Asian locales reacted swiftly to the threat of COVID-19 by leveraging lessons learned from previous pandemics and making use of serology testing in aggressive contact tracing

America’s healthcare leaders in government, hospitals, clinical pathology, and medical laboratories can learn important lessons from the swift responses to the early outbreaks of COVID-19 in countries like Taiwan and South Korea and in cities like Singapore and Hong Kong. 

Strategies such as early intervention, commitment to tracing contacts of infected people within two hours, quarantines, and social distancing all contributed to significantly curtailing the spread of the latest coronavirus pandemic within their borders, The New York Times (NYT) reported.

Another response common to the efforts of these countries and cities was the speedy introduction of clinical laboratory tests for SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), supported by the testing of tens of thousands of people in the earliest stages of the outbreaks in their communities. And that preparation and experience is paying off as those countries and cities continue to address the spread of COVID-19.

‘We Look at SARS as the Dress Rehearsal’

“Maybe it’s because of our Asian context, but our community is sort of primed for this. We will keep fighting, because isolation and quarantine work,” Lalitha Kurupatham, Deputy Director of the Communicable Diseases Division in Singapore, told the NYT. “During peacetime, we plan for epidemics like this.”

Clinical laboratory leaders and pathologists may recall that Hong Kong was the site of the 2003 severe acute respiratory syndrome (SARS) epidemic. About 8,096 people worldwide were infected, and 774 died from SARS, according to the World Health Organization (WHO). In Hong Kong, 299 died out of 1,755 cases. However, Singapore had just 238 cases and 33 deaths.

To what does Singapore attribute the country’s lower COVID-19 infection/death rate today?

“We can look at SARS as the dress rehearsal. The experience was raw, and very, very visceral. And on the back of it, better systems were put in place,” Jeremy Lim, MD, Co-Director of the Leadership Institute for Global Health Transformation at the National University of Singapore, told TIME.

“It’s a mix of carrots and sticks that have so far helped us. The US should learn from Singapore’s response and then adapt what is useful,” Lim added. 

Singapore Debuts Serology Testing for COVID-19 Tracking

It was Singapore where scientists first experimented with serology testing to track the breadth of coronavirus infection in a community, Science reported, adding that the tests are different from the SARS-CoV-2 tests, which analyze genetic material of the virus from a person’s samples. (Dark Daily recently covered such genetic testing in “Advances in Gene Sequencing Technology Enable Scientists to Respond to the Novel Coronavirus Outbreak in Record Time with Medical Lab Tests, Therapies,” March 18, 2020.)

As microbiologists and infectious diseases doctors know, serology tests work by identifying antibodies that are the sources of infection. In the case of COVID-19, these tests may have aided in the surveillance of people infected with the coronavirus.

This is one lesson the US is learning.

“CDC (Centers for Disease Control and Prevention) has developed two serological tests that we’re evaluating right now, so we can get an idea through surveillance what’s the extent of this outbreak and how many people really are infected,” Robert Redfield, MD, CDC Director, told STAT.

Singapore’s Health Ministry and its Duke-NUS Medical School previously used an experimental serology test for contact tracing the source of 23 COVID-19 cases at a Singapore church, according to Science.

The graphic above, which is based on data from the federal Centers for Disease Control and Prevention, illustrates how contact tracing is accomplished. “We believe this is the first time in the world where these particular tests have been used in this context of contact tracing,” Danielle Anderson, PhD, Scientific Director, Duke-NUS Medical School ABSL3 Laboratory, told Science. (Graphic copyright: CDC/Carl Fredrik Sjöland.)

‘Leaving No Stone Unturned’

As of March 27, Singapore (located about 2,374 miles from mainland China with a population of 5.7 million) had reported 732 COVID-19 cases and two deaths, while Hong Kong had reported 518 cases and four deaths.

According to Time, in its effort to battle and treat COVID-19, Singapore took the following steps:

  • Clinical laboratory testing for COVID-19 of all people presenting with “influenza-like” and pneumonia symptoms;
  • Contact tracing of each infected person, including interviews, review of flight manifests, and police involvement;
  • Using locally developed test to find antibodies after COVID-19 clears;
  • Ran ads on page one of newspapers urging people with mild symptoms to see a doctor; and
  • Government paid $100 Singapore dollars per day to quarantined self-employed people. 

“Singapore is leaving no stone unturned,” Tedros Adhanom Ghebreyesus, PhD, Director-General of WHO, told TIME.

The Singapore government’s WhatsApp account shares updates on the coronavirus, and Singapore citizens acquire wearable stickers after having their temperature checked at building entrances, Wired reported. The article also noted teams of healthcare workers are kept separate in hospitals—just in case some workers have to be quarantined.  

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Meanwhile, in Hong Kong, citizens donned face masks and pressured the government to respond to the COVID-19 outbreak. Officials subsequently tightened borders with mainland China and took other action, the NYT reported.

Once the COVID-19 genetic sequence became available, national medical laboratory networks in Singapore, Hong Kong, and Japan developed their own diagnostic tests, reported The Lancet, which noted that the countries also expanded capacity for testing and changed financing systems, so people would not have to pay for the tests. In Singapore, the government pays for hospitalization as well, noted The Lancet.

Lessons Learned

The US has far less experience with pandemics, as compared to the Asian locales that were affected by the H1N1 influenza (Spanish Flu) of 1918-1920 and the H5N1 influenza (Avian Flu) of 1957-1958.

And, controversially, National Security Council (NSC) officials in 2018 discontinued the federal US Pandemic Response Unit, moving the NSC employees into other government departments, Associated Press reported.

According to the March 26 US Coronavirus Task Force’s televised news conference, 550,000 COVID-19 tests have been completed nationwide and results suggest 86% of those tested are negative for the disease. 

The fast-moving virus and rapidly developing story are placing medical laboratory testing in the global spotlight. Pathologists and clinical laboratory leaders have a unique opportunity to advance the profession, as well as improving the diagnosis of COVID-19 and the health of patients.

—Donna Marie Pocius

Related Information:

Tracking the Coronavirus: How Crowded Asian Cities Tackled an Epidemic

What We Can Learn from Singapore, Taiwan, and Hong Kong About Handling Coronavirus

Singapore Claims First Use of Antibody Test to Track Coronavirus Infections

CDC Developing Serologic Tests That Could Reveal Full Scope of U.S. Coronavirus Outbreak

Singapore Was Ready for COVID-19, Other Countries Take Note

Are High-Performing Health Systems Resilient Against the COVID-19 Epidemic?

Trump Disbanded NSC Pandemic Unit That Experts Had Praised

Advances in Gene Sequencing Technology Enable Scientists to Respond to the Novel Coronavirus Outbreak in Record Time with Medical Lab Tests, Therapies