Singapore has a high record of COVID-19 cases. Are we more dangerous, virus-wise?

TL;DR – Or are we just better at “catching” the cases, and other countries at “hiding” them?

So there’s an article on the South China Morning Post (SCMP) yesterday that went quite far. I had a quick look and if they’re not bluffing me, it’s the 17,000-shares kind of far.

The article looks at why Singapore has more Covid-19 (the virus formerly known as coronavirus) cases than Hong Kong (and in fact, a lot more other countries too). Such a good article I think all of you should go read if you have not already.

Spoiler alert 

So why does Singapore have more cases than Hong Kong? It boils down to three main reasons.

One, we have very high standards of detection. We cast the net so wide and so deep. The approach that our authorities take is a very proactive one, and our approach is to weed out all suspected cases and test. I guess with our small land size and high population density, this is the only right way. Singapore has a 70-strong team to work 24/7 for contact tracing.

Two, Singapore incentivizes people who suspect they might be infected to come forward by footing the medical bills and even providing allowance for people on Quarantine Orders and Leave of Absence (LOA).

Conversely, the punishment for not doing the right thing is high. People who breach Quarantine Orders stand to be fined up to $10,000, and landlords who evict tenants under Leave or Absence (LOA) are punished.

Last week, we even saw cases of Ministry of Manpower revoking work passes and suspending employer privileges for breaches.

Three, Singaporeans, by and large, have a high level of trust in the Government and tend to have faith in what the Government says in times of crisis or special situations like this. Also, if the people can trust that they will receive proper care and that quarantine facilities are decent, they will be more willing to come forward.

I suppose what is left unsaid in the article is that just because a country reported fewer cases or no case (think Indonesia, where they didn’t even test the people who returned from Wuhan), it doesn’t necessarily mean that you would be safer in those places.

Who knows? There may be silent carriers who have not been traced or are unwilling to step forward to be tested or treated.

Anyway, there’s a sorta related Facebook post from John Lam that has been going around. It is nearing 1,000 shares as I’m writing this.

John is in the asset management industry and would sometimes make insightful posts about finance and investment related topics. In the past, he has even explained in layman terms the differences between Temasek, GIC and MAS, and also discussed Net Investment Returns Contribution (NIRC), which is a key contributor to the Government’s revenue to fund our national budget.

His post yesterday about Singapore’s approach towards Covid-19 is just too good not to share, so I reached out to John who kindly gave me permission to republish.

Thanks, John!

Let’s assume that a particular hospital had 2 doctors. If you learnt that one doctor had a higher mortality rate than the other doctor, would you automatically assume that the doctor with the higher mortality rate is the lousier doctor?

What if you learnt that the doctor with the higher mortality rate was the more experienced and senior of the 2. Would you still come to the same conclusion?

What if I provided you with another piece of information – that the tougher, harder cases, were passed on to the more experienced physician while the younger doctor took on less life threatening cases.

Now it starts to make sense that because the senior doctor treated more life threatening patients, he would naturally have a higher mortality rate on record than the junior doctor.

In the same vein, Singapore has the highest record of COVID-19 cases outside of China. However, this does not necessarily mean that Singapore is more dangerous (virus-wise) than a neighbouring country with no cases or another cosmopolitan country with many Chinese visitors but somehow have fewer cases.

Looking at case numbers alone is just part of the picture. The other part of the equation is how effective the country’s administration is at detecting cases and whether people are disincentivised from “coming out”.

Although we can criticise the current administration for many things, such as not implementing travel restrictions sooner, etc. One thing we do know for sure is that Singapore is super efficient at contact tracing. Probably more so than any other country.

Singapore has 7 teams of 10 people working 2 shifts, 7 days a week to check on “close contacts” of coronavirus patients. Every patient warded would be made to do an activity map that is incredibly detailed, covering 24 hours, minute by minute over the previous 2 weeks in a process that leaves absolutely no gaps.

If there are gaps in memory, contact tracers will go through hours of CCTV footage from cameras dotted across the island to literally hunt down every possible close contact.

In essence for every confirmed case, Singapore could easily trace and lock down 80-100 close contacts and put them on a 14 days leave of absence (LOA).

Secondly, Singapore has done whatever it can to remove any disincentives that prevent people from reporting their illness.

If someone is placed on LOA but worried about losing their income or their jobs, they (if they are self-employed) or their employers will be compensated $100 a day until they get better or the LOA is over.

If a potentially infected patient is worried about sky high hospital bills, the government has stepped in to confirm that all their hospital bills will be covered until they are discharged.

If someone on LOA is worried about being kicked out of their accommodations by their landlord, ministers have gone on television giving stern warnings to errant landlords, who can be assured that punishment will come down fast and hard on them if they were to evict people on LOA.

This means that an infected person in Singapore is less disincentivised to own up to being infected than anywhere else in the world where someone might worry about losing income, losing their jobs, losing the roof over their heads or losing money over hospital bills if they were found to be sick from the coronavirus.

I don’t know how long this viral epidemic would last, but what I do know is that you are probably in no more danger in sunny Singapore than in many other countries in the world, where there may be few reported cases but an unknown number of “silent carriers” lurking around.

In times like these, the last thing we need to do is to panic. We need to stand together and overcome selfish instincts of self-preservation at the cost of societal good.

So let’s all do our part to not leave our hands unwashed, not touch our faces and not discriminate against healthcare workers.

End of the day, it is the society that works together and stand together that will survive this viral threat the best.

#SGTogether

DORSCON Orange is NOT an excuse to treat the frontline workers badly