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We have had a frantic week, but a productive one. So far, we have been lucky: there are no cases in Singapore.
The virus has spread to 21 countries. The global response has been robust. Mexico in particular has been transparent and decisive. Its early alert and bold decision to close the country down for 5 days, at great cost to its economy is highly commendable and responsible. Outside of Mexico, the virus is proving to be mild. WHO alert level is at Phase 5 and it may further raise it to the final Phase 6. If it does, we should not be shocked as the WHO alert level merely refers to the geographical spread of the outbreak. It does not imply severity.
Within Singapore, our alert level is currently at Orange.
I am impressed with the response from Singaporeans, our hospitals, clinics, airport, check-points, schools, kindergartens, companies. Years of pandemic preparation are paying off. Singapore moved into Orange readily, without much fuss. Singaporeans did well last week, with distinction; there was no panic and Singaporeans took the inconvenience in its stride. I know that many have been inconvenienced: patients, visitors, office workers, visitors to mass events, returned travellers from infected regions. I am most grateful to all.
This second week has given us time to analyse the data, reflect and draw tentative conclusions about the virus and the severity of the outbreak. The incubation period for the disease appears to be one to five days, nearly that of a seasonal flu virus. The new strain appears to be the same in confirmed cases around the world, and it remains responsive to two antiviral drugs, Tamiflu and Relenza. It is till not clear in what percentage of cases the disease results in serious respiratory disease. A complete picture will not be available for a long time; there are still unanswered questions, while the virus will continue to mutate and surprise. We have to nevertheless act based on incomplete information, and make the relevant judgement call, based on evidence available and past experience of managing such public health risk.
In so doing, we must stick to good science and sound evidence, not emotion or prejudice. We certainly must not be trapped in old SARS mindset, for as I have explained before this is a different enemy, we are fighting a different war.
But there are also similarities which remain applicable this time round. The public health response plan based on PDIP: Protect the borders (from imported cases), Detect & Isolate suspect cases (by hospitals and GPs), and Personal hygiene at the highest possible level by the community, remains valid and important. PDIP will save lives and minimise casualties.
In fact, this time round the last P: personal hygiene is even more crucial, so let me spend time on this. This time round, the public play a much bigger role than hospital staff in the war against this virus.
SARS was not very infectious but very deadly. It was like a big Elephant, can be identified early and we can shoot it with an elephant gun. H1N1 is the opposite, very infectious but so far not so deadly. It is like locusts, thousands of them. Elephant gun won't work.
We need to deal with different threats differently. With H1N1, the Govt is separating anyone from Mexico. We will watch where else the virus spreads to and introduce containment measures appropriately. But at some point when it is in too many places and we will not be able to block it further, we ourselves will get infected. That's why I have been warning about cases appearing here and causing local clusters. It is a matter of time that such a scenario will happen here.
We have bought ourselves some time with strong border controls and Home Quarantine Orders. Meanwhile, let's get ready at the community level - up our personal and public hygiene standards. Let's benchmark ourselves against the Japanese. The Japanese are well-know for being clean and of high hygiene standard Singaporeans are not there but we can be like the Japanese too. Let's use this crisis to get one another to reach this goal.
The Government is doing everything possible, hospitals and the healthcare people are all geared up. But every Singaporean must take it seriously. SARS, H1N1, bird flu, Chikungunya, food poisoning are out there. We should clean up our act personally and as a community.
NEA has relaunched the SOK campaign, spring cleaning our hawker centres, food courts, toilets; schools, kindergartens are teaching our children on proper hand washing and cough etiquette. We must sustain this as part of our way of life. Please join us in this effort.
This is because the next outbreak may not be so kind. We have now been warned twice, first through SARS (deadly but not contagious), now H1N1 (contagious but not deadly). The next outbreak may be both contagious and deadly; we may not be so lucky next time. We need to have all the pillars PDIP of defence to be robust. We are confident of PDI. I am less confident of the last P: please prove me wrong.
Meanwhile, we should shift to a sustainable level of precautions and control measures. We must avoid "flu fatigue". Now that we have a better knowledge of the outbreak, we can pull back some of the measures, and move from Orange to Yellow, not immediately, but over 5 days, progressively. Bear in mind that Yellow is not Green. The virus is still out there circulating and making people sick and is likely to come here soon. So we will still need to impose temperature screening at borders, hospitals and clinics, Home Quarantine Orders, but some of the tighter measures, like one visitor-rule, temperature taking at public offices can be eased. Please see handout on the measures today under Orange, and what they will be from tomorrow and from next Monday.
Let me stress that the situation remains dynamic and we must continue to stay vigilant and manage this crisis nimbly, scaling up or down as necessary. We should keep an open mind, not to prejudge the situation and to adjust our responses according to data that subsequently become available.
Vigilance remains important because this is a new disease to which people have limited immunity and whose course remains uncertain. Singaporeans have no natural immunity to it, because it is a new strain. So once an imported case comes in, it will spread easily, infecting many. Fortunately, the cases seem mild. But pandemics can start out mild, and over the course of several months become a severe illness. So we are definitely not yet out of the woods, but some easing of the measures will avoid "flu fatigue" and conserve valuable resources, eg N95s, for the big battle which may come several months later.
In revising this alert, our experts have taken into account two likely developments. First, even if the WHO upgrades alert level from Phase 5 to Phase 6, our move is still applicable, provided the virus remains mild. Second, even if Singapore begins to encounter its first few confirmed cases, our move is still applicable, provided the illness is not severe, as observed in the US, Europe and elsewhere. But if the virus has become more virulent and case fatality rate begins to soar elsewhere, we will review our alert level and recalibrate our control measures appropriately.
In short, we have had a good week, the enemy is still out there, ready to pounce and some may get through our defence and cause some damage. We will deal with the intruders and treat our casualties as best we can. We remain on high alert but some of the measures introduced last week can be eased.
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