[The Straits Times] Coronavirus more like H1N1 than Sars: Lawrence Wong
Code orange was declared only once in Singapore, prior to the present coronavirus outbreak.
That was in 2009, when the world was hit by the H1N1, or swine flu, pandemic. The virus was first detected in humans in the United States in April 2009, though it is now said to have originated in Mexico.
Singapore had its first imported case in May that year and the first local transmission was detected the following month. Within a month of that, 100 people were infected with the H1N1 virus.
In less than a year, about 430,000 people in Singapore were estimated to have had been infected with H1N1, and 21 people died from the disease.
There are no accurate global figures, but millions were infected and estimates of deaths caused by H1N1 range from 150,000 to 575,000 in the first year.
Faced with a global pandemic, Singapore moved the alert level from yellow to orange in a matter of three to four days. But as more information emerged, it was stepped down to yellow in 12 days - even before the first case appeared here.
Had it existed then, Sars would also have been at code orange, said Mr Lawrence Wong, who co-chairs the multi-ministry task force dealing with the current coronavirus outbreak.
On Friday, he said Covid-19 is more like the H1N1 flu in 2009 than Sars in 2003.
During Sars, people got very sick very quickly. Out of 238 people infected by Sars in Singapore in under four months, 33 died.
But Covid-19 appears to be infectious when the symptoms are mild, like H1N1, said Mr Wong, who is National Development Minister.
For H1N1, the country was on heightened alert at a very early stage, before the virus was even here.
For Covid-19, the move to yellow came only when local transmission occurred - and close to a fortnight after the first imported case was diagnosed.
The move to orange came after there were cases with unknown local sources of infection. Code orange has been in force now for 11 days, and looks set to continue for some time.
The Ministry of Health (MOH) has said that it has no plans to move the alert level to red, the next step up, which signals widespread community contagion.
But before the Dorscon was activated, measures were in place to prevent the import and spread of the virus. As Mr Wong has pointed out several times, the colour codes are fixed but the implementation of measures can be flexible.
The reason for moving back to yellow so quickly in the case of the H1N1 outbreak was that by then, information on the virus indicated a very low rate of mortality. With that known, it was no longer necessary to maintain high vigilance.
At the height of the H1N1 outbreak, doctors here were seeing more than 2,000 cases of H1N1 flu a day. Yet deaths were limited to 21 in the first nine months.
The virus is still circulating today. The fatality rate for H1N1, at possibly less than 0.02 per cent, is close to that of seasonal influenza, of which it is now a part.
Covid-19, however, appears to be more deadly, with a fatality rate of 2.6 per cent in Hubei in China, and 0.6 per cent elsewhere. But these figures are subject to changes daily.
So while people infected with either virus may spread the disease even when their symptoms are mild, the fatality rate may be far higher in the case of Covid-19. This is why Singapore is still in code orange.
Mr Wong said Covid-19 is milder than Sars, which had a 10 per cent mortality: "It is not a mild illness at all, but certainly not of the severity of Sars."
He added: "To give this some perspective, if you look at H1N1 and the flu pandemic in 2009, 10 per cent to 20 per cent of the global population contracted the illness."
The same may not happen with Covid-19, he said. "But because the transmission patterns are similar to H1N1, we should be prepared for a scenario where you get wider transmission around the world," he said.
Should the majority of cases, say 80 per cent, be mild, then Singapore's strategy will move away from contact tracing and quarantine, he said. Instead, the milder cases will be dealt with by primary care doctors and only the very sick will be hospitalised.
But Mr Wong cautioned: "It's the strategy we used to deal with H1N1. Again we are not saying we are there yet."
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