PRC with virus uses public transport but MOH says risk low; Bloomberg says some patients have no fever

It was reported yesterday (24 Jan) that two more imported cases of the Wuhan virus into Singapore has been confirmed by the Ministry of Health (MOH) in addition to the first case.

The first case is a 66-year-old PRC from Wuhan. MOH said 46 close contacts were identified with 24 already left Singapore. Another case is his son.

The third case, however, is a 53-year-old female PRC also from Wuhan who has no relationship with the first two. She arrived in Singapore on Tuesday (21 Jan) and presented herself at Raffles Hospital the next day with cough and fever. However, she was immediately transferred to Tan Tock Seng Hospital before being isolated.

MOH noted the PRC woman’s movements as reported by her:

  • Landed on 21 Jan on Scoot flight TR121 from Wuhan at 5.30am
  • Cough and fever developed on 22 Jan
  • Traveled with a companion
  • Stayed at J8 Hotel near Lavender MRT station
  • Visited Orchard Road
  • Visited Marina Bay Sands
  • Visited Gardens by the Bay
  • Traveled on MRT and taxies

MOH spokesperson, Director of Communicable Diseases Vernon Lee said there is no need for alarm.

Dr Lee said for those who may have come into contact with a patient but were not in close proximity or for a prolonged period – for instance, someone who encountered a patient at a check-in counter, they would be put under phone surveillance. They would receive daily phone calls from the authority for 14 days since their last exposure to the patient to ensure they are well.

“If they are not feeling well at any point in time, we advise them to put on a mask and see a doctor,” said Dr Lee.

For transient contacts like those who walked past the person on public transport or in public places, their risk of getting the infection is low, Dr Lee added. Still, he advised anyone to see a doctor if ill.

The authorities are carrying out contact tracing to find out what exactly the 53-year-old did in the places she visited.

No fever in some patients with Wuhan virus

Meanwhile, Bloomberg also reported yesterday (24 Jan) that some of the patients in China with the virus may not have any fever and the pathogen’s incubation period could be up to two weeks, according to people familiar with the matter, who asked not to be named discussing the situation.

A spokesman for China’s National Health Commission (NHC) said that the understanding of the new virus and its symptoms changes over time, and that their doctors have observed some patients with low or even no fever as the number of infections increased.

The lack of fever as a symptom means that temperature screening – the main method now being deployed at airports and transport hubs to control the outbreak – would fail to pick up on at least some cases.

”The whole airport screening exercise is to simply give people comfort that there is some government action to protect the public,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy in Washington, D.C. “It has no real public health utility in the case of coronaviruses. What really matters is surveillance, infection control and isolation.”

The discovery that people could be infected without their temperatures spiking, and that the virus could lie dormant for a relatively long period of time, increases the likelihood that carriers are currently traveling freely, intensifying the virus’s spread.

Several people who’ve died from the virus in China didn’t display symptoms of fever, NHC revealed, though they displayed other symptoms such as breathing difficulty, chest tightness and coughing.

Dr David Heymann, a UK infectious disease researcher who advises the World Health Organization, cautioned that relying solely on thermometers would not be sufficient to catch all possible cases. “Alone as a means of keeping infection out of countries, they provide a false security,” said Dr Heymann. People can cross borders without a fever then get sick after their arrival and taking paracetamol or aspirin can bring a fever down so it isn’t detected, he said.

“Screening is not 100% efficient but without screening you are even worse,” said Wang Linfa, a diseases expert at the National University of Singapore (NUS). “Other than monitoring temperature, the other thing is to encourage citizens to stay in and do not go out.”


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