Why Singapore's admired virus playbook can't be replicated

By John Geddie and Aradhana Aravindan

SINGAPORE (Reuters) - A day after Jeanhee Kim learned of a coronavirus case in her Singapore apartment block, she was visited by a distinguished-looking man she later learned was a senior government minister.

Kim, a 51-year old American who had just relocated to the island as the outbreak began, said the man had asked her how her family were feeling, gave her some surgical masks and reassured her that Singapore was on top of the situation.

Her experience exemplifies the fastidious approach taken to combat the outbreak in the city-state - which has included using police investigators and security cameras to help track and quarantine more than 2,500 people, and won international praise.

"Singapore is leaving no stone unturned," World Health Organization chief Tedros Adhanom Ghebreyesus said this week.

But experts say Singapore's virus-fighting playbook cannot be easily copied in other countries that lack its geographic attributes, financial clout and wide-ranging state controls.

"If Singapore can't contain it, I don't see any country that can," said Michael Osterholm, an infectious disease expert at the University of Minnesota.


The densely packed island of 5.7 million has 84 coronavirus cases, the highest number outside mainland China, if the hundreds of infections on a cruise ship docked near Tokyo are excluded from Japan's count.

But experts say Singapore's high tally says more about its ability to detect the disease.

A recent study by Harvard University's Center for Communicable Disease Dynamics estimates Singapore is picking up three times more cases than other countries due to its disease surveillance and contact-tracing capacity.

Size also matters - Singapore has less than a tenth the land area of the Chinese city of Wuhan where the virus first surfaced late last year and around half its population, making containment easier.

As a sovereign state that has been ruled by the same party since independence in 1965, it also maintains tight control over the movement of people into and out of the city and has strict laws to keep potential virus-spreaders in line.

When the first cases of infected Chinese visitors to Singapore surfaced in late January, a 140-strong team of government contact tracers set to work interviewing patients and identifying and quarantining those close to them.

A close contact is defined as anyone who has been within two metres and spent 30 minutes with an infected patient.

Finding these contacts has involved asking airlines to hand over flight manifests, tracking patients' movements on security cameras and roping in police investigators for the search, health ministry officials said.

To date, Singapore has quarantined nearly 2,593 people.

"There is an acceptance of that intrusiveness in Singapore," said Chong Ja Ian, political science professor at the National University of Singapore. "The public response to these sort of demands tends to be quite ready, so that helps with the ability to trace."

It is an offence for individuals to withhold or provide inaccurate information to a contact tracing officer. Moreover, people who breach quarantine orders can be fined up to S$10,000 ($7,137.76), jailed for up to six months, or both.

Authorities have also enforced 14-day confinement of workers who have recently travelled to China, with more than 1,000 calls and visits made a day to ensure compliance. Breaches have seen work passes revoked and employers lose their rights to hire foreigners.

In other measures, nearly 400,000 people have signed up to a government WhatsApp service that sends daily virus-related alerts on case numbers, disease prevention and warnings about internet rumours.


Singapore's decisive response draws to some extent from its experience with the Severe Acute Respiratory Syndrome in 2003-2004, which led to over 30 fatalities on the island, one of the highest counts outside mainland China.

The country was one of the first to ban Chinese travellers earlier this month, a move that came at significant economic cost to the global transit hub, which counts China as its largest trade partner and biggest source of tourists.

The prime minister has already warned the outbreak could tip its fragile economy into recession.

But Singapore has deep pockets.

It is the wealthiest country in Asia and among the top 10 globally, in nominal GDP per capita terms, and on Tuesday unveiled a $4.5 billion package in its annual budget to fight the virus and manage its economic fallout.

There have been some missteps in Singapore's response. The government has said there was some "misunderstanding" when it raised its virus alert level two weeks ago, sparking panic buying of essentials like rice, noodles and toilet paper.

Its methods may also not be sustainable, especially if the epidemic worsens.

"We can't keep doing what we are doing forever. We can’t keep all elective surgery cancelled, we can’t stop everyone going on holidays," said Dale Fisher, an infectious diseases expert in Singapore who chairs the Global Outbreak Alert and Response Network coordinated by the World Health Organization.

"Eventually this will have to be undone a little bit," said Fisher.

But for Kim, who regularly gets emails from family overseas urging her to stay safe, Singapore's response has brought comfort.

"There is definitely concern among our loved ones," she said. "But I've been just reassuring them that the response has been very good and the new practices and policies in place seem to be very sound."

(Reporting by John Geddie and Aradhana Aravindan; Editing by Sam Holmes)