Monday, March 30, 2020

Had covid virus spread widely in Singapore? We ushered in a "critical tipping point"

Reporter : Lu Lingzhi 
Publisher : Zaobao Digital
Ref : https://www.zaobao.com.sg/znews/singapore/story20200330-1041477
Picture, Translation, editing : Gan Yung Chyan
                                              / KUCINTA SETIA




The COVID-19 (covid, in short) epidemic in Singapore has ushered in a short period of plateau after withstanding the first wave of imported cases from China. But in the past few weeks, a new wave of imported cases has come mainly from Europe and the United States. 54 cases, 49 cases, 73 cases ... The number of cases of covid has repeatedly reached a single-day high in the past few weeks, which is alarming.

After zaobao.sg flipped through a lot of information (a lot is right), we sort out intuitive charts:

It can be seen that the change curves of daily input cases and newly added cases are roughly consistent. Since 17 March 2020, the number of imported cases has increased significantly. It surged to 17 on the same day, and reached a peak of 48 on a single day on 23 March.

On the other hand, the number of local cases also soared from March 24, and the largest number of 35 local cases so far on 25 March 25, even on 27 March, exceeded the number of imported cases.

What is worrying is that new cases of local unlinked cases (local unlinked cases) have also rapidly increased with the outbreak. If you do not believe you see the following picture:



The so-called "unlinked cases" are not clearly defined by the World Health Organization (WHO). Based on the data provided by the Singapore Ministry of Health, we speculate that “unrelated cases” means that the patient has not recently gone abroad to the affected country, and has not had known close contact with other local confirmed cases.

It should be noted that, for example, the nth patient was diagnosed without going abroad recently, and was classified as an unrelated case on the a day but after that, he was found on the a + b day to have contact with the mth patient and the mth patient was diagnosed positive on that day.  In this case, the mth and nth patients are not unrelated cases (although it is still unknown how the nth patient became infected and where the source of the infection was).

Therefore, judging from the daily new unrelated cases to judge the situation is not accurate, and it can better reflect the current outbreak of accumulated unrelated cases.

As of 12 pm on 29 March 2020, there were 71 unrelated cases in Singapore. In other words, in just 10 days, the number of unrelated cases tripled from 24 on 20 March 2020!

Does this mean that the covid virus had spread widely in communities across the island? We interviewed three infectious disease experts to hear their opinions.

Questions:

In view of the recent increase in domestic unrelated cases, is there a signal that the covid virus is more serious in local communities?
What is the reason for the climb?
Has the covid virus spread widely in communities across the island?
Does this make it more important to maintain social distancing?

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If you don’t have time to read  the following paragraphs, you can directly read the summary first: Although the epidemic has not reached the point of "widespread", it is approaching the critical point. The next two weeks are the key to contain the spread. How to achieve it? Keep a safe social distance of two metres. It is best to stay home and not go out.
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Dr. Liang Haonan, Infectious Disease Consultant, Elizabeth Novena Hospital:
New cases of covid of unknown local origin have recently been spreading in local communities. On the one hand, Chinese and foreigners who have lived in Europe and the United States for a long time recently entered Singapore. Some of them may not pay much attention to local news, and it is not clear to be vigilant and keep a safe distance. Some of them may not have local medical insurance and are reluctant to seek medical treatment in time when they are sick. As a result, they are still active in the community before isolation. On the other hand, there may be more asymptomatic patients with covid in the community, who do not know they are infected.

But the covid virus has not reached the point of "widespread" in communities across the island. Singapore government has banned short-term visitors of all nationalities from entering Singapore or transiting in our country from 11.59 pm on 23 March. The Ministry of Manpower also only allows work permit holders and their immediate family members who provide necessary services to enter our country. One measure is that if after the 14-day incubation period from 24 March 2020, that is, 7 April, there were more unlinked cases in Singapore, then it could be concluded that the virus had spread widely in our communities.

"This underscores the importance of maintaining a two-metre safe social distance during this period. The number of unrelated cases in the country is a direct reflection of whether Singaporeans have taken good social safety distance measures."


Alex Cook, Associate Dean (Research), Surrey School of Public Health, National University of Singapore, who studies infectious disease transmission models:
Although the increase in the number of unrelated cases in the country is worrying, so far only less than 0.1% of the total population has been diagnosed locally, so it has not yet reached the "wide spread" situation. It is possible that our country will enter the Red Outbreak Response System (DORSCON) red level in the next few months, but for now, the orange level is in line with the status quo.

The increase in unassociated cases underscores the importance of maintaining social distance. We should also consider installing the "TraceTogether" application on mobile phones.

Professor Paul Tambyah, President of the Asia-Pacific Society of Clinical Microbiology and Infectious Diseases:
It is still difficult to judge whether we have entered the stage of "wide community communication", but the next two weeks will be a key turning point. If the situation deteriorates further, we can only consider a complete lockup of the country, but this will cause a more severe economic blow; and spend more manpower and resources to step up the close contact tracking of diagnosed patients.

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