SINGAPORE: Singapore confirmed on Tuesday (Feb 4) its first locally transmitted cases of the novel coronavirus, among six new cases of the disease detected in the country.
Four Singapore residents with no recent travel history to China have tested positive for the virus, which has sickened more than 20,000 and killed more than 420 people since it was detected in Wuhan in central China.
One of them was a tour guide for a group of Chinese tourists, two work at a shop the group had visited, while a fourth case of local transmission was the domestic helper of one of the cases, the Ministry of Health (MOH) said at a briefing.
The tour group had arrived in Singapore from China on Jan 22 and went to Malaysia from Jan 24 to 26. They re-entered Singapore via Woodlands Checkpoint at 3am on Jan 27 and flew from Changi Airport Terminal 1 at 6am.
Pending confirmation from the Chinese authorities, the travellers are from Guangxi, and at least two of them have since been confirmed to have the coronavirus, said MOH.
"The Ministry of Health has commenced contact tracing to identify individuals who had close contact with these cases, so as to ring-fence the cluster and limit further spread," said Health Minister Gan Kim Yong.
Another two new cases announced by the authorities on Tuesday are Singapore residents who had been evacuated from Wuhan.
This brings the total number of cases in Singapore to 24.
Two of the patients who caught the virus here are salespeople at Yong Thai Hang, a health product store that serves primarily Chinese tourists. They are the 19th and 20th cases reported.
The tour group had visited the store, among other places, on Jan 23.
The 19th case, a 28-year-old Singapore permanent resident, reported developing a sore throat and fever on Jan 29. She went to Tan Tock Seng Hospital emergency department on Jan 30 and was discharged after a chest X-ray found she did not have pneumonia.
She stayed at home from Jan 31 till Sunday before being admitted to the Singapore General Hospital (SGH) on Monday.
The 20th case is a 48-year-old Singaporean woman who lives at Hougang Street 61. She reported symptoms on Jan 25 and was admitted on Monday to the National Centre for Infectious Diseases (NCID).
Information about her movements between Jan 25 and Monday was not provided.
Case 19's maid, a 44-year-old Indonesian national, is the 21st case. She reported onset of symptoms on Sunday and did not leave her house until she was admitted to SGH the next day.
A tour guide who brought tour groups to Yong Thai Hang is the 24th case. The 32-year-old Singaporean was asymptomatic when she went to NCID.
The 22nd and 23rd cases, both Singaporeans, were among 92 people evacuated from Wuhan on Jan 30 and the two had no symptoms when they boarded the flight to Singapore.
They were put under quarantine in Singapore and tested positive on Monday despite showing no symptoms. They are now both in isolation rooms at NCID.
Authorities on Tuesday said that the four cases of local transmission are not evidence of community spread as they can be traced back to recent travellers from China and some had close contact with one another.
Mr Gan elaborated on the difference between a local transmission cluster and community spread: “The main difference is that for this cluster, we could identify all the sources that were involved. The source was a group of mainland China tourists. We have their names, we have an indication of the patients that fell ill.
“Therefore we could identify the specific source… If we are able to ringfence this particular cluster, we can control the spread. Therefore we say it is a limited local transmission.”
But if there are multiple clusters and the Government cannot determine the source, that is when it would be labelled a widespread community transmission, he added.
“When that happens, we will move to Dorscon (Dors condition) Orange. Today, we are still at Yellow.”
Currently, Singapore is at Dorscon Yellow, signifying that the virus is severe and can infect from person to person, but is chiefly occurring outside Singapore. The next step up is Dorscon Orange, whereby the virus is spreading in Singapore but not widely, and is being contained.
At the heart of Singapore’s response plan is the Disease Outbreak Response System (Dors), a crisis management plan which did not exist in 2003, but was drafted after SARS and refined again in the wake of the swine flu (H1N1) pandemic in 2009.
MOH's director of medical services Kenneth Mak added that even though the domestic helper of one of the cases was infected, it was in an "enclosed setting" within the home.
"We're still continuing to do contact tracing and we'll continue to be vigilant for more cases. There may be more cases that come out in relation to the same exposure to ... this travel group," he added.
Answering queries from reporters, Mr Gan said that the mode of transmission between the tour group and the patients cannot be determined, but the tour guide would have been with the tour group for a long period of time while the salespeople would have interacted with the travellers at the shop.
"It's not transient contact ... where you happen to meet (the person) on the street," he said.
Dr Mak said that the tour guide reported that some of the travellers were coughing and sneezing while they were in Singapore but it would be "speculative" to say that this was the mode of transmission.
As the tour group has returned to China, some of the contacts are a result of checking with the Chinese authorities, Mr Gan added.
ADDITIONAL PRECAUTIONS, CONTACT TRACING
As an added precaution, individuals who, like the cases of local transmission, have had recent close contact with people with travel history to mainland China will be contacted.
Authorities are also tracking the contacts of a Malaysian who had tested positive for the novel coronavirus after attending a meeting at the Grand Hyatt Hotel in Singapore that involved Chinese nationals.
In addition, MOH has expanded surveillance efforts to conduct 2019-nCoV testing on all individuals with pneumonia at Singapore hospitals since last week.
Other measures to pre-empt possible community spread of the virus were also announced, including enhanced cleaning of public areas.
Authorities have urged places with high human traffic to step up cleaning, including food and beverage outlets, shops and hotels.
"Current evidence suggests that the likely modes of transmission are mainly through contact with droplets from infected individuals, either directly or indirectly through hands that have come into contact with these droplets," said MOH.
"The virus can also transmit through surface contact."
Sanitation and hygiene advisories have been disseminated by the National Environment Agency.
"I URGE SINGAPOREANS TO REMAIN CALM"
A more cautious stance will be taken with vulnerable groups like young children and the elderly, authorities said.
Schools will not hold mass assemblies and recess sessions will be staggered, while school camps will be cancelled.
Pre-schools facilities will suspend large-group and communal activities, while eldercare facilities will also suspend external excursions and large gatherings.
Should community spread occur, more measures to reduce human interaction will be considered, authorities added.
"We are closely monitoring the situation and stand ready to ramp up our measures if necessary," said Mr Gan. "I urge Singaporeans to remain calm. We will spare no effort to protect our people."
ONE MAN DISCHARGED
The 18 earlier confirmed cases in Singapore all had recent travel history to Wuhan, the epicentre of the coronavirus outbreak.
In an update, MOH said one of the cases was discharged on Tuesday after testing negative for the virus. The patient discharged, a 35-year-old man from Wuhan who, was the seventh case detected in Singapore.
Many of the remaining cases are improving and at least two are asymptomatic; several need oxygen support but none are critically ill.
Chief Health Scientist Tan Chorh Chuan said that many of the patients are on supportive treatment while a small number are on an antiretroviral combination of Lopinavir and Ritonavir.
As of noon on Tuesday, 289 suspect cases have tested negative for 2019 novel coronavirus and test results for 20 cases are pending.
As a precaution, they will be quarantined for 14 days from their last exposure to the patient. All other identified contacts who have a low risk of being infected will be contacted daily to monitor the status of their health.
MOH has also identified 311 close contacts. Of the 239 who are still in Singapore, 234 have been contacted and are being quarantined or isolated. The ministry is trying to contact the remaining five.
On Saturday, Singapore widened travel restrictions to bar all new visitors with recent travel history to mainland China from Singapore. These visitors are also not allowed to transit in Singapore.
Hong Kong on Monday reported the city's first fatality from the coronavirus, and the second outside mainland China.
Additional reporting by Ang Hwee Min.