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Why Singapore will overcome Covid-19 even though outbreak could get worse before it gets better

Although it may feel like ages, we are still in the early days of the Covid-19 outbreak caused by a new coronavirus.

A volunteer holding up a sign at the Feb 20 launch of SG United Portal for Singaporeans looking to support community efforts in response to Covid-19.

A volunteer holding up a sign at the Feb 20 launch of SG United Portal for Singaporeans looking to support community efforts in response to Covid-19.

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Although it may feel like ages, we are still in the early days of the Covid-19 outbreak caused by a new coronavirus.  

As two old hands who experienced the struggles of the severe acute respiratory syndrome (Sars) pandemic in Singapore, we are gratified to see that preparedness systems are in place here and working well. 

The measures introduced have even been endorsed by infectious disease experts such as the London School of Hygiene and Tropical Medicine’s Professor David Heymann, who noted that despite causing inconveniences, Singapore “is not overdoing it”. 

Nonetheless, a crisis of public confidence is moving faster than the crisis of public health. 

Masks, hand sanitisers and disinfectants were the first to fly off the shelves. Even in our traditionally stoic society, a breach in our psychological defence occurred when some took to hoarding food and household items once Singapore moved to Dorscon Orange on Feb 7.  

Can we succeed in beating this virus? The answer is most certainly yes, and we are confident of the reasons why. 

UNDERSTANDING OUR INSECURITY 

Insecurity amidst uncertainty is to be expected. Many reports, some untrue, are making their rounds in chat groups, stoking public anxiety, doubt and fear.

We are sad to see Sars revisited in many ways, with the old unfounded fears of infection prompting members of the public to shun healthcare workers and landlords to throw out tenants who had travelled to China. 

But Covid-19 is much less deadly than Sars or the Middle East respiratory syndrome (Mers). Case-fatality rate measures the number of deaths among those infected and this is now coming out consistently to be much lower for Covid-19.  

On the other hand, this disease is far more capable of transmitting between humans than Sars or Mers. Transmissibility is measured by its reproduction number — cases directly generated from each case — and this is showing to be more like pandemic influenza.

While social media can be useful, it also means that information can be overstated. Bad news spreads faster than good news. Media, which build in algorithms that prioritise sites similar to those often visited, compound biases in line with previous viewpoints and worsen fear.

The authorities have been quick to provide timely updates and dispel rumours.  

But people have different ways to judge the impact for themselves, with some even contemplating the “what-ifs” future state, such as Dorscon Red. Hence, expectations and beliefs honed from prior experience and observation of other countries contribute towards behaviours such as panic buying.

The verdict on this outbreak is not out yet. Much attention is on the effectiveness of control measures in China.

Some assess that disease incidence will decline into the warmer months of summer. Others believe Covid-19 will last longer, and possibly become endemic in a way similar to influenza.  

Whichever the case may be, we can prepare for the worst while hoping for the best. 

Co-author Leo Yee Sin (right) briefing Prime Minister Lee Hsien Loong during his visit to NCID on Jan 31, 2020. Photo: Raj Nadarajan / TODAY

WHY WE ARE CONFIDENT OF SUCCESS 

Whether the outbreak lasts weeks or months, halting this outbreak in its tracks ultimately depends not so much on disease duration as on our collective resilience. 

Sustainability is key to preparing for a long battle. Support for each other is crucial to our psychological defence. 

When we recall events of 2003, the immediate impact of Sars was fear. But out of this grew one long-lasting positive effect, in the form of a nationwide crash course on the importance of good hygiene practices.  

Being a compact city state with a high population density, and dependent on global connectivity for our life blood, we have to accept many hard truths. 

But we are not helpless. There are many actions we can take together to safeguard public health and minimise the impact of acute events that endanger us.  

Unwelcome as they are, public health emergencies will occur from time to time and they represent opportunities for us to derive valuable information not just about the disease threat, but also about ourselves.  

Courageous volunteers are offering their skills and support in the community. Scientists are readily sharing knowledge to address the dearth of understanding on how Covid-19 originates and spreads.

And we have dedicated healthcare and public health professionals, many with experience from Sars. 

In addition, Singapore's unique size also works in our favour. Many challenges are much more manageable in scale here than they would be in other countries. 

We have ample resources, invested heavily during peacetime. We also have the will to learn from our mistakes and stand together.

These assets collectively constitute our urban health security. Hence, we are confident of success.

COMMUNITY-BASED RESPONSE VITAL 

New cases are being reported at an alarming rate in many places outside China. As global events unfold, the momentum of this disease is such that we can expect the outbreak (and case-fatality) to get worse before it gets better. Nonetheless, we remain optimistic.

Just as with Sars, here is a chance for us to improve our community-based response with social norms of self-reliance, solidarity and cooperation.

With concerns over rapid local spread, we must wash our hands regularly and if we feel unwell, wear a mask and avoid contact with others. We must also be judicious in the use of limited resources.  

Inconvenience is inevitable, but we must be patient. The virus does not discriminate, and neither must we. 

While we stay geared to fight, our spirits are uplifted by human stories of selflessness. We sense a groundswell of people motivated to strengthen our urban health security.

Indeed, some of the panic buying ostensibly for one’s own and relatives could be arising from pent-up emotions seeking ways to respond. Perhaps we can harness this for a greater good. 

Acts of kindness — people cooperating to give unused masks and hand sanitisers to others, and to cheer on frontline workers with food and messages of love and care — nourish our hearts with a warm glow of togetherness.

The National Centre for Infectious Diseases and Saw Swee Hock School of Public Health have linked up with various groups to address requests on how to mount community-based responses, and clarify any misinformation on the outbreak.

As the national crisis unfolds on two fronts — public health and public confidence — we see an excellent learning moment for all of us. 

The community is proving vital to Team Singapore. Hence, connection and engagement with them in one whole-of-society approach should not be ignored.

Once Singapore ceases its containment efforts and life gets back to a semblance of normality, we may yet be surprised that it happened sooner than we expected.

 

ABOUT THE AUTHORS:

Associate Professor Ooi Peng Lim is senior consultant with the National Centre for Infectious Diseases (NCID) and teaches field epidemiology at the Saw Swee Hock School of Public Health. Professor Leo Yee Sin, an infectious disease specialist, is Executive Director of NCID.  

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