Singapore had the coronavirus under control. Now it's locking down the country

By Sareena Dayaram

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Singapore, an island nation of approximately 5.6 million, was praised by the World Health Organization for its approach in tackling the novel coronavirus.

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For the most up-to-date news and information about the coronavirus pandemic, visit the WHO website.

As the world scrambles to contain the coronavirus, Singapore has been held up as a role model for its early and decisive response to the threat. The city-state drew international praise for its ability to blunt the spread of COVID-19 while avoiding some of the drastic containment measures seen in countries like China, Italy and Spain. But Singapore's lauded response has come into question. This week, it enforced a partial lockdown as it struggles to contain a sharp rise in coronavirus cases. 

As part of Singapore's stricter "circuit breaker" measures, it shuttered most workplaces on Tuesday. The following day, school closures went into effect for at least a month, shifting students to "full home-based learning." The government has also banned public and private social gatherings of any size, meaning residents who entertain guests face six months of jail time or a fine of up to $7,000.

"We have decided that instead of tightening incrementally over the next few weeks, we should make a decisive move now, to preempt escalating infections," Singapore's prime minister, Lee Hsien Loong, said in an address to the nation on April 3.

The move underscores the risks that the coronavirus poses -- even after a country has seemingly taken the necessary steps to protect itself. The semi-lockdown came after Singapore witnessed an explosion of confirmed coronavirus cases, from 106 infections on March 1 to 1,000 on April 1. Those figures indicate most infections were transmitted locally and that a growing number of cases have no known links to confirmed patients. 

Until this week, Singapore was one of a few countries that refrained from closing schools, pointing to early research that suggested children aren't as vulnerable to the COVID-19 disease as adults, even as more than 150 countries had shut down their educational institutions. 

Lee said the situation is under control, but the prime minister also noted that daily reported cases have "routinely" increased. 

"Looking at the trend, I am worried that unless we take further steps, things will gradually get worse or another big cluster may push things over the edge," Lee said.

The island nation's spike in cases comes at a time when the world is scrambling to flatten the curve. The number of coronavirus cases is near 1.7 million globally, and the virus has caused more than 102,000 deaths, according to a Friday tally by Johns Hopkins University. Across the world, cities remain in lockdown, hospitals are inundated with patients, and the global economy is reeling. Germany and France have each warned of their worst economic downturn since World War II, while nearly 17 million people in the US have filed for unemployment benefits over the last month.

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Singapore's circuit breaker strategy "should help to reset the epidemic to a lower level to mitigate the effect of recent rises," said Alex R. Cook, vice dean (research) of the Saw Swee Hock School of Public Health at the National University of Singapore. "It has been calibrated to be long but not too long." 

Second wave strikes

On Thursday, Singapore's Ministry of Health confirmed that coronavirus cases had climbed to a record daily high of 287, quickly surpassing another record of 120 set last Sunday. Like Hong Kong, Singapore is in the grip of what experts call a second wave of infections. Initially, many of the new cases originated from returning Singaporeans who'd contracted the coronavirus while traveling overseas, mostly in Europe. Then in the last few weeks, the island nation began to witness a worrying spike in locally transmitted cases. 

"Even if the social distancing is perfect going forward, unlinked cases will go up for some days" as transmissions that happen in recent days are detected, Jon Huang, an epidemiologist at Singapore's Institute for Clinical Sciences, said in a thread on Twitter on Thursday.

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The spike in confirmed coronavirus cases in Singapore from March to April, including a growing proportion of locally transmitted cases (yellow and red).

Singapore Ministry of Health

Singapore has at least 20 local clusters, including a bridal studio and a nursing home, but a significant number of local cases have been traced back to at least three foreign workers' dormitories. 

Authorities promptly quarantined the migrant workers -- some 50,000 people mostly from India and Bangladesh -- in their rooms in those dorms, saying it was necessary to curb local transmission. 

But the move has drawn criticism from human rights groups and Singaporean citizens alike as media reports surfaced about the crowded and unsanitary living conditions at the dorms, which among other things reportedly make it next to impossible to stay at least a meter apart.

"They stay in overcrowded dormitories and are packed likes sardines, said Rector Professor Tommy Koh, Tembusu College, National University of Singapore, in a widely shared Facebook post. "The dormitories were like a time bomb waiting to explode."

Human Rights Watch said the quarantine at the dorms created a "tinderbox" for infection and urged the government to test all workers and move those that were sick to health care facilities.  

Since then, more than 5,000 workers have been moved out to safer locations, and more will be relocated in the coming days, Lawrence Wong, a cabinet minister and co-head of the government's virus-fighting task force, said at a press conference Thursday. Lee also said a task force made up of government, military and police personnel has been established to aid the dorm operators and the housed workers.

"We are sparing no effort to contain the spread of the virus in the foreign worker dormitories," said Wong.

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Singapore announced massive stimulus measures to soften the economic shock from the coronavirus outbreak.

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Singapore in a global context

Last month, it appeared that Singapore had managed to keep a lid on coronavirus infections through a system that included exhaustive contract tracing, early travel restrictions and strict social distancing measures. Though it was one of the worst-hit places in the early stages of the pandemic, the country managed to keep cases to fewer than 390 and had zero deaths until March 21, nearly two months after it reported its first coronavirus infection. 

Since then, Singapore's confirmed cases have risen dramatically, to 2,108 as of Friday, according to a Johns Hopkins University tracking tool, but the island nation still appears to be handling the coronavirus better than many other developed countries and cities. US cities and counties that have roughly double Singapore's population size of 5.6 million have a disproportionately higher number of cases. Los Angeles County, for instance, has 8,430 confirmed cases and 241 deaths as of Friday, while the state of Georgia has 11,859 confirmed cases and 425 deaths as of Friday. Singapore has seven deaths. Meanwhile, New York, which has a similar population size and density to Singapore, has 5,820 deaths as of Friday, after confirming its first cases more than a month after Singapore. Hong Kong and Taiwan are perhaps some of the few if not only places that have an edge over Singapore in their containment of the coronavirus.

"What they [Singapore] are really showing the rest of the world is that this is just a difficult virus to beat back and keep down," Michael Osterholm, an infectious disease expert at the University of Minnesota told Reuters.