COVID-19 has gripped headlines in recent weeks as the world struggles to contain this outbreak. Singapore has not been spared but has responded well.
Singapore’s Harvard-praised “gold-standard” response is made possible by a system of emergency preparedness measures supported by the legal framework of the Infectious Diseases Act (IDA).
The IDA regulates quarantines and other preventive measures for infectious diseases.
What is Considered an Infectious Disease?
Not every infectious disease outbreak will require quarantine or preventative measures. The more notorious diseases are mentioned in the First and Second Schedules of the IDA. The First Schedule contains a list of infectious diseases that include dengue, Zika virus, tuberculosis, malaria, Ebola, SARS and COVID-19.
On the other hand, the Second Schedule picks out the infectious diseases in the First Schedule that are regarded as more dangerous, such as Ebola, SARS, and COVID-19.
The IDA provides for additional measures to specifically deal with diseases in the Second Schedule, such as:
- Ensuring that a carrier of a Second Schedule disease, their contacts or caretakers do not act in ways that can spread the disease in Singapore;
- Allowing the authorities to declare an overseas location that may introduce a Second Schedule disease into Singapore as an infected area and prohibit anyone from an infected area to enter Singapore; and
- Quarantining of ships infected with a Second Schedule disease.
Even if a disease is not mentioned in either the First or Second Schedule, the IDA also allows the authorities to act in cases where the disease can spread between people and cause an epidemic if left unchecked.
How Does Singapore Respond to a Disease Outbreak?
The following infographic summarises how Singapore responds to a disease outbreak:
Determining the appropriate response based on the disease’s threat to public health
Singapore’s response to a disease outbreak is dependent on the disease’s threat to public health. These threats are assessed based on two factors:
- Transmissibility: This refers to how easily a disease can spread.
- Virulence: This refers to the disease’s ability to cause serious illness.
The disease’s public health impact, including its chance of being imported into Singapore, availability of vaccine or medicine, and recommendations by the World Health Organisation (WHO), are represented by the various Disease Outbreak Response System Condition (DORSCON) levels, ranging from Green, Yellow, Orange to Red.
The DORSCON levels will be activated upon the Ministry of Health’s recommendation according to the following ranges of public health impact:
- DORSCON Green: Green is activated when the outbreak has negligible to low public health impact. Typically, this is used when an outbreak does not spread easily and is about as mildly harmful as the seasonal flu.
- DORSCON Yellow: Yellow means the outbreak could have low to moderate public health impact. Possible scenarios for DORSCON Yellow include:
- When the outbreak is largely overseas and looks controlled;
- When the disease can cause serious illness in vulnerable groups; or
- When a vaccine is available for the outbreak
- DORSCON Orange: This denotes a moderate to high public health impact. DORSCON Orange can happen in the following scenarios:
- When the disease is severe, spreads easily between people, and is spreading overseas, but not in Singapore.
- When the disease is severe, spreads easily between people, but its spread in Singapore is controlled.
On 7 February 2020, Singapore raised its DORSCON level to Orange in response to the ongoing spread of COVID-19.
- DORSCON Red: This denotes a high public health impact. DORSCON Red is triggered when the disease is highly virulent and transmissible within Singapore. This DORSCON level is mainly targeted at reducing the overall impact of the disease within the community and is also known as the mitigation phase.
There are different measures available to the authorities in the event of an outbreak. As most outbreak situations are fluid, the authorities may implement these measures at any DORSCON level. Generally, the measures will also vary in scale according to the DORSCON level.
Border control measures
Border control measures are Singapore’s first line of defence in an outbreak and will vary according to the DORSCON level. For example:
- DORSCON Green: Typically limited to the dissemination of health advisory notices for visitors. The IDA allows the authorities to direct flight and cruise operators to provide health advisory notices to their passengers.
- DORSCON Yellow: May include health advisory notices, health declarations, and temperature screenings of inbound traffic. Persons arriving in Singapore may also be required to undergo medical examinations as permitted by the IDA. This includes physical examinations, obtaining bodily samples and the medical history of a person.
- DORSCON Orange: Measures may be stepped up to include temperature screenings for all inbound and outbound traffic.
- DORSCON Red: Temperature screenings for all inbound and outbound traffic may be continued at this stage, apart from non-border related measures to curb the spread of the disease.
Depending on the severity of the outbreak and its public health impact, the authorities may also choose to prevent those who had visited the affected countries from entering Singapore. This reduces the risk of importing the disease and having it spread locally.
In such a situation, Singaporeans and those with long-term visas are still permitted to enter the country. However, they will have to be quarantined for the duration of the disease’s known incubation period.
For example, the quarantine period is approximately 14 days for those who had travelled to countries with confirmed cases of COVID-19. Among such travellers, work pass holders must serve a 14-day Leave of Absence upon arrival in Singapore or risk having their work passes revoked.
Contact tracing and quarantine
Contact tracing identifies the people who have been in close contact with an infected person. Depending on the risk, those identified may either be required to periodically check in with the authorities to ensure they have not developed symptoms, or be quarantined.
Quarantine refers to the isolation of healthy persons who have been exposed to an outbreak. This is because there is a concern that they might be infected but are not yet showing symptoms.
The IDA empowers the authority to order and enforce a quarantine. Ignoring a quarantine order or leaving the place of isolation without the relevant authorities’ permission can get you a fine of S$10,000, or imprisonment of up to 6 months, or both for a first-time offence.
Contact tracing and quarantine measures both help limit the spread of the disease within Singapore. They will be implemented at DORSCON Green, Yellow, and Orange once the outbreak has been imported into Singapore. Generally, these measures will continue until DORSCON Red, or once they are impractical or ineffective.
Social distancing measures are aimed at slowing down the infection rate by limiting contact between people. They can include cancellation of mass events and school closures. Because of its impact, social distancing measures are generally reserved for DORSCON Red.
However, a limited form of social distancing can kick in at DORSCON Orange or Yellow to reduce spread in specific contexts.
The IDA allows MOH to cancel mass events, and close and disinfect premises in an outbreak. Disobeying such orders can lead to a fine of S$10,000, or imprisonment of up to 6 months, or both, for a first-time offence.
Handling of deceased persons
There is a risk of transmission when handling the body of a person who died of an infection. Thus, the handling and disposal of bodies of persons who died of infectious diseases are regulated by the IDA. For example, MOH requires the use of gloves, surgical masks, disposable gowns and other measures.
Further, ritual washing or embalming of the deceased may be restricted. MOH may also prohibit the holding of a wake for the deceased. However, the exact restrictions will depend on the nature of the disease.
Declaration of a public health emergency
If the Government believes that an outbreak can cause many fatalities, it can declare a public health emergency. Declaring a public health emergency allows the Government to declare the whole of Singapore, or a part of it, as a restricted zone. The Government can restrict movements and mass gatherings within this area.
A restricted zone may be in force for up to 14 days. However, the Government can extend this for further periods of up to 14 days each, if necessary. If you fail to follow an order in the restricted zone, you can be fined up to S$10,000, or imprisoned up to 6 months, or both, for a first-time offence.
When might a DORSCON level be lowered?
A DORSCON level may be lowered, for example, from DORSCON Orange to DORSCON Yellow, if the situation has stabilised.
On the other hand, the DORSCON level may also be lowered should the disease spread widely worldwide and it is impractical to retain border control measures. This means that Singapore’s response mode will transit from containment (i.e. stopping or limiting the spread of the disease) to mitigation.
During the mitigation phase, contact tracing, phone surveillance and quarantine will cease as such measures will be ineffective (as mentioned above). Instead, emphasis will be on community-based public health measures such as outpatient management and business continuity plans such as requiring staff to undergo temperature screening and implementing work from home arrangements.
Nevertheless, the mitigation phase can occur at any DORSCON level (mainly at DORSCON Red, as mentioned above) with varying mitigation measures at each level, and need not be implemented only when the DORSCON level is lowered.
What are the Do’s and Don’ts During a Disease Outbreak?
There are several things you can do to lessen the impact of a disease outbreak. They can be categorised into 2 categories:
1. Protecting yourself
- Practise good personal hygiene. Wash your hands frequently with soap and avoid touching your eyes, nose and mouth. This is because your hands may have come into contact with contaminated surfaces as you go about your day, and any viruses on your hands then enter your body through your eyes, nose or mouth.
- Maintain social distancing. Keep some distance, preferably at least a metre, from other people. This is especially if they are coughing or sneezing.
2. Protecting your community
- Practise good respiratory hygiene. Cover your mouth with a tissue paper when you cough or sneeze. Then, throw the used tissue paper into a closed bin. If you use your hands, do not forget to wash them with soap. This will help to prevent the spread of viruses.
- Do not communicate any fake news regarding the outbreak. Doing so can cause unnecessary panic within the community and risk overloading essential services. You may also be penalised accordingly.
- If you are infected or are taking care of someone who is, do not act in a way that can spread the disease. This could include visiting many different locations, sharing cutlery or clothes, and/or not abiding by the practices mentioned above. If the situation involves a dangerous infectious disease listed in the IDA’s Second Schedule, you can be fined up to S$10,000, or imprisoned up to 6 months, or both, for a first-time offence.
- See the doctor early if you have symptoms. If you are feeling unwell, seek medical treatment earlier. It will also prevent the spread of any infectious diseases to your family and friends if you have been infected with one.