SINGAPORE - Singapore has recorded its first cases of local coronavirus transmission, with four women here infected who had not travelled to Wuhan, the epicentre of the outbreak.

Two work at Yong Thai Hang, a Chinese health products shop in Cavan Road, in Lavender, that caters to Chinese tour groups.

The third is a maid of one of the women, while the fourth is a tour guide who had taken groups to the same shop.

The tour group in question has since returned to China.

In addition, another two confirmed cases were announced on Tuesday (Feb 4).

The two were among a group of 92 people flown back to Singapore from Wuhan on a Scoot flight last Thursday. Before this, another two on the same flight had been reported as confirmed cases.

In total, there are now 24 confirmed cases in Singapore.

Four of the new cases constitute "limited local transmission", the Ministry of Health (MOH) said on Tuesday.

"There is, however, no evidence of widespread community transmission," said Health Minister Gan Kim Yong at a press conference.

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"Despite our best efforts, Singapore could still see extensive community spread," he told reporters.

Should that happen, Singapore will consider additional measures to reduce human-to-human interactions - such as cancelling mass gatherings, suspending schools, and paring down non-essential care services - to slow the spread of disease.

The country has been preparing for such clusters, and measures implemented so far have been directed towards preventing and containing the risk of spread beyond such local clusters to the broader community, MOH said.

As surveillance has been stepped up, more such local clusters are expected, including more cases of local transmission, it added.

The ministry has also started contact tracing to ring-fence the cluster and limit further spread.

Cases with limited community transmission are not unexpected, said Mr Gan, who co-chairs a multi-ministry task force to defend the country against the virus.

"This is a scenario which we are prepared for," he said, noting that efforts will help reduce the risk of escalation.

"As the situation evolves, we will step up our posture accordingly to further contain the situation in Singapore."

With local transmission happening here, the Government is stepping up cleaning of public areas, as well as measures to lower the risk for vulnerable groups such as young children and the elderly.

To keep students safe, for instance, schools will implement staggered recess times, and stop activities such as mass assemblies and school camps. Eldercare facilities will also suspend excursions and large-scale gatherings.

As an added precaution, the authorities said they are also contacting people with similar profiles to the four cases of local transmission, who have had recent close contact with individuals with travel history to China.

In addition, all patients with pneumonia at public hospitals have been tested for the 2019-nCoV, as the virus is called, since last week.

Current evidence suggests that the virus can be spread by droplets from infected individuals, and the best way to prevent this is through personal hygiene and social responsibility. Businesses and organisations are also advised to clean their premises more often, especially high-traffic areas.

The earlier 18 confirmed cases of the virus here were all imported, comprising 16 Chinese nationals and two Singaporeans who had all travelled recently to Wuhan, the capital of China's Hubei province.

One has been discharged, said the ministry on Tuesday.

MOH also said that as of Tuesday, 12pm, 289 of the suspected cases have tested negative for the coronavirus. The test results for 20 more cases are pending.

The ministry has identified 311 close contacts of the confirmed cases as well. Of these, 239 are still in Singapore, with 234 contacted and being quarantined or isolated. Efforts are being made to contact the remaining five close contacts.

The ministry said that once a confirmed case of the virus is identified, it will closely monitor all close contacts. As a precautionary measure, they will be quarantined for 14 days from their last exposure to the patient.

All other identified contacts who have a low risk of being infected will be under active surveillance, and contacted daily to monitor their health status.



(From left) Director of medical services at the Ministry of Health Kenneth Mak, Health Minister Gan Kim Yong; Permanent Secretary for Manpower Aubeck Kam; and director of schools at the Ministry of Education Liew Wei Li at a press conference on Feb 4, 2020. ST PHOTO: KUA CHEE SIONG



The updates were given after a two-day lull on Sunday and Monday, when no new cases were reported.

The coronavirus outbreak shows no signs of abating, and while Singapore has put in place multiple lines of defence to check cases coming in from abroad or being passed within the community, it must prepare for a long fight against the virus, Mr Gan had told Parliament on Monday.

The coronavirus was first reported in Wuhan late last year. As of Monday, it had infected more than 20,000 people and claimed over 420 lives, mainly in China.

Outside mainland China, there have been close to 300 cases and two deaths, one each in Hong Kong and the Philippines.

Global authorities have warned of more person-to-person spread, with the United States, Thailand, South Korea and Hong Kong all reporting local transmission.

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On Tuesday, Malaysian health authorities also confirmed the first citizen to be infected with the coronavirus, bringing the total number of confirmed cases in the country to 10. They said the 41-year-old Malaysian had travelled to Singapore for a meeting last month with colleagues from China - including one from Wuhan. But he showed symptoms only on Jan 29, nearly a week after he returned to Malaysia.

Chinese data suggests that the coronavirus, while much more contagious than Sars, is significantly less lethal, although such numbers can evolve rapidly. It very likely passed from certain wild animals to humans at Wuhan's South China Seafood Market and then evolved into human-to-human transmission.

Singaporeans are advised to defer all travel to Hubei and all non-essential travel to China, while visitors with recent travel to China will not be allowed entry here.

The six new cases

- The 19th case is a 28-year-old Singapore permanent resident, a woman who had no recent travel history to China. She works as a sales staff member at health product shop Yong Thai Hang at 24, Cavan Road, in Lavender, that primarily served Chinese tourists.

She developed a sore throat and fever on Jan 29 and was taken to Tan Tock Seng Hospital (TTSH) last Thursday, but was discharged from hospital after her chest X-Ray result came back negative for pneumonia.

She did not leave her home in Jalan Bukit Merah from Friday to Sunday and was admitted to the Singapore General Hospital (SGH) on Monday.

- The 20th case is a 48-year-old Singaporean, a woman who also had no recent travel history to China. She lived in Hougang Street 61 and also worked at Yong Thai Hang.

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She reported symptoms on Jan 25 and was admitted to the National Centre for Infectious Diseases (NCID) on Monday.

- The 21st case is a 44-year-old Indonesian woman who also had no recent travel history to China. She is the domestic helper of case 19, and stayed with her employer in her home in Jalan Bukit Merah. She reported symptoms on Sunday and had not left her home since then.

She was admitted to SGH on Monday.

- The 22nd and 23rd cases are Singaporeans evacuated from Wuhan on Jan 30. They did not have symptoms when they boarded the flight and were quarantined when they landed in Singapore.

The two cases tested positive for the coronavirus on Monday even though they still showed no symptoms.

They are now warded in isolation rooms at NCID.

All Singaporeans evacuated from Wuhan were, as an added precaution, were tested for the coronavirus.

- Case 24 is a 32-year-old Singaporean who had no recent travel history in China.

She is a tour guide who took groups to Yong Thai Hang, the same shop where cases 19 and 20 worked.

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The tour guide did not show any symptoms when she went to NCID on Monday. She was immediately isolated and is now warded in an isolation room in the centre.

She tested positive for the virus on Tuesday afternoon.

Discharged

One of the confirmed cases, case seven, a 35-year-old Wuhan resident, has recovered and tested negative for the virus. He was discharged from NCID on Tuesday.

Additional reporting by Rei Kurohi and Timothy Goh

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