Ministerial Statement on Whole-of-Government Response to the 2019 Novel Coronavirus (2019-nCoV)

1.         Mr Speaker, Members. Many members of this house and our fellow Singaporeans are concerned about the 2019 novel coronavirus. This virus has affected not only China but many countries worldwide, and cases are still growing daily with no signs of abating yet.

2.         The Singapore Government has set up a Multi-Ministry Taskforce to coordinate the whole of Government efforts to combat this outbreak even before the first confirmed imported case occurred here. On Jan 30, the World Health Organisation declared that the outbreak constituted a Public Health Emergency of International Concern, raising the global alert levels.

3.         We have therefore put in place pre-emptive measures, to protect the public health. Some other countries have also done so. It is heartening to know that China is doing all they can to contain the spread of the virus, and we have witnessed their decisive actions to put in place strong measures, such as travel restrictions for their own residents, cancellation of outbound tour groups, and bringing back residents from overseas. We wish China well in their efforts to combat this virus, and we have every confidence that China and other countries, including us here in Singapore, will work together and complement each other to win this battle internationally. This is not just a problem for China, but for the world. We have to work together and collaborate with each other. For this reason, Singapore will be putting together an assistance package to help the communities in China affected by the novel coronavirus. More details of the package will be provided later.

4.         I understand why Singaporeans are concerned, as there are many unknowns about the virus, how it will develop, and how long this will last. Beyond health, businesses would also have concerns and many have been affected by our prevention and containment measures.

5.         Let me take this opportunity to provide some background on the virus, give an update on the current situation, and touch on the healthcare-related measures that we have put in place. Minister Wong, my co-chair of the Taskforce, will provide more details on the efforts of the various government agencies and how we are working together with all the stakeholders.

6.         As the situation unfolds, we will share as much information as possible and as soon as possible. While we cannot be complacent, I am confident we will overcome this challenge as we have in the past if we work together. We have been preparing for this, we are anticipating scenarios ahead, taking decisive actions as the situation evolves, and we will do our best to keep Singapore and Singaporeans safe.

Situation Update

7.         First, let me start with an update. The situation in China and globally is still developing rapidly even as we speak, and we still have very limited knowledge of the virus as scientists all over the world are racing against time to understand this virus better.

8.         The virus was first detected in Wuhan, in December 2019, although it may well have existed earlier while remained undetected. On 31 December, the World Health Organisation (WHO) was first informed of a cluster of pneumonia cases of unknown cause detected in Wuhan.

9.         Soon after, on 2 January, MOH alerted our medical professionals, and effected temperature screening for all flights arriving from Wuhan at our airport.

10.       The infection continued to spread in China. By 22 January 2020, over 500 confirmed cases were reported in China with a death toll of 17, when we decided to set up a Multi-Ministry Taskforce. We anticipated that we will need a whole-of-government effort to respond swiftly to this threat when it arrives in Singapore. We had to take precautions, and coordinate plans across Government agencies to fight this.

11.       In fact, the following day, after we had set up the taskforce, we saw the first local imported case. Wuhan and additional cities in Hubei were then locked down by the Chinese Government. By this time, we had already issued travel advisories for Wuhan, and extended our temperature screening at our airport to all incoming flights from China.

12.       The infection continued to spread at a rapid pace, reaching several foreign countries and all provinces of China by 29 January 2020. Latest WHO report showed that there were more than 14,000 reported cases in China and 304 deaths. 23 countries had also reported a total of 146 confirmed cases and one death. The number is changing everyday.

13.       Locally, we have 18 confirmed cases. 43 recently admitted suspect cases are pending test results, while 240 suspect cases were tested and cleared. All of the confirmed cases are being treated in isolation rooms. Overall, the conditions of most of our confirmed cases are improving.

14.       To date, there is no evidence of local community transmission. However, we should not be complacent and we must be prepared for this scenario.

Epidemiology of Novel Coronavirus

15.       Let me now share about what we know about this novel coronavirus.

16.       The virus comes from the family of coronavirus, which includes other viruses such as MERS and SARS, as well as the milder variance causing common cold. The medical consensus at this moment is that the novel coronavirus is more transmissible, but appears less deadly than SARS.

17.       Transmission. Available evidence suggests that the rate of human-to-human transmission of this virus appears to be higher than that of SARS. For now, the evidence also suggests that transmission is mostly via droplets. What this means is that the virus is carried within droplets emitted from an infected person over a short distance, such as when the person coughs or sneezes. If these droplets come into contact with the eyes, nose or mouth of an individual, directly or indirectly through hands that have come into contact with these droplets, the individual may become infected.

18.       To clarify, there is no evidence currently to suggest that the virus is airborne. There are other viruses, such as chickenpox, which can easily be transported via air currents, and do not require droplets to contact the eyes or nose. The novel coronavirus is not in this category of viruses.

19.       The novel coronavirus could also transmit through surface contact. When a person sneezes or coughs, the droplets fall onto the surfaces of tables and chairs for example and the virus may remain alive for up to a few days. When someone else touches the surfaces, the virus can be transferred to his hand and if he then rubs his eyes or nose without washing his hands, he may become infected. So we should wash our hands. This is also why we only quarantine the close contacts of confirmed cases. For more transient contacts, such as individuals that the confirmed cases may have walked past in malls or hotels, the risk of transmission is low.

20.       For coronavirus generally, the person is most infectious when he is displaying symptoms or symptomatic, and this is likely to be the case for the novel coronavirus as well. There is evidence of limited spread from a person without symptoms, during the incubation period. However, this form of transmission may be uncommon, and] has so far involved isolated cases only. At this point, the evidence still points towards higher transmissibility when the person is displaying symptoms.

21.       As such, medical professionals both overseas and in Singapore have advised that the most effective way that we can protect ourselves is to practice good personal hygiene. We should regularly wash our hands with soap and water, and avoid touching our face with our hands.

22.       These may sound simple, but are effective in preventing all kinds of infection. Potential infection from asymptomatic persons is less likely to be from coughing or sneezing directly but more likely by touching contaminated surfaces, for which masks offer no protection. Wearing a mask when we are well often give us a false sense of security instead, and we are more likely to touch our faces when we constantly adjust our masks, which is one way the disease spreads.

23.       At the same time, we need to protect others – our loved ones, friends, colleagues and fellow Singaporeans that we come into contact with. If we are sick, we should rest and recover at home as far as possible. If we do need to go out to see a doctor, for example, we should wear a surgical mask to protect others. So this is when a mask is needed – when we are unwell and have to go out.

24.       Symptoms and treatment. Persons exposed to the virus may be well for a few days, before developing symptoms such as fever, or cough and some may develop pneumonia eventually.

25.       There is currently no known curative treatment for the novel coronavirus. Development of a successful cure may take time, may be months or years. The current approach is to provide good supportive care for the patients to reduce complications and to allow time for the patient to recover.

26.       The current case fatality rate stands at about 2-3%. Majority of the deaths are among those with underlying medical conditions. The fatality rate seems lower than SARS, which was around 10% but we are still at the initial stages of the outbreak and the actual severity can only be assessed properly in time to come.

27.       Regardless, the Government’s response has been, and will continue to be swift and decisive, to contain the spread of the virus here. Let me elaborate on the preparations we have made and measures we have taken.

Preparation for the virus

28.       We have been preparing for the possibility of an infectious disease outbreak like this one since SARS. We have been building capacity and capability in addressing infectious diseases, such as SARS, MERS, H1N1, and more recently Zika and Monkey Pox.

29.       We had strengthened our epidemiological surveillance and containment capabilities, and our agencies hold regular emergency preparedness exercises to keep themselves operationally ready.

30.       In addition, we have set up the National Centre for Infectious Diseases (NCID), a purpose built facility to strengthen our ability to manage the outbreak of infectious diseases. It is benchmarked to international standards and best practices for treatment and safety. In April 2018, a Joint External Evaluation by the WHO experts stated that Singapore had demonstrated strong leadership and high capacity to detect and respond to potential public health emergencies.

31.       We had followed the situation in Wuhan closely since Dec 2019 and we had responded rapidly, putting in place a series of measures to reduce the risk of import and spread of the virus since early January 2020. These include the implementation of temperature screening at the airport, and we also alerted all our medical practitioners to be vigilant.

32.       Once we saw a significant increase in confirmed cases in Wuhan, I decided that it was necessary to set up a Multi-Ministry Taskforce. I asked Minister Lawrence Wong to co-chair this, and invited DPM as our advisor. The Taskforce is to plan and coordinate whole-of-Government efforts, so that we can mount a national response quickly and effectively. Representatives from the Ministry of Home Affairs, Social and Family, Transport, Education, Manpower, Trade and Industry, Communications and Information, Environment and Water Resources and the labour movement are all involved. The list is very long, but it is a reflection of the multi-agency coordination that is required.

33.       As the global and local situation evolves, the Taskforce has stepped up our measures accordingly, taking into careful consideration relevant factors, including the impact on our society.

Multiple Lines of Defence

34.       We had set up multiple lines of defence to reduce the risk of imported cases and local community transmission. We have been stepping up our posture and efforts at each line of defence.

35.       First, we have measures that serve to prevent further importation of the virus into our shores.  These include temperature and health screening at all checkpoints, land, sea, and air, as well as international travel controls.

36.       Second, we have measures that help us to detect and contain the virus, and prevent it from spreading further. We have good surveillance systems to identify cases. Our healthcare providers, especially our polyclinics and General Practitioners (GPs), are right at the front line. They are on heightened alert and stand ready to deal with cases as they emerge.

37.       Third, and perhaps most importantly, all of us must play our part and exercise social responsibility, to prevent or stem any possible spread of the coronavirus in the community. We should also be considerate for others around us and lend a hand as a community to support each other and stay united.

38.       None of these measures on their own are fool-proof. But when taken together, they will improve our resilience and ability to respond to this disease.

39.       Let me elaborate on the key roles that the healthcare system plays in the defence of this novel coronavirus. Minister Wong will touch on the other measures.

Key Role of Healthcare Providers

40.       Detection and Isolation of confirmed and suspected cases. Our healthcare providers play a key role in the detection and isolation of suspected and confirmed cases. Our frontline doctors – polyclinics, GPs and Emergency Department doctors are on high alert for persons with travel history and respiratory symptoms such as fever and cough. Such persons will be assessed, isolated and tested for the novel coronavirus. We also test samples from our influenza surveillance systems and hospitalised pneumonia cases for novel coronavirus to pick up unlinked cases, if any.

41.       Let me take the opportunity to provide an update on the confirmed and suspected cases.

42.       All of our confirmed cases are Wuhan residents, or persons who had recently travelled to Wuhan. There is no evidence of community spread in Singapore. Many of them stayed mostly at their hotels, or with their family in their family’s homes, and did not move around extensively. However, some of them did visit our tourism sites, such as Gardens by the Bay and Orchard Road, where any interactions would have been transient. The confirmed cases are being treated at the various hospitals, and their conditions are stable and most of them are improving.

43.       With each confirmed case, we will conduct contact tracing. We will check on the health of these contacts, and if they are unwell with fever, cough or other respiratory symptoms, they will be classified as suspected cases. We will arrange for them to go to hospital via a dedicated ambulance for isolation and testing. For contacts that are well, we adopt a risk-based approach. For close contacts, they will be put under quarantine for 14 days since their last contact with the confirmed case. For other contacts, they will be put on active surveillance with daily health  checks by MOH, as the risk of infection is lower for them.

44.       The detection and management of suspect cases and proper care and isolation of these confirmed cases would not have been possible without our healthcare providers and professionals. They are our key partners in this war against the novel coronavirus.

45.       Our polyclinics and GP partners play an important role in identifying and notifying MOH of any cases that meet the case definition so that they can be followed up. Dr Lam Pin Min and I recently met a group of GPs, including representatives from the Singapore Medical Association (SMA), and the College of Family Physicians Singapore (CFPS), to hear their feedback and to see how we can support them.

46.       Our hospitals will similarly isolate any individuals that present themselves at the emergency department who meet the case definition and test them to determine whether they are infected with the novel coronavirus.

47.       I would like to extend my sincere appreciation to all our healthcare workers and their families. They have worked tirelessly over the last few weeks, missing their holidays or reunion dinners. They work very hard to keep Singaporeans and Singapore safe. Their families may also need to take over caregiving roles at home, or make alternative arrangements as these healthcare workers work overtime to manage the cases.

48.       Let me give you an example: Dr Margaret Soon, the Director of Nursing at NCID. She is an exemplary leader. She was a veteran from SARS, and an Infection Control Nurse. Dr Soon immediately rose to the occasion when we activated NCID. She led her team to prepare the isolation rooms, held townhalls to update the NCID nurses, and ensured that her nurses had adequate essential supplies such as protective gowns and masks. Throughout this period, she was out of the house before sunrise, and mostly back only after her family have gone to sleep. She had to cancel a family trip during the Chinese New Year period, but her family understood and was supportive. This included her daughter, whom she was pregnant with during SARS. Stories of such dedication like Dr Soon’s abound in our healthcare community.

49.       I would also like to emphasise that there is no need to avoid our healthcare workers during this time. We have instituted strict safety policies and procedures at our hospitals and other healthcare providers. For example, healthcare workers managing cases are required to don personal protective equipment, and this ensures that they are protected from the virus.

50.       Instead, let us stand behind them and support them in this period. They may be our friends and family, or even strangers that we meet on the streets or public places. A smile, a kind word or an encouraging message goes a long way to help themkeep their spirits up, and know that we are behind them.

51.       I am also very encouraged by our various community-led efforts. For example, Akram Hanif and his youth volunteers have been engaging a group of about 45 young adolescents and youths at Marsiling CC to instill in them good values and character. Akram had organised the kids to draw a banner to thank our frontline medical staff from the Tan Tock Seng Hospital (TTSH) and encourage them to press on.

Preparing for road ahead

52.       There could be a long road ahead. SARS took about 8 months from the first detected case in November 2002 till the WHO declared the SARS outbreak contained in July 2003. We are not sure how long this virus will turn out. Therefore, we must stand ready to respond to new developments as the situation evolves.

53.       There remain risks ahead, and we are preparing for the various contingencies. Let me share some of these scenarios.

54.       First, there could be community spread in more Chinese cities beyond Wuhan or in other countries. We may need to roll out additional measures to prevent importation and to contain the virus. The decision to do so would again not be an easy one. We have to do what is necessary to protect the health and safety of our people and those who travel to Singapore.

55.       Secondly, there could be community spread locally. Despite our best efforts, this is a possibility we must be ready for. The key to managing this is quick detection and limiting further spread, which calls on social responsibility from all of us. If the infected Singaporean wears a mask to protect others, and promptly sees a doctor and gets triaged for testing, the risk of further spread can be greatly reduced. Even if there is spread, quick action will help to limit its extent. Once tested positive, the Government will contact trace quickly, helping to reduce further spread to their close contacts. If the community spread becomes very extensive, we will need to consider measures to reduce human to human interactions, such as cancelling mass gatherings, suspending schools, paring down non-essential care services and introducing further infection control and monitoring measures, to slow the spread.

56.       Third, the virus could mutate to become more infectious and spread widely, resulting in a pandemic. This is the known unknown, and we have to assess what best to do, depending on how the virus mutates. It may also become less infectious or less severe. But it is a scenario that we worry about when it comes.

57.       On the healthcare front, we are stepping up preparations for these potential scenarios. For example, we have increased our capacity of isolation beds by around 100 in the past two weeks. We have also been increasing our testing capacity, to enable us to more quickly confirm suspect cases.

58.       Overall, we must stay calm, but cautious. Our early intervention efforts have helped to contain the spread so far, but while we hope for the best, we must plan for the worst.

Closing

59.       Working together. Let me conclude by once again appealing to all Singaporeans to work together with us in this fight. I am very heartened by the many examples of volunteers stepping forward to support our efforts. Indeed, this effort requires a whole-of-Singapore response. I have elaborated on the public health measures that we have put in place. Minister Wong will elaborate on the other measures. We seek Singaporeans’ understanding and cooperation.

60.       I would also like to acknowledge once again our healthcare workers on the frontlines, and commend them for their bravery and selflessness. Let’s stand together and show our support for them.

61.       Addressing anxiety. We understand that Singaporeans may feel anxious, given the many unknowns about the novel coronavirus. Here, I want to reiterate the Government’s firm commitment that we will spare no efforts in protecting our people.  We will act swiftly and share information on the novel coronavirus openly and as soon as possible.

62.       Confidence for the road ahead. We have overcome several challenges as a nation in the past, such as SARS, H1N1, and Zika. In the face of this novel coronavirus, we have built up our defences, our capabilities, and we are stronger and more prepared. While we cannot be complacent, we must remain calm, and confident. This is a fight that calls on every individual to do our part. We are confident that we can manage and overcome this challenge as a nation, and emerge stronger together.