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. 2020 Mar 20;69(11):307-311.
doi: 10.15585/mmwr.mm6911e1.

Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore - January 2-February 29, 2020

Yixiang Ng, Zongbin Li, Yi Xian Chua, Wei Liang Chaw, Zheng Zhao, Benjamin Er, Rachael Pung, Calvin J Chiew, David C Lye, Derrick Heng, Vernon J Lee

Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore - January 2-February 29, 2020

Yixiang Ng et al. MMWR Morb Mortal Wkly Rep. .

Abstract

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019, and has since spread globally, resulting in >95,000 confirmed COVID-19 cases worldwide by March 5, 2020 (1). Singapore adopted a multipronged surveillance strategy that included applying the case definition at medical consults, tracing contacts of patients with laboratory-confirmed COVID-19, enhancing surveillance among different patient groups (all patients with pneumonia, hospitalized patients in intensive care units [ICUs] with possible infectious diseases, primary care patients with influenza-like illness, and deaths from possible infectious etiologies), and allowing clinician discretion (i.e., option to order a test based on clinical suspicion, even if the case definition was not met) to identify COVID-19 patients. Containment measures, including patient isolation and quarantine, active monitoring of contacts, border controls, and community education and precautions, were performed to minimize disease spread. As of March 5, 2020, a total of 117 COVID-19 cases had been identified in Singapore. This report analyzes the first 100 COVID-19 patients in Singapore to determine the effectiveness of the surveillance and containment measures. COVID-19 patients were classified by the primary means by which they were detected. Application of the case definition and contact tracing identified 73 patients, 16 were detected by enhanced surveillance, and 11 were identified by laboratory testing based on providers' clinical discretion. Effectiveness of these measures was assessed by calculating the 7-day moving average of the interval from symptom onset to isolation in hospital or quarantine, which indicated significant decreasing trends for both local and imported COVID-19 cases. Rapid identification and isolation of cases, quarantine of close contacts, and active monitoring of other contacts have been effective in suppressing expansion of the outbreak and have implications for other countries experiencing outbreaks.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Figures

FIGURE 1
FIGURE 1
Date of symptom onset and date of report for cases of coronavirus disease 2019 (COVID-19) (N = 100), based on importation and linkage,† status — Singapore, January 14–February 28, 2020 * Linked patients defined as those who were found to be epidemiologically linked to other COVID-19 patients or who had recent travel to China. † Unlinked patients defined as those whose source of infection could not be determined.
FIGURE 2
FIGURE 2
Interval from symptom onset to isolation or hospitalization (7-day moving average), of coronavirus disease 2019 (COVID-19 cases) (N = 100), by importation status — Singapore, January 14–February 28, 2020
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