13 Apr 2020 (12 pm - 10pm)
REACH
[11:37 am, 13/04/2020] : [Sent by Gov.sg - 13 Apr
COVID-19: Stay updated with official sources
π» Websites on COVID-19 situation
MOH: moh.gov.sg/covid-19
Gov.sg: gov.sg/features/covid-19
π±Receive updates on the go
go.gov.sg/whatsapp
go.gov.sg/govsg-telegram
π€ COVID-19 Info Bot - a repository of answers to your questions on latest measures
βΉ Summarised info from different govt agencies, organised into topics that are of interest to you
gov.sg/infobot
π₯ Sick? Find a PHPC clinic near you
phpc.gov.sg
π€§ COVID-19 online symptom checker
sgcovidcheck.gov.sg
π€³ Installing TraceTogether app
tracetogether.gov.sg
✅ Support for S'poreans & businesses
singaporebudget.gov.sg/budget_2020
π SG United Jobs Portal
sgunitedjobs.gov.sg
π³ Check how crowded malls/parks are before going
www.spaceout.gov.sg
safedistparks.nparks.gov.sg
π Hotlines
MOH COVID-19 hotline 1800 333 9999
National CARE hotline -for those facing anxiety and stress: 6202 6868
Full list:
go.gov.sg/covid-resources
[11:57 am, 13/04/2020] : Greetings from REACH
A warm welcome to those who have just been added to this chat group.
The topic for today will be posted shortly.
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https://go.gov.sg/reach-whatsapp-terms
Megan π
[12:00 pm, 13/04/2020] : Dear contributors,
Welcome back! ☺️
⏰ Our chat will be open till 10pm today.
REACH is constantly taking note of all the feedback and suggestions shared on our WhatsApp chats, and will send them to relevant authorities for consideration.
π’ Topic: π’
Today marks one week since the start of the "circuit breaker" period.
1. Have you adjusted to the tightened circuit breaker measures?
2. How are you staying connected to your family, friends, schoolmates or colleagues?
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[6:46 pm, 13/04/2020] ☸️ Danny εΏ:
Joint Contribution with my close friend :-
(1) The rise in unlinked cases (167 on 12 apr) and large number of cases (in the hundreds) is alarming as this suggests community spread is (i) becoming pervasive (ii) likelihood that asymptomatic persons are contributing to the rapid spread and (iii) current method of contact tracing is unable to cope.
(2) we hope that the relevant authorities widen the test criteria for covid19 e.g. It was reported that a confirmed case was having fever and cough but was not tested and after the symptoms persisted for several days and was finally tested and confirmed. During the period where the symptoms appear to confirmed it might have spread to several others and chain of transmission proliferates exponentially. When community spread has become pervasive, can the authorities consider widening the test criteria e.g. Persons who showed symptoms and worked in public facing environment should be tested.
(3) In the case of diamond princess cruise ship, asymptomatic cases constitute 18%. In south Korea case, 20% out of 9000 studied. This is a very worrying statistic. In the case of outbreaks at foreign workers dorms, our foreign workers are like the passengers on board of diamond princess cruise who are isolated within their cruise ship cabins. The covid19 virus thrives in the environment and invisibly being carried around. Can we plead with the authorities to rapidly test and isolate and treat those workers who already have been infected and not wait for symptoms to appear please. From the humanity standpoint, we are responsible for their well being. From the pandemic standpoint, we cannot afford to let the cases explode.
(4) With the large daily number of cases and if these were a result of community asymptomatic spread, contact tracing based on closed contact will need to be enhanced. Can the authorities look into contact tracing using mobile signals. The privacy issue related to such tracing should be allowed during such special situation. Once a person is confirmed, can the authorities retrieve from Telcos the mobile signal logs related to the person in question and trace his/her movement over the past 14 days. And all the related mobile signals that were in close vicinity. We can them identify all the persons who have come close the the confirmed case and perform tests in them on them. If positive, isolate and treat quickly without waiting for symptoms to appear and isolate those who are tested negative.
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[6:47 pm, 13/04/2020] ☸️ Danny εΏ:
Taking reference to SKorea experience in briing local transmission down
We can also take reference to a SKorea epidemic professor interview - in which they have adopted and succeeded in bringing down their local transmission :-
--- SKorea conduct many tests and 20% of 9,000 don't show symptoms.
--- SKorea wear mask including resusable washable ones (and many wear spectacles) - good barrier to reduce infection (as oppose to the West - who dislike wearing mask).
- WHO recommendation initially for public not to wear mask is wrong - which explain why West has such a rapid infection rate as opposed to Asians who wear mask in public.
-- SKorea are using location tracking system to ensure quarantine people stay at home and help to do contact tracing - as people in SKorea consent to their Government - even means intruding into their personal privacy.
- The best scenario is where covid-19 run its course by itself like SARs or if vaccine is developed like smallpox where the whole human race got vaccinated and the epidemic cease.
- Plasma of recovered patients have anti-bodies that can help critically ill patients (who belong to the same blood type) to recover.
- covid-19 patients will depend on their immune systems to fight against the virus to recover as there are no vaccine and standard treatment announced currently (only trial medicine). Thus older patients with existing conditions will have weaker immunity and thus more vulnerable.
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[8:33 pm, 13/04/2020] ☸️ Danny εΏ:
Coronavirus: WHO says 70 vaccines in the works, with three leading candidates
https://www.straitstimes.com/world/united-states/coronavirus-who-says-70-vaccines-in-the-works-with-three-leading-candidates
DRAFT :-
Key points are :-
(1) Ring fencing a bigger target.
(2) Then widen criteria to test.
(3) Lesson learned from SKorea.
Joint Contribution with my close friend :-
Part ! - 2 Things that we felt have loopholes - that can be done better (at the backdrop of more and more local transmission)
(1) We are getting increasingly more and more concern as local transmission - is now the predominant infection source. Imported infection is very low and in 13 Apr 2020 is zero.
(2) What is worst, now the main transmission sources come from unlink cases :-
13 Apr 2020 - 167 cases (where 141 are foreign workers working in dorm) and the rest are residents.
12 Apr 2020 - 119 unlink cases
10 Apr 2020 - 71 unlink cases
(3) We felt that mild asymptomatic cases could be the major infection sources in our local transmission.
(4) If this is the case, 2 things we do currently may not go right and may have flaws :-
a. Contact tracing and Testing
b. Quarantine in dorm and Testing
a. Contact tracing and Testing
- by identifying the infected person - and trace those people he/she contacted with - may have misssed important infection sources :-
- eg. the toilet he/she visit (as he/she may discharged droplets and virus in wash basin and toilet bowls.
- eg. infected person use his contaminated fingers to press the lift buttons, hold the handrail in MRT or bus or sneeze or cough in the lift.
- eg. infected person eat in food court and contaminate the chairs, tables, utensils etc
- although other people did not come into contact with this infected person --- they may still get infected - that result in the many unlink cases.
- Tracetogether mobile apps - will not be able to detect such unlink cases.
- So even if the contact tracing is 100% successful and all those who come into contact with the infected person are trace through the Tracetogether apps (assume all people installed) or detective means, tested and quarantine or Stay at Home ----- the above infection sources can still infect healthy people that come into contact with contaminated areas --- as tracetogether won't tell where the infected person has leave his/her trace of contamination.
Even through personal interview, he/she may not remember all the places he/she goes.
b. Quarantine in dorm and Testing
- Currently, we are using gold standard test ktis - a very accurate lab test - that take about 1 day to know the result.
- And in total, can only conduct about 2,900 to 3,000 test a day.
- In a dorm that are currently quarantine, there are 24,000 foreign workers - and it will need 8 to 9 days to complete.
- While waiting for the tests, there could be more infection even though social distancing may be implemented as mild asymptomatic cases may sneeze or cough and infect the doors, chairs, water basin, toilets, food, utensils, TV, gadgets - and anyone touch if may get infected - if the tests are not done fast enough.
- This could have explained why we have 141 dorm workers are infected as unlink cases in 12 Apr 2020.
Part 2 - Proposed 2 Alternative approaches to plug the loopholes
aka datang .............
==============
Joint Contribution with my close friend :-
Part 2 - Proposed 2 Alternative approaches to plug the loopholes
(1) And we will like to propose an alternate perspective and approach (that deviate from how the above 3 things are done) - as the number of local transmission cases and unlink cases are on the rise every day.
a. Contact tracing and testing
- Based on the scenario described in Part 1, where vicintiy and surface areas can be contaminated by infected persons ---- Cannot be based on close contact anymore.
- Adjusting Contact tracing approach become important.
- "Like I heard in HK", one person infected , entire block qurantined, everyone in the block need to be tested and the whole block need to be disinfected.
- By using this approach - we can catch and weed out those mild and asymptomatic cases where they don't come into contact with the infected person - but got infected by contaminated surfaces, aerosol left in the air.
- Thus we felt that using Tracetogether mobile apps and even detective legworks - will not fully cover all the contaminated areas as well as those people who don't come into contact with the infected person - but got infected by touching contaminated areas (as tracetogether don't identify areas that the infected person visit and people may tend to forget certain place they visit when interview by detective).
- A more effective method is to use location-based tracking - such as mobile signal data, GPS location tracking that we can collect from the respective Telcos - that provide all contact data for contact tracers to scientifically traced all people in the vicinity that is visited by the infected person - and get all these people tested, quarantine if need be.
(Question :- Is it possible to use mobile signal tracing to trace all the places that the person has visited over the past 14 days? And trace all the signals that were in the same premises around the same time?
Answer :- Yes. All are logged into the syslog.)
- There is a need to widen the criteria for tests - as we know that there is a limit a test can be done per day using our golden standard test kits - that need lab test to verify the outcome and will need a day to know the test result.
- As such, there is a need to have a faster and cheaper tests --- that is a rapid test kit to quickly test those people in the vicinity that have no close contact with the infected person - though with 95% accuracy.
- For those that show symptoms and for those that come into contact with the infected person --- the golden standard lab test kit - can be retested on these people - to ensure they are not infected - if yes - then sent to hospital for treatment, else quarantine at home.
(The point is - Even if there 95% accuracy, can quickly isolate the infected.)
b. Quarantine in dorm and Testing
- As foreign workers are so many and even by practising social distancing - it is still possible to get infected by contaminated surfaces as mention in scenarios described in Part 1.
- And in total, as we can only conduct about 2,900 to 3,000 test a day using golden lab test kits ---there is a need to quickly ramp up the tests before more and more foriegn workers got contaminated --- as evident in 141 foreign workers are infected on 12 Apr 2020.
- Thus using the rapid test kits will be one way to speed up the dorm foreign workers testing.
- For essential jobs, foreign workers need to undergo the golden standard lab test - as they will need to go out to community to work - and if not 100% proven - can infect the community.
- For those who are symptomatic, golden standard lab test also need to be conducted - and if found infected - got to be treated in hospitals.
Summary :-
- We felt that the above 2 approaches will be able to plug the gaps and bring down the number of local transmission - either through unlink cases, new clusters or continue infection in foreign workers dorms.
------
Joint Contribution with my close friend :-
Part 3 - Taking reference to SKorea experience in briing local transmission down
We can also take reference to a SKorea epidemic professor interview - in which they have adopted and succeeded in bringing down their local transmission :-
--- SKorea conduct many tests and 20% of 9,000 don't show symptoms.
--- SKorea wear mask including resusable washable ones (and many wear spectacles) - good barrier to reduce infection (as oppose to the West - who dislike wearing mask).
- WHO recommendation initially for public not to wear mask is wrong - which explain why West has such a rapid infection rate as opposed to Asians who wear mask in public.
-- SKorea are using location tracking system to ensure quarantine people stay at home and help to do contact tracing - as people in SKorea consent to their Government - even means intruding into their personal privacy.
- The best scenario is where covid-19 run its course by itself like SARs or if vaccine is developed like smallpox where the whole human race got vaccinated and the epidemic cease.
- Plasma of recovered patients have anti-bodies that can help critically ill patients (who belong to the same blood type) to recover.
- covid-19 patients will depend on their immune systems to fight against the virus to recover as there are no vaccine and standard treatment announced currently (only trial medicine). Thus older patients with existing conditions will have weaker immunity and thus more vulnerable.
----
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