Kuan Yew: The Man And His Ideas, we chanced upon a speech in which Mr Lee spoke on how best to deal with a major outbreak of disease in Singapore.

He was addressing community leaders on the 1967 swine flu. Wild rumours had spread that men who ate meat from pigs that had been inoculated against the disease might lose their manhood, quite literally, causing a panic. (Fake news, even then.)

Mr Lee declared: "In other parts of the world, when their pigs suffer from swine flu, they hush it up. They pretend they do not have it. Net result: All pigs get infected, the position becomes permanently chronic.

"We can do likewise, but we will become a permanently chronic society: sick. So when we get swine fever, we announce it, alert everyone so that we can arrest the spread of the disease and bring back normalcy."

Ever one to rally his people, he added that Singapore had to keep pressing forward, come what may.

"This is what is required of this community... we must have an awareness of the realities of life. A good striving, hardy people cannot be kept down."

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A version of this article appeared in the print edition of The Sunday Times on February 16, 2020, with the headline Fighting the coronavirus, with openness and information. Subscribe