Interrupting transmission of COVID-19- lessons from containment efforts in Singapore

Interrupting transmission of COVID-19: lessons from containment efforts in Singapore 1,2 1 1 Vernon J Lee, PhD , Calvin J Chiew, MPH , Wei Xin Khong, PhD 1Ministry of Health, Singapore 2Saw Swee Hock School of Public Health, Singapore Corresponding author: Vernon J Lee, Communicable Diseases Division, Ministry of Health, Downloaded from https://academic.oup.com/jtm/advance-article-abstract/doi/10.1093/jtm/taaa039/5804843 by guest on 22 March 2020 Singapore, 12 College Road, Singapore 169852, Email: [email protected] Highlight Despite multiple importations resulting in local chains of transmission, Singapore has been able to control the COVID-19 outbreak without major disruption to daily living. In this article, we describe the combination of measures taken by Singapore to contain COVID-19 and share some early lessons learnt from the experience. Keywords: COVID-19; outbreak; Singapore; coronavirus; mitigation; importation; Introduction As of Mar 9, 2020, more than 100,000 COVID-19 cases and 3,800 deaths have been reported 1 globally, including over 28,000 cases and 600 deaths in 100 countries or regions outside China. Countries are now facing emerging outbreaks that threaten to develop into local epidemics if not well contained. China, which had initiated the largest community containment effort in history, has been successful at containing the outbreak, and since mid-February the daily number of new COVID- 19 cases has been declining in China.2 In the Republic of Korea (ROK) with one of the highest number of infections outside China, the outbreak also appears to have stabilized after application of rigorous measures such as strict contact tracing and large-scale quarantine. Singapore, a city-state and global travel hub in Southeast Asia, was one of the first countries to be affected by COVID-19, and for a while was the country with the highest COVID-19 numbers outside of China from Feb 5, 2020 to Feb 18, 2020. This was in part due to Singapore’s strategy of using a comprehensive surveillance system to detect as many cases as possible, and to contain them at the individual level. Despite early importations resulting in local chains of transmission, the rise in the number of cases has been steady without the exponential growth observed elsewhere. This suggests that this strategy, coupled with community-based measures proportionate to the transmission risk, has been effective in containing spread, and could be considered in countries in the early stages of the outbreak where it is not possible to mount massive community-wide containment efforts. Singapore’s approach Singapore was one of the worst affected areas in the 2003 SARS outbreak, and since then Singapore has steadily built up its outbreak preparedness, including developing a national pandemic preparedness plan based on risk assessment and calibration of response measures that are proportionate to the risk. This includes holding regular exercises, and building the National Centre for Infectious Diseases (NCID), a 330-bed purpose built infectious diseases management facility with integrated clinical, laboratory and epidemiologic functions.