Coronavirus: Preventing an intense spread is in hands of each person as S'pore enters new phase of community transmission, say experts

In Singapore, the number of unlinked cases has seen an upward trend in the last few days.
In Singapore, the number of unlinked cases has seen an upward trend in the last few days.ST PHOTO: KELVIN CHNG

Singapore entering new phase of community transmission and next two weeks are crucial

As coronavirus clusters and cases with no known connections mushroom here, Singapore is facing the threat of the virus spreading uncontrollably, experts warned yesterday.

Whether this potential time bomb is defused or not is now firmly in the hands of each individual in the country, they stressed.

People must decide at this point whether they choose to cooperate and listen to the reminders on personal hygiene, physical distancing and to stay at home unless absolutely necessary, or if they continue to behave irresponsibly especially in public, said Professor Teo Yik Ying, dean of the National University of Singapore's Saw Swee Hock School of Public Health.

"Right now, it is really in the hands of ordinary citizens to act responsibly and break any community transmission in Singapore," he told The Straits Times.

"If many in Singapore refuse to follow the simple instructions, then no matter what the Government puts in place, we will see an uncontrollable outbreak."

The next two weeks are crucial in the coronavirus battle.

Associate Professor Hsu Li Yang, who leads Saw Swee Hock School of Public Health's infectious diseases programme, said that if the number of cases can be held in check, it bodes well for the longer term.

"If we can get through this and next week without a dramatic rise in cases - particularly unlinked cases - we should achieve a period of stability again."

As imported cases taper off, the nation is entering a new phase of community transmission, with local cases set to dominate yet again.

This is of concern because it means the virus is becoming more entrenched in the community.

In the last three days, the number of local cases has spiked by 15 per cent, compared with a 5 per cent rise in imported cases.

Local cases look set to overtake imported cases as the number of people returning from abroad shrinks.

POTENTIAL TIME BOMB

Right now, it is really in the hands of ordinary citizens to act responsibly and break any community transmission in Singapore. If many in Singapore refuse to follow the simple instructions, then no matter what the Government puts in place, we will see an uncontrollable outbreak.

PROFESSOR TEO YIK YING

Returnees from the United States and Britain, for instance, fell from 1,200 daily last week to 300 a day this week.

Cases here will continue to rise in tandem, said Prof Teo.

While imported cases are a result of the Republic's immigration rules, local cases are firmly linked to citizens' compliance with measures, added infectious diseases expert Leong Hoe Nam.

With 926 people testing positive here so far, the Republic will certainly cross the 1,000 mark within the week, the experts noted.

But this is purely a psychological number and there is no need for alarm, Dr Leong said.

"Many countries have crossed 1,000 and we should not just look at the total number, but the number of unlinked cases."

Globally, the number of cases has surged past 800,000, with more than 40,000 deaths reported.

In Singapore, the number of unlinked cases has seen an upward trend in the last few days, with the Health Ministry conducting contact tracing for 93 locally transmitted cases as of yesterday.

These unlinked cases suggest community spread, something much harder to contain should it become widespread, said infectious diseases expert Annelies Wilder-Smith.

"More stringent and painful measures will then need to be taken," said Professor Wilder-Smith, a visiting professor at Nanyang Technological University's Lee Kong Chian School of Medicine.

Despite the increase in cases, the situation is manageable and contact tracing remains highly relevant and should be done for as long as possible, the experts stressed.

Said Prof Teo: "At the moment, we are not at the stage of widespread local transmission, but we are certainly seeing signs we might be progressing towards that.

"At this point, the outbreak is still manageable for the teams overseeing contact tracing to handle."

He added: "As long as there is capacity for contact tracing, we should continue. This is one important and effective way to manage community transmission.

"However, if local transmission continues to increase significantly, then yes, there will come a time when the ability to contact trace may become strained."

The country's healthcare system has yet to reach a breaking point, as there is still considerable capacity, they said.

 
 
 

The healthcare system will be overwhelmed once demand for intensive care unit (ICU) beds exceeds the number of ICU beds available, noted Prof Wilder-Smith.

"Indeed, what Singapore needs to do, and is in fact already doing, is to increase the number of ICU beds and ventilators," she said.

Nonetheless, the system cannot withstand the onslaught of a dramatic spike in cases. If this happens, an already stretched healthcare system could be overwhelmed in days, Dr Leong warned.

He noted that if people abused their freedoms now, tougher and more painful measures may be instituted to fight the spread.

Ultimately, this could mean a lockdown, such as those in Wuhan and Italy, said Prof Hsu.

He added: "Naturally we would not wish to do this unless truly necessary, but such extreme physical distancing measures will be effective in bringing down the transmission rate of the virus."

 
A version of this article appeared in the print edition of The Straits Times on April 01, 2020, with the headline 'Preventing an intense spread is in hands of each person: Experts'. Print Edition | Subscribe