MINISTERIAL STATEMENT IN PARLIAMENT
24 APR 2003

BATTLEFRONT 1 - PUBLIC HEALTH

Firstly, public health. Besides medically treating those who have caught the disease, we must take public health measures to stop the spread of the illness, and minimise the number of people who fall ill. We need to set up lines of defence around three groups of people :
a. those who are already infected or who might be infected,
b. those who are not infected, and
c. those entering Singapore who might bring in the virus.
Detect, Isolate and Contain

For those who are already infected or who might be infected, our strategy is "detect, isolate and contain". This means sending those who are ill with SARS promptly to the Tan Tock Seng Hospital, contact tracing - to identify and locate those who have had contact with SARS patients, and issuing Home Quarantine Orders (HQO) to those who are at risk. The HQOs are to put their health under close monitoring, and also to prevent them from spreading the virus to others. This way we can break the cycle of infection and spread, and bring the outbreak under control.

The most stringent precautions are taken at the hospitals. This is where most SARS patients are. They must be prevented from infecting other patients or health care workers. If doctors and nurses get infected and fall victim to the disease, our health care system may collapse, and SARS will spiral out of control. Hence health care workers are required to don protective gear and monitor their own temperatures closely. We have also severely restricted visits by family members and friends to patients in hospital. These stringent measures are working. Because of them, since 31 March, no patients in Tan Tock Seng Hospital have fallen ill from SARS as a result of being infected in the hospital.

In the community, we must trace all the contacts of SARS patients quickly and comprehensively, and place them on home quarantine. For this strategy to work, patients and their families have to cooperate with the authorities, to tell fully and truthfully where the patient has been and whom he has had contact with. Also the quarantine system must be watertight. It takes only one undeclared contact, one irresponsible breach of an HQO, to start a whole new cluster of infections. It is therefore absolutely essential that those served with HQOs obey the orders and stay at home, and not put many others at risk. Thus we have acted firmly against HQO defaulters. We have installed electronic cameras in their homes, and implemented tougher enforcement measures such as electronic tagging. While most people on HQOs have complied and cooperated, a minority are recalcitrant and incorrigible.

This is why the Minister for Health is amending the Infectious Disease Act, on a Certificate of Urgency, to give additional powers to the Ministry to take action against persons who breach HQOs, refuse to cooperate with health officers to take SARS control measures, wilfully hide medical information related to SARS control, or fail to comply with any directives/regulations related to SARS control. Violators can be levied composition fines of up to $5,000, instead of being charged in Court. Furthermore, the general penalty for committing an offence under the Act will be doubled, to a maximum of $10,000 or 6 months imprisonment for a first offence, and $20,000 or 12 months for a repeat offence.

These public health measures to "detect, isolate and contain" the disease are all the more necessary because there is not yet a diagnostic test for SARS, which can tell quickly and reliably whether or not a suspected case has the disease. Scientists in A*STAR research institutes in Singapore have been working flat out as part of a worldwide effort to identify and understand the SARS virus. They have successfully mapped the genome of the SARS virus, confirming and extending the results of mappings done elsewhere. The Genome Institute of Singapore is developing new diagnostic methods, and several other diagnostic methods are becoming available from other laboratories. We will be testing these out over the next weeks and months, to identify the best methods to use. The ultimate goal of the scientific research is to develop a treatment and a vaccine for SARS, but this is not going to occur overnight, and may take several years or even longer.

Protect and Monitor the healthy
For those who are not infected, we are taking vigorous measures to prevent them from contracting SARS. We need to pay special attention to public areas with heavy human traffic, and mass institutions such as schools and military camps.

The Ministry of Environment (ENV) has taken preventive actions to raise the overall standard of public health and hygiene, to minimise the risk of environmental transmission of SARS. ENV will clean and disinfect public areas, check for and eliminate pests, ensure that waste disposal and collection is done properly, and make sure our sewerage systems are in proper working order. We will also ensure that our environmental workers are properly equipped and protected, and do not inadvertently become a mode of transmission. Within the next week, ENV will work with market stallholders to spring-clean in all wet markets. Food handlers in all food establishments will be required to take their temperatures twice a day.

The Ministry of National Development together with HDB and Town Councils have instituted several measures to improve the cleanliness of our housing estates. These include stepping up the general cleaning of HDB common areas and implementing an SOP to respond to complaints of sanitary pipe leaks within 24 hours. BCA has reminded all Management Corporations of private buildings to maintain the sanitary pipes in their buildings in good working condition.

The Ministry of Education (MOE) has also introduced a series of measures. Schools are educating students about SARS, issuing every student with a personal thermometer, and teaching them to check their own temperatures daily. Students and staff are also required to regularly declare their travel history. The Institutes of Higher Learning are segmenting their large campuses into smaller sections, to reduce movement across the campus and to facilitate contact tracing should a SARS case occur.

MOE and the Ministry of Community Development and Sports (MCDS) have implemented standard operating procedures for child-care centres and kindergartens, to screen and manage the children.

The Ministry of Defence (MINDEF) has instituted all possible precautionary measures. It has disseminated to all Singapore Armed Forces (SAF) units information on SARS, tips on personal hygiene, travel advisory, and procedures for handling suspected SARS cases. Critical units are working in shifts to ensure that operations continue seamlessly in case there is an outbreak in the units. All recruits and NSmen undergoing in-camp training will be screened for SARS daily. By end of this month, MINDEF will issue personal thermometers to all MINDEF and SAF personnel to do twice daily temperature checks. These measures will keep the SAF SARS free, while maintaining its operational readiness.

It is a useful practice for Singaporeans to take their own temperatures daily, and if they have a fever to stay away from work or school and see their doctor. Temperatures are already being taken at many workplaces and large gatherings. It reassures everyone there that the group is less likely to contain an infectious SARS case, and helps to detect early anyone who is ill, before he can infect too many people. Even if this measure is only partially effective, it will still reduce the chances of SARS spreading from one person to many others, and thus help to bring the outbreak under control.

Every home should have a thermometer. Every Singaporean should know how to take his temperature, so that he can take personal responsibility for his own health, and monitor his own and his family's temperatures. It will take a month or two to obtain the supplies, distribute the thermometers to homes, and teach Singaporeans how to use them. Our first priority is to provide all pupils in schools with thermometers. After that we will progressively supply the homes. By June, every student and every household should have a thermometer.

Safeguard borders
A third major concern is to prevent fresh cases of SARS from being introduced into Singapore by travellers, and Singaporeans infected with SARS from going abroad and infecting other countries. SARS is a major problem in China and Hong Kong, and cases have been reported in nearly every country in the region, including Malaysia and Indonesia. We must expect new index cases to enter Singapore from time to time. This was in fact how the SARS outbreak in Singapore started.

We cannot shut our borders, and stop the movement of people and business completely. But we must institute effective border controls, to identify people with fever so that they can examined more thoroughly by doctors. We have built thermal scanners that enable us to scan the temperatures of large numbers of people efficiently and without intrusion.

We have already started screening all inbound air passengers from SARS affected areas. This includes passengers coming into Changi Airport for transit. As soon as we acquire more scanners, we will extend the screening to inbound passengers from all areas.

We have also started screening all passengers departing from Singapore. These measures make Changi Airport both a safe transit point for passengers from all round the world, as well as a safe place to visit. There is no reason for either locals or foreigners to avoid Changi Airport.

We are also paying close attention to the Causeway and the Second Link, where more than 100,000 travellers move in and out daily. We have installed thermal scanners at both the Woodlands and Tuas land checkpoints. Singapore and Malaysian health and immigration officials have been meeting to discuss the SARS problem, and will work closely together to draw up measures to screen for SARS at the Causeway and the Second Link.

Newly arrived work pass holders coming from SARS affected areas are being required to undergo a 10-day quarantine to minimise the risk of their bringing in SARS to the workplace.

ASEAN leaders recognise the seriousness of the SARS problem. They are holding a Special ASEAN Leaders' meeting in Bangkok later this month, to co-ordinate our efforts and collectively respond to SARS as a region. We need to work out measures to manage the movement of people across ASEAN borders, so that we can stop SARS from spreading between countries while we maintain the flow of commerce.

Plan for the unexpected
Besides taking immediate steps to keep the SARS outbreak under control, the Ministerial Committee has also been working out contingency plans to deal with various scenarios that could arise. These include measures relating to health, the economy, transport, border control, childcare centres, kindergartens and schools, emergency housing and social support, and public communications. For example, we are working out the housing and social support plan should a large number of people need to be quarantined. We hope that we will not need these arrangements, but should any such situation develop we will be prepared.