Dengue fever, second wave: what are the hurdles Singapore faces in its coronavirus fight?

An eight-week lockdown, rigorous testing and strict social distancing laws turned Singapore's fortunes around from being the most infected Southeast Asian country in April with more than 1,000 infections a day, to several hundred new cases a day.

At its peak, Singapore reported 1,426 new coronavirus infections on April 20, while on Tuesday, July 20, it had 399 cases. But it is still trying to clear infections in migrant worker dormitories, while placing safeguards against the second wave hitting economies that were previously successful at combating the virus.

Six months from its first reported Covid-19 case on January 23, here's a look at the situation in Singapore and the key challenges it faces.

Singapore reported its first coronavirus case on January 23, 2020. Photo: Reuters alt=Singapore reported its first coronavirus case on January 23, 2020. Photo: Reuters

Since April, when Singapore saw a dramatic increase of infections after the disease broke out in crowded dormitories, the number of monthly cases has been gradually stabilising.

Even so, the vast majority of Singapore's cases today continue to be concentrated among low-wage foreign workers, some 300,00 of whom live in such dorms.

Community transmissions " which the government has defined as infections contracted by Singapore citizens, permanent residents and foreign workers who live among the local population " remain low, although it rose marginally in July after Singapore ended its eight-week partial lockdown, or "circuit breaker", in June.

After the city state encouraged citizens working and studying overseas to head home, Singapore saw a small number of community cases from imported cases.

The city state has reported more than 48,000 total coronavirus cases, 92 per cent of whom have recovered. Its death toll of 27 is among the world's lowest.

Singapore is gradually reopening after coming out of a strict partial lockdown. Photo: Reuters alt=Singapore is gradually reopening after coming out of a strict partial lockdown. Photo: Reuters

The city state introduced targeted measures for the local community and the migrant workers in dormitories.

In May, the local community had to undergo an eight-week circuit breaker, during which schools and workplaces were shut, people were banned from dining in at food establishments, and the wearing of face masks in public was made compulsory. The partial lockdown was so strict that people were not allowed to visit the homes of relatives. Those caught loitering, visiting homes, or not wearing a mask in public were fined or given jail sentences.

Migrant workers in dormitories were put under isolation orders " meaning they had to stay in their rooms, could not socialise, and could not go to work. The construction industry ground to a halt while the authorities tested workers to ensure healthy staff from crucial industries, termed as essential services, could be separated from the rest.

Health workers taking nasal swab samples from essential workers in June 2020. Photo: AFP alt=Health workers taking nasal swab samples from essential workers in June 2020. Photo: AFP

On top of that, Singapore also boosted its testing capabilities and the number of facilities to deal with the outbreak, including space to contain patients with mild or no symptoms.

As of July 13, it has swabbed 519,911 people, and it is aiming to conduct 40,000 tests a day in the later part of the year. Singapore has performed 177,100 tests per million citizens, the highest in Southeast Asia, which is also above the US but below Britain's 199,874 per million. Monaco has performed the most tests at 973,000 per million population.

Amid a global shortage of nasal testing swabs, researchers from the National University of Singapore (NUS) have found a low-cost way of producing 40 million swabs in the next few months, using 3D-printing and injection moulds.

Clearing the Covid-19 disease from worker dormitories remains the biggest challenge.

Lawrence Wong, co-chair of the multi-ministry task force dealing with the coronavirus, described the effort as "quite a massive undertaking".

Speaking in a July 17 press briefing, Wong said the government was testing workers block by block, and ensuring those who had tested negative were isolated for 14 days. The testing in dorms is now in the "final stretch", with 232,000 cases confirmed as recovered or virus-free as of July 16, Wong said.

Singapore's second challenge comes from imported cases, although the city state has limited this risk by shutting its borders.

The travel restrictions began in January with China, where the first coronavirus outbreak was reported, then gradually toughened to allow only citizens or residents to enter the country.

All returnees from overseas must serve a 14-day "stay-home notice" to confirm they are virus-free before being allowed into the community.

Singapore also faces the risk of a resurgence in infections triggered by a failure to comply with safe-distancing rules, which remain in place despite the lockdown being lifted. Dining in is allowed, gyms and cinemas have reopened, but groups are limited to a maximum of five. People still have to remain one metre apart and homes cannot receive more than five visitors at once. Weddings and funerals can have up to 20 attendees, while nightclubs and karaoke bars remain closed.

The government has reminded residents not to become complacent as the country gradually reopens. It drew from experiences in places such as Hong Kong, which recently saw a decline in compliance with mask-wearing in restaurants and cafes, and South Korea, which had new clusters at religious gatherings and workplaces. In Israel and Australia, some people were reported to have gone out when unwell, and organised large parties during the pandemic.

A worker sprays insecticide in Singapore amid a dengue fever outbreak on July 13, 2020. Photo: Xinhua alt=A worker sprays insecticide in Singapore amid a dengue fever outbreak on July 13, 2020. Photo: Xinhua

The fourth challenge is the simultaneous onset of dengue fever in Singapore, which has seen some 19,000 cases so far this year.

The city state reported 1,736 cases of dengue fever in the week ending July 18 " the highest weekly number ever recorded in Singapore, the National Environment Agency said. Nineteen people have died from the disease, which is spread via mosquito bites and can cause symptoms including fever, nausea and body aches.

The country's environment agency has warned that the total number of dengue cases this year is expected to surpass the high of over 22,000 reported in 2013. Last week, Singapore announced stiffer penalties for households and businesses repeatedly found with mosquito breeding grounds on their premises, while vector control efforts like fogging have increased.

Singapore is expecting its worst recession since independence this year, with the economy projected to shrink by 4 to 7 per cent. Photo: AP alt=Singapore is expecting its worst recession since independence this year, with the economy projected to shrink by 4 to 7 per cent. Photo: AP

Public health expert Jeremy Lim said as the country continues to open up " both in terms of public activities and border control " there is a threat of a virus resurgence.

"The acid test will come soon enough," said Dr Lim, an associate professor at the National University of Singapore's Saw Swee Hock School of Public Health.

The likelihood of a second coronavirus wave will depend on the government's ability to detect and control new cases quickly, he said.

Lim said Singapore was "as well prepared as any country ever can or will be". It now has systems for testing, contact-tracing, isolation, he said.

"And there is very deep experience across the health system and government now, given the last four months of managing the dorms and community clusters," Lim said.

Irvin Seah, a senior economist at DBS Bank, the city state's largest bank, said the worst was over from an economic point of view, but that the road to recovery was uneven, with some sectors rebounding to its pre-crisis real GDP faster than others.

"For the economy, on average it will take two years, and for certain industries like tourism and aviation, it will take more than two years," Seah said.

The coronavirus pandemic has battered Singapore's economy. Photo: AFP alt=The coronavirus pandemic has battered Singapore's economy. Photo: AFP

He said what could worsen was the labour market, which has been propped up by government support.

When these support measures run out, the labour market could see a "greater fallout", he said, adding that even if the economy grows, it may not immediately lead to new jobs as employers take a cautious approach towards hiring.

Singapore is expecting its worst recession since independence this year, with the economy projected to shrink by 4 to 7 per cent.

To cope with the economic fallout, Singapore is seeking to establish "travel bubbles" and corridors with other countries which have been successful in containing the virus. Already, six cities in China have secured a "fast-lane" arrangement with Singapore for those on business or official travel.

Leisure travel, however, is a long way off. "Our overall advisory ... for everyone in Singapore is not to travel, to avoid all travel," Wong told reporters on July 17.

Additional reporting by Bloomberg

This article originally appeared on the South China Morning Post (SCMP).

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