Virus mitigation measures suggested by medical practitioners implemented two months later

On 10 February, four medical practitioners in Singapore came together to sign a letter advising people to wear face masks when leaving their homes to help control the spread of COVID-19 in Singapore. In the letter entitled, “Health advisory from senior medical practitioners to Singaporeans”, the practitioners highlighted how “things are not so straightforward” with the Covid-19 as it was with Severe acute respiratory syndrome (SARs) coronavirus in 2003. The doctors—Dr Tham Hoe Meng, Dr Colleen Thomas, Dr Judy Chen, and Dr Lim Pin Pin—pointed out that given this virus is said to be milder and can be transmitted silently by asymptomatic people, “a certain percentage” of the population will be developing this deadly disease. The doctors warned that temperature screening is less effective in identifying those who might be infected, stressing that masks are crucial to curb the spread of the virus. “As they mingle freely and unmasked, more and more people could be infected daily without even knowing it,” said the practitioners. “We are advising everyone to wear a mask always when leaving home. If one faces a person and both parties are masked, it is considerably safer, constituting a 2 barrier protection. It may not possible for everyone to get a new surgical mask every day. We need to find creative solutions. Some people have purchased washable cloth masks, sewed them, constructed them with suitable paper, or tied a scarf to the face. These measures are better than no mask at all.” wrote the letter. The letter also advised people to avoid unnecessary mingling and included tips on how this could be achieved such as. Here's a run-down of their advice:

• Everyone should wear a mask at all times
• Avoid necessary mingling
• Minimise mingling in air-conditioned environments such as malls and eateries
• Use online delivery services
• Schools to switch to home-based learning
• Minimise crowds and length of service at places of worship, and use natural ventilation

The doctors noted, “If we all do this 2M rule (wear Mask, stop Mingling) in 2 weeks the worst could be over.” The practitioners clarified that they are not trying to disclaim the health authorities who have a very challenging task but professionally they feel the need to disseminate this message immediately in the interest of safety and life preservation. “We are confident that the authorities will respond accordingly in the interest of Singaporeans’ health.”

MOH says "mask is not the most important thing"

However, a couple of days after the letter was circulated online, Associate Professor Kenneth Mak, director of medical services at the MOH responded that wearing a mask is not the most important thing to do to keep the coronavirus at bay. When queried about the letter, he said that the other advise in the letter such as ensuring hands are regularly washed, is relevant. He elaborated, “And be aware of things you commonly touch. The thing most commonly touched is your phone, so wearing a mask is not the most important thing.” This has been the government’s stance since the beginning of this pandemic, at least until recently. The multi-ministerial task force headed by Health Minister Gan Kim Yong and Lawrence Wong had urged Singaporeans to refrain from hoarding masks and said that masks are needed only by those who are unwell and need to see a doctor. The same message was echoed by Prime Minister Lee Hsien Loong who highlighted on his Facebook page on 30 January the Ministry of Health’s (MOH) advice to only wear masks if unwell. “There is no need to wear a mask if we are well.” wrote PM Lee. Mainstream media also continued to peddle this stance by continuously reporting on similar points, and with MOH placing ads in major daily newspapers telling the public that they only need to wear a mask if they are sick. Beyond the policy on mask usage, the government also did not adopt measures as other countries such as neighbours Malaysia which initiated a nationwide lockdown and movement control order on 18 March that is still ongoing till the circuit breaker measures were announced on 3 April.

U-turn on policy and gradual tightening of measures

Now, despite the advice of those four medical practitioners being seemingly brushed aside when the letter was first released, it appears that the government has implemented most of those suggestions at this point. Though it took them some time to get to this point. The government opted for a gradual tightening of measures starting with first restricting only travellers from the Wuhan region before expanding that to include all travellers from China. Only later did the ban include travellers from high risk regions such as Italy and Iran. Then on 26 March, the government ordered a shutdown of all bars and entertainment outlets where there is a higher risk of transmission. However, other public venues such as retail malls, museums and attractions, where contact is more transient were allowed to remain open at the time. Also, all religious services and congregations were suspended as well, though places of worship were allowed to remain open for private worship and essential rights so long as groups were strictly limited to 10 persons or fewer at any one time. The tightening of measures to curb the virus picked up ace on 3 April when PM Lee announced in a televised broadcast that the country would be implementing stricter regulations, what he termed “circuit breaker” measures. This included that the government will no longer be discouraging the public from wearing a mask, a reversal of previous government policy. “We also now have evidence that an infected person can show no symptoms, and yet still pass on the virus to others,” said the premier, adding: “This is why the WHO is reviewing the issue of face masks, and so is the US CDC.” “Therefore we will no longer discourage people from wearing masks,” said Mr Lee. He said that this advice is based on scientific advice and guidelines” from the World Health Organization (WHO), a point that was reiterated by Mr Wong in the multi-ministry task force press conference that followed PM Lee’s address on the same day. With these new circuit breaker measures which kicked in on 7 April, the government has also shifted schools of all levels to home-based learning, prohibited dining in at eateries including hawker centres, encouraged people to only leave their house for essential products and services, urged the public keep a safe distance from others when exercising in neighbourhood parks, closed non-essential offices and encouraged employers to switch to remote working. Bars and entertainment outlets remain closed, but that list now included casinos, sports and recreational facilities, and all recreational facilities in hotels. Houses of worship also remain shuttered. According to the MOH's latest report, Singapore has confirmed 3,252 cases of  COVID-19 thus far, and 10 fatalities due to complications from the virus. So the question is, would the situation in the country be better if the government had implemented these measures as suggested by those four medical practitioners months ago?