Evaluation of the effectiveness of surveillance and containment measures for the first 100 patients with COVID-19 in Singapore -- January 2–February 29, 2020
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Evaluation of the effectiveness of surveillance and containment measures for the first 100 patients with COVID-19 in Singapore -- January 2–February 29, 2020

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      What is already known about this topic? First detected in China in late 2019, coronavirus disease 2019 (COVID-19) transmission has spread globally. What is added by this reportSingapore implemented a multipronged surveillance and containment strategy that contributed to enhanced case ascertainment and slowing of the outbreak. Based on review of the first 100 cases, the mean interval from symptom onset to isolation was 5.6 days and declined after approximately 1 month. What are the implications for public health practice? A multipronged surveillance strategy could lead to enhanced case detection and reduced transmission of highly infectious diseases such as COVID-19. 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. On January 2, 2020, days after the first report of the disease from China, the ministry of health (MOH) in Singapore, a small island city-state in Southeast Asia with a population of approximately 5.7 million, developed a local case definition (Supplementary Table, https://stacks.cdc.gov/view/cdc/85735) and advised all medical practitioners to be vigilant for suspected COVID-19 patients (2). A confirmed case was defined as a positive test for SARS-CoV-2, the virus that causes COVID-19, by reverse transcription–polymerase chain reaction (RT-PCR) (3), or a positive viral microneutralization antibody test using a SARS-CoV-2 virus isolate (BetaCoV/Singapore/2/2020; GISAID accession 76 number EPI_ISL_407987) and conducted using previously published protocols (4). At hospitals, patients with suspected COVID-19 received chest radiographs and RT-PCR testing on at least two nasopharyngeal swabs collected 24 hours apart (5). Physicians are mandated to report all suspected and confirmed COVID-19 patients through a centralized disease notification system. Suggested citation for this article: Suggested citation for this article: Ng Y, Li Z, Chua YX, et al. Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore — January 2–February 29, 2020. MMWR Morb Mortal Wkly Rep. ePub: 13 March 2020.
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