How does Singapore’s virus response really stack up?

As the world grapples with COVID-19, Singapore has been praised for its ability to keep a lid on new coronavirus infections without imposing major social and economic restrictions.

But with its government now “very concerned” by a rise in locally transmitted cases, Singapore has ratcheted up its response.

On April 3 it announced strict new measures to curb further spread. They include shutting non-essential businesses and schools.

On some fronts, Singapore took earlier, tougher action than Australia. But now on issues such as outdoor exercise, it is catching up.

So, what has been Singapore’s approach to date, and what’s changed?

RMIT ABC Fact Check examines the key areas of its response.

School measures

Singapore had introduced a range of measures into schools before deciding to close them from April 8.

On March 19, for example, the government announced “wipe-down routines” would be introduced to classes, kids would be assigned seats in the canteen and groups split up in the playground following term break (March 14 to March 23).

Recess times were already being staggered and group activities such as assemblies cancelled, and now any non-classroom activities would also cease.

Schools hadalso been conducting daily temperature checks of students.

The decision to close was announced just a week after the government said on March 27 that schools would start transitioning to one day per week of study from home from April 1.

Now, all primary and secondary students will move to full “home-based learning” and all preschools and kindergartens will “suspend their general services”. The Ministry of Education said parents “working in essential services such as healthcare, who are unable to secure alternative care arrangements, may approach their children’s primary schools and preschools for assistance”.

Before the closure, Australian political leaders including Prime Minister Scott Morrison and federal Education Minister Dan Tehan had pointed to Singapore as a model for Australia’s schools policy.

Testing times

Singapore began temperature screening all plane arrivals from the Chinese city of Wuhan on January 3 and by later that month pre-schools were checking temperatures for all children, staff and visitors.

The country reported its first case on January 23, two days before Australia.

By January 29, Singapore was temperature screening anyone arriving by land, air or sea and by early February, company employees and even taxi drivers were being screened.

As of February 3, Singapore had conducted more than 300 laboratory tests, with 240 people cleared, 43 “suspect cases” waiting on results and 18 cases confirmed.

On March 25 the Health Minister Gan Kim Yong said it had a test rate of 6,800 per million people.

At that time Australia had conducted almost 163,000 tests for a population of 25.6 million, a rate of just under 6,400 per million people.

Australia has since surpassed Singapore’s test rate, which on April 5 stood at 7,000 tests per million people, according to local news reports.

By March 31, Australia had conducted 209,000 tests, a rate of nearly 8,200 per million people.

Isolation measures

Singapore began isolating people from January 20. At first this applied only to those with symptoms travelling from Wuhan and by January 22to anyone with symptoms travelling from China.

Between February 2 and March 16, it progressively barred visitors from specific countries (China, Iran, South Korea, Italy, Spain, France, Germany) and denied entry to cruise ships. On March 24, it shut the door to all visitors, four days after Australia did the same.

Locals returning home or foreigners who arrived in Singapore before the bans took effect were initially required to avoid work for 14 days but allowed to leave the house to buy essentials.

From February 19, however, the government began issuing stricter “stay-home notices”.

These notices allowed family visitors but forced people to “remain in their place of residence at all times”, and were soon issued to anyone coming from Italy, Iran or South Korea.

By March 21, they were served to anyone returning from abroad.

Locals returning from some countries were subsequently required to serve out their “stay-home notice” at a dedicated facility, such as a hotel, rather than in their own residence.

Australia introduced self-isolation for all returning travellers on March 16.

Meanwhile, travellers to Singapore from China’s Hubei province, along with confirmed cases or their close contacts, were put into full quarantine. That meant no physical interaction with anyone. If that wasn’t possible at home, they were sent to a government facility for two weeks.

Unlike Australia, Singapore put people with mild symptoms in hospital rather than sending them home to self-isolate.

Writing for The Conversation, National University of Singapore’s Professor Dale Fisher said that Australia, Europe and the US were sending home “mild cases”.

“In Singapore, we think it’s better to hive those people off and look after them elsewhere until the virus is clear.”

On April 5, Singapore’s health ministry said it had quarantined a total 17,345 people who had been in close contact with a confirmed case.

After the government became more concerned about local transmission, it declared two sites housing almost 20,000 foreign workers to be “isolation areas”, preventing residents from going to work and restricting recreational activity.

Enforcing the rules

The Singapore government has deported and permanently banned foreign workers caught flouting isolation rules and punished their employers.

At least one person who breached their stay-home notice has been stripped of their permanent residency.

Stay-home notices (for travellers with no symptoms and no suspected contact with confirmed cases) and quarantine orders (for travellers from China’s Hubei province or confirmed cases and their close contacts), both have legal force, with breaches attracting fines as high as SGD$10,000 (roughly A$11,000 ) or up to six months in jail.

Those who don’t comply with the stricter quarantine order can also be forced to wear an electronic tag.

Lawrence Wong, the head of Singapore’s cross-government coronavirus taskforce, has said the government “will use a whole range of methods to enforce and make sure that there is compliance with the regime.”

“We can do so through video calls, through their phones, identifying where their locations are, through spot checks,” he said.

In Australia, states began introducing legal sanctions for breaching isolation rules on March 16.

Contact tracing

Singapore has been noted for its ability to quickly track down people who have been in contact, wittingly or not, with someone who has COVID-19.

Evaluating Singapore’s early response, the US Centers for Disease Control and Prevention published research showing contact tracing had identified 53 of the country’s first 100 cases, of whom roughly a quarter were caught before showing symptoms.

According to local news reports, every day between 30 and 50 Singapore police assist health officials in piecing together timelines and transmission networks by trawling data, scanning CCTV footage and conducting interviews.

Those numbers can be quickly doubled if needed, and police are assisted by Singapore’s embrace of technology.

On March 20, the government launched an app that records whenever users come near each other. This phone data can be shared if a user develops COVID-19. (The Singapore government says the app requires user consent.)

Businesses serving food and drinks have also been encouraged to log customer details using a government registration system.

Singapore’s government has released potentially identifying personal information alongside each confirmed case, making it possible for others to map the spread of the coronavirus in detail.

Australia has been more cautious about releasing personal information, with the expert health advisory panel arguing it may erode public cooperation.

Still, there are examples of using technology to track cases. In February, the ABC reported South Australia Police had tracked an infected couple through Adelaide using their phone data for the state’s health department.

Australia’s contact tracing efforts have ramped up since the outbreak of coronavirus, with Victoria boosting its contact tracing personnel from 57 to 230, for example, and the Australian Defence Force starting to assist the states.

Social distancing and other measures

In January, Singapore established a whole-of-government coronavirus taskforce and on February 16 launched a campaign to raise awareness of good public hygiene.

By comparison, Australia launched a public awareness campaign on March 14.

With Singapore’s doctors already being asked to write 5-day medical certificates for anyone with respiratory symptoms, on February 18 the government began activating 900 “public health preparedness clinics”, designed to provide subsidised treatments during outbreaks.

More recently, the government has significantly increased its social distancing restrictions.

From March 13, gatherings larger than 250 people were “advised” to cancel or take precautionary steps. By March 20, they were banned, and anything smaller required at least one metre between people.

From March 27, groups larger than 10 were banned and the government closed all bars and entertainment venues like night clubs, cinemas, theatres and karaoke outlets, “where there is a high risk of transmission due to sustained close contact over a period of time”.

However, other public venues “such as retail malls, museums and attractions, where contact is more transient” could remain open.

On April 3, the government announced that, starting April 7, food and beverage outlets would be restricted to takeaway and delivery only. All attractions, sports and recreation facilities would close, along with churches and non-essential businesses.

Sport Singapore, a government agency, said on April 5: “If you wish to exercise outdoors, exercise on your own or only with members of your own household around your immediate neighbourhood in open, uncrowded places.”

Additionally, the government said, “The general public is advised to stay home and avoid interactions with anyone other than immediate family members living in the same household.”

Australia banned outdoor gatherings of 500 people on March 18, began shutting down pubs, gyms and cinemas and restricting restaurants and cafes on March 23, and limited both indoor and outdoor gatherings to two persons only on March 31.

Can all this be quantified?

Academics at the University of Oxford have attempted to quantify and compare the steps taken by governments around the world to control the spread of COVID-19.

They have created a composite index tracking the stringency of government responses.

The index tracks seven policy measures — closures of schools, workplaces or public transport, cancellations of events, restrictions on travel or internal movement, and public messaging — and four financial indicators, covering fiscal and monetary measures and public spending on emergency healthcare and vaccines.

The authors say: “Where data for one of the seven indicators are missing, they contribute “0” to the index … Our conservative approach therefore “punishes” countries for which less information is available, but also avoids the risk of over-generalizing from limited information.”

On the day Singapore recorded its first case, it had a stringency score of 29 out of 100 and Australia scored 7.

For most of February, Singapore’s score was 33 while Australia’s rose to 29.

By March 15, the most recent data available for Singapore, it scored 38 while Australia remained on 29.

Australia’s strongest measures have been introduced since that date, and accordingly its score has risen progressively to 71 on April 2. No comparable figures are yet available for Singapore.

Before the outbreak, the 2019 Global Health Security Index — produced by the Johns Hopkins Centre for Health Security, among others — ranked Singapore 11th in the world for countries most prepared to respond to an epidemic, and Australia 10th.

Principal researcher: David Campbell

factcheck@rmit.edu.au