Expert Speak Health Express
Published on Feb 27, 2020
Dispatch from Singapore: How Singapore is managing Covid-19 and lessons to be learnt The main building of the Lee Kuan Yew School of Public Policy has a calming white color. At the entrance, the flags of Singapore and the National University of Singapore stands tall side by side. As I walk in, I see two tables. On the right, two staff members with blue masks on their face are eagerly waiting with electronic thermometers and big sanitizer bottles. On the left, a third staff member is using a video camera mounted on a screen to record the entry of people into the school. I feel calm and yet a bit nervous as I clumsily pull out my student card to verify my identity and get my temperature checked. The staff takes the thermometer like a gun and points it between my eyebrows and it reads 36.6 degree Celsius. I feel relieved and walk to the library. The Covid-19 outbreak has made such measures omnipresent in Singapore. Whether it is a place of work or worship, every area with high footfall is required to check the temperature and keep visual evidence for two weeks to facilitate contact tracing. This system extends to all entry ports of Singapore-air, water and land. Furthermore, people with travel history to China or those suspected to be sick are required to stay at home or seek care. If they don’t, they are severely penalized. This month, the government has cancelled six work passes and suspended visas of six employers for flouting the rules. Being a small island-state with a high population density compared to other rich countries and large tourist footfall, Singapore is doing its best to grapple with this public health emergency. Apart from the health responsibilities placed on individuals and institutions, the government has mobilized the army to pack and distribute masks and thermometers- which I too received- and is also paying a daily allowance to those missing work because of the outbreak. It has also banned travelers from China. With these measures in place, the government has a very good idea of how and where the disease is spreading. This information is also being publicly displayed to keep everyone informed (see chart 1 below). As of 21February, Singapore had 86 confirmed cases of which 47 have been treated and discharged.

(Chart 1: The Evolving Situation of Corona Virus in Singapore; Source: Ministry of Health, Singapore)

As the situation is, what should we expect in the coming months? Well, no one can say for sure, but experts claim that the disease should die down by April or May. Given the low fatality rate of 2% and low R0 of 2-3 (the number of people who can be infected by one infected person), this prediction seems to be likely. If you compare with many other zoonotic diseases from the past decades (Image 1), COVID-19 does not appear to be that big of a problem at the moment. However, that does not mean that the virus cannot mutate in the future and spread so quickly that health systems around the globe get overwhelmed.

(Image 1: Comparison of COVID-19 with other disease outbreaks in recent decades. Source: Business Insider)

Therefore, Singapore is preparing for the worse. The country is currently on level orange on DORSCON – a color-coded framework that tells the current disease situation (Image 1). Once this turns red, the country will move to full-combat mode. This will mean stricter measures like all university courses conducted online. Measures like contact tracing will then become futile and the focus will shift to mitigation rather than prevention.

(Image 2: How the DORSCON system works. Source: Ministry of Health, Singapore)

Why is this important for us in India? To start with let us look at some of the measures that the central and state governments in India have taken to tackle the situation. Firstly, the Ministry of External Affairs has imposed restriction on individuals traveling from China to India and has initiated temperature screenings at all entry ports to India. Secondly, the National Center for Disease Control (NCDC) of India has issued advisories regarding what must be done at state-level in order to deal with COVID-19. This is a positive sign of government’s acknowledgment that there is a possibility of the disease having already spread across India. In fact, as many commentators observe, the outbreak in China started way back in December 2019, making it possible that many cases of COVID-19 were already spread across the world before anyone came to know. Although, the central government and some state governments have been conducting press conferences to keep the public informed, more needs to be done. The government should provide regular (if not daily) updates on state-wise number of tested, admitted and treated cases of COVID-19. One cannot replace the need for good quality health data with mere assurances. For instance, the Jharkhand government has issued advisory to health officials that all necessary precautions should be taken and reporting of the cases must be done according to the central government and NCDC’s directions. But one needs to ask the simple question whether Jharkhand’s public health system has the needed health personnel, equipment, medicines and the overall administrative capacity to execute even preventive measures like temperature screenings and quarantine? Jharkhand is not Kerala. The WHO has already called COVID-19 a Public Health Emergency of International Concern (PHEIC) for countries with poor health systems and if one were to be candid, that would definitely include many Indian states as well. Given the failing public health systems of many Indian states, we must recognize that they don’t have the capacity to hold the doors when the outbreak comes knocking. What might be our alternatives? Looking at the work of many armed forces in the Ebola crisis, we might have to make use of alternative organizations to tackle this problem. In the Ebola crisis, the armed forces helped in building make-shift quarantine facilities and provided medical training to combat outbreaks. Maybe the army or the National Cadet Corps (NCC) can be involved to provide necessary support in India too, going beyond quarantine of Indians from China? Also, note that ‘community surveillance and quarantine’ only works when individuals have a credible threat of being persecuted if they do not follow the guidelines. In case of India, there has been no report of government taking any action against those who put public health in danger because of their own negligence. In fact, there have been many cases of fake news where some people are even taking advantage of the fear and panic that this outbreak has caused. In such a case, public communication is extremely important to tackle fake news and ensure that the people don’t go into a panic mode. If they did, the health system of India will be overburdened with cases like cold and seasonal flu which have similar symptoms like COVID-19. This  would reduce access to people with more urgent needs. The recent speech by Singaporean PM Lee Hsein Loong is a good example of how public communications must be handled in such cases. One thing is clear, if the disease comes for India, it will be a litmus test for many of India’s public institutions. This will not only include the public administration apparatus and the healthcare system but also the social security system. As people fall sick or are quarantined, companies and individuals will lose a lot of money and with India’s meagre social safety net, it will impose a severe hardship on families-especially those who live on daily wages and are at the bottom of the pyramid. Given the current situation of the economy, this is the last thing we want because we don’t have the fiscal capacity like Singapore to hand out  S$100 a day to anyone missing a day’s work.
Mohnish Kedia is a student at the Lee Kuan Yew School of Public Policy.
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Mohnish Kedia

Mohnish Kedia

Mohnish is pursuing his PhD at the Lee Kuan Yew School of Public Policy (LKYSPP), National University of Singapore. He is theoretically interested in policy ...

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