When you’re battling a contagious disease, speed is of the essence. Healthcare staff and the government are in a race to put infected patients in isolation to reduce the virus’s chances of spreading.

Before the pandemic, many governments didn’t have systems dedicated to contacting and isolating patients. Over the last four months, Singapore has built one that pulls together tech, people and platforms from across the government.

The goal is to ensure that Covid patients are isolated within hours after testing positive, said Bruce Liang, CEO of Integrated Health Information Systems (IHiS), speaking at the Cities Against Covid-19 summit. “We will be quite close to that in the very near future.”

Rapid detection and isolation

Singapore has built a system connecting testing labs, hospitals, and ministries, so patients can be isolated within hours of testing positive. Central to this is a new “Covid test repository” (CTR) that pulls together electronic records of all test results in Singapore. “Whatever result is recorded into the lab information systems, it gets to CTR almost on a real-time basis,” Liang noted.

The test results go straight on to a set of tools used for contact tracing and quarantine operations. “As soon as the Covid management system receives the positive test result cases, we will pull in information from other sources to reach out to the close contacts of the new positive patient within hours.” The platform pulls together tools from across the government – the Ministry of Health, GovTech and the Singapore Armed Forces. A platform developed by Defence Science Technology Agency is used to identify the source of infection and links across clusters.

Over the last four months, GovTech has built a set of apps that comprehensively gather information on whom patients may have come in contact with. TraceTogether uses bluetooth pings to record who is in close proximity, while SafeEntry is an app for people to digitally check in and out of public places. “The Covid management system actually uses proximity and movement data from national consumer apps,” said Liang.

A separate tool allows officials to enforce home quarantines. People in isolation report their GPS location and verify their identity with a photograph through the Homer app. It has AI built in to watch out for GPS spoofing.

Risk profiling

From the moment a patient reports sick at a clinic, Singapore’s Ministry of Health consolidates information to estimate their likelihood of testing positive for Covid-19.

Every patient is given a risk profile based on their symptoms, travel history and contact history with suspected Covid-19 cases, Liang explains. This information guides doctors’ next steps, for example, segregating patients who are considered to be at high risk of COVID-19.

The risk profile is also crucial for identifying gaps in the country’s Covid testing strategy. “We know who are at higher risk of Covid-19, and with the Covid test repository, we will know if these patients have been tested, and hence can identify who have not been tested,” he said.

Taking strain off hospitals

A third area where tech has helped is to take strain off acute facilities by allowing clinically low-risk cases to be monitored in community care facilities. Today, three such facilities are capable of housing 13,000 patients, Liang added, with Singapore standing ready to launch three more to top it up to 20,000 beds if necessary.

In attending to such large numbers of patients, optimising healthcare manpower is a priority.
IHiS and the Ministry of Health Office for Healthcare Transformation have created toolkits for patients to monitor their vital signs themselves. Staff monitor this on a dashboard, which alerts them to patients with abnormal readings who may need medical attention.

The facilities also get patients’ information before they arrive, so they can be prepared. Another online system, GPConnect, allows access to patients’ history from the Ministry of Health’s national electronic health records. “As a result, medical consults can be conducted within a few minutes, and can be conducted virtually as well,” he added.

Every moment is critical in how countries respond to Covid-19. With the great burden on healthcare systems globally, Singapore’s approach shows how timely and immediate quarantines are crucial in breaking the transmission chain.