Why Hong Kong doesn't have far more confirmed Covid-19 cases than Singapore

A man wearing a protective face mask, walking on a street in the central business district in Hong Kong on Feb 12, 2020. - AP

HONG KONG (The Straits Times/ANN): You'd have thought the number of confirmed coronavirus cases in Hong Kong should long have exceeded those in Singapore, and by far more.

After all, the city has 13 border crossings with mainland China, where the virus - officially named Covid-19 - is thought to have originated, and three remain open. Singapore, in contrast, is more than 3,500km away and has closed its borders to all new visitors from China since Feb 1.

Yet, the number of cases that have tested positive for the virus in Hong Kong surpassed that in Singapore only on Tuesday (Feb 11). Hong Kong now has 49 confirmed cases and one death, compared with Singapore's 47 cases.

Experts point to a difference in the two cities' standards of detection, according to the South China Morning Post.

Singapore's relatively high number of cases could be due to its government's approach of actively weeding out those affected, while Hong Kong's relatively low number may mean there could be silent carriers within the community, health-care experts say.

Singapore may be detecting more cases because it gives citizens an incentive to come forward when they are unwell, SCMP cited Dr Leong Hoe Nam, an infectious disease expert at Mount Elizabeth Novena Hospital, as saying.

For example, the health ministry is providing financial help to Singaporeans, permanent residents and work pass holders who are quarantined, such as giving $100 to the self-employed, and to employers of those who are in isolation. If Singaporeans are sick with the coronavirus, they could get free medical treatment, he said.

"You are not shortchanged at all so there is no reason to stay away and hide," Dr Leong said.

"Essentially, it is a get-out-of-jail-free card, and the idea is to draw every [potential] case out into the open and get tested."

By doing so, officials hope to ring fence local transmission clusters and have them quarantined and tested to prevent the virus from spreading further.

Singapore authorities have identified three possible clusters: a health products shop that catered primarily to Chinese tourists; a church, and a business event at Grand Hyatt Singapore, at which a Malaysian, two South Koreans and a Briton are thought to have been infected.

"We are looking very hard for cases, and the harder you look, the more cases you'll find. The upturn [in cases] will come down later because we are actively quarantining," Dr Leong said, adding that Singapore's neighbouring countries are likely to have many more cases but they aren't "looking hard enough".

There have been fears that Indonesia, which has close links with China, is under-reporting cases, with officials saying that Indonesian nationals evacuated from Wuhan, the epicentre of the outbreak, would not have to be tested for the virus.

Jeremy Lim, a partner at global consultancy firm Oliver Wyman's health and life sciences practice, said more developed nations tend to have better detection and reporting of cases, more "sophisticated" contact tracing, and a wider availability of test kits.

"It is not just because the culture of transparency is stronger and motivation for learning higher, but [also because of] the resources that can be invested in tracking events," Lim said.

Singapore's research institutes had even developed their own test kits and sent 10,000 of them to help virus-hit communities in Wuhan, he said.

"More testing means more cases."

Dr Leong said Singaporeans also have a high level of trust in their government.

The emptier-than-usual streets show that citizens are heeding authorities' advice to avoid crowded places, he told SCMP.

Singapore's health ministry advised against large social events and gatherings after it raised its outbreak alert level on Friday to orange.

The alert level indicates that while the nature of the disease is severe and can spread easily from person to person, it is being contained and has not spread widely.

Following the raising of the alert level, citizens flocked to supermarkets to hoard essential supplies, which then prompted Prime Minister Lee Hsien Loong to make a national address on Saturday, stressing that the country was well-prepared to face the outbreak and had sufficient food supplies.

A measure of calm returned on Sunday, with Claire Hooker, a senior lecturer at the University of Sydney's Centre for Values, Ethics and the Law in Medicine, describing Lee's speech as a good example of risk communications.

"It gave people very concrete actions" that "handed back a measure of control to people whose sense of control will feel threatened", she told Bloomberg.

Singaporeans also trust that the government will provide quality health care, Lim said.

"If people trust that quarantine facilities are decent and that they will receive proper care, they will be more likely to come forward," he said.

Singapore is using its universities and chalets to house its suspected cases, which initially drew flak from undergraduates who were made to evacuate within a day.

The national development ministry said about 370 people were at government quarantine facilities, well within its capacity of 1,000 people.

Meanwhile, in Hong Kong, authorities are scrambling to ensure there are adequate quarantine sites, SCMP reported.

Chief Executive Carrie Lam - in the face of public anger - has also backed down from a plan to offer free treatment in the city to mainlanders and anyone else needing hospitalisation due to the coronavirus.

Thousands of medical workers went on strike in the city last week to demand a complete ban on entries from mainland China, worried that hospitals would be overwhelmed by new cases as mainland Chinese sought to use Hong Kong's health-care system.

There have also been protests against the use of certain housing estates as potential quarantine facilities.

Hong Kong Doctors Union President Henry Yeung Chiu-fat said Hongkongers had lost trust in Lam's administration after the anti-government protests against the now-withdrawn extradition bill that began last June.

Various moves by the government in relation to the coronavirus have also exacerbated the situation, he said, citing the example of the city's ongoing clamour for surgical masks.

Lam said on Saturday that the Hong Kong government was running low on masks, and that her administration was left with 12 million, or one months' supply.

Private firms have stepped in to hand out free masks to the public, drawing crowds of people desperate to protect themselves.

In contrast, the Singapore government has been keen to assure its citizens that it has enough masks to go around; authorities have distributed four masks for each of Singapore's 1.3 million households.

"It goes all the way to when the people were shouting for the closing of the borders [with China] before the Lunar New Year, and the government turned a deaf ear to them," Dr Yeung said.

Hong Kong leader Lam shut 10 of the 13 borders with mainland China on Feb 3, but only after intense pressure from the public. Singapore, on the other hand, was one of the first countries to ban the entry of foreigners arriving from mainland China.

Even now, there were deliverymen ferrying food supplies from mainland China to Hong Kong, Dr Yeung said, adding that this posed a "danger".

Another issue was the large number of Hong Kong citizens that had until recently been crossing the border on a daily basis, either to live, work or study, David Hui Shu-cheong, a respiratory medicine expert from Hong Kong's Chinese University, told SCMP.

Though Lam's restrictions last weekend cut down on this practice, critics said the move was too little, too late.

Among the city's new measures to tackle the coronavirus is implementing a two-week quarantine for all travellers entering from mainland China, including Hong Kong residents.

Dr Yeung said Hong Kong's relatively low number of infections may be because the punishment for flouting quarantine orders was "weak".

Hong Kong officials on Monday said nine people had breached such orders so far, and two were on the run.

"The first time they give such an order, there is just a soft reminder or warning," Dr Yeung.

In Singapore, people who flout quarantine orders can be fined up to S$10,000 and jailed for up to six months.

On Sunday, Singapore's manpower ministry revoked the work passes of four people who were caught working while they were supposed to be in isolation. - The Straits Times/Asia News Network

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Singapore , Hong Kong , Covid-19 , cases


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