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SINGAPORE: A new case of COVID-19 in the community, after more than fifteen days without such cases having been reported, indicates that the virus is still “lurking”.
“Just because we have not seen any reports of cases before does not mean that the coronavirus has been completely eradicated from Singapore,” Saw Swee Hock School of Public Health Dean Teo Yik Yin told CNA.
“What is more likely, and as reflected in this situation of having a new community case after a stretch with no reports of community transmission, is that the coronavirus is still lurking in the community.”
Singapore reported on Thursday (November 26) its first community case of COVID-19 in more than two weeks, a 32-year-old citizen whose infection is currently not linked.
READ: 5 New COVID-19 Cases In Singapore, With First Community Infection In Over 2 Weeks
Experts the CNA spoke with said the new community case indicates that the virus is difficult to eradicate and that there may be pockets of asymptomatic or recovered COVID-19 cases undiscovered in the community.
“Having detected zero or few cases in the community does not mean that the coronavirus is not circulating within the community, it means that our surveillance has not been able to detect any cryptic transmission, especially since we know that an asymptomatic infection is possible,” said Professor Teo . .
Infectious disease expert Leong Hoe Nam said the virus will be difficult to eradicate because it spreads like a “Trojan horse” – it can cause asymptomatic disease and spread asymptomatically.
“People can have the disease and not know it and yet transmit it to others … You invite someone into the house without knowing they have the virus,” he said, adding that places like South Korea and Hong Kong were declared initially virus free, but now we are seeing a resurgence of cases.
“This shows how difficult it is to eradicate the virus. The main reasons are the ability to eliminate the virus for a long time and the ability to transmit the virus even if the patient is asymptomatic.”
In the United States, the first cases in Washington state stem from asymptomatic or minimally symptomatic transmissions, and it was not until large groups of nursing homes formed that the disease was recognized, said the president of the Society for Clinical Microbiology and Infection. from Asia Pacific, Paul Tambyah.
“In Singapore, nursing home staff are screened regularly, so hopefully, if that happens, it will be caught before large clusters occur. The more widespread the testing, the less likely we will be. let’s find ourselves in that scenario. “
Although Singapore went 15 days without a community case of COVID-19, more than one cycle of infection, this also does not mean that COVID-19 has been eradicated, experts said.
“The virus does not respect arbitrary distinctions between ‘community’ and ‘others,'” Dr. Tambyah said.
READ: New community case of COVID-19 dined with 12 family members in Seoul Garden, ongoing investigations
COVID-19 is more likely to be considered eradicated when Singapore has passed 28 days, or two incubation periods, without any cases, which is the criterion used by the Ministry of Health (MINSA) to close the clusters, he added.
“Experience in Shanghai with locally transmitted cases arising from the airport suggests that as long as infected people enter the city, there is a risk of continued transmission,” said Dr. Tambyah.
“We are also not sure that there are no locally transmitted cases, the reports tell us that there are no locally transmitted cases detected locally.”
On November 21, the Ministry of Health revealed that COVID-19 patients visited Bugis Street and Kopitiam @ Jurong East while they were still infected. This suggests that there may have been a locally transmitted case detected abroad, Dr. Tambyah said.
“If all the cases were imported and detected while the visitors or returnees were in SHN in hotels or in homes, then there should be no people in Bugis or Jurong East potentially exposed unless there was a violation.”
THE RISK OF IMPORTED INFECTIONS
Experts the CNA spoke with also agreed that it was important to secure imported cases and prevent infections from leaking into the community, similar to how the pandemic started here in February.
Singapore cannot close its borders completely, and there will be interactions with people from abroad or incoming travelers who are holders of long-term working passes or returning Singaporeans, said Professor Teo.
Therefore, there will always be a “very small risk of spread” from any infected traveler to the community, as a negative swab test after a 14-day stay-at-home notice may not completely rule out the possibility of infection. develop an infection.
“Indeed, I do not see the need for Singapore ever to declare that we have successfully eradicated the coronavirus within Singapore,” he added.
“The reality is that we will never be able to find out anyway, especially as we are not conducting repeated mass screening of the entire population, which is hugely inefficient and unnecessary for Singapore.”
Singapore has “well calibrated” border control measures that are adjusted according to assessments of import risks, said Professor Teo. This, he added, explains why there are different rules depending on where travelers arrive from, in terms of the duration and location of the quarantine, as well as the scope of testing before departure and on arrival.
“After all, the major COVID-19 outbreaks in Singapore in late January and mid-March were all started by incoming tourists and returning Singaporeans who had been infected prior to entering Singapore.”
The decision of the Ministry of Health to increase the availability of tests from December 1 “will give us a clearer idea” of whether there are actually cases in the community that are not being detected by current measures, said Dr. Tambyah.
Starting December 1, any business or individual who requires a COVID-19 polymerase chain reaction test will be able to obtain one from approved vendors.
This includes people who need pre-departure testing before traveling. Businesses can also purchase such services from approved providers.
READ: COVID-19 PCR tests for businesses and individuals will be available through approved vendors starting December 1
“While it is very encouraging to see that no cases of local transmission have been detected in the last two weeks, it is not possible to fully assess the effectiveness of current methods without knowing how much testing was done in the various sentinel surveillance groups,” he added. Dr. Tambyah.
Despite the low number of community cases of COVID-19, Singapore “cannot let down its guard” and must continue with safe management measures, said Professor Teo.
Safe management measures are primarily focused on minimizing the possibility of an infected person transmitting COVID-19 to others in the community as a result of any social, public or workplace interaction, he added.
Routine large-scale testing for certain segments of the high-risk population that interact more with the public or stay in higher-density dormitories would be more practical than mass testing of the entire population, said Professor Teo.
“These measures have been tried and tested to be effective, taking into account the control of the COVID-19 situation in the community.”
“It is prudent to remember that, until the world truly gets COVID-19 under control, Singapore cannot let down its guard and must continue our safe management measures,” he added.
“Otherwise, there is a real risk that Singapore will follow the path of other countries, where community measures are repeatedly dialed up and down, and sector-specific or even national blockades are repeatedly re-established, when cases community flares over and over. “
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