How the COVID-19 pandemic shaped Singapore’s strategy for future health crises

SINGAPORE: The coronavirus pandemic has seemingly faded into the background, with gatherings, crowds and air travel back in full swing.

Life was vastly different during the height of the outbreak in 2020, when the streets were mostly empty and usually-bustling areas fell quiet.

But while memories of social distancing have become a thing of the past, the lessons Singapore picked up from the pandemic have proven crucial this year.

They have driven the government’s response to other recent outbreaks like tuberculosis and mpox, said Professor Vernon Lee, director of the Ministry of Health (MOH)’s Communicable Diseases Group.

“We have learned a lot from the COVID-19 response – both the need to have a comprehensive whole-of-government and all-of-society response plan, and also the need to incorporate new technologies … and be flexible depending on the situational changes,” the public health specialist told CNA.

Prof Lee advised the multi-ministry COVID-19 task force and was a key figure in shaping the country’s response.

He noted how COVID-19 and SARS are both coronaviruses, but their spread and presentation as well as the response measures were “vastly different”.

“A future pandemic can come in many different ways, and it is difficult to predict how a future pandemic will actually transmit and will spread,” he said. 

COORDINATING ACROSS DIFFERENT SYSTEMS

When several active cases of tuberculosis were detected at Jalan Bukit Merah, MOH responded by working with various sectors along with grassroots and community leaders to engage residents, said Prof Lee.

By understanding the issues they faced, the authorities were able to put measures in place to help them, he added.

The ministry conducted a mandatory screening exercise in January among 2,548 residents at an open-air carpark. Most of them tested negative, while 322 were diagnosed with latent tuberculosis infection. Two infectious cases were detected.

This effort to isolate and detect infectious diseases quickly was a key part of Singapore’s pandemic strategy.

Tuberculosis is transmitted through respiratory droplets from an infected person. It usually affects the lungs but it can also affect other parts of the body, such as the brain, lymph nodes, kidneys, bones and joints. 

Some of the common symptoms include a persistent cough that lasts three weeks or longer, low-grade fever, night sweats, fatigue, weight loss, chest pain and coughing up blood or sputum. 

IT SYSTEMS, COMMUNICATION

The government also used systems developed during the pandemic, such as registration platforms, to deliver test results and follow-up notices to residents.

“This helped to smoothen and make the entire process a lot more efficient, a lot more pleasant for the residents,” said Prof Lee, who also helms the National Centre for Infectious Diseases (NCID).

Another takeaway was how to communicate effectively.

“We learned during the COVID pandemic that we need to be very swift in communicating what we know to the residents, and also to prevent misinformation and disinformation from taking root,” Prof Lee added.

To that end, the authorities went door-to-door to relay information about tuberculosis and what residents needed to do. Grassroots organisations helped to reach out to those who were not home.

PREPARING FOR MORE SEVERE MPOX CASES

Similarly, when the World Health Organization declared mpox a global public health emergency in August, Singapore developed response measures that it learned from the pandemic.

Prof Lee noted that the epidemiology and transmission of mpox – which has been around for several decades, especially on the African continent – has changed.

“Part of … what we learned during COVID was to anticipate such changes and to be flexible in our response,” he said.

A new and deadlier variant of mpox, known as clade 1b, emerged last year and has since been detected in countries like Germany, Pakistan and Thailand.

Singapore has seen 17 confirmed mpox cases so far this year, all of which are the milder clade 2 strain.

Prof Lee noted: “While we are currently preparing for a potential mpox outbreak of cases based on the current evidence that we know, we are also trying to look at all the other possibilities that could occur and to be prepared for them, should anything change in terms of the disease characteristics.”

The COVID-19 pandemic showed the government the need to strengthen healthcare capacity, such as keeping isolation and quarantine facilities warm, said Prof Lee.

This allows patients with mpox to be rapidly isolated if cases are detected. The authorities can also quickly perform contact tracing and quarantine any close contacts if required, he added.

Mpox is mainly spread from human to human through close contact with an infected person. This can include sex, kissing or just merely touching. 

Symptoms of mpox can vary. These include a rash that may last for two to four weeks, fever, headache, muscle aches and swollen lymph nodes.

TRAINING HEALTHCARE WORKERS 

Assoc Professor Lim Poh Lian, director of the NCID’s High-Level Isolation Unit, pointed out another challenge in tackling outbreaks or pandemics that was underscored during COVID-19: Healthcare workers having to be on the frontlines.

To address this, she said NCID is continuing to train staff to ensure its infection control processes are “excellent at all times”, not just when an outbreak is on the horizon.

Prof Lee also said the MOH is working to ensure that the healthcare system can meet demands during peacetime and also adapt to respond to any future pandemic outbreaks if needed.

Assoc Prof Lim added: “We need resources to care for patients, testing, treating, admitting patients – making sure we get them home safely. NCID is working to refresh these workflows in advance of the next outbreak.

“Most important of all, we seek to grow a spirit of resilience and responsiveness, resourcefulness. And it comes out of a camaraderie from having weathered COVID and become stronger together.”