Singapore’s ‘second wave’ warning for Australia

We thought Singapore was a guiding light. That it had COVID-19 under control. That it had flattened the case-number curve. But the virus is battering-down the city-state's defences.

As Italy, Spain and the United States flounder under a seemingly relentless pandemic, several Asian nations stand out as sources of hope.

Singapore. Hong Kong. South Korea. Japan. These countries had heeded the lessons of the 2003 SARS virus outbreak. They responded fast. Their health systems were well prepared. Stockpiles were primed.

And, at first, the pay-off seemed self-evident.

The rate of infection remained low. Hospitals were coping.

 

And Singapore won international renown for establishing 'best practice' pandemic control.

But, now, the number of COVID-19 cases has begun a new and relentless rise.

The virus is beginning to break through social-distancing, contact tracing and medical defences.

The first wave of cases appears to have been mostly among travellers.

With airlines, trains and cruise ships now sitting idle, hopes rose that the virus had been contained. Instead, it was quietly multiplying among their communities.

Now, its relentless exponential growth is raising fears of a second, larger wave.

 

Singapore has been hailed as an example for its suppression of COVID, but it could be making a comeback. Picture: Ore Huiying/Getty Images.
Singapore has been hailed as an example for its suppression of COVID, but it could be making a comeback. Picture: Ore Huiying/Getty Images.

 

CANARY IN THE COVID MINE

On Sunday, Singapore recorded its biggest single-day jump in numbers since the pandemic began. It added 120 confirmed cases.

It's total caseload leapt 50 per cent in just one week.

Under the exponential math of pandemics, unless new measures are found to keep this number down, it's likely to get much bigger, fast.

"We have kept the outbreak under control," Singapore's prime minister Lee Hsien Loong said in a national address.

"But looking at the trend, I am worried that unless we take further steps things will gradually get worse, or another big cluster may push things over the edge."

In the past, most of Singapore's cases had been infected while travelling overseas. But, this time 116, had caught the disease locally - with no known links to other victims.

Singaporean authorities have traced much of this surge to three new 'clusters' of infection.

Two are in residential dormitories. The third is a construction site. But contact tracing is yet to determine where or how the final 66 likely came in contact with COVID-19.

Authorities there are blaming residents returning from overseas - and growing complacency among the community.

So they're cracking down further.

"If you were to put (these measures) in place too early there may well be fatigue and when there is fatigue people may not abide by the measures so well … it may well be counterproductive," Singapore's coronavirus taskforce co-chair Lawrence Wong told local media.

Even long-term residents must now seek approval before entering the country. Residents are being told to stay at home and not to mix with people outside their own households. Going outside is limited to buying groceries or takeaway food, or socially-distant exercise in parks.

Schools and universities will also now be shut down, as will non-essential businesses.

And the city will stop discouraging its citizens from wearing masks.

It's a disturbing trend being echoed elsewhere.

 

WORLDWIDE RETREAT

In Asia, the struggle against COVID-19 has ramped up another notch.

Singapore, Hong Kong, South Korea, and Japan have all tightened their social distancing regulations in the past week. New immigration controls are being enforced. Returning citizens are being quarantined for 14 days, and those suspected of having been exposed are being tracked via smartphone apps.

It's all an attempt to choke a second wave of COVID-19 infections before it overwhelms their healthcare systems.

Hong Kong had managed to keep its new cases to below 11 per day during the early stages of the outbreak. It was one of the first places to close schools, public buildings and parks.

It didn't go so far as a full lockdown. But a fresh wave of infections is resulting in strict new social distancing measures being enforced.

After a wave of residents returning from overseas, it's now regularly reporting over 50 new cases daily.

The island city's health system is now struggling.

Japan initially seemed to be on top of the pandemic. It has now declared a state of emergency.

During January, February and March it appeared to be holding off the virus. But Tokyo has emerged as a hotspot of the infection amid claims of social-distancing complacency and insufficient testing. The virus may have been more widespread there longer than believed.

At the weekend Japan reported its biggest one-day jump - 130 new confirmed cases.

South Korea seemed to achieve the impossible. After starting out with one of the worst outbreaks - largely due transmissions through a secretive Christian cult - it managed to turn the epidemic growth curve around. Accurately targeted testing and lockdown orders dramatically reduced the rate of infection.

But all it took was for a few to slip through the cracks. South Korea's caseload is on the rise again. The virus appears to have hitched a ride with citizens returning from overseas. And, from there, it's entered the broader community.

China has repeatedly claimed to have beaten the virus, though this has been a source of much controversy. For most new cases, Beijing's also been blaming its own citizens returning from overseas. But that doesn't explain a new lockdown of Henan province's population of 600,000. Epidemiologists have been warning for weeks that relaxing restrictions on hot spots like Wuhan too early could result in a second wave of cases by August.

 

STEALTH VIRUS

COVID-19 appears to be more contagious than initially thought. And more people than expected are carrying it without showing symptoms.

The US Centres for Disease Control (CDC) has published a report suggesting each COVID19 carrier will likely infect five or six other people.

And the British Medical Journal has just published a study based on experience in Italy suggesting some 78 per cent of people with COVID-19 show no symptoms.

Together, these elements makes the virus especially hard to contain. It also means a much higher level of vaccination before it can be choked.

About 85 per cent of any given population will have to have resistance before they can begin to go about 'normally', without offering a chance for the virus to spread.

The CDC study also found the virus generally takes about 4.2 days between contraction and the emergence of symptoms, though this can still extend out to 14 days.

But what if one in five never feel sick. Or four out of five?

"When 20 per cent of transmission is driven by unidentified infected persons, high levels of social distancing efforts will be needed to contain the virus, highlighting the importance of early and effective surveillance, contact tracing, and quarantine," the CDC study reads.

When the asymptomatic transmission rate is about 80 per cent, the challenge is "formidable".

"Given the rapid rate of spread as seen in current outbreaks in Europe, we need to be aware of the difficulty of controlling SARS-CoV-2 once it establishes sustained human-to-human transmission in a new population," the CDC study warns.

Jamie Seidel is a freelance writer | @JamieSeidel

 

Originally published as Singapore's 'second wave' warning for Australia



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