There has been much debate in Singapore’s social media scene about the travel ban that has been enacted on individuals who have been to China. Many have argued that the Singapore government had a very delayed reaction to the situation, and that it was reactive rather than proactive. Specific criticism has been levied on the travel ban and how the government took too long to implement it. But to what extent are these arguments valid? Did the Singapore government really implement the travel ban too late?

In today’s explained, we dismantle the fluff and rhetoric behind these arguments, and look at facts and science to answer the question.

1. What are the Travel Restrictions that Singapore has implemented?

Singapore’s travel restrictions have been gradually implemented.

The first wave of restrictions were placed on 28 January. At this point, the World Health Organisation (WHO) still refused to call the 2019-COVID a global health crisis, which had over 4593 confirmed cases. With this in mind, the government banned entry and transit through Singapore for individuals with Hubei travel history within the preceding 14 days, and holders of PRC passports issued in Hubei.

Three days later, on 31 January, the government implements harsher travel restrictions as the situation evolves. It announces that from 1 February, all visitors who travelled to mainland China within the preceding 14 days would be denied entry into Singapore. It also suspends the issuance of new visas and the country’s status as a visa-free transit facility to visitors with PRC passports. By this point, the Novel Coronavirus has been declared a global health emergency by the WHO, and has nearly doubled in its spread.

Singapore was one of the first countries to implement these measures, with the United States following suit on Feb 2, banning the entry of nationals who traveled in China within 14 days of arrival to the United States.

2. How effective are these measures in the first place?

Airport temperature screening in Australia. (Source)

We aren’t really sure right now.

A 2014 WHO review of 23 different studies showed that travel restrictions are ineffective in delaying the peak and magnitude of epidemics. More specifically, it argued that an almost complete (90%) air travel ban is needed in order to delay the spread of pandemics by 3–4 weeks. These policies also have a minimal impact on the overall magnitude of the pandemic, typically reducing attack rates by less than 0.02%. While this slight delay might seem insignificant, proponents of travel restrictions argue that they provide valuable time for other interventions. It allows scientists and governments to research, produce and distribute effective vaccines and antiviral drugs. The later the stage of the epidemic, the less lethal the virus becomes.

However, there are issues with these types of reviews. Measuring the effectiveness of specific policies during pandemics is hard. This is mostly because they aren’t implemented exclusively, and are part of a broader countermeasure approach to the virus. In other words, we might not know how many cases of the 2019-COVID have been stopped by the travel restrictions alone because these numbers are also affected by other measures like the 14-day mandatory quarantine.

Maths, Models and Epidemics

The only other reliable way that scientists can conduct studies are through mathematical models, which have their own variables and limitations.

One such variable is the basic reproductive or R0 number (pronounced R-nought) of the virus. Measuring the transmissibility of the strain, it can be thought of as the expected number of cases directly generated by one case. Generally, the higher the R0, the less effective travel measures are. Preliminary studies of the 2019-COVID place its R0 anywhere from 1.4–6.6. In other words, scientists aren’t in agreement over how contagious the disease is and thus, the probable effects of these policies hang in the balance as well.

Another issue with mathematical models are that they are highly specialised. A look through the studies compiled by the WHO show that most of these models were constructed for individual countries like the U.S and the U.K. Considering that Singapore has a special relationship with China, with the Chinese constituting the highest number of visitors to Singapore, it wouldn’t be right to apply those models here.

Enforcement might be an issue as well. While these models assume that it would be possible to completely and systematically stop travellers from specific regions, in reality things might be much harder. Adam Kamradt-Scott, a professor in global health at the University of Sydney shared a revealing example in an interview with Vox. When the SARS outbreak was at its peak, he had a colleague who needed to return to the U.K from Toronto, one of the most badly affected cities. To circumvent U.K travel restrictions, which prohibited travelers from Toronto, she took a domestic flight to Vancouver, then boarded a plane to London. “When she arrived at Heathrow and authorities asked her, ‘Have you been to Toronto,’ she said no and walked right through.”

So to answer the initial question, while we don’t know how much these travel restrictions have delayed the spread of the 2019-COVID in Singapore, there seems to be a general consensus they should have delayed the spread to some extent — and that might be a good thing.

3. What are the other implications of implementing these measures?

China has been increasingly asserting its will on South-East Asia. (Source)

The implications are far-reaching and transcend the public health debate.

On a diplomatic level, banning people from a certain country could be interpreted as a vote of no confidence in that country’s government, and its ability to handle the crisis. Beijing for its part denounced Washington for its travel ban and for “unceasingly manufactured and spread panic,” noting that the WHO has advised against travel restrictions. While the spokesperson didn’t refer to Singapore, the only other country that had similar restrictions at that time, it isn’t a stretch to say that these statements could apply to the island state as well. As the only country outside China, Hong Kong and Taiwan to have a majority-Chinese population, many observers also argue that Beijing has been increasingly assertive with Singapore — wanting it to keep China’s interests at heart.

There is a very fine line here. On one hand, Singapore needs to safeguard its own independence and do what’s best for its people. On the other, souring ties with a superpower (that also happens to be the country’s biggest trading partner) is not an option. This careful balancing act can even be seen in the way the government announced the travel ban. Minister K. Shanmugam first made it a point to emphasise that the restrictions were made based on the “situation” rather than on nationality, and that Singapore has confidence in China’s ability to deal with the virus. DPM Heng Swee Keat then announced on February 7, that the Republic would be sending China “test kits to conduct 10,000 tests at the first instance, together with three polymerase chain reaction (PCR) machines.” The message here is clear: the travel restrictions were implemented on a completely utilitarian basis and aren’t an indictment of China or its response.

4. So were the policies implemented too late?

Probably not.

The Chinese authorities instituted the Hubei lockdown on 23 January. The event was a turning point in the virus’s spread, as it signalled that the situation had become dangerous — so much so that China was willing to take measures that were “unprecedented in human public health history.”

One might argue that Singapore should have followed suit and banned people with travel history to China on 23 January as well. But logically, these arguments don’t stand up to scrutiny. If we look at the first 10 cases of imported 2019-COVID, we can see that the patients all arrived in Singapore on or before 23 January. This would mean that this specific travel ban would not have had much impact on the import of the initial cases.

In order to stop the earliest possible imported case, the travel ban would have had to be implemented on 19 January. This would have been way too premature, considering that the severity of the situation had not been determined. At this point, the total number of worldwide confirmed cases, according to the WHO was only 282. In fact, it wasn’t till 20 January that Chinese scientists declared that human-to-human transmission was even possible.

There are also the diplomatic considerations — a travel ban instituted that early would not only be seen as an overreaction by the international community, but also by China. Given the lack of information during the initial stages of spread, the motives for implementing such a travel ban would be scrutinised and be called out for being discriminatory.

Overall, it is important to note what the science says about travel restrictions: they have very little impact on the overall number of people affected, but are useful only in delaying the inevitable. In order for the delay to be of use, it needs to be significant — so that we can find cures and better means of treatment. Thus, a difference of a week or two might not make a profound impact in the first place. We also need to look at these policies with a geopolitical lens before we pass quick judgement.

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