Singapore is controlling its outbreak with case finding and contact tracing. Any other country can do the same. Singapore is a particularly clear case. They test everyone for COVID-19 if they go to a doctor or clinic for treatment with symptoms of a respiratory disease. For instance if you are living in Singapore, and get a cough or fever, and go to see your doctor - he or she will take a swab which is automatically tested for COVID-19. That's in a country of over 5 million, as large as Scotland.
skip to: Contact tracing in Singapore
On the 20th Singapore had 40 new cases. Of those, most were imported cases or contacts of recently imported cases. Only 3 were new cases within Singapore, not already contact traced to another cluster, and another 3 were contacts of previous new cases within Singapore. None of the big clusters had any new cases on the 20th.
You don't need to find everyone to stop an outbreak, just most of them. If you break most of the chains of transmission, and a few get through but you find those and break most of the chains of transmission for those too, andso on, it will soon stop. Singapore acted promptly and never needed lock down. China has done this with tens of thousands of cases and only used full lock downs in Hubei province - for two days it has now had no cases of local transmission. South Korea has done it with over 8000 cases, and without using lockdowns.
In a country of a billion people, Chinese provinces are the size of European countries. 21 Chinese provinces have a total of less than 100 cases each, and in the case of Tibet, only 1.
It is not too late for Europe to do this though. China has shown you can control this disease even at tens of thousands of cases in a province the size of the UK (Hubei province is roughly the same population size as the UK).
The way these countries achieved this doesn't seem to be widely understood in some other countries. It is not about isolating everyone who is in the same building, school or workplace but about meticulously tracing their personal close contacts. The reason for doing this is because COVID-19 is not airborne, and it almost always requires very close or prolonged contact to spread to someone else.
Your country can do this too. I hope this article can help encourage others to follow the example of Singapore and get COVID-19 under control.
When the WHO declared COVID-19 a pandemic, Dr Tedros, Director General of the WHO said:
We are convinced that, although this is the first coronavirus to be labeled as pandemic proportion, at the same time we believe it will be the first also to be able to be contained or controlled.
Transcript for WHO Emergencies COVID-19 Press Conference, 11th March 2020
In another press briefing he said:
"Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same; it's whether they will."
This is another article I'm writing to support people we help in the Facebook Doomsday Debunked group, that find us because they get scared, sometimes to the point of feeling suicidal about it, by such stories.
Please share with friends if it helps you - they may be panicking too.
CONTACT TRACING IN SINGAPORE
skip to: How can other countries do contact tracing?
contact_tracing_in_Singapore
This is the situation as of 20th March
Of the 40 new cases on the 20th March,
- none are imported from China
- 30 are directly imported from other countries
- 4 are traced contacts from recent direct imports from countries other than China
- 3 are locally transmitted without a traced previous contact, and
- 3 are contacts from local transmission.
Most of the local cases trace back to seven gatherings or functions
- Private diner fuction at Safra, Jurong
- Grace assembly of God church
- Seletar Aerospce heights construction site.
- The Life church and missions, Singapore
- Yong Thai Hang medical products shop
- Grand Hyatt Singapore
- Wizilearn technoologies.
As of 20th March, of those 385 cases only 49 were diectly infected within Singapore in some other way
All the others came via contact tracing from those six gatheringss, imported from overseas, or contacts of previously traced cases
This is how it started:What we know about the locally transmitted coronavirus cases in Singapore
If there was large scale local spreading in Singapore, and this was causing serious illness or killing people, they would have reported to the clinics or hospitals and we should have come across some of those cases by now.
Here is just a small part of their big chart.
Explore it here, and notice how many are closely related:
You couldn’t do that with flu. If any of those people had passed it on to someone in a bus, coach, plane, train, waiting in a queue or something, it would be impossible to do this contact tracing.
Also notice that most of the cases are end points in this graph, which means they don’t infect anyone. This virus spreads by just a few people of the many already infected spreading the virus to many. Then just one or two of those spread to many again, and so it goes on, on and on.
We know this graph is complete, apart possibly from symptomless non spreaders, because they test everyone in Singapore for COVID-19 that presents with fever or respiratory symptoms in a population of over 5 million and these are the only cases they found. If there were significant numbers of symptomless spreaders, they would be seeding other small clusters of cases throughout Singapore by now.
COVID-19 in Singapore shows there can't be a hidden population of symptomless superspreaders
Singapore can't stop its cases increasing slowly for as long as other countries are sources unless it imposes travel bans which it doesn't want to do. It can keep the imported cases well under control at current levels of imported cases however.
Hong Kong and China have also done a fair bit of testing in fever clinics too, and so has South Korea.
South Korea is using the same method for over 8,000 cases. The WHO said that these are still nearly all in a few well defined huge clusters. China has done it with
This is what makes it so different from flu.
This is another article I'm writing to support people we help in the Facebook Doomsday Debunked group, that find us because they get scared, sometimes to the point of feeling suicidal about it, by such stories.
Please share with friends if it helps you - they may be panicking too.
HOW CAN OTHER COUNTRIES DO CONTACT TRACING?
skip to: Need to be able to scale up
Contact tracing is something that any volunteer or civil servant can do.
It does not mean that you isolate everyone else in the same building or place of work or school.
It means that you ask the case about their movements over the last few days and who they were in close contact with.
E.g. if they were staying over with a friend for a couple of nights - you phone up that friend and get them to self isolate, if they had an evening out with another friend you contact them, if they had a family gathering, you contact all the family, if they kissed someone at a party, you contact them, and so on.
It is straightforward stuff. Anyone can do it. Civil servants or volunteers can do it. You can re-use civil servants from other branches of government or local community organizations. You don't need to have any experience as health workers to do this.
But you have to be organized and methodical and thorough about it.
NEED TO BE ABLE TO SCALE UP TO KEEP TRACK OF ALL OF TENS OR HUNDREDS OF THOUSANDS OF CONTACTS
skip to You don't need to find everyone
This is not so hard with a dozen cases, but the experience of China is that it gets much harder as it scales up unless you have good tools to track them all.
This is much like the way it is not so hard to host a small website with a thousand or even ten thousand visits a day. But if you get tens of millions or even billions of visits a day, like Facebook or Wikipedia, then you need serious levels of technological expertise to keep it running.
This process has to be very organized to keep track of, say, 100,000 contacts.
You don’t just find them all, and ask them to self isolate. You also have to keep in touch with them all and get them tested as needed and retested.
This was something the Chinese did with large databases and software. The West can learn from them how they achieved the co-ordination to get it working.
Countries should be looking into how to do this before their outbreak starts, or from their very first few cases.
Instead, sadly, many countries keep track of the first few contacts, but when it starts to get hard to keep track of them all, they give up.
In the UK where I live, we have stopped doing case finding altogether for mild cases. The main issue here is not the number of diagnostic tests. It is a challenge but there are machines you can get that have a throughput of thousands of diagnostic tests per day per machine, so this is certainly not an unsurmountable problem.
The main issue is to keep up with contact tracing once you have thousands, or tens of thousands of known cases.
The UK gave up on this on the 13th March at less than 1000 total cases.
The Chinese continued all the way through to tens of thousands of active cases and half a million contacts traced at the peak of its epidemic.
We know that the UK has large numbers of undetected mild cases.
To get back on track, we need to do rapid case finding now, as many as we can find. Then we must trace their contacts.
We can expect to have thousands of cases by now. So we can expect to have tens of thousands of contacts to trace.
So, yes this is going to be a big challenge. We should already be working on the software and the administration to be able to follow all these tens of thousands of cases, and get them repeatedly retested for COVID-19.
We can do this. We can afford to do it as a country. We have the ingenuity and technical expertise to do this. Our software developers are up to the job, or they can import software from other countries.
This should be our absolute top priority right now, to ensure thorough and accurate contact tracing. We have to find all the cases too, but without the contact tracing then it will not be possible to keep it under control.
You have to do the contact tracing to get all the contacts of known cases to self isolate.
If you don’t do that, people who don’t know they are contacts of a known case can infect others from 2 days before onset of symptoms, through the first days of symptoms as well, until they realize they might have COVID-19 and get tested. Some contacts with very mild symptoms may not guess they ever had COVID-19 if you haven't contact traced them first.
YOU DON'T NEED TO FIND EVERYONE
skip to You can protect yourself and others from COVID-19
Suppose each new person on average infects 2 more for simplicity.
Then 100 cases infect 200 then 400, 800 and now you have a total of 1500 cases already. It doesn't take much longer to reach tens of thousands. If you have a doubling time every 3 days then it's a ten-fold increase roughly every ten days.
If you can break three quarters of those chains of transmission with contact tracing and isolation the outcome is very different.
This time, 100 cases infect 50 (3/4 of 200) which then infact 25 (3/4 of the 100 cases 50 would infect) which infect 13, ,6, 3, 2, 1 and then it is over.
It will be over at around 200 cases.
YOU CAN PROTECT YOURSELF AND OTHERS FROM COVID-19
skip to So what do we do next?
Do you do these four things?
- Wash hands thoroughly
- Stay 1-2 meters from anyone coughing.
- Wash your hands before you touch your eyes, nose or mouth [try to get out of the habit of touching your face in the day]
- Cough or sneeze into your elbow OR cough or sneeze into a tissue and put it into a bin immediately.
Do this as thoroughly as the experts, and you can say:
"I don't have COVID-19 - I am very low risk".
Dr Bruce Aylward said that immediately after he returned from Wuhan. He knew he was safe because he did those things.
These simple instructions save lives. They are not hard to do if you make them into a habit. More details here:
If you are doing the right things to prevent COVID-19 you can still get a cold. Colds are more easily transmitted than COVID-19
In theory if everyone did that rigorously it should stop pretty quickly. But in practice it's hard to get everyone or even a majority to do that.
It is the same for physical distancing - if literally nobody had the discipline to stay at least 1-2 meters away from everyone else, of course it would be over soon, within 14 days. But in practice that's also difficult to achieve.
Those are both measures that you can't force everyone to do if they are not diagnosed as having COVID-19.
However it is legally possible to enforce quarantine in a free country for someone who is a known risk such as a COVID-19 patient or a close contact.
Not only is it much easier to enforce. :They also are likely to take it much more seriously if they know they have the disease, or that the person they need to distance themselves from does.
So, by far more important is case finding with lots of diagnostic tests, quarantine, contact tracing and isolating contacts. It depends how rigorously and thoroughly they do that. South Korea and Wuhan got it well under control within a month of doing that, peaked within a fortnight of doing that.
So, on a personal level then the hygiene and social distancing can save your life and others and everyone who does this is helping to break transmisison chains in our society. On a society level, this is also important but we need a significant number to adopt it. The government and the media here can help, to stress to everyone its importance and necessity, in every way they can.
Then case finding is of the utmost importance - testing all suspect cases, quarantining, contact traeing and isolating contacts. It depends how rigorously and thoroughly they do that. South Korea and Wuhan got it well under control within a month of doing that, and it peaked within a fortnight of doing that.
The combination of case finding, contact tracing, an element of physical distancing and personal proteciton through hand hygiene etc is very powerful as a way to stop this epidemic.
The number of new cases with onset of symptoms peaks almost immeidately, within a few days - but you don't know that until you have the diagnosis, up to a fortnight later as they have to recognize that it is potentially COVID-19 and then get tested. You can see this strikingly with China in Wuhan, with the effect of the lock down. It would be the same with any new measures.
In China, if you look at the date of onset of symptoms, then it peaked on the 25th of January, only 3 days after the Wuhan city shutdown on the 25th January
However if you look at the date of diagnosis, it seemed to peak 9 days late on the 5th February.
It would be the same for any measure that radically changes the transmission dynamics.
For instance if the UK were to immediately do widespread testing, and quarantine all those cases and isolate their contacts, the onset of symptoms would peak almost immediately, but we would not know that for maybe as much as a week or more as we wait for the new cases to be diagnosed.
WE DON'T HAVE THE LUXURY OF TIME TO EXPERIMENT WITH A RADICALLY DIFFERENT APPROACH
skip to What do you think?
The methods used by some other countries such as the Netherlands and the UK are experimental, and are based on models for flu that are not yet validated against the data for COVID-19. If not controlled properly, this virus can increase very fast. It often doubles in cases every 3 days, or a ten fold increase n 10 days. For details see:
We don't have the luxury of time to spend weeks learning how to control such a virus again from scratch in the UK or Netherlands.
This means that if you use the wrong methods to control it then, from a small cluster of 10 cases, and increasing ten fold every 10 days, it increases like this:
10 → 100 → 1,000 → 10,000
After a month of using the wrong measurse to control it, your 10 cases have increased to 10,000. After another month you wiill have 10 million cases. You don't have the leisure to experiment with unproven methods for long when we already have a proven method that works.
This doesn't mean we should copy everything Singapore, South Korea or China did. Rather we need to learn from them what worked, and what didn't work, and apply those lessons to our own situations. We also need to adapt these ideas and take account of what is practical in our own local situation. But there is nothing they did that we can't do too, in our own unique ways.
SO WHAT DO WE DO NEXT?
skip to What do you think?
First you need to find the virus in your society, or else, as Dr Tedros put it, it is like trying to fight a fire blindfold. You also need to understand how this particular disease is being transmitted in your society.
Then to control it, your control methods have to respect the way the virus is transmitted in your society.
The methods used by China, Singapore and South Korea are proven - they work.
Many of the Chinese provinces stopped it before it got anywhere e.g. there is only one case in Tibet. 21 provinces never had more than 100 cases and only 4 outside of Hubei had over 1000 cases, none reached 2000. These provinces are the size of European countries and the Chinese population is larger than that of Europe. Only Hubei province had cities in complete lock down.
I am working on these as petitions for the UK government (as I am a UK citizen), so it gives an idea of the priorities. It is based on the priorities of the WHO:
Find and quarantine COVID-19 cases and isolate all their contacts
The World Health Organization recommend that countries test every suspected case of COVID19, and isolate and treat every confirmed case. It also recommends that they trace every contact and isolate those until they are free of the virus. We call on the UK government to do all these things.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: "Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries ...is not whether they can do the same; it's whether they will. ." The UK is one of the few countries to stop contact tracing and quarantine. The world needs to join in solidarity to suppress and control this virus, both for ourselves and other countries that we may infect, especially with weaker health care systems.
Then another one:
Test everyone with influenza-like illness for COVID-19
The Government must test everyone with influenza-like illness for COVID19 as recommended by the WHO-China Joint Mission headed by Dr Aylward and Dr Liang and published on 25th February
Singapore, Hong Kong, South Korea and China have all shown the value of extensive testing for COVID19. When combined with quarantine, contact tracing, and contact isolation, this is a proven method to nip new clusters of infections in the bud, reduce the numbers of deaths and save the lives of frontline health workers. Dr Tedros said we can’t fight a fire blindfold. Now that we have lost sight of where the virus is in the population we need to test everyone with symptoms to find it again.
I did an earlier petition a week ago, as soon as the announcement was made that the UK would stop testing mild cases and quarantining them - but the moderators felt it wasn’t clear enough. It took a week for them to get to it:
Similarly this petition is not likely to be approved before next week.
Still if this new one is approved, then a week from now would be crunch time, likely to be over a thousand deaths by then at the current rate of doubling every two days and that week would then see a build up to 18,000 by two weeks from now- that is if the doubling progression continues.
I very much hope that our government changes course before then, but if not then that would be a time when there are likely to be lots of protests and many trying to really put pressure on them to do something about what’s happening.
I am glad to see that at last the BBC is reporting how China, South Korea,and Singapore were able to stop their outbreaks:
Coronavirus: What could the West learn from Asia?
First, yes of course Europeans can follow orders of their government, it's not unique to Asian societies.
Back in WWII residents in the UK blacked out their windows to prevent German bombers from seeing the houses from the air at night. They covered them with thick curtains and other materials so that the lights they had didn’t show outside of the houses. Just a few people not doing it would have made our cities easy targets.
This is how they did it in WWII, a big campaign with posters such as this
Blackout (wartime) - Wikipedia
Of course most European countries are continuing to do the testing, case finding, quarantine, contact tracing and isolation through to many thousands of cases. So far only the UK and Netherlands have given up on this.
The other day the WHO mentioned the Republic of Ireland as a country that is doing contact tracing right. They are using lots of local community organizations throughout the country to do it.
And yes you can enforce self isolation in a free country.
Liike many countries, UK already has legally enforced self isolation - at least it did until this switch from the contain to the delay phase. Italy also enforced lock down, with the military standing in as extra police to guard the locked cities and this also is permitted in a free country.
A free country can enforce self isolation when there is a clear danger to society of them leaving the self isolation. It can certainly do that for COVID-19. It can't enforce quarantine on people who might well just have a cold or flu.
The UK were doing case finding and contact tracing until they decided to switch to the delay phase. So it is NOT impossible to do in a free country.
You don't have to have 100% success. If only a few people avoid the quarantine then you still are reducing the amount of transmission to the next round of casese and if you can reduce that by, say, 75% it will soon stop. We need to TRY before giving up.
Where is the legendary British "Fighting spirit"?
But at least some in the UK who read the BBC news may now be becoming aware of what the WHO has been saying all along, probably for the first time.
WHAT DO YOU THINK?
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I am no expert on diseases or COVID-19. All that I am is a good science communicator. I hope that by writing this article I have helped to communicate the findings of the experts on COVID-19 and help spread awareness of why it is that the WHO say this can be controlled, and how they say we should do it.
Do comment with your thoughts on this.
Also please say if you spot any mistakes in this article however minor and I will fix them. Thanks!
If anyone reading this is an expert on any of this and notices anything I got wrong here, or have anything to add or correct please say in comments. And do share your thoughts on this. Thanks!
This is based on sections of my larger article here:
For the latest WHO press briefings go to
See also my
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