REACH - 53. 28 days circuit breaker may not be enough if we don't obey (SK)
17 Apr 2020 (12 pm - 10pm)

REACH
[12:02 pm, 17/04/2020] : Dear contributors, welcome back!
📢Topic📢
Environment and Water Resources Minister Masagos Zulkifli said on Thursday (Apr 16) that a 28-day "circuit breaker" may not be enough if Singaporeans continue to flout measures put in place to stem the spread of COVID-19.
What can we do to help those around us adapt to the COVID-19 measures and abide by the rules?
👉https://www.channelnewsasia.com/news/singapore/covid-19-circuit-breaker-mask-enforcement-masagos-coronavirus-12649274


REACH
[2:50 pm, 17/04/2020] : In the meantime, how about we move on to our next discussion topic?
☕Tea Break Question☕
What inspiring stories of hope have you come across during the circuit breaker period?
Together, we can overcome!
#SGUnited

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[4:02 pm, 17/04/2020] ☸️  Danny 心: ----

Joint Contribution with my close friend :-

Part A - Sizing up the current infection scenarios :-

NOVEL CORONAVIRUS CASES IN SINGAPORE (16 Apr 2020)
New cases announced on Apr 15 728
Confirmed cases so far 4,427
Recovered 683
Still in hospital 1,886
In isolation 1,848
Deaths 10

My close friend observation :-
[6:01 pm, 15/04/2020] ☸️  Danny 心:
(1) Covid19 is teaching the world many lessons. One of which is mathematics. Please see attached 6 day forecast for singapore from 12 apr to 19 apr. Given yesterday's new cases we are already heading towards the worser scenario (source : http://rocs.hu-berlin.de/corona/docs/forecast/results_by_country/). Moving forward, we heading in the direction of 4000+ to 5000+ cases by Sun, 19 apr.

(2) Yesterday total infection is now 4,427 - very close to my close friend mathematical projection of of 4000+ to 5000+ cases by Sun, 19 apr.

(3) What are the 3 major sources of infection in Singapore now :-
a. Dorm foreign worker infection (yesterday figures are 654)
- this is like a cruise ship where many workers are living in close environment.

b. Community spreading (yesterday figures are 48)  - likely to come from 2 sources :-
i. family member or in nursing homes - members who are infected but show no symptoms - and quietly spreading to those who stay with them.
ii. People working in essential services - where some are infected with no symptoms but quietly spreading to the community (eg. 4 netlink workers infected - and 2 has visited homes for fiber broadband installation).
Note :- there are people working in hawker, food centre, supermarket and other essential services at workplace.

c. Foreign workers living outside dorm (yesterday figures are 26)

d. Imported cases = 0 for many consecutive days.

aka datang ......
Part 2 - What should be our focus point to bring our local transmission to Zero

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Part 2 - What should be our focus point to bring our local transmission to Zero

(1) Foreign Workers dorm infection
- though the number is increasing exponentially - we feel that this is not a major cause for alarm as it is not unexpected because it is cram inside like cruise ship.
- With more aggressive testings, the big number will surface.
- However when all foreign workers in the dorm are tested, the number will go down and can even go down to zero as those infected will have been sent to the hospital for treatment.
- The situation in the dorm is self-contained - as they are quarantined in the dorm and will not spread to the community.
- The only concern is that our hospital facilities and medical personnel could be over-strain.
- But no choice, if we don't do aggressive testings to identify those infected - the virus will not stop infecting --- and in fact will continue to snowball quietly and exponentially.
- Thus aggressive testings to quickly identified all symptomatic and asymptomatic - is the key to curb and prevent the quiet snowballing and quickly quarantine and put them in a hospital or community medical settings away from the main community --- will be the only effective way to bring the local transmission down to zero.

(2) Spreading within the local Community

a. Family members or people staying in the same house
- I intend to focus on tackling the community spreading which actually worries me even though circuit breaker measures are in place.
- Assume everyone is observing the measures conscientiously by staying at home or wearing mask, how did the community still get infected?
- It could be their families members or in nursing homes, those people who are staying with them.
- Then to weed out the mild asymptomatic cases, there may be a need to test those who are staying with them.
- I think we are not too far off from weeding out and bringing down the community spreading to zero if we do that because community will have little chance to spread if their contact with others are limited except those who stay with them. (Assume that everyone take the Circuit Breaker measures seriously by staying at home and wear mask when going out for essential).

b. People working outside in essential services (eg. food courts, coffeshops, supermarket, bus captain, counter staff, delivery persons etc
- My close friend added that - we should not forget about those people who are working outside in essential services that may get infected by asymptomatic cases. (As we speak, CNA news reported that :- Four employees of Netlink contractor test positive for COVID-19, two visited homes for fibre broadband installation).

- My close friend noted that :-
i. Family members known group, can test.
ii. Non  public facing workers limited interaction, can trace.
iii. Public facing workers cannot trace. Therefore, once they display symptoms must quickly test. The old protocol is go home rest 5 days, still sick see doctor. But now we know, covid cases becoming clinically well still carry virus with them
Before releasing quarantined, important to test them.

-- The above approach should also apply to those foreign workers that are not living in the dorm).

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Part 3 - Strain public medical facilities and medical personnel
- Of course the Circuit Breaker measures (where people need to Stay-at-Home and wear face masks if go out to buy essential) --- will be the most effective way to break the transmission chain ---- if everyone observe the measures conscientiously.

- Our only worry is that, by adopting aggressive testing to weed out the mild asymptomatic cases, can our hospital facilities, medical officers cope?

- But the good news is :- CNA just reported that more private clinics are gearing up to do tests in Singapore.

- That's good. Maybe test kits have geared up - and private sector clinics medical personnel can be an added medical manpower sources to relief the over-strain public hospital facilities and public medical personnel.

Summary :-
- We hope that by adopting the above measures in tackling :-
a. foreign worker dorm - once all tests conducted (the number will drop to zero)

b. community (family members or people not of same family staying together) - by containing and testing the house as a group

c. workers working in essential service (by containing and testing those who are not facing public) as well as contact tracing those workers facing public

c. foreign worker not staying in dorm - apply the same approach as point b. (by containing and testing those workers that stay together).

-- there is a possibility of bringing down the local transmission to zero --- provided that the rest of the Community strictly and conscientiously observe the Circuit Breaker measures - by Staying-at-Home, wear a mask if go out for essentials.

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Ron Ho
[4:12 pm, 17/04/2020] : Summary of a webinar with DMS Dr Kenneth Mak

1. Current outbreak is the 4th wave.
Theory: travellers who were asymptomatic spread the infection to Mustafa Centre. 50 staff members of Mustafa’s were quarantined. Then the foreign workers (FW) visited Mustafa and got infected.

The infection then spread between the dorms because the workers from the various different dorms work together in a common construction site.

2. Steps taken to control the spread among FW:

A) segregate the FW

B) set up medical posts in some dorms, manned by doctors and nurses.
This was met with limited success because the FW were too afraid to go down to the medical posts to get tested when they had symptoms

C) Active Searching - in some dorms, they actively went to the rooms and did the swabbing. This method picked up some positive cases.
The recent increase in Covid cases is due to this Active case finding.

D) Decant some FW from the more contested dorms (this is still ongoing)

E) Identify and remove the FW at risk (>50 years old, with concurrent chronic medical condition) from the dorms

3. The new suspect case definition included anosmia as a symptom because local experience showed that some cases presented initially only as fever and anosmia. The respiratory symptoms only occurred later.

4. If GPs send their patients to SASH polyclinics, the polyclinics won’t inform the GPs if the results are positive. The GP has to check NEHR for the results. So they’re encouraging all GPs to quickly sign up on NEHR.

5. Temasek is going to roll out community testing via imported testing booths (!)
The private labs will be running the Covid tests for them.

6. Currently there are 170 GP clinics which are SASH clinics. That’s an encouraging response from the GP community.

7. The current available POC antibody test kits are not reliable.
The manufacturer had quoted over 90% sensitivity but when MOH tested them, it was only about 30% sensitivity!

Dukes serology test is more sensitive than the POC kits.
MOH will be doing more serology testing in the coming weeks.

8. They are coming up with protective face shields for the general public.
But these are not for HCWs in high risk clinical situations.

9. Dr Mak said the circuit breaker was meant to stop local community transmission. It wasn’t intended for the situation currently seen in the FW dorms.

MOH will be watching the numbers very carefully this weekend to see if the local numbers come down. This will determine if the CB needs to be extended or not.

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[9:43 pm, 17/04/2020] ☸️  Danny 心:
As we conscientiously debate and observed the circuit breaker measures - we must not lost track of the bigger picture :-
(1) Circuit breaker measures is to stop the chain of local transmission - so that the health of residents in Singapore must not be endanger.

(2) Economy must continue to survive and engine must not stop - albeit functioning behind the background - through telecommuting, eCommerce, Digital Economy and eDelivery.

(3) We must be mindful that the Country has spend $59.9 billion on the circuit breaker to ensure the chain of local transmission is broken.
We have already drawn out on our reserve of $21 billion - do everyone want to continue to burn our money away by not taking the circuit breaker measures seriously?

(4) We must also bear in mind that if we don't succeed in keeping the infection down and flatten the infection curve :-
- some business may not be able to survive
- some people may start to lose their jobs
- cause tremendous strain on our hospital facilities and tired out our medical personnel toiling round the clock from Dec 2019 to Apr 2020 --- 5 months already - and may burn them out.
- and the Country may have to continue to burn more of our National savings and reserves to extend the circuit breaker measures.

The above are the bigger picture that we must always bear in mind - in our input to REACH ---- that we must never lose the big picture.
Our ideas must focus on  trying how to bring the infection number down, community spreading down and our ultimate KPI as a whole is to flatten the curve.

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[9:53 pm, 17/04/2020] ☸️  Danny 心:
(1) Most important, this Circuit Breaker measures is the best time for the business in Singapore - to transform business in Singapore to adopt eCommerce, Digital Economy, eTransaction, eDelivery ---- that ITM (Industry Transformation Map) has set out to do for the 23 industry sectors.

(2) We have mixed result prior to the pandemic.

(3) Now with this pandemic hitting our Economy with furore - and force people to work online and remotely ---- it is the best opportunity presented for our business to switch instanteously and with urgency into eCommerce, Digital Economy, eTransaction, eDelivery etc --- in order to survive.

(4) This seems like "Blessing in Disguise" --- a small light in Universe of Deep Darkness.

(5) When pandemic are finally defeated one day ----- our business will have been successfully transformed - as what ITM has orignially set out to achieve --- with little effort to entice or push it - it is driven by a crisis.

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