Health authorities have severed sev-
eral transmission chains, tracking down people who have been in contact with a known case and ordering them into home quarantine. They are checked twice daily to see if they developed a fever. Mass gatherings were canceled.
Schools have not been closed, though students go through temperature screening to enter. So does anyone entering most buildings or restaurants. Heymann, who was in Singapore re-
cently to lecture at Saw Swee Hock School of Public Health, said at the start of each class, a picture would be taken of the classroom, so that if any student became ill, there would be a record of who had been in close contact with him or her. “So there’s all kinds of innovations and mea- sures going on,” he told STAT. Singapore also quickly developed a
much-needed serology test — a blood test used to look for antibodies in blood that are a sign of previous infection. Getting a handle on how many people have been infected is critical to understanding how deadly this virus really is, experts stress. Authorities in Singapore actually used the serology test in late February to find the source of a cluster of cases in a church
group.
How about Hong Kong? Hong Kong, like Taiwan and Singa-
pore, bears deep psychological scars from the 2003 SARS outbreak. Hong Kong had the most cases of the disease outside of mainland China and people there remem- ber the trauma that came with it. So do their public health leaders, who
have prepared for disruptive infectious diseases outbreaks in the years since SARS and the 2009 H1N1 flu pandemic. People take respiratory health hygiene seriously, routinely wearing surgical masks in public if they are sick to prevent spread to others. “These places were better equipped
to face an outbreak of the new coronavirus than many others,” Ben Cowling, a profes- sor of infectious diseases epidemiology, and Wey Wen Lim, a graduate student in infectious disease epidemiology at the University of Hong Kong, wrote in a recent opinion piece in the New York Times. Hong Kong responded very quickly
— within days of China’s Dec. 31 an- nouncement that it was finding unusual cases of pneumonia. Doctors were told to report any patient who had influenza-like illness and a travel history to Wuhan. Bor-
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ders crossings into China were closed — first some, then all. Schools and universities haven’t been
open since the Lunar New Year, on Jan. 23, though online learning has replaced classroom teaching in some circumstanc- es.
Hong Kong has been testing for the
virus, aggressively trying to locate cases. People have been urged to telework if possible and to practice social distancing. Gabriel Leung, dean of medicine at
the University of Hong Kong, said mea- sures have largely worked, but the toll is high. And both he and Cowling are con- cerned people are starting to let down their guard. “I think we are already beginning to
see a little bit of response fatigue among the people,” Leung said, noting it has be- come apparent over the past couple of weeks. “You see that people are beginning to mix again, they’re beginning to come out again, because it’s been two months already. So how do you still keep alert and keep this up? There is only so much that any population would be able to tolerate.”
What of Taiwan? Taiwan didn’t move initially to cut off
air travel with Wuhan, as Singapore did. But doctors boarded incoming flights with temperature scanners looking for people who were unwell. Later it did ban most flights from China. Mass gatherings were not banned, but
were discouraged. The government con- trolled the distribution and pricing of medical masks, Cowling and Lim wrote. Stiff fines — up to more than $30,000 — were threatened for people who violated home quarantine orders. “All of these places are coupling ag-
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gressive testing strategies to identify cases, with isolation, contact tracing and some- times quarantine of at-risk people,” said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security, speaking of Singapore, Taiwan, Hong Kong, and South Korea. “And they have also layered on commu- nity mitigation strategies, school closures … and other closures. So what I take away from that is that it’s important to layer these strategies to try to accommodate both of them.” Rivers tried to look at whether the
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