COVID-19: Official Information and Useful Health Tips

[therock]

[Carbon82]

Don't play play hor!

PROMULGATION OF REGULATIONS UNDER INFECTIOUS DISEASES ACT

1.   MOH has promulgated two sets of regulations under the Infectious Diseases Act to give legal force to the safe distancing measures announced by the Multi-Ministry Taskforce, and provide enhanced enforcement for breaches of the Stay-Home Notice (SHN).

Regulations on Stay-Home Notice (“SHN Regulations”)

2.   It was previously announced that from 20 March 2020, 2359 hours, all travellers, including Singapore Citizens, Permanent Residents and Long Term Pass holders returning to Singapore, are issued a 14-day SHN [1]. From 25 March, 2359 hours, returnees from the United Kingdom and United States of America will serve their 14-day SHN in dedicated facilities.

3.   Under the SHN Regulations,

a)  Anyone issued an SHN must not leave their place of accommodation for the duration of the SHN.

b) Any individual who is issued a medical certificate by a medical practitioner certifying that he/she has acute respiratory symptoms must not, without reasonable excuse, leave the individual’s place of accommodation for five days starting on the day the medical certificate is issued.

4.   The penalty for an offence under the SHN Regulations is a fine of up to $10,000 or imprisonment of up to six months or both. (Please refer to Annex A for the SHN Regulations.)

Regulations on Safe Distancing (“Safe-Distancing Regulations”)

5.   Stricter measures will come into effect from 26 March 2020, 2359 hours, to limit gatherings outside of work and school to 10 persons or fewer, and ensure that physical distancing of at least one metre is maintained in settings where interactions are non-transient [2]. 

6.   Under the Safe-Distancing Regulations, any person who is guilty of an offence shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 6 months or to both. (Please refer to Annex B for the Safe-Distancing Regulations.)

 

MINISTRY OF HEALTH
26 MARCH 2020

[1] Returning residents and Long Term Pass holders from Hubei province (mainland China) will be quarantined at home or other suitable facilities.
[2] The stricter safe distancing measures are detailed in MOH’s press release on 24 March, “Tighter Measures to Minimise Further Spread of COVID-19”.

[Blueray]

COVID-19: Entry approval required for all long-term pass holders entering Singapore

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SINGAPORE: All long-term pass holders will require an entry approval before entering or returning to Singapore from Sunday (Mar 29) at 11.59pm, according to the Immigration and Checkpoints Authority (ICA), Ministry of Education (MOE) and Ministry of Manpower (MOM).

In a media release on Saturday, ICA, MOE and MOM said the additional precautionary measures are in view of the risk of imported COVID-19 cases into Singapore. 

Long-term pass holders include those who hold long-term visit passes, student passes, as well as those who have been granted in-principle approval for a long-term pass. 

https://www.channelnewsasia.com/news/singapore/covid-19-entry-approval-required-for-all-long-term-pass-holders-12585386

[therock]

https://www.scmp.com/week-asia/health-environment/article/3077345/coronavirus-why-so-few-infections-singapores-health?fbclid=IwAR1p-BR8ems_J4f5GZOaEA91rPD_gPNVQQFhOCNr5WQJNzfHxLl3OnJgF00

 

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A REASON FOR OPTIMISM

However, amid all the gloom, 

Singapore’s experience

 is being held up as a reason for optimism. The city state has reported more than 630 cases of infection, all of which are being treated in hospital, yet only a handful of its health care professionals have been infected. What’s more, even these cases, according to Vernon Lee, director of communicable diseases at the Ministry of Health, are thought to have been infected outside the health care setting.

Experts suggest this has been more than just luck, pointing to a case in which 41 health workers were exposed to the coronavirus in a Singapore hospital yet evaded infection.

The workers had all come within two metres of a middle-aged man with Covid-19 who was being intubated, a procedure which involves a tube being inserted into the patient’s trachea. The procedure is seen as being particularly hazardous for health workers as it is “aerosol generating” – patients are likely to cough.

The workers had not known at the time that the man had the virus and all were quarantined after he tested positive. However, on their release two weeks later, none of them had the virus.

Coronavirus: as Malaysia braces for third wave, doctors make their own face masks

27 Mar 2020

The case has come to widespread attention partly because the workers were wearing a mix of standard surgical masks and the N95 mask, which doctors see as the gold standard as it filters out 95 per cent of airborne particles.

The conclusion, published in The Annals of Internal Medicine this month, was this: “That none of the health care workers in this situation acquired infection suggests that surgical masks, hand hygiene, and other standard procedures protected them from being infected.”

Surgeon and writer Atul Gawande mentioned the case in an article for The New Yorkeron how health care workers could continue seeing patients without becoming patients. He said there were things to learn from Asia and that some of the lessons came out of the “standard public health playbook”. In other words, there is much to be said for social distancing, basic hand hygiene and cleaning regimens.

 

Not every country has a plan like this. Last year’s Global Health Security Index by the Economist Intelligence Unit found that 70 per cent of 195 countries scored poorly when it came to having a national plan for dealing with epidemics or pandemics. Almost three in 10 had failed to identify which areas were insufficiently staffed. In India, with a population of 1.3 billion, only about 20,000 doctors are trained in key areas such as critical care, emergency medicine and pulmonology.

Singapore, Hong Kong, Taiwan: the real coronavirus world leaders

19 Mar 2020

In contrast, Singapore published its first Influenza Pandemic Preparedness and Response Plan in June 2005 and has since honed it to a tee. Hospitals regularly war-game scenarios such as pandemics or terrorist attacks and the simulations are sometimes observed by the Ministry of Health, which grades the performance and recommends areas for improvement.

The plan also covers the need to stockpile equipment to avoid the sort of shortages many countries are now facing, another lesson inspired by Sars when masks, gloves and gowns were in short supply.

In a pandemic preparation paper published in 2008, Singapore public health specialist Jeffery Cutter wrote that Singapore’s stockpile was sufficient to cover at least 5 to 6 months’ use by all front-line health care workers.

During the Covid-19 outbreak, it has also told citizens to not wear masks so it can conserve supply for medical staff.

Having enough protective gear has reassured Singapore’s health care workers such as Kua, a mother of six who blogged about her experience fighting Covid-19. Kua said: “I’m safe and my family is safe.”

 

Edited March 28, 2020 by therock

[therock]

[Ody_2004]

Very clearly explained.. sorry if been posted..

[therock]

 

[therock]

[Ody_2004]

 

[therock]

[Blueray]

Explainer: When community transmission can be considered ‘widespread’

Read more at https://www.todayonline.com/singapore/explainer-when-can-community-transmission-be-considered-widespread-and-singapore-there-yet

 

 

What are the essential services that will remain open amid stricter Covid-19 measures in Singapore

 

https://www.straitstimes.com/singapore/what-are-the-essential-services-that-will-remain-open-amid-stricter-covid-19-measures-in

Edited April 3, 2020 by Blueray

[therock]

[Blueray]

EXPANSION OF ENHANCED STAY-HOME NOTICE REQUIREMENTS TO MORE COUNTRIES

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To protect Singaporeans and further ring fence the risk of community transmission from imported cases, all Singapore Citizens, Permanent Residents and Long Term Pass holders returning from ASEAN countries, France, India and Switzerland from 5 April 2020, 2359 hours will be required to serve a 14-day self-isolation at dedicated Stay-Home Notice (SHN) facilities. This arrangement will continue to apply to returnees from the UK and US. 

https://www.moh.gov.sg/news-highlights/details/expansion-of-enhanced-stay-home-notice-requirements-to-more-countries

[therock]

[therock]

https://www.straitstimes.com/asia/se-asia/coronavirus-indonesia-announces-biggest-daily-rise-in-cases-24-doctors-now-dead

This is what happens when your HCWs don't get the PPE and masks they need. 

[therock]

This article is important and if we do the right thing and stay home, we have a chance.

https://www.straitstimes.com/opinion/circuit-breaker-for-covid-19-why-time-is-of-the-essence-now

 

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The number of Covid-19 cases worldwide has passed the one million mark. Tens of thousands have died. Many countries are in lockdown mode and face a recession.

Last Friday, the Singapore Government announced strict social distancing rules that will kick in from today. These include closing all businesses, except those offering essential services, and schools.

These measures are necessary as Singapore now has over 1,300 cases. Dozens of new local cases arise every day, a significant number of them unlinked. There are clusters in foreign worker dormitories and cases among healthcare workers.

As late as early February, some people were still saying that the coronavirus outbreak was like a bad case of flu and decrying the border closures and quarantine measures taken.

Today, it is clear, from how Covid-19 ravages Europe and America, that the outbreak can spiral quickly out of control if societies continue with business as usual.

Singapore's efforts, from a medical or healthcare perspective, to battle the scourge of Covid-19 can be summarised in two points.

First, at the public health and community level: to keep effective the reproductive ratio of the virus at less than 1.

Second, at the clinical and hospital level: to keep fatalities down by not allowing our hospital services, especially intensive care unit services, to be overwhelmed.

DISEASE DYNAMICS

Communicable disease outbreak control is always a race against time. Time wasted or chances missed means many more cases and lives lost to the disease.

The measures imposed from today buy the country a valuable four weeks in which to get the reproductive ratio down and break the transmission cycle.

Reproductive ratio, or R0, is the number of additional cases each case is expected to generate in the course of the case being infectious.

The basic R0 is the reproductive ratio of a disease in the absence of any deliberate intervention in disease transmission, or in its "natural" state, where societies do not practise interventions like social distancing or lockdowns and everyone is susceptible to the disease.

The World Health Organisation website has estimated the basic R0 of Covid-19 to be between 2 and 2.5.

On the other hand, the effective reproductive ratio (R or Rt) is the prevailing reproductive ratio after interventions such as social distancing have been put in place.

The aim of every country now is to bring their Rt from its "natural" state or R0 of 2 to 2.5, to below 1 through various interventions.

When Rt is less than 1, the size of the infected pool of people shrinks with time. The pool increases in size if Rt exceeds 1 - that is, there will be a growing epidemic.

TIME MATTERS

The dimension of time in controlling epidemics and pandemics cannot be overemphasised.

Doubling time is the time taken for the infection numbers to double.

Incubation period is the period from infection to developing symptoms. In a paper published by Singapore researchers in The Lancet on March 28, the median incubation period for Covid-19 was four days.

Another time-based measure to note is serial interval - the time between successive cases in a chain of transmission. In a recent paper published in the journal Emerging Infectious Diseases based on Chinese data outside of Hubei province, the mean serial interval time was estimated to be four days.

Since the median incubation period and mean serial interval time are both about four days, this would imply that there is significant asymptomatic or pre-symptomatic transmission.

This is a very important epidemiological feature of Covid-19 that makes it different from Sars (severe acute respiratory syndrome) and also more dangerous.

CUTTING DOWN RT

The fastest and most effective way to cut down on Rt - the effective reproductive ratio - quickly is to practise social distancing.

If a case has close contact with half the usual number of persons in a normal day for the entire period he is infectious, his Rt is half of the basic R0.

The Rt for an entire community is likewise halved if everyone practises social distancing and halves his number of close contacts over time.

For example, if on average a person meets 50 people a day in his usual daily routine, and through social distancing he meets only 25 people, then if he gets infected, he will infect half the number of people had he not practised social distancing. Once halved, the overall cluster numbers become a lot more manageable.

Let's take an example from the table. Assume that serial interval is four, and Rt is 2.5. That is, each case gets transmitted to 2.5 other cases over a cycle of four days each.

At this rate, in 16 days there will be 64 cases. In 28 days, there will be a whopping 1,016 cases.

Now assume that social distancing measures kick in, and we manage to bring the Rt to 1.25. Assuming the same serial interval of four, in 16 days there will be eight cases and after 28 days, there will be only 19. These are much smaller than when Rt was 2.5.

Once numbers are brought under control, a good field epidemiology team can investigate an outbreak and quarantine close contacts in about two weeks.

Besides social distancing, good personal hygiene, such as frequent hand washing and not touching one's face as well as appropriate mask-wearing, also helps to bring down the Rt significantly.

Serial interval also has a dramatic effect on the cluster size. Shortening the serial interval by just one day will increase the cluster size by multiples.

A cluster needs to be aggressively contained within two weeks of the first case because by the time one month has passed, the size of the problem has mushroomed to probably crisis levels.

Unfortunately, while we can change our behaviour to cut down the Rt quickly, serial interval is a characteristic of the virus that is not easily altered; hence, quick and decisive action to contain a cluster, such as via contact tracing and quarantine, is most important.

Understanding the basics of epidemiology helps us appreciate the need to cut down the reproductive ratio and the need to act very quickly.

Left uncontained, a single case can lead to a cluster of about 100 to 200 plus cases in about a month if the serial interval is between four and five days and the R0 is 2.

If the R0 is 2.5, then the cluster size becomes calamitous: A single case may have spawned 400 to 1,000 cases. This may have been what has happened in places such as Italy, Spain, the United States or the United Kingdom.

Singapore has been aggressively contact tracing every case and ring-fencing them, to reduce the Rt.

We need to step up our control measures. Unlike the earlier rounds, which depended more on government and healthcare workers, this round of measures requires all our compliance and discipline.

Each of us can play an important role in this race against time to bring down our infection numbers. We must do it or face the consequences.

[Jman888]

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[Adrianli]

Hello. Can dont start thread or not. There is already a dedicated for this.