DORSCON: What you need to know about the framework that guides Singapore's pandemic response
SINGAPORE: The way Singapore deals with outbreaks like the novel coronavirus is guided by a framework known as DORSCON (Disease Outbreak Response System Condition), according to the Ministry of Health (MOH).
The colour coded system - which has green, yellow, orange and red categories - shows the current situation. It also indicates what needs to be done to prevent and reduce the impact of infections.
DORSCON takes into account the current disease situation overseas, how transmissible the disease is, how likely it is to arrive in Singapore and what impact it may have on the local community, MOH said.
Here is what you need to know about the DORSCON framework:
HISTORY OF DORSCON
While the crisis management plan did not exist in 2003, it was drafted after SARS and refined again in the wake of the swine flu (or H1N1) pandemic in 2009.
According to a book published by MOH Holdings, global concern that avian flu could mutate to transmit easily between people led MOH to publish its first version of the influenza preparedness and response plan in 2006, which was built around a colour-coded DORSCON.
The MOH said in 2013 that the H1N1 influenza pandemic four years before highlighted some limitations in the old DORSCON framework. While the disease had widespread transmission in the community, there were few hospitalisations and deaths.
Hence, flexibility was applied to allow relevant control measures to cater to the milder disease.
In the response plan, which was last revised in 2014, MOH said the DORSCON is a generic framework that enables the Whole-Of-Government to respond immediately to any outbreak and serves as the nucleus to ramp up for a higher level of response during a pandemic.
LEVELS ARE RECOMMENDED BY MOH, ENDORSED BY MHA
The response plan also says that the activation of the DORSCON levels are based on MOH’s recommendations and endorsed by the Ministry of Home Affairs.
The recommendations are endorsed by the Homefront Crisis Ministerial Committee (HCMC), which provides strategic and political guidance during a crisis, and the Homefront Crisis Executive Group (HCEG), which ensures that a comprehensive and integrated multi-agency system is in place to anticipate threat and disaster scenarios.
The HCMC is chaired by the Minister for Home Affairs and the HCEG is headed by the Permanent Secretary for Home Affairs.
The HCEG is supported by various Crisis Management Groups that deal with the operational issues under their charge. MOH chairs the Crisis Management Group for Health.
WHY IS THE DORSCON LEVEL AT YELLOW?
During a press conference announcing the first local transmissions of the coronavirus on Tuesday (Feb 4), Health Minister Gan Kim Yong described them as “limited”. This is because MOH has so far been able to identify all the contacts that are involved in the cluster of infections and the source of the infection.
Things will be different if there are cases "popping up" in different parts of Singapore, he said.
"You have a few clusters where you have no idea where these cases come from, they do not have a specific source, then you have widespread transmission."
"When that happens then we will then move to DORSCON Orange," he said.
“So today we're still at DORSCON Yellow, but we're watching the situation very carefully, monitoring the developments and we may adjust as we go along,” he said.
At its most severe, the H1N1 pandemic in 2009-2010 was at Orange status. According to the National Library Board’s Infopedia, an estimated 415,000 people were infected with the H1N1 influenza in Singapore, and there were at least 18 fatalities.
WHAT THE DORSCON LEVEL MEANS FOR YOU
MOH said the DORSCON framework contains a communications component to convey the health impact to the public and to advise people on how to respond. The definitions of the four DORSCON levels have been crafted to correspond to the public health impact of the disease.
At the yellow level, the disease is expected to cause minimal disruption to the public. This stage could be marked by additional measures in efforts to contain the disease. The advice from MOH for the current yellow level is to stay at home when sick, maintain good personal hygiene and look out for health advisories.
The Government has also put in place social distancing measures, such as suspending large gatherings in schools and eldercare facilities. According to MOH’s response plan, while such distancing measures may be activated at the most severe level, under certain circumstances, selective social distancing measures may be required in the mitigation of a milder pandemic.
WHAT HAPPENS IF THINGS GET MORE SEVERE
If DORSCON existed during the 2002-2003 Severe Acute Respiratory Syndrome (SARS), it would have been colour-coded Orange, according to MOH.
At this stage, the disease would be deemed severe and spreads easily from person to person, but has not spread widely and is being contained. At this stage, moderate disruption is expected, due to measures like quarantine and visitor restrictions at hospitals.
At the red level, the disease is severe and is spreading widely. Major disruption is expected, such as school closures, and this stage denotes a “significant” number of deaths. Despite school closures during the SARS period, it was classified as DORSCON Orange in retrospect.