COVID-19 PANDEMIC IN SINGAPORE

The National Centre for Infectious Diseases (NCID) is the result of many years in the planning, and it finally officially opened its doors in September 2019, just months before the entire world was tested by the COVID-19 pandemic. This book is the work of many people who represent an even larger pool of people from NCID, Singapore and the rest of the world in trying to understand and contain the SARS- CoV-2 virus. There are chapters on science, the public health response both locally and globally, as well as personal reflections from NCID and Tan Tock Seng Hospital staff and staff from other public healthcare institutions who were deployed to NCID which bring home the human impact of the pandemic. We are very grateful to all the authors for taking the time to put together their thoughtful chapters as well as the senior academics and public health leaders who have provided us with generous comments on the manuscript. We hope that the readers of the book will gain a better insight into the response to the virus from so many different perspectives. Although the pandemic has evolved far beyond the pages of this book globally, the lessons learned from the early days are still relevant. We hope that the chapters will be helpful as we review our experience of this pandemic and face the next emerging infectious disease in the years to come.

This book provides a comprehensive look at many different aspects of response in Singapore to the pandemic in the crucial first several months, including clinical, laboratory, epidemiology, research, community engagement and the unprecedented challenge of outbreak involving migrant workers in dormitory settings. On a personal note, it has first-hand accounts of staff at the NCID who were at the forefront of battling COVID-19 in Singapore. It also gives a global perspective of the pandemic, together with insights into the unique Singapore experience of managing the pandemic. The Singapore response to the pandemic has been something which the global community has been very interested in and this book is the first to comprehensively describe that response from a number of different angles which will be useful to scientists, clinicians, public health professionals and policy makers.

Contents:

• Overview of the COVID Outbreak in Singapore
• Introducing NCID
• Role of Animals in the COVID-19 Outbreak
• The Global Perspective on the COVID-19 Pandemic
• Epidemiology of COVID-19
• Singapore's Laboratory Response to the Covid-19 Pandemic
• Clinical Care and the COVID-19 Outbreak
• COVID-19 Research — The Singapore Story
• Community Engagement and Response to COVID-19
• Maintaining Business-As-Usual for NCID Clinical and Public Health Functions During COVID-19 Pandemic
• Public Health in Action Over at the Migrant Worker Dormitories
• Personal Stories from the Frontline

Readership: Healthcare, research, academia, public health, science.

'A blow by blow account by the key players in NCID, MOH and related agencies to apply the lessons learnt from SARS. A must read for all those with an interest in public health and infectious diseases in Singapore. This tome showcases the historical epic effort of many. Documenting it in the midst of the pandemic in itself is a herculean task. Kudos to the authors and the key actors for pulling such a feat.' - Clinical Associate Professor Tan Thuan TongSenior Consultant & Head, Department of Infectious Diseases, Singapore General Hospital

'This is an important and insightful capture of the multi-sectoral partnerships, as well as the planning and preparations that Singapore put in both before and during the COVID-19 outbreak, that allowed Singapore to respond effectively to manage the exceptional public health crisis.' - Professor Teo Yik YingDean, Saw Swee Hock School of Public Health, National University of Singapore

'COVID-19 has brought home cogently the point that unilateral actions have little chance of success and that we must pull together to overcome this pandemic. Besides showcasing the remarkable knowledge we have gleaned in the short time since SARS-CoV-2 arrived on our shores, this book reflects nicely the collective and coordinated efforts that Singapore has taken along with our international partners to combat COVID-19.' - Professor Chong Yap SengLien Ying Chow Professor in Medicine & Dean, NUS Yong Loo Lin School of Medicine

'Singapore has mounted a sophisticated, comprehensive and successful response to the spread of the COVID-19 virus, with remarkably low loss of life. This compendium of stories places the pivotal contribution of NCID in the context of Singapore's and the world's struggle to survive the pandemic. I am greatly impressed by the very rapid co-ordination of such a complex campaign, involving public health, laboratory, clinical and research modalities. What strikes me in all these reports, particularly the personal stories, is a wonderfully high level of morale, mutual trust and confidence in a positive outcome. This attitude is undoubtedly underpinned by a high level of preparedness and outstanding leadership and teamwork. It is an inspiring and compelling account from Singapore of the 2020 pandemic that has shaken the world.' - Professor James BestProfessor of Medicine and Former Dean, Lee Kong Chian School of Medicine

'Working closely together, researchers and clinicians from Duke-NUS and NCID demonstrated the full value of multi-disciplinary research moving from bedside-to-bench and back. As this book chronicles, these teams advanced understanding of this novel coronavirus and its origins, including significant breakthroughs in serological testing. Their contributions emerged as the first COVID-19 cases appeared in Singapore, while the rest of the world was just coming to grips with the magnitude of the pandemic. Collaborations like this transform medicine and improve lives.' - Professor Thomas CoffmanDean, Duke-NUS Medical School

'This book sums up Singapore's swift and coordinated response to the COVID-19 outbreak, drawing from past lessons learned. Undergirding these ecosystem efforts was NCID's playing a pivotal role as Singapore's vanguard against infectious diseases, and bringing together the R&D ecosystem, including A*STAR, the IHLs and other stakeholders, to pool our collective capabilities to render our fullest support to our healthcare sector. The resilience of our frontline workers shines through in the various stories in this book, and provides life lessons that all of us can draw from. When we look back at this moment in time, we will remember proudly how Singapore rose up to the challenge, especially our healthcare system. We will also remember the strong teamwork between NCID, the local healthcare system, research institutes and IHLs, public agencies, the private sector, voluntary welfare organisations and many others who worked tirelessly to keep Singapore and Singaporeans safe.' - Mr Frederick ChewChief Executive Officer, Agency for Science, Technology and Researchand Chief, Public Sector Science & Technology Policy & Plans Office, Prime Minister's Office

'The COVID-19 pandemic is unfolding as the greatest crisis of our age. Having mounted a valiant response to keep the virus at bay, Singapore has emerged from the initial phase of the pandemic undefeated and unbowed, with our heads held high. This book chronicles the heroic efforts of public agencies, healthcare institutions, academia and ordinary Singaporeans in these initial months, including the leading roles NCID played. It contains valuable lessons on the importance of decisive leadership combined with an evidence-based, collaborative and whole-of-society approach in pandemic response.' - Professor Yeoh Khay GuanChief Executive, National University Health System

'2020 will always be etched in history as the year a pandemic brought the world to its knees and disrupted everybody's life, without exception. Singapore was no different from the rest of the world in that we were not expecting such an unprecedented massive disruption from a novel virus. However we were fortunate on many counts, like having battled SARS in 2003, to be more prepared to tackle the many unknowns in this crisis. Four months before the first patient was diagnosed in Singapore, the National Centre for Infectious Diseases (NCID) was officially launched. The NCID played a leading role in the successes that we have had.This book is an excellent read that is written with clarity and precision. The authors give first person accounts of the various aspects of this defining period and there are many learning points that are well documented. I would highly recommend this book to both healthcare professionals and the general public.' - Professor Ivy NgGroup Chief Executive Officer, Singapore Health Services Pte Ltd

'Historians looking back at the COVID-19 pandemic in Singapore will find many stories of sacrifice, solidarity, scientific advancement, and the human spirit. For generations after, academics, policy makers and even artists and novelists will continue to study and write about this epochal period that we are living in. I want to congratulate the authors of this book for chronicling the accounts of the people who were there, adding richness and texture to the otherwise sterile statistics of morbidity and mortality. I also want to thank my teachers and the co-editors of this publication, Prof Leo and Prof Tambyah, for their leadership, for being a voice of science and reason in a tumultuous time.' - COL (Dr) Lo Hong YeeChief of Medical Corps, Singapore Armed Forces

'COVID-19 has changed the world. NCID has been at the forefront of Singapore's fight against COVID-19 and has rallied the research community to make a real difference in the global COVID-19 battle. I congratulate Yee Sin, Paul and the many eminent authors who have contributed to this book, which will serve as a record of this 'crisis of a generation' for many generations to come.' - Associate Professor Tan Say BengExecutive DirectorNational Medical Research Council

'This book provides a thorough overview of the COVID-19 outbreak and management response to the pandemic in Singapore. It is very well written with fascinating personal stories. We are fortunate that we have great leaders in healthcare in Singapore including many in Infectious Diseases, who helped tackle the problem with a pragmatic approach, from planning ahead, curbing community transmission by implementing stepwise social distancing measures and carefully balancing public health demands with the country's economy. We can learn so much from the valuable insights provided -congratulations on this outstanding publication!' - Professor Aung TinKwan Im Thong Hood Cho Temple Professor of Ophthalmology, Duke-NUS Medical SchoolExecutive Director, Singapore Eye Research InstituteDeputy Medical Director (Research) and Senior Consultant, Glaucoma Dept, Singapore National Eye CentreProfessor, Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore

'Every pandemic is different. Different lessons, both positive and negative, can be drawn to prepare not just the health system but the whole country for the next pandemic. The next pandemic will come and it may be the dreaded Disease X, with high person to person transmission as well as high case fatality rates. Countries will need to take a comprehensive and organised systems approach to analyse their response to COVID-19 so that they will be prepared for Disease X. The starting point is proper documentation.This book is an excellent record of the COVID-19 pandemic, seen through the eyes of Singapore's frontline personnel: from doctors to nurses, policy analysts and policymakers, medical technologists, researchers and modellers and public health specialists. It highlights the areas where we have done well: the well-coordinated whole-of-government approach with strong input from the academic and healthcare community. It also does not shy away from topics which the lay public perceived as less than perfect in the handling of the crisis like the massive third wave of the outbreak among dormitory migrant workers or the change in mask wearing advisories.The book also highlights the very low fatality rate and very low infection rates among healthcare professionals. These are very crucial outcome indicators for any country managing this pandemic, especially when there is a strong temptation to focus on output indicators like the number of cases. The authors have attempted to suggest the factors that contributed to these outcomes: however a more formal system-level analysis will be needed in the future including the impact of the pandemic on the mortality and morbidity rates of non-COVID cases.The personal stories from doctors, nurses, allied health staff and porters were a joy to read. It was refreshing and speaks of their commitment, dedication and resilience in the midst of fear and uncertainty. These give a human face to the concept of pandemic preparedness.' - Professor Chia Kee SengSaw Swee Hock School of Public Health, National University of Singapore andYong Loo Lin School of Medicine, National University of Singapore

'Thoughtful, scholarly, thorough. COVID-19 Pandemic in Singapore is a must-read primer for those wanting to understand the SARS-CoV-2 phenomenon - it spans from virology, COVID-19's global spread, the early response in Singapore and worldwide, to shared experiences from those on the pandemic's front-line. The many authors' expertise is evidenced in their chronicling the rigorous planning and action taken to tackle the public health needs of Singapore's different populations, diagnostics, clinical management, infrastructure expansion, manpower deployment, community engagement, and clinical research needed to mount a campaign which has thus far been successful. I highly recommend COVID-19 Pandemic in Singapore.' - Associate Professor David AllenAssociate Vice President (Health Innovation and Translation), National University of SingaporeAssociate Professor, Yong Loo Lin School of Medicine, National University of Singapore

'Healthcare is always in between outbreaks and our response always a work-in-progress as we learn with every outbreak. No outbreak is ever the same but the people we have and the relationships we build ready us for the next one. I am incredibly proud of my colleagues who have stood as the first and last line of defence against the COVID-19 pandemic.' - Adjunct Professor Eugene Fidelis SohChief Executive OfficerTan Tock Seng Hospital and Central Health, National Healthcare Group

International:'This is a book about a country that was prepared for the pandemic of COVID-19 because it had applied lessons from previous responses to SARS, pandemic influenza, and Zika; and more exotic diseases such as human monkeypox. It is an important case study, written by experts in Singapore, of how one country dealt with the COVID-19 pandemic from the detection of first infections to gaining epidemiological and clinical understanding, and then using this to implement evidence-based measures that made Singapore's response exemplary, including its concept of a 'circuit breaker'. The testimonies of medical workers in the last chapter are especially poignant and describe their emotions, concerns, and devotion.' - Professor David L HeymannProfessor of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine

'This book highlights the significant contributions by Singaporean colleagues toward successful control of the COVID-19 pandemic in Singapore, and shows what can be achieved through coordinated, collaborative, and integrated partnerships among public health epidemiologists, clinicians, clinical investigators, and laboratory scientists to effectively respond to emerging infectious disease threats.' - Dr Tim UyekiCenters for Disease Control and Prevention, Atlanta, Georgia

'More than one year into the COVID-19 crisis, the sobering truth is that we are only at the beginning of this pandemic. But the good news is that countries like Singapore have shown that it is possible to suppress the spread of the virus. Bringing together some of the most authoritative voices on COVID-19, this vital book distils essential lessons learned from Singapore and globally for the COVID-19 response. We must not only deal with the acute crisis but also plan and prepare for the long-term and the ever-present risk of another pandemic. The National Centre for Infectious Diseases and the learnings captured in this book serve as a real blueprint for countries around the world.' - Professor Peter PiotHanda Professor of Global Health, London School of Hygiene & Tropical Medicine

'While the world still battles the COVID-19 pandemic, this book provides a useful and comprehensive synthesis of country case studies, disease epidemiology, and the containment measures and actions taken by Singapore to control the spread of the virus. It shows clear insight into the hurdles and successes of the Singapore response, providing lessons learnt which could and should be used by other nations. The opportunity to learn from the expertise and experience of colleagues in Singapore has been a longstanding privilege. The book will also be valuable in planning for future pandemics and in outbreak responses.' - Professor Alison HolmesProfessor of Infectious Diseases,Imperial College London andPresident of the International Society for Infectious Diseases

'As of April 27, 2021, the COVID-19 pandemic has caused more than 147 million infections and more than 3 million deaths worldwide. Singapore was forward-thinking in creating and building a National Centre for Infectious Diseases following SARS in 2003 and the H1N1 influenza pandemic in 2009. The Centre was designed to respond to the emergence of a new pathogen and SARS-CoV-2 was exactly that. In this book, scientists, clinicians, epidemiologists, including academics and policy makers from Singapore have written about their experiences and response to the COVID-19 pandemic. As 2020 draws to a close, although vaccines are on horizon, millions of people are still suffering and many countries are struggling with waves of COVID-19. The global public health, medical and scientific community must learn from each other. This book, that narrates the Singapore experience is very timely, informative and inspiring. I congratulate the authors for sharing their insights in these challenging times.' - Professor Kanta SubbaraoDirector, WHO Collaborating Centre for Reference and Research on Influenza and Department of Microbiology andImmunology at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia

'The NCID has done a remarkable job summarizing the many activities and achievements during the past, the most extraordinary year of 2020.Singapore, like Hong Kong, having experienced the indelible imprint of SARS, quickly implemented those lessons learned and have therefore fared much better than many other places, for the public's health. The insights gained by its experts and healthcare professionals are of value to all of us, making this book an important contribution to the global dialogue on understanding and controlling COVID-19.' - Professor Gabriel M LeungDean of Medicine, The University of Hong Kong