Singapore: The Limits of a National Response

This post is part of a series from Asia Unbound. The post is authored by Simon Tay, Chairman of the Singapore Institute of International Affairs (SIIA), and Kevin Chen, research analyst at SIIA.

The COVID-19 pandemic in Singapore has entered a new phase as we write. The Singapore government initially dedicated its efforts to lessening imported cases through travel bans and isolation protocols. However, as the focus changed from imported cases to local infections, policies followed suit. As of April 7, schools and nonessential services have gone online, while new and tighter social distancing rules restrict social interactions. On April 21, Prime Minister Lee Hsien Loong extended these measures until June 1.

Another recent and negative development has emerged from dormitories that house the many thousands of long-term foreign workers. The spread of the virus in these dormitories has largely been contained among the foreign worker community, but has driven up the number of nationally cases exponentially. As recently as March 29, there were 844 COVID-19 cases Singapore in total. On April 19, as we were writing this, 942 new cases were announced for the day alone.

There are lessons to be learned from this. Early on, Singapore’s approach to combating COVID-19 was praised as a “gold standard” response. It was deserved at the time but, without a vaccine and cure, no one can declare victory and none should be complacent. But conversely the second lesson is that, despite the recent rise in numbers, the policy framework and choices made in Singapore should not be rubbished; there are positive aspects that bear consideration.

Our brief survey will consider the factors that guided policymakers in shifting measures against COVID-19. We also mention in closing some factors that relate to external risks, which lie beyond Singapore’s control and yet have outsized impacts on the country as a small, trade-dependent hub. 

Three Phases (So Far)

Singapore first encountered an imported COVID-19 case on January 23, 2020, and moved quickly to establish a multiagency task force upon recognizing the threat posed by the disease. Chaired by the Health and National Development Ministers, the ministerial task force incorporated all relevant ministries and a range of expertise and jurisdictions. Efforts made can be broadly seen in three phases with different emphases:

1. Initial Outbreak: Acting against an outbreak largely limited to provinces in China and countries close to it, the government sharpened border restrictions and isolation protocols for suspected cases.
2. Pandemic and Imported Cases: Border restrictions were in focus and continued to tighten as the outbreak went global. However, the government also began preparing domestic movement restrictions.
3. Local Infections, Community Regulation, and a Specific Hot Spot: As local transmissions increased, “circuit breaker” measures were introduced to regulate business and social movement more tightly. Facing a sharp spike in cases from foreign work dormitories, the government has instituted measures trying to address that specific hot spot with a parallel and different approach.

Brief characteristics are set out below.

These measures are broadly similar to what other countries have done. What makes Singapore stand out is its effort to be rational and incremental, responding to changing circumstances as scientific knowledge and evidence-based assessments changed. This leads, in comparison with others, to see the country as moving both faster and slower. For example, Singapore acted early to ban travelers from China, but only closed their border entirely after other countries had done so. In domestic measures too, Singapore strongly pursued testing and contact tracing ahead of movement restrictions, and yet even its current and tightened rules stop short of a full “lockdown”.

Background Factors in Brief

To understand Singapore’s approach to combating COVID-19, one should look to Singapore’s experience with the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003-2004. While the 228 cases and thirty-three deaths are dwarfed by COVID-19’s numbers, the brush with disaster was a wake-up call. It was due to SARS that Singapore’s healthcare sector ramped up its capacities to respond to future outbreaks, including building the National Centre for Infectious Diseases and sending staff abroad for training. SARS also highlighted the importance of developing thorough contact tracing to combat an outbreak, and ensured public buy-in to its demands for their personal information. A mobile phone app (TraceTogether) to allow tracing of networks has been launched with a fair level of voluntary adoption among citizens.

The second factor is the systemic need to manage Singapore’s scarce medical capacity. The ministerial task force took measures to repurpose public sector buildings as makeshift hospitals and stockpile medical goods. However, in a prolonged crisis, stockpiles would be of limited use while Singapore’s healthcare capacity could be overwhelmed. Hence, efforts were made to conserve and maximize the efficiency of existing resources. Residents were initially advised to only wear masks if they were ill, while people are only tested for COVID-19 based on a clinical assessment by a doctor, even if they were displaying symptoms. A range of isolation protocols were also enacted, with only the most serious cases being admitted to hospitals. The rest were issued strict stay-home notices (SHNs), but freed up crucial hospital capacity in doing so. While Singapore’s testing ratios are relatively high, the government has not pursued a wider or mandatory testing policy; largely to conserve and focus resources.

A third factor was Singapore’s desire to balance normality with compliance from residents. Incremental policies were aimed at keeping business and social life in Singapore relatively normal, and delay or even avoid sharp knocks to society during a seemingly prolonged outbreak. The Singapore government also introduced three concurrent financial assistance packages to address the economic impacts of COVID-19 (Detailed below). Yet, the government had to tread a line between punishing or teaching those who ignored health guidelines. Some have decried harsh penalties for defying SHNs, with permanent residents losing their status and barred from re-entry over such offenses. Others point to the deployment of “ambassadors” to promote social distancing etiquette as signs of a softer approach, though the recent move to fine first offenders S$300 (US$ 211) without a warning suggests that the balancing act is still evolving.

Broader capacities, External Factors

Looking further back, Singapore’s actions are based on a disposition to plan and prepare for future uncertainty, acquired following its independence from Malaysia. From building up its armed forces to maintaining substantial financial reserves and addressing threats from climate change, the country is perennially angled towards preparing for that “rainy day”.

The three budget measures taken are outlined below:

Yet, these factors do not guarantee success. As our timeline of phases and budget measures show, the situation is fast-moving—with sharp changes measured in weeks, days, and hours. Furthermore, blind spots will surprise: Singapore’s prime example being the rapid spread of infections in dormitories occupied by foreign workers living in very tight quarters that, it is now recognized, leave them especially vulnerable to the spread of infectious diseases.

To deal with this specific “hot spot”, the Singapore government has instituted a parallel and different regime. Social distancing is strictly practiced with all practical measures to segregate workers. Checking for symptoms and testing are increased and response time is accelerated with dedicated frontline medical teams emplaced within the dormitories. Any of the workers who show symptoms are quarantined in facilities that have been specifically set up or set aside. Those who test positive are afforded free and equal standard treatment at hospitals. The number of cases has grown exponentially but while this causes alarm, assurance can be gained from two facts: first, most of the foreign workers exhibit mild symptoms and respond well to treatment; and the cluster has been isolated and does not seem to be spreading to the broader community outside the dorms.

While it remains to be seen, the dual-approach appears to be coping with a bad situation. It also bears evidence to the general lesson that the COVID-19 pandemic punishes the weakest links in a system – in this case the density of living conditions for the foreign workers.

There are also other weak points and needs for Singapore that extend beyond what governments can control. Citizen and private sector buy-in are crucial but challenging factors that must be cultivated for a successful national approach to an outbreak. External factors such as U.S.-China tensions could hinder national recoveries as the helm of global leadership against the outbreak remains empty. Challenges in Singapore’s vicinity are also significant, with outbreaks in many ASEAN countries likely to continue into June. ASEAN has limits to its abilities, but it could coordinate cross border regulations surrounding the movement of people and medical goods. Working with the Northeast Asian economies of China, Japan and South Korea will be necessary, as it was during the Asian Financial Crisis of 1997 to 1998. Partnerships with Australia and New Zealand are also needed.

The pandemic underscores global interdependencies. No man is an island, as Donne wrote. Even an island like Singapore is not an island. There are strengths but also limits to what national responses to a global pandemic can achieve.