What SARS taught Singapore about testing

By Yun Xuan Poon

Interview with Tan Chorh Chuan, Executive Director, MOH Office for Healthcare Transformation (MOHT) and Chief Health Scientist, Ministry of Health (MOH).

When the SARS virus reached Singapore in 2003, hospitals had no diagnostic tests available for the first month.

The nation was determined to learn from this. It set up infrastructure for tests and diagnosis, including the National Centre for Infectious Diseases. These have been crucial in Singapore’s response to the Covid-19 pandemic, believes Tan Chorh Chuan, Executive Director, MOH Office for Healthcare Transformation (MOHT) and Chief Health Scientist, Ministry of Health (MOH).

Tan shares how the SARS crisis helped Singapore prepare for the Covid-19 pandemic, and how Singapore will prepare for future healthcare challenges.

Lessons from SARS

SARS required fast testing because visible symptoms proved unreliable. The disease “had different faces”, says Tan, who was Director of Medical Services at the Ministry of Health at the time.

“We had a patient with fever and diarrhoea who only developed lung infection near the end of his illness. The patient was not recognised as having SARS until he had sparked a large hospital outbreak.”

The response to Covid-19 has been a different story. “We had a good diagnostic test and full containment systems by the time the first case was diagnosed in Singapore,” he says.

Testing has been a vital part of Singapore’s strategy against the pandemic. As of 31 August, more than 2 million swab tests had been administered, according to figures from the Ministry of Health.

Singapore was able to quickly meet the surging demand for Covid-19 tests in the early stages of the outbreak. As Singapore’s Chief Health Scientist, Tan coordinated Covid-19 research amongst the academic, clinical and public health communities to develop these diagnostic tests. The National Public Health Lab developed a test just over a week after the viral gene sequence was released by Chinese researchers, he says.

This highlights how “R&D is an indispensable part of effective outbreak prevention and response”, he says. Policymakers need to understand how a disease behaves to contain its spread. “Seventeen years later, this is still one of the big lessons from the SARS epidemic.”

This extensive testing allows for a rigorous contact tracing and isolation system. Singapore connects its labs with hospitals and government ministries, so test results can be shared in almost real time, CEO of healthtech agency Integrated Health Information Systems (IHiS) said at the Cities Against Covid-19 summit this year. Health officials use this central repository to reach close contacts of confirmed patients within hours.

Defeating the enemy at hand

What lessons has this pandemic taught us so far? “Front-loading” public health measures is crucial, Tan says. “Aggressive containment measures have to be carried out right at the beginning to have the best chance of suppressing spread from the infection clusters.”

This requires fast and effective contact tracing, he notes. He points to how tech was central to this. In March, Singapore launched the TraceTogether app to speed up contact tracing efforts. The app uses bluetooth signals to identify devices that have been in close proximity to infected patients.

Singapore also ramped up testing for higher-risk activities, such as singing, or in vulnerable places like nursing homes. People who have a higher risk of infection are regularly tested as well, to reduce the risk of asymptomatic transmission, he explains.

Design thinking for healthcare

Mental and emotional wellbeing have been impacted by the pandemic too. “The shielding of the elderly, who are more likely to have severe illness if infected, has also contributed to loneliness and social isolation which are hard to address,” Tan says.

The government invited civic hackers to help design solutions through the Design4Impact initiative. One team created an app that matches volunteers to seniors who live alone. Another proposed a game of bingo between housing blocks to encourage family and community bonds despite physical distancing.

MOHT, along with the National Council of Social Service, Design Singapore and the National University of Singapore’s Institute of Systems Science, provided training on user-centered research and design thinking. They also gave funding, mentorship, resources and networks to help teams bring their ideas to life.

Targeted healthcare

Data will be a big part of Singapore’s healthcare in the future, believes Tan. For instance, data could nudge people to make better lifestyle choices. The Health Promotion Board’s Healthy365 fitness app tracks a user’s daily steps and calories intake, while also giving personalised lifestyle suggestions based on their profile.

Town planners can also use data to design healthier living spaces, Tan says. It can help improve walkability in a neighbourhood, and even introduce healthier food options in nearby hawker centres.

Singapore plans to use data to design more targeted treatments, he says. For a start, predictive analytics will help healthcare providers decide which patients with chronic diseases can be safely monitored through telehealth, and which patients should continue to turn up at clinics, he explains.

Data analytics will also be important for early healthcare intervention. Singapore’s healthtech agency, IHiS, worked with public healthcare organisations to build a model that predicts how likely a discharged patient will be readmitted, Tan says. This model is now used in all public healthcare institutions in Singapore.

Singapore has learned its lessons from the SARS epidemic well. Armed with targeted countermeasures, strong research capabilities, and predictive analytics, Singapore is gearing up to face the healthcare challenges to come head on.