ARIZONA — Singapore did it right.
That’s the story that emerges from a study of how the island city-state of 5.7 million reacted to COVID-19, posted on the website of the federal Centers for Disease Control.
New cases have already climbed to nearly 200,000 worldwide, with 7,500 deaths as of Tuesday. The US accounts for 5,000 cases – with about 96 deaths.
Singapore had its first case in early January, linked to exposure to the virus in neighboring China. So far, Singapore has just 200 reported cases and no deaths, with the rate of increase in infections tapering off quickly.
What happened? How did they contain a virus increasing exponentially in most other countries, including the United States?
• Immediate quarantine at the border.
• Quick and widespread testing.
• Immediate isolation of people infected.
• Aggressive follow up on the contacts of anyone who tested positive, followed by quarantine of those contacts – even if they had no symptoms.
• A universal healthcare system that includes private insurance that has produced one of the world’s healthiest, longest-lived population – at a fraction of the per-person cost as the United States.
By contrast, the US delayed screening at the border until the epidemic had infected tens of thousands in China and elsewhere and even this week still does not have enough test kits sufficient to test people unless they have relatively advanced symptoms or clear exposures. Instead of quickly quarantining people exposed to the virus, the US has increasingly shut down businesses, mass gatherings and schools.
The doctors in Singapore’s comprehensive healthcare system made preparations as soon as the first case popped up in China. Singapore developed a test to detect the virus and immediately warned all its doctors and healthcare providers to get ready. Singapore repeatedly updated its test and protocols as new information emerged.
Singapore immediately started screening at the border, testing for symptoms, barring entry from affected areas and requiring quarantine for incoming travelers.
Moreover, health officials immediately contacted and quarantined anyone who tested positive and then contacted and quarantined anyone they’d had close contact with – even if those contacts weren’t showing symptoms. Anyone who then developed symptoms or tested positive was transferred to a hospital.
The health system also administered tests to anyone in intensive care units with symptoms suggestive of an infection. The health system also tested anyone with flu-like symptoms and anyone who died in circumstances that suggested an infectious disease, in addition to all hospitalized patients with pneumonia. Doctors were also able to easily test anyone else, usually patients with a respiratory problem or potential exposure.
The tests suggested most symptoms developed within seven days of exposure.
Among the first 100 patients who tested positive, the average age was 43 years, with 72 percent between the ages of 30 and 59. Males accounted for 60 percent of the cases.
Tracing the contacts of people who tested positive produced 53 percent of the cases detected. Another 20 percent of the cases were detected by doctors and clinics, because patients met the case definition. Another 16 percent were detected as a result of the enhanced hospital screening. Surveillance accounted for the balance of cases.
The comprehensive system of screening and testing enabled Singapore to detect about three times as many of the cases in the early stages as in most other countries, with prompt quarantine quickly reducing the incidence of new cases.
The combination of testing involving hospitals, travelers, health clinics and contacts “were all important in detecting initially unlinked patients for further investigation,” according to the CDC report.
The system caused the increase in cases to level out in a month. As of Tuesday, prompt, early treatment of those infected had averted any deaths.
Singapore did not close schools or businesses and did not generally shut down society, since the surveillance system and quick use of quarantine prevented a more general spread, according to the CDC report.
Singapore also benefitted from one of the world’s most advanced healthcare systems, which provides universal, government-sponsored health insurance but also has a relatively free-market system for setting prices and a substantial private health sector.
Singapore has the highest life expectancy in the world at 85 years. The system ranks in the top five world-wide on a variety of measures. It finances the system through a combination of government subsidies, a compulsory health savings account, national healthcare insurance and cost-sharing. Many residents have private health insurance supplement plans to cover additional services, but everyone has health coverage.
Singapore’s healthcare system in 2014 spent about $4,000 per person, compared to about $10,000 in the United States.