Lessons from Singapore to control Coronavirus in Latin America

To date, 266 cases of coronavirus (Covid-19) have been reported in Singapore, with no deaths. Since the first case was diagnosed in that country almost two months ago, it is highly significant that the control implemented has allowed to reduce cases and avoid deaths. Especially if compared to Latin American countries, such as Brazil and Chile, in which the registration of cases has reached more than 200 in less than two weeks.

The comparison with very different countries, in social and economic terms, such as Singapore, is often underestimated. It is argued that the conditions are very diverse, that the availability of resources is not similar, among other considerations. In the case of Singapore, it is also added that its particular geographic and population-density characteristics make it impossible to establish points of coincidence with Latin American countries.

Despite these real differences, there are elements that allow us to draw lessons that can be applied in our contexts. Firstly, Singapore has achieved remarkable economic and social achievements over time. For example, just to take the coverage of financial protection in health, it can be seen that the expenditure that people have to pay with their own resources (also called “out-of-pocket expenditure”) has been reduced from 48% in 2000 to 32% in 2017 (last year of information by WHO), one of the lowest figures in Asia. That is, the introduction of policy changes is a continuous practice in Singapore. On the other hand, the country’s population is close to 6 million, similar to some countries in our region. In other words, the differences noted may be related to decision-making characteristics, rather than to pre-determined factors.

Singapore is closely linked to China (330,000 people arrive from this country every month), which has notable implications, including on health aspects. The 2003 SARS epidemic, which originated in China, caused 33 deaths in Singapore. Since then, the health system has taken decisions to prevent a similar situation from recurring. One of these was the creation of the National Centre for Infectious Diseases and the National Public Health Laboratory. The number of isolation beds in the public system was also increased, as well as the provision of protective equipment and technologies required to deal with epidemics. Similarly, inter-institutional coordination mechanisms were designed to act in emergency situations. The country also took on the task of strengthening its capacities in the management of infectious diseases.

China’s Covid-19 report on 31 December 2019 found Singapore in a good position to implement the required actions. On January 2, the Ministry of Health notified all doctors to be on the alert for cases of pneumonia in patients coming from Wuhan. The next day, temperature measurement was started for travelers from China. The Multi-Ministry Task Force was also set up to coordinate action against the epidemic at all levels.

As a result of this preparation phase, the first case of Covid-19 was detected in Singapore on 23 January. From that moment on, contact identification and quarantine of confirmed cases was carried out. Entry restrictions were also imposed on persons who had travelled to China in the previous 14 days. Approximately 700 travelers from Hubei were quarantined, and 14-day leave of absence were issued to Singaporean nationals returning from China. All suspected cases were tested to rule out the diagnosis.

As a result of this preparation phase, the first case of Covid-19 was detected on 23 January in Singapore. Since that time, rigorous identification and quarantine of contacts of confirmed cases has been carried out. Entry restrictions were also imposed on persons who had travelled to China in the previous 14 days. Approximately 700 travelers from Hubei were quarantined, and 14-day work permits were issued to Singaporean nationals returning from China. All suspected cases were tested to rule out the diagnosis.

These measures, and the strict monitoring of cases, succeeded in reducing the number of infected persons and preventing deaths. So Singapore’s success in controlling the Covid-19 pandemic is the product of deliberate actions, built into a systematic work plan over more than 15 years. The dimensions of these investments are perfectly compatible with the availability of resources in Latin American countries. The fact that they have not been made is not a fatalistic effect, but rather the consequence of not having taken adequate measures where appropriate.

The fact that two months after the announcement of the epidemic by the Chinese authorities, there are still countries in the region that do not have the required plans and resources is linked more to a lack of foresight and priorities than to insurmountable gaps in good practice at the global level. Singapore’s experience in controlling the Covid-19 illustrates that successful policies are more expressions of routines (planning, allocating resources, monitoring) than of actions arising from emergency and improvisation. Hopefully, there will be time to take into account the lessons of Singapore, in order to avoid cases and deaths from Covid-19 in Latin American citizens.

Published in Spanish on March 18, 2020. See: https://marinojgonzalez.blogspot.com/2020/03/lecciones-de-singapur-para-controlar-el.html