SINGAPORE: It is "clearly emerging" that COVID-19 is different from Severe Acute Respiratory Syndrome (SARS) and has more similarities with H1N1, Minister for National Development Lawrence Wong said on Friday (Feb 14).

The COVID-19 fatality rate in China is lower than SARS, said Mr Wong, but it is more infectious and may spread at a faster rate than SARS.





Over the past week, the multi-ministry taskforce dealing with the COVID-19 situation in Singapore has learnt more about the nature of COVID-19 based on emerging trends in China and around the world, and also based on research by experts.



Mr Wong said COVID-19 is "different in several ways" from SARS.









COVID-19 TRANSMISSION, FATALITY RATE DIFFERENT FROM SARS



"The transmission mechanism of COVID-19 is different from SARS. In fact, the transmission mechanism is closer to H1N1 or influenza," said the minister.



Researchers at the National Centre for Infectious Diseases (NCID) have confirmed this, he said.

Like influenza, COVID-19 is infectious when symptoms are mild, the researchers found.

Because of this transmission mechanism, COVID-19, like influenza, can spread "quite quickly", said the minister.

"With our mild symptoms, we sometimes let our guard down – we continue going out even though we don’t really feel well, and that’s how the virus transmits," he said.

The other difference between COVID-19 and SARS is the severity, he said, adding that the fatality rate in China for COVID-19 is lower than SARS.

"Outside of Hubei province in China, it is even lower. Outside of China, it is low too. So mortality rates are lower than SARS," he said.



The fatality rate of SARS globally during the 2002-2003 outbreak was 9.56 per cent, as compared to a 2.14 per cent fatality rate for COVID-19 so far.

The SARS outbreak led to 774 deaths out of 8,098 cases, according to figures from the World Health Organization (WHO), while COVID-19 has so far killed at least 1,380 people out of about 64,400 cases.



He cited a study by the WHO based on 17,000 patients, which found that 82 per cent had "mild symptoms", 15 per cent severe symptoms and 3 per cent had critical symptoms.

"It is not a mild illness at all, but certainly not of the severity of SARS. These are the facts that we know about COVID-19 today," Mr Wong said.

Because of the "higher degree of infection", experts believe COVID-19 may spread at a much faster rate than SARS, which means COVID-19 is more similar to H1N1.

COVID-19 STRATEGY COULD CHANGE

If there is evidence of widespread community transmission in Singapore, Mr Wong said the Government could change its strategy on fighting the virus.

For instance, it could stop contact tracing because the large numbers make it impractical, and start sending confirmed COVID-19 cases with mild symptoms home to recover in isolation.

"If that takes place, the same precautions and advice we give to patients now still must prevail," the Ministry of Health (MOH) director of medical services Kenneth Mak said.

"Such patients must stay at home, they must not mix with other people, they must not go into crowded places.

"Therefore, even if a person has an infection and even if he does well, the potential for him then to spread this to other people is then controlled."



Those who need more acute care – possibly because they are old and vulnerable or have mobility issues – can still be admitted to hospital.

Associate Professor Mak said the Government will not decide on adopting this strategy solely based on the total number of confirmed cases.

"It’s actually on the basis of how we see each case arising, where we think the method of transmission is, whether it still remains confined perhaps within a cluster, whether it’s possible still for us to ring fence and limit further spread within that cluster," he explained.

Until then, Mr Wong said the current strategy of contact tracing and containment remains "relevant" for Singapore, adding that other countries are also doing the same.

"But as I said, there is growing evidence about how transmissible it is, how difficult it is to detect because it is transmissible and infectious when symptoms are mild," he added.



VIRUS MAY HAVE SPREAD UNDETECTED IN SOUTHEAST ASIA

Given so, it could be that the disease may have spread undetected to other countries, said Mr Wong.

"Experts are already saying that that spread of the virus to other countries may already be happening, but it’s undetected, particularly in Southeast Asia as well," he said.

Mr Wong cited a Harvard study that looked at airline travel volume which concluded that the virus may have spread undetected to various countries, including Indonesia and Thailand.



Researchers at the Harvard T H Chan School of Public Health in the United States, said in a study last week that Indonesia should rapidly strengthen outbreak surveillance and control, and that its lack of confirmed cases "may suggest the potential for undetected cases".



The study also cited Thailand as a country that could have undetected cases, based on the researchers' model.

Public health experts have concluded that the number of people infected with COVID-19 outside of China "cannot possibly remain at current levels", he said.

"It will eventually rise, and it’s a matter of time before you see a lot of people around the world getting the disease."

He gave the example of the H1N1 pandemic in 2009, which saw "10 per cent to 20 per cent" of the global population contracting the illness and more than 400,000 people in Singapore contracting H1N1 in less than a year.

"We’re not saying that this will happen for COVID-19. It’s a different disease than H1N1 so the patterns of transmission and the number of people contracting the disease will be different," he said.

"But because the transmission patterns are similar to H1N1, we should be prepared for a scenario where you get wider transmission around the world.

"At this stage, as we have emphasised, if you look at the number of cases we have, if you look at the number of cases around the world outside of China, at this stage, there is no widespread community transmission of the virus in Singapore.

"There is no widespread community transmission of the virus in any country outside of China."

Mr Wong's remarks came as Singapore on Friday confirmed nine new cases of the disease, taking the total number of people who have tested positive for the coronavirus to 67.

MOH said hundreds of general practitioner clinics will be reactivated as Public Health Preparedness Clinics (PHPCs) as part of efforts to better detect and manage COVID-19 infections.

This is a "proactive step" to reduce the risk of further community spread, said MOH.



Singapore is "doing everything" to reduce the risk of further spread of COVID-19, Mr Wong said.

"But this is a fast-changing situation. We are getting new information every day and we are learning more about the virus every day," he said.

"We will also reassess and update our strategies to deal with this evolving situation."

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