Despite Adam’s mild symptoms, doctors were concerned about his travel history and sent him to Singapore’s National Centre for Infectious Diseases (NCID) to be tested.

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Throughout his stay at the hospital, he only had a sore throat and runny nose that was treated with regular medication: flu pills, paracetamol, Vitamin C and lozenges.

Shawn Vasoo, clinical director at NCID, told This Week in Asia that the illness for many of Singapore’s virus patients would result in a fever that would eventually resolve itself.

“After the fever disappears, some coughing may continue. So far, the runny noses and sore throats have been quite mild. The patients may have an occasional cough, but it is quite uncommon for them to be constantly coughing. Many reported coughing as a result of itchy throat,” he said.

Vasoo said those with mild coughs or sore throats would take about one week to recover, while those with pneumonia – about 40 per cent of the patients – would take 10 to 14 days.

“But if they have respiratory failure and need to go to the intensive care unit (ICU), it can take several weeks to get back to normal,” he said.

Singapore has been treating patients in intensive care with supplemental oxygen and, if required, mechanical ventilation while their lung function recovers. Most are also treated with antiviral drugs such as lopinavir-ritonavir, which is used in treatment for HIV.

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Earlier this month, the city state had one of the highest recovery rates for coronavirus patients until it saw a spike in imported cases – between March 10 and 19, a total of 126 travellers returned and tested positive for the Covid-19 illness.

Health economist Phua Kai Hong said: “We’re constantly looking and calibrating accordingly. Some people may think it is a bit draconian, but to me, it is systematic.”

FLATTENING THE CURVE

Singapore, which has a population of 5.7 million people, has won praise for controlling the spread of the infection. Its infection rate is slow compared to other countries.

Italy’s cases saw a 200-fold increase within 23 days, going from 155 to 31,506 infections among its population of 60.5 million people. In Germany, which has 82.7 million people, cases spiked by 70 times – from 130 to 9,257 – in just 16 days.

Iran’s cases rose to more than 20,000 since its first reported infection on February 19, with its death toll hitting 1,556 on Saturday. Last week, its health ministry spokesman Kianush Jahanpur said on Twitter that based on information it had, “every 10 minutes, one person dies from the coronavirus and some 50 people become infected with the virus every hour in Iran”.

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Singapore’s ability to flatten the curve – public health expert speak for slowing the rate of infections to ensure hospitals are not overwhelmed – has been attributed to its aggressive tracing and containment methods and top-notch health care system.

“When we had our first case, we traced contacts aggressively so we could quickly isolate them. The moment the race started, Singapore ran but the other countries were just getting ready,” he said. “You see that happening in the US, UK and Europe. Once there were cases, they couldn’t detect, isolate and quarantine fast enough.”

Singapore on Sunday announced that it will ban all short-term visitors from entering or transiting through the city state indefinitely, starting Monday.

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Every time a case is confirmed, authorities will leap into tracing close contacts, asking infected patients questions such as “Who did you meet? What did you do? Did you share food?”.

Officers from the police’s criminal investigation department have been roped in to conduct investigations into contacts, with CCTV footage and data visualisations used as well.

The government on Friday also launched an app called TraceTogether that uses Bluetooth technology to note down the close contacts of citizens – people whom they have come within 2 metres of and spent at least 30 minutes with.

All infected patients have been hospitalised, those deemed at high risk of contracting the illness are quarantined, while others who are potentially exposed are ordered to stay home for 14 days. Flouting either orders can result in a fine of up to S$10,000 (US$6,900) and/or six months in jail.

The city state freed up government chalets and school hostels to be used as quarantine sites, and postponed elective surgeries at public hospitals so the focus could be on Covid-19 patients.

Managing this strain on the health care system was important because while most Covid-19 patients showed mild symptoms and could recover while resting at home – an option if hospitals were not able to provide isolation rooms for them – some had respiratory failure and would need critical care.

The ability of countries to keep patients alive are constrained by their number of ICU beds and equipment such as the extracorporeal membrane oxygenation (Ecmo), which pumps and oxygenates blood outside the patient’s body, allowing the heart and lungs to rest.

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Infectious diseases expert Leong said about 11 per cent of patients would need oxygen that could be given in general wards of hospitals and nine per cent would need critical care. The remaining 80 per cent would most likely be able to recover at home.

As of last year, Singapore had 11,321 hospital beds in private and public hospitals, with Leong estimating that about 300 were ICU beds.

According to US media reports, modelling by the US Centres for Disease Control and Prevention show that between 2.4 million and 21 million people could require hospitalisation, potentially crushing the nation’s medical system, which has about 925,000 staffed hospital beds including 95,000 ICU beds.

WUHAN-STYLE LOCKDOWNS?

China, which has been criticised for missteps that allowed the virus to spread, locked down Hubei province where infections were first reported, built new temporary hospitals and tested suspected cases aggressively. After a three-month battle, by this week it was reporting no new local infections, with new cases coming from travellers who had been abroad.

While Singapore’s schools and businesses are still running – although some firms have asked staff to work from home – the country is ramping up social distancing measures. On Friday, it announced that at all public venues, people would have to maintain a distance of one metre from each other, among other steps.

Experts say more drastic restrictions could be the way to go.

“The best example of this is Wuhan in China,” Hsu said, referring to the city in Hubei province.

Despite the large number of cases in Wuhan, most of the Chinese population had not been infected. “The curve has also been flattened there.”

Leong agreed. “You’ve to do it the Wuhan way,” he said. “So you literally have to restrict everyone’s movement in and out of the house.”

Leong said this would stop the community spread of the virus, which has a 14-day incubation period, because in the first seven to 10 days, those who fell ill could be taken out of their homes and quarantined.

“In the next seven to 10 days, family members who fall sick in the second cycle can also be taken out for quarantine,” he said.

“By the third [cycle of] seven to 10 days, those who did not fall sick are clear of the virus. So in about two months, the situation will be quite safe. Now people in Wuhan are free to go around again,” he said.

“If you have the resources to enforce a strict lockdown, which many first-world countries do, then you should just do it. It is either two months of pain, or you let it burn on for one to two, and even three years.”