A month after reports of the novel coronavirus (2019-nCoV) outbreak in China, Singapore confirmed its first imported case on 23 January 2020. At the time of writing, this number has risen to 28 confirmed cases, including 7 instances of local transmission. According to Singapore's Ministry of Health, there is "yet no evidence of widespread sustained community transmission in Singapore."
Why did WHO override their initial decision to not call it a global emergency?
The World Health Organization (WHO) initially refused to declare the coronavirus outbreak a PHEIC (Public Health Emergency of International Concern). But on 30 January, this decision was overridden.
"I agree that it was the right decision [at that time] not to call it a PHEIC yet, but this has changed, mainly in relation to the possible spread to countries with fragile health systems," says Professor Tikki Pangestu, a global health expert and Visiting Professor at the Lee Kuan Yew School of Public Policy.
The earlier decision to not raise international alarm is based on various criteria. Factors like disease severity, mortality rate and moderate transmissibility are assessed by an independent group of experts, not just WHO staffers.
According to Professor Pangestu, this was a difficult call for WHO. Just a few years ago, WHO had been accused of overreacting by declaring a PHEIC around pandemic influenza H1N1, which then turned out to not be a major public health crisis.
China's response
Medical staff transfer a patient to hospital in Wuhan, Hubei, the epicentre of the outbreak.
China's transparency has garnered international acknowledgement. This is very different from the SARS outbreak in 2003.
As Professor Pangestu notes, the Chinese government has been forthcoming in sharing data, responding with alacrity and unprecedented speed to deal with the outbreak.
In light of the Mayor of Wuhan's interview admitting the poor management of the epidemic by city officials, China has much room for improvement. There still is a "governance gap" in controlling infectious diseases but within the country itself, due to its massive size.
"Clearly there needs to be better communication channels and raising of awareness among provincial officials of the potential public health implications of such events," says Professor Pangestu.
Despite that, China has implemented remarkably aggressive state-level efforts to wrest back control of the situation now. In order to house patients, China has constructed two hospitals in two weeks to house 2,600 patients. At the height of the Lunar New Year holidays, authorities also made a bold move to put major cities in Hubei Province on lockdown.
While the lockdown makes sense, maintaining it poses tremendous challenges and could possibly exacerbate the situation, Professor Pangestu says. "Beyond inconvenience, economic impacts, enforcement challenges and human rights issues, the big question in Wuhan seems to be 'how many have already left the city before the lockdown was implemented'?"
With the evidence that it has now spread around the region, the call for the quarantine seems too late. Wuhan's healthcare system is overwhelmed, and there is concern this situation might replicate itself in other developing nations. Already the number of confirmed deaths within China has risen above 600, and there have been two deaths outside China, in Philippines and Hong Kong.
Relative danger
Speaking on Channel NewsAsia, Professor Pangestu responded to a question about the virus' R0 (pronounced R naught) or measure of contagion. "The R0 for the Wuhan coronavirus is around two...compare that with measles, a childhood disease, that has an R0 of between 16 to 18." He added that the figure is an average number and is changing every day, so to "take it with a pinch of salt".
Asked if we were on the verge of a worldwide pandemic, Professor Pangestu replied that we were not. He said that a pandemic would mean, "very widespread distribution, with high fatality rate, with no vaccines...I don't think this is going to happen here".
How Singapore is handling the situation
Singapore has taken numerous measures in response to combat this outbreak. There are extensive quarantine measures and travel restrictions on those who have recently been to China.
Although the move to utilise university halls as quarantine centres has raised some eyebrows, Professor Pangestu does think it to be reasonable. According to the Ministry of Education, "the designated hostels will only be primarily activated when a student in our educational institutions or schools is required to serve QOs (quarantine orders) and does not have suitable accommodation."
But Professor Pangestu points out that in overall terms the WHO does not recommend travel bans or quarantines.
There was a mask shortage recently when the news of the first coronavirus patients in Singapore were confirmed, and the government is also doing its best to stem public panic over the outbreak.
As Professor Pangestu notes, "It [the mask shortage] is a reflection of unnecessary anxiety and panic, even when the government has stated multiple times that you don't need to wear a mask unless you are ill." In this case, what can be done to educate and ensure that the public take steps in ensuring that their own preparedness?
"This is a hard one, beyond better education and awareness, and scientific literacy, among the public," says Professor Pangestu. He continues, "There is also the danger of misinformation on social media making the situation worse and causing confusion."
Other concerns
There are also other issues to consider, such as having in place an international plan to deal with the shortage of medical supplies. When a country's healthcare resources are tied up with one disease, the treatment of other illnesses experience setbacks. This applies particularly to low- and lower-middle-income countries (LMICs). In West Africa, for example, the Ebola epidemic in 2014-15 resulted in a large drop in immunisation rates among children.
Professor Pangestu believes that an international global fund is one possible approach that can help LMICs. WHO can also step up its technical assistance so LMICs can strengthen their health systems as a whole.
Looking towards the future
The SARS outbreak in 2003 caught the world off guard, but it showed us the need for a national contingency plan. For Singapore, the Disease Outbreak Response System Condition (DORSCON) is a crisis management plan drafted after SARS, and improved again after the H1N1 pandemic in 2009. As of 7 February 2020 Singapore has set their DORSCON level to "yellow" with a "low to moderate" impact on public health.
As Professor Pangestu said on CNA, "engagement, and cooperation with the public, that is the most important thing."
(Photo: Macau Photo Agency)