Though infectious diseases Zika and Tuberculosis (TB) claimed the spotlight last year, Singapore needs to be on high alert as the threat from foreign bugs is set to stay and might even intensify as the country continues to see large numbers of people and goods flow in and out of its border, says health experts.
“Singapore is constantly in a vulnerable position in receiving emerging and re-emerging bugs … We are as ready as we can be, but every bug has its own characteristic. We need to be flexible and learn to adapt,” said Professor Leo Yee Sin, who heads the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital.
Despite Singapore now being better equipped with hardware to tackle various infectious diseases, its health system will continue to be tested more frequently, as recent events have shown.
It remains a mystery how the Zika virus made inroads into Singapore in August, 2016 when it reportedly affected about 400 patients. Last August, the Ministry of Health (MOH) announced the first localised community spread of the Zika virus, with the number of cases shooting up to more than 150 within a week. The mosquito-borne infection, discovered in the 1940s, had spread wildly after it was reported in Brazil in May 2015 in Latin America, the Caribbean, the United States and South-east Asia.
Similarly, tuberculosis hogged the limelight when MOH announced that a cluster of six multi-drug-resistant tuberculosis cases had formed at a Housing and Development Board Block in Ang Mo Kio.
In 2015, lapses at the Singapore General Hospital led to a hepatitis C outbreak that affected 25 patients, of whom eight have died — seven with the virus likely contributing to their deaths.
Singapore’s status as a transport hub — a key port-of-call between Australasia and Europe — makes it particularly vulnerable to pandemics from abroad.
“Flights come and take off from (Singapore). It is good for commerce, good for logistics, good for viruses and epidemics too. They take the same trade routes,” said Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Specialist Centre.
The Republic has the “basic pieces” in place to deal with any outbreak, but the region in which it is situated poses significant risks, said general practitioner Dr Leong Choon Kit, who sits on the Singapore Medical Council.
Professor Duane Gubler, founding director of the Programme in Emerging Infectious Diseases at the Duke-NUS Medical School, urged the Government to be more pro-active in collaborating with neighbouring countries in infectious disease control.
“Singapore has a good surveillance and control system. This is where it can play a leadership role in imparting its knowledge to neighbours, and getting more involved with their healthcare infrastructure development,” said Prof Gubler.
Besides the Government and infectious disease specialists, primary-care physicians and the community play a critical role in Singapore’s battle plan in the war against emerging and re-emerging diseases.
Three doctors at Sims Drive Medical Clinic — Dr Tan May Yen, Dr Lim Chien Chuan and Dr Chi Wei Ming — raised the alarm that led to the discovery of the first locally transmitted Zika cases when they saw a sudden spike in patients complaining of fever, rash and joint pain.
Dr Leong Choon Kit said: “We see diseases at its early stages and are experts in the undifferentiated stage. Often we may not be able to nail down the exact diagnosis. Training would allow us to raise alerts far ahead of an epidemic. We are like watchmen of the old days.”
Dr Leong added that GPs and community leaders are well-positioned to advocate for vaccinations and good hygiene practices, which are often key to preventing the spread of diseases.