COVID-19 Lessons from China and Singapore

March 28, 2020

On December 31st, 2019, China informed the World Health Organization (WHO) that it had registered several cases of a respiratory virus, which originated in Wuhan, a port city of 11 million people in Hubei province. That was more than three weeks after the first cases were reported internally.

As a result of the SARS outbreak in 2003, China built a disease control and prevention system, which was supposed to be ready for a very rapid response. This system successfully detected H1N1 and Avian flu but failed to report the early cases of Covid-19. The first internal reporting appears to be on December 29, 2019. While investigating the failure of the early reporting, the National Health Commission kept the number of the infected patients artificially low to 27 sick patients of which 7 patients were critically ill while later, China's CDC acknowledged that by the end of December numbers were 104 cases of which 15 had died. During that time, the risk of human-to-human contagion was downplayed, whistleblowers were silenced and punished, celebrations connected with the Lunar New Year went on as usual. At least three crucial weeks in early detection, reporting and prevention were lost in reporting system failures and political cover-ups, mainly by the local Wuhan and Hubei authorities. The lost time, eventually led to the lock down of Wuhan on January 23, 2020 and of Hubei province on February 13, 2020.

China's chaotic, confused, uncoordinated mismanagement of the initial outbreak, which contributed to the spread of the virus not only in Hubei, but also outside China's borders, is strikingly different from the approach Singapore took to tackle the new virus.

Before the recent COVID-19 outbreak, Singapore already had a hospital, legal, and reporting system in place, which allowed for immediate response. When WHO announced COVID-19 as a public health emergency, Singapore was ready. It started doing extensive free testing, which due to the excellent and accessible healthcare system, was readily available. During the first week of January, only people arriving from Hubei province were tested. After that, everyone, who had been in China in the last 14 days, was tested. By the end of January, all public hospitals in Singapore were able to test, which allows for widespread testing even if there is a slight suspicion for COVID-19. Only 1% of the tested patients have been positive, showing how extensive the testing system is. All cases, even the mild ones, are isolated and treated in hospitals. The contacts of each infected person are tracked down with the help of tracking teams. These contacts are then tested and even without symptoms placed under a strict quarantine at home. Their location is monitored by phone several times a day. Those who don't obey are penalized. The communication to the public from day one has been very open, clear and consistent. Unlike in China, there has been much more transparency from the government of Singapore from the onset of the outbreak. Social distancing, early sickness symptoms, wearing a mask in public, "coughing" etiquette were all communicated via text messages to the general public early on. The government sends all citizens text messages via WhatsApp twice a day offering an update on the COVID-19 status in the state, including locations, which could have an outbreak. And on March 20, the authorities introduced the TraceTogether app. TraceTogether uses Bluetooth technology to identify people who have been in close proximity -- within 6 feet for at least 30 minutes -- to coronavirus patients. It is worth mentioning that in early February China also introduced Close Contact Detector phone app, offering citizens to see if they are at risk for novel coronavirus. This app is not as user friendly as the Trace Together app. The close contact detector requires access to apps like Alipay, WeChat or QQ, and the user's name, ID and phone number. Since then, the Chinese authorities have also developed another app called Color Code, which assigns a health color to each user according to his or her travel history and contacts.

As of March 23h, short-term visitors, tourists and transit passengers are not allowed in Singapore. Bars, movie theaters and other entertainment outlets are closed as of March 26th. However, schools, malls and restaurants remain open. People are not restricted to move. These actions were taken by the Singaporean government because the state experienced its first 2 deaths and is seeing an increase in the number of coronavirus cases.

As it stands, despite its proximity to China and interconnectedness between the two countries, Singapore has 432 COVID-19 cases and 2 deaths so far, comparing to China, with 81340 cases and 3292 deaths most of which occurred in Hubei province. China's higher mortality rate reflects higher number of fatalities in the early stages of the outbreak (17% of the cases between January 1-10, dropping to 0.7% after February 1), which also points to an early outbreak mismanagement. The exceptionally low fatality rate in Singapore attests for a successful early detection, prevention and preparedness to tackle and treat COVID-19.

The relative success of Singapore may not be possible to replicate. Singapore is a wealthy, relatively small city-state with an authoritarian government and accessible healthcare system. However, the contrast between the disorganized, chaotic and delayed response of China and the organized and efficient approach of Singapore can be of tremendous help for all other countries trying to contain COVID-19 pandemic.

News from China and Singapore

  • July 5: Up to 8,000 Chinese nationals came into US after Trump banned travel due to coronavirus (1)
  • China recorded 8 new coronavirus cases for July 4, up from with 3 a day earlier (1)
  • July 4: WHO revises coronavirus timeline to clarify its China office raised alert, not authorities (1)
  • July 3: WHO admits China did not self-report its coronavirus outbreak (1)
  • July 2: China reports three new coronavirus cases (1)
  • June 30: China recorded 19 new cases of coronavirus on the mainland on Monday (1)
  • Traveler from US infects 71 people in China with Covid-19, research finds (1)
  • June 29: EU named 14 countries whose citizens are deemed "safe" to be let in from 1 July, US, Brazil and China are excluded (1)
  • China’s military approves coronavirus vaccine for use on soldiers (1)
  • China puts 400,000 inhabitants of Anxin, 90 miles southwest of Beijing in coronavirus lockdown in response to a new outbreak (1)
  • June 28: China reports another 17 coronavirus cases, including 14 that were locally transmitted (1)
  • China industrial firms' May profits post first monthly rise in 6 months (1)
  • June 27: China recorded 21 new coronavirus cases on Friday, including 17 locally transmitted in Beijing, according to country's National Health Commission (1)
  • June 26: China records 13 new coronavirus cases (1)
  • June 21: China reported 26 new confirmed coronavirus cases for June 20, down from 27 a day earlier (1)
  • China suspends poultry imports from Tyson Foods plant in Arkansas following an outbreak of coronavirus cases at the facility (1)
  • June 20: China publishes genome data from latest Beijing outbreak, tracing it to Europe (1)
  • There may be no immunity against Covid-19, new Wuhan study suggests (1)
  • June 19: China bans imported pork from German meat plant after more than 650 infected in outbreak (1)
  • June 18: Beijing reported 21 additional infections Thursday, down from 31 on Wednesday; authorities confirmed 158 new coronavirus cases in Beijing over past week (1)
  • Asymptomatic Covid-19 patients have weaker immune response, China study finds (1)
  • June 17: Beijing cancels 60% of flights to contain fresh coronavirus outbreaks: report (1)
  • Chinese airlines suspended two-thirds of flights out of Beijing amid fresh spike in coronavirus cases (1)
  • June 16: Beijing puts more neighbourhoods under lockdown, boosts testing as it tries to contain new coronavirus outbreak (1)
  • June 15: China locks down 10 more Beijing neighborhoods over new Covid-19 outbreak at wholesale market (1)
  • China to launch new airline despite travel downturn (1)
  • June 14: Coronavirus cases linked to Beijing market climbs to 36, China sees highest daily total in 2 months (1)
  • June 13: Beijing district on lockdown after coronavirus spike shuts market (1)
  • June 12: China reported 7 new virus infections and 1 asymptomatic case (1)
  • June 11: China offers trial vaccines to workers going abroad (1)
  • First new Covid-19 case in Beijing for nearly two months (1)
  • June 8: Satellite data suggests coronavirus may have hit China earlier, researchers say (1)
  • June 4: Thousand of cinemas in China under threat of closure (1)
  • China allows flights from US after pressure from Trump administration (1)
  • June 2: Wuhan tests nearly 9.9 million residents with no new cases found but 300 asymptomatic carriers (1)
  • June 1: China reported 16 new coronavirus cases for May 31, the highest number since May 11 (1)
  • May 24: Chinese state media: Wuhan virology institute had three live bat coronaviruses but none match the global contagion, its director said (1)
  • May 23: China reports no new coronavirus cases for first time since pandemic began (1)
  • May 21: Chinese city of Shulan now under Wuhan-like coronavirus lockdown (1)
  • April 11: Scientists say coronavirus can spread 13 FEET from sufferers - more than twice the 6ft social distancing gap demanded by government - and that isolating infected people at home is not a good strategy (1)
  • April 10: Nearly half of severe COVID-19 cases showed neurological symptoms (1)
  • April 2: Virus masks, apps: The race is on to avoid hidden carriers (1)
  • The FDA Now Says It Will Allow Imports Of KN95 Masks, An Alternative To Scarce N95 Masks (1)
  • March 30: Wuhan Residents Dismiss Official Coronavirus Death Toll: ‘The Incinerators Have Been Working Around the Clock’ (1)
  • March 29: Coronavirus Cases Have Surged, But The US Is Refusing To Take The World’s Most Available Masks (1)
  • Countries reject China pandemic product batches (1)
  • March 26: $20 trillion lawsuit against China! US group says coronavirus is bioweapon (1)
  • March 25: Median time from onset of symptoms until discharge from hospital was 22 days. Those who died lasted 18.5 days after symptoms first appeared. (1)
  • March 23: The Lancet finds 24% fatality rate if admitted to hospital, a 97% fatality rate if requiring mechanical ventilation, and a 100% fatality rate if requiring ECMO. (1)
  • March 19: The pandemic began in China. Today, it reported no new local infections for the first time. (1)
  • March 18: As world cowers, China glimpses coronavirus aftermath (1)
  • New Research: Coronavirus Vulnerability Could Be Partially Determined by Blood Type (1)
  • Second wave hits Asia. (1)
  • China Says Japan-Developed Drug Avigan Works Against Coronavirus (1)
  • HIV drug combo fails as treatment for severe COVID-19 in China study (1)
  • March 17: 6 out of 7 people with coronavirus are walking around undetected, study says (1)
  • People with Type A blood are MORE likely to catch coronavirus than those with Type O, study claims (1)
  • March 16: Moderna and Inovio to start vaccine trials (1)
  • Restaurants in China Are Reopening, But Finding It Hard to Recover Business (1)
  • March 15: India suspends all tourist visas until at least April 15. Declares 14 day quarantine for citizens returning from China, Italy, Iran, South Korea, Spain, France, and Germany (1)
  • March 14: Hungary extends entry ban. Includes Iran, China, South Kora, Italy, and Israel.
  • March 11: Qatar bans people from 14 countries (1)
  • Coronavirus x-rays show terrifying damage in lungs of Covid-19 victims (1)
  • March 3: Shanghai Government Officially Recommends Vitamin C for COVID-19 (1)
  • February 28: How early signs of the coronavirus were spotted, spread and throttled in China (1)
  • February 17: US and Chinese companies partners to develop vaccine. (1)
  • February 4: The steps needed to lockdown Wuhan, China. (1)