As a general practitioner, my decision to send a high-risk suspect patient to a restructured hospital by ambulance currently depends very much on his travel and contact history, as defined in a Ministry of Health (MOH) circular sent to all medical practitioners.

Based on medical reports of the confirmed cases and the fact that there is currently no local spread - that is, all of those infected have been imported cases - the risk level does seem to hinge on the patient's travel and contact history instead of signs and symptoms of the infection.

This being the case, MOH could consider sharing high-risk case criteria with the public so that these patients may self-quarantine and proceed directly to the hospital for confirmatory testing, minimising unnecessary contact at primary healthcare facilities and on public transport.

For instance, based on the latest criteria by MOH to medical practitioners, a person with a respiratory illness of any severity who had been specifically to Wuhan city or Hubei province, or to any hospital in mainland China, or had close contact with a confirmed case, in the 14 days before the onset of illness, would be deemed high risk.

A person returning from any part of mainland China with a respiratory illness and breathlessness is also considered high risk.

Currently, MOH advises unwell persons with recent travel to countries with confirmed cases (a growing list of countries) to seek medical attention promptly. This may create unnecessary anxiety and confusion. High-risk patients should not visit GP clinics, as there is currently no confirmatory testing or proper isolation facilities available, and contact precaution methods of cohorting patients in a constrained clinic space and providing personal protective equipment are limited at best.

At the same time, low-risk patients with no travel history should seek medical attention first at the primary healthcare level and avoid overloading public hospitals.

A 24-hour MOH public hotline can be set up to triage an individual's risk level, give proper advice and dispel fake news.

An ambulance may be arranged for transport to the hospital if a patient is deemed high risk.

Roger Teo Chee Yih (Dr)