SINGAPORE: The growing number of COVID-19 clusters in the community are a concern, experts said, as they urged people to take existing safety measures seriously and monitor their health.
Senior consultant at the National University Hospital’s division of infectious disease Professor Dale Fisher said that the community cases are a “major test” for Singapore.
“The question is whether our public health systems and community behaviours can respond adequately to avoid another circuit breaker,” said Prof Fisher, who is also chair of the national infection prevention and control committee at the Ministry of Health (MOH).
READ: 14 new community COVID-19 cases in Singapore, including 11 linked to Tan Tock Seng Hospital cluster
He urged people not to go out unnecessarily for the next few weeks and to minimise mingling with people outside their households.
He encouraged people to be “obsessed” with wearing masks properly and exercising hand hygiene, and social distancing “especially when eating and drinking”.
“I am very concerned that we could lose control, yet we know by tightening our efforts we can defeat this surge together. This has to be a community effort,” he said.
Prof Fisher’s comments in response to queries from CNA came amid a growing number of clusters in the community and unlinked cases.
“RELATIVELY LARGER” CLUSTERS IN COMMUNITY
As of Sunday (May 2), there were 27 COVID-19 cases linked to a cluster at the Tan Tock Seng Hospital (TTSH), Singapore’s first hospital cluster. Other clusters include one linked to a cleaner who works at a community care facility in Tuas South, and one linked to an officer from the Immigration and Checkpoints Authority working at Changi Airport Terminal 1.
Among the cases linked to the TTSH COVID-19 cluster are healthcare workers and elderly patients. MOH said on Saturday that an 88-year-old woman linked to the cluster died from complications related to COVID-19.
As of Friday, TTSH put 76 staff members who had been in close contact with COVID-19 cases on leave of absence awaiting their quarantine orders based on further contact tracing, swabbing inpatients and staff members and locking down four wards.
The Government also announced on Friday at a COVID-19 multi-ministry task force press conference that it will take action to try to reduce the transmission arising from the hospital cluster. Among the measures are limits to the number of social interactions in a day, closing down public places visited by infected cases for two days for cleaning and casting a wide net in trying to discover more cases.
Co-chair of the task force Education Minister Lawrence Wong said that this is the “first time in quite some time” that Singapore has seen “relatively larger clusters emerging in the community”.
“Obviously, it is cause for concern, but we have also learned from experience that in order to control and break the transmission chains we must move in quickly,” he said.
“We now have better tools to do this, we have testing capabilities we have a better tracing system.”
DESPITE CONCERNS, SITUATION MANAGEABLE, RESPONSE REASSURING: EXPERTS
Prof Fisher said that having a hospital cluster has been a “long-term concern”.
“These have repeatedly happened in overseas hospitals so it’s actually to Singapore’s credit that this is the first such event,” he said.
While infection prevention efforts are core in hospitals, “unfortunately they can never be 100 per cent”, he said.
“The measures being undertaken should stop transmission. If all cases are isolated, all contacts are quarantined and even 'low risk' contacts, sent home then any future positive cases should not have spread,” he said.
READ: 'I'm used to it already': Tan Tock Seng Hospital staff on the risks of working at the heart of a COVID-19 cluster
Assistant Professor at the National University of Singapore’s Saw Swee Hock School of Public Health Hannah Clapham said that while the current increase in cases is concerning, “it is reassuring that we are seeing the rapid response to the current cases and a tightening of measures to try to control transmission”.
“I am sure the situation will be monitored closely to assess whether further measures are required,” Dr Clapham said.
Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, similarly said that the hospital outbreak is a “concern”, but said that quick measures have been put in place by the ministry and the hospital “so hopefully these will work”.
The key is to understand how these clusters occurred, he said, pointing to “detailed molecular fingerprinting” as critical to doing this.
“For the hospital cluster, the key has to be identifying the primary case and tracking where else this individual might have been in contact with others. This has implications for vaccine strategy and control efforts in general,” he said.
He added that quality control at the labs is also very important to ensure that there were no false positive serological results earlier on and also at the vaccination centres to make sure that the cold chain was preserved.
He said that the cases in vaccinated individuals are “a concern”. Some of the cases linked to the TTSH cluster have been vaccinated.
Nevertheless, he said that the current situation is “manageable” given a few factors.
“Firstly, the number are relatively small in the few clusters and most cases are linked. Secondly, we now have vaccines and thus we are much more able to contain outbreaks if we use strategies such as ring vaccination,” he said.
Ring vaccination involves vaccinating contacts of people who test positive, creating a "ring" around each infected person.
Such a strategy was used for smallpox in the past and mumps in recent years, Prof Tambyah said.
SITUATION THEN AND NOW ARE DIFFERENT
Dr Clapham and Professor Tambyah said that the difference in the situation now and the early stages of the pandemic is the availability of vaccines.
Prof Tambyah said the difference between last year and this year is the “the presence of licensed vaccines”, adding that there are also better tests including antigen tests, polymerase chain reaction tests and serology tests.
He said there is also a possibility of using preventive agents like antiseptic throat sprays.
Dr Clapham also stressed the importance of people taking their vaccination when offered, as vaccines are a “huge advantage” now, compared to the early stages of the pandemic.
“We have a better understanding of disease spread, which can help with refining control measures,” she added.
COMPLYING WITH MEASURES IMPORTANT
The doctors said the public should continue to take COVID-19 seriously.
“If people are sick they should seek care and get tested, even with mild symptoms, in order to get care and stop transmission early,” Dr Clapham said.
“We're lucky in Singapore to have access to vaccines, and high uptake in vaccination will be an important step in future SARS-CoV-2 control,” she said.
On Friday, director of medical services at MOH Associate Professor Kenneth Mak had also said at the press conference that authorities are concerned that “we may not be so vigilant, so disciplined” in the use of masks and safety measures.
“There's always the risk at we may become complacent,” he said urging people to be vigilant amid the tightening of measures.
“I don’t think that the public should be overly worried, they should get vaccinated and practice good hygiene and see a doctor if not well. They also need to keep up to date with the information on hospital visitation and other guidelines,” Prof Tambyah said.