Whole-of-Government Response to the 2019 Novel Coronavirus (2019-nCoV)

Mr Speaker, I thank the two Ministers for their very comprehensive updates. I have two supplementary questions.

First, could the Task Force update us on how many Singaporeans remain in China? And if there are any confirmed cases of Singaporeans remaining in China but outside of Hubei who may have contracted novel coronavirus, are there any plans for further evacuations from China?

My second question relates to the state of the economy. While Mr Lawrence Wong has indicated that the Deputy Prime Minister will announce a slew of measures in the Budget Statement, however, can the Government provide an update at the moment of the scale of the impact on our economy so far and also the possible total impact for the coming financial year? And if the situation worsens, what can SMEs do, especially businesses which are affected at the moment by supply from China as well as their workers still being in China? What can they do in the short term?

Mr Speaker, we have been in touch with the Chinese authorities and also with all the Singaporeans who are in Wuhan. Our Beijing Mission is in touch with them. So, in the last exercise, there were about 90-plus Singaporeans and four of them were unable to come back because they had already shown symptoms: one was hospitalised and three of them had shown symptoms and they were deemed not fit to fly. So, 92 came back. That was in the last exercise. The vast majority of this group had come back.

We believe that there are still about 140 Singaporeans in Wuhan now. Most of them have spouses who may not be Singaporeans. So, they have either chosen to remain in China for the time being or they would like to come back but we have to work out arrangements because it is not so straightforward, being married to non-Singaporeans. So, we are still in touch with the Chinese authorities to see what else can be done for the group of people who wish to come back and we are also in touch with the Singaporeans directly.

On whether there are any Singaporeans outside of Hubei who have been infected with the virus, we do not know of anyone at this point in time.

On the scale of the impact on the economy, we are monitoring this very carefully. I think we are only seeing the initial brunt of it now because, with the viral situation continuing to grow, with the travel restrictions and the situation continuing to escalate, I am sure the impact will not only be for the sectors that are directly impacted, like trade, transport and tourism, but there will be knock-on impacts. China's own economy will slow down and the global economy will slow down. So, there will be an overall impact on the economy. That is why I said we are studying this very carefully to develop a series of measures and a strong package in the Budget to help companies and workers. In the interim, wherever we can, we will develop and quickly roll out initiatives to help firms without having to wait for the Budget. STB has already put up one set of initiatives and we are in the midst of studying if more can be done.

Mr Speaker, I would like to pose two questions to the Minister for Health. First: what would his comments be for those employees who seek certification on being free from the novel coronavirus in order to go back to work? Second: is there a shortage of ambulance services right now because, lately, GPs have had to wait many hours for such services for emergency and novel corona suspected cases?

I would like to thank Dr Lily Neo for her two very useful questions. I can expect her to raise very important questions like these.

First, on the certificate for coronavirus-free individuals. Actually, there is no such thing as a coronavirus-free certification. The reason is because we test the patient based on his viral load and there is an incubation period during which the patient may have very low or zero viral load. But at the same time, because it is the incubation period, the virus may emerge later on. Therefore, at any point in time, when we test a person, when it is negative, it does not mean that he is virus-free. He may be virus-free at that moment, but he may already have been infected but is within the incubation period. So, it is not possible for our hospital or for any screening centre to give a certificate that this person is virus-free. We can only say that, for this moment in time, the test shows no virus detectable in his bloodstream. But the virus can emerge the following hour or the following day. Therefore, it is not possible to give a free-from-disease certificate, as what Dr Lily Neo was alluding to.

I would also like to take this opportunity to urge employers not to send their workers to our hospitals for testing in order to certify their workers as virus-free. As I have explained, first, it is not possible for such certification to be issued; second, you are simply loading our hospitals unnecessarily. So, the best way to do it is to monitor yourself if you have been exposed to contacts, or, if you have come back from China, monitor your own health for 14 days. This is the incubation period. If there are any symptoms, wear a mask as you go to see a doctor and tell the doctor your travel history, that you have been to Wuhan or you have been to China, so that all these factors can be taken into account when we assess the patient. But please do not go to the hospital to ask for blood tests in order to get a certificate that you are free from coronavirus. It is just not possible for such certificates to be issued and you will just load the hospital unnecessarily.

Secondly, Dr Neo asked about ambulance services. We have ramped up our ambulance services in order to respond to this outbreak situation. And these ambulances are used to convey those who are suspected cases because we want to make sure that they are protected and isolated while we are transporting them to hospital for testing. In the initial first few days, there were some organisational difficulties among the service operators. We have sat down and discussed with them and the logistics are managed better now. Sometimes, when there is a peak, it may take a while, few minutes, an hour, but we try to respond as soon as possible. We have also set up a hotline for the doctors to call. This is operated by our College of Family Physicians that we help to answer queries, whether it is ambulance or any other thing. So, we do recognise that, in the initial days, we do have some logistics difficulties in organising our ambulance responses. And every time we change our case definition, it is also quite natural that it will suddenly have a larger number of suspected cases because, when you change the definition, the definition will include a bigger catchment and, therefore, we will need to adjust our logistics support accordingly.

Thank you, Mr Speaker. The first question I have is for Minister for Health. Do we have enough healthcare workers and professionals to help manage patient cases in NCID and the hospitals in this period of heightened healthcare alert seeing to the increased demand and work stresses on them?

And for our own healthcare workers and professionals, do they have sufficient rest and enough social and emotional support for their own well-being? The third question is are we able to activate volunteer healthcare workers to pitch in if and when the need arises.

Mr Speaker, I have another two questions meant for Minister for Education but I am not sure whether it should be addressed to Minister Lawrence Wong.

It is related to schools. Are there any specific or additional measures in schools, particularly for pre-schoolers and Primary school children who may not always be aware or practise proper personal hygiene as we try to educate Singaporeans in this? And will there be a postponement or review of overseas school tours or trips seeing that there are other similar virus outbreaks beyond the 2019 novel coronavirus, for example, the avian flu or H5N1 virus outbreak in Hunan, China as well as in Chhattisgarh, India?

Let me address the first question and maybe Minister Ong, with the permission of the Mr Speaker, can address the second question. On the manpower requirements, yes, in fact there is a heightened need for manpower because of the intensity that we are going through – testing of the cases, quarantining them and managing them; and the management is quite intensive as you can imagine. We also need to look after the suspect cases to detect signs of infection when they occur. We require a lot of manpower and the rest of healthcare needs need to continue to be met.

Therefore, we have been working with our clusters to ensure that there is sufficient manpower and to make sure that their schedules are also properly looked at. I reminded the group CEOs just recently that we need to plan for the long term. It is not dash to the end point because we need to be prepared that this may take months. Therefore, whatever duty schedules, rosters and so on have to be planned on a sustainable basis to ensure there is sufficient turnaround and sufficient rest given to our doctors, healthcare workers so that they are able to sustain in the long term. So, these are part of our plans. We do have contingency plans in place to ensure that we have sufficient manpower to cater to situations like these.

In terms of volunteer manpower, yes, this is also part of the plan for our clusters, our hospitals to call back some of the volunteers. Some of those who are on leave also volunteered to come back and have said, "Why not I come back and help to supplement the manpower". So, I think, all these are in place and as we go along we will continue to augment our manpower resources.

But at the same time, part of the plan is to see how we can re-organise ourselves into an emergency crisis mode, an outbreak mode, so that we can operate differently. Some of the medical care that is non-urgent, some of the elective procedures, for example, may need to be postponed. We may manage them in a different way so as to lighten the load on our core medical manpower.

All this is part and parcel of our contingency plans. We have the plans in place.

On pre-schools and schools, over the weekend, educators have worked really hard. They have developed a package, a syllabus, to teach students about what the viruses are, how they are transmitted and what we can do about it to prevent transmission. The lessons covered are what both Minister Gan and Minister Wong have described just now, on how it transmits. Therefore, two things you need to do, which is that you need to wash your hands with soap and not touch your face. You just touch your face, Dr Intan. [Laughter.]

When you think about it, it becomes very hard to do. When you do not think about it, I think it is easier. Stop thinking about "I should not touch my face" or you will keep touching it.

We want to tell students that in this fight with the nCoV virus, we are going to fight it with our hands – by washing them regularly and keeping them away from our face. The intention is also to give the students some homework to bring home and tell their parents. Likewise, we want to do it in pre-schools as well.

As for overseas trips, all overseas trips to China have now been postponed, from Primary schools to all the way to tertiary. Yes, there are cases sprouting out in other parts of the world. We will monitor them. So far the cases are not many. But we will watch the situation carefully.

Last week alone, we made three major decisions because the Taskforce met every day to monitor the situation. Every day is different. We have to look at the facts and make the decisions decisively. So, likewise these are things that we will continue to monitor.

Thank you, Sir. I thank the Ministers and the Taskforce for their comprehensive responses. Indeed, fear is a greater threat to us in such a time as this. There are residents currently living near the Government quarantine facilities. And they have expressed concerns about being near the folks who are asked to stay in these centres. If things should get worse, there could be more quarantine facilities. Can I seek Minister's views and assurance that the residents need not be fearful of any spread from these centres, even as we all believe that we are all in this together? That is my first question.

My second question is this: for Minister for Education, we know the mask is not effective for everything and hygiene is most effective. Currently, most of the masks found in the marketplace and distributed are adult sized. There are parents and staff in schools who are concerned that should there be a need, is there a supply of masks of smaller sizes. Because some of the masks are so big, they cover the whole face of the children. I would like to seek Minister's views on that.

I will ask Minister Lawrence Wong to answer the question on the quarantine facilities. On the masks, it is a more general question for children's masks. As we mentioned or explained multiple times, the mask is to protect the person not wearing the mask. So, the mask is prevent the cough and sneezes from the person who is sick. So, for that purpose, for younger children the mask can be used because it is just preventing them from spitting out their sputums or their sneezes, to prevent the droplets from going out. With some adjustments, the masks can be used for younger children. And if they really cannot be used, then what you should do is to use a handkerchief or whatever to cover the mouth to prevent it from spitting out and to observe hygiene: if you do that, please wash your hands.

If you have to go to the hospital or clinic to see a doctor, you can use a mask. If the child is sick and if there is no need to go out, please do not take him out. Keep him at home so that he can rest and recover as soon as possible.

Dr Vivian Balakrishnan asked me to read this. He said while I was giving my speech, he had observed out 13 out of 41 Members of Parliament sitting opposite us, touching your faces within the 25 minutes. Therefore, touching face is not easy to avoid, but please wash your hands. So, it was not just Dr Intan, I just wanted to clarify. Between then and now, another 13 would have done it. So, please just observe personal hygiene, wash your hands regularly. That will protect yourself and protect many people.

Mr Speaker, I can confirm to Ms Denise Phua's question that there is no need to fear having a Government quarantine facility nearby or even having somebody within the same apartment block subject to home quarantine. Firstly, we have to be mindful that anyone who is in quarantine is not an infected person. They are not. They have been exposed so they are of some risk. Yes, they have been subject to some exposure perhaps through close contacts, perhaps they have been back home from China recently, particularly in Hubei, so we want them to be quarantined just to be safe. But we should not assume automatically that anyone in quarantine is infected. They are not.

Number two, when they are in quarantine, there are strict protocols and procedures to ensure that they stick and they remain within the place of quarantine. I mentioned a few things that we do – phone calls, video calls, spot checks, a whole range of things for home quarantine. In the quarantine facilities, there are also strict parameters. These people will be within the location where they are quarantined. They will not be able to wonder about so easily.

Thirdly, there are also some fear that let us say there is a person nearby under quarantine, yes, quarantine is safe, but if there is some chance that this person later on is found to be infected then he may have moved around; then this is fear somehow that I mentioned on WhatsApp avoid coming to this place. I do not know if I have touched objects or places around me or contaminated, and if I touch them I might get sick. So, thirdly, whenever there is a confirmed case, there is a thorough cleaning and disinfection process to make sure the place is entirely cleaned and disinfected; and NEA supervises that.

With all these measures in place, we should continue to assure Singaporeans there is no need to be fearful or to overreact due to fear or panic. In fact, this is critical because if the situation were to escalate, as Minister Gan said, we have to be prepared for things to get worse. We have to be prepared for more cases in Singapore even for community spread. If that to happen, we do need quarantine facilities and Singaporeans all have to cooperate and we seek their understanding that this is an essential part of ensuring that we can get through situation together.

Thank you, Mr Speaker. My clarification is for Minister Lawrence Wong, on whether he can elaborate on what Singaporeans who are returning from China through Changi Airport can expect. The reason I am asking this is I have a resident who came back from Wuhan but through another airport and he is currently under home quarantine with his family. He told me that it was a very stressful experience for him and his family at the airport because he and his family with young children were basically kept in a locked room for about four hours waiting for vehicles to arrive to bring them back and so on. I wonder if the Minister could elaborate about what Singaporeans coming back through the airport, through the Chinese routes can expect, whether the processing time of four hours for example is normal or has it been more streamlined? And whether passengers coming from Hubei and other airports are treated differently?

Mr Speaker, anyone coming back from Hubei, Wuhan, basically Hubei province would be deemed to be of higher risk. And therefore anyone coming back, we would want them to be isolated and quarantined. There are these processes in place. Can we improve them, can we make the waiting time shorter? I am sure the agencies are going all out to see how it can be streamlined and improved, but we hope Singaporeans and travellers in this category would understand. First of all, for new arrivals we have already stopped the flow. But Singaporeans, PRs and long-term pass holders can still come back. And if you are coming back from Hubei, you are of a higher risk and we will want you to be isolated and quarantined. There will be some inconvenience but please bear with us while we work through the process and see if these processes can be continued to be improved.

Mr Speaker, on the quarantine allowance, over the week, we have spoken to some taxi drivers and private hire drivers, they are very assured that if anyone of them is quarantined there is a $100 daily allowance given by the Government. For employees who have Leave of Absence in which employers pay for them when they are on leave but for the self-employed there is this element whereby if I am at home for 14 days I do not have the income. That may be some concern to the self-employed. So, perhaps we can consider some calibrated support for this group of self-employed individuals who may be on leave of absence. They will self-quarantine themselves at home but let us see how we can help them tide through this period.

Mr Speaker, we are aware of this feedback from the groups that under Leave of Absence because they are doing this on advisory with their employers, or if they are self-employed, then they are doing it themselves. There is quarantine allowance and they are seeking some help. So, we are mindful of the feedback. We are studying if there are some immediate measures that can be put in place to support and help them.

Thank you, Speaker. The first death outside of China was reported in Philippines. I just want to ask for an update from the Minister on the 18 patients who are currently under observation, what is their health situation? Have they improved? What is happening to them?

And in Thailand, the doctors have apparently come up with a cure, an antidote for the virus. Can this news be verified? What hopes can we have on such a cure being found? Some are saying that there are no cure virus and so on. So, perhaps the Minister can share on that.

And the next supplementary question, xenophobic tendency and sentiments have surfaced around the world. In Singapore's context, we are a small country, how can we safeguard ourselves from having such tendency in the public?

I will deal with the first two questions and I will leave it to Minister Lawrence Wong to deal with the last question.

First, on the status of the 18 confirmed cases, I gave an update in my speech earlier. All of them are isolated and being supported in our hospitals. Most of them are improving and we hope to be able to see a discharge soon. But that is something that we are working towards. We will continue to provide them with support.

Currently, there is no known curative treatment. That means, we are not able to definitively cure a person. There will be news of possible discoveries because scientists are working overtime to make sure to put in efforts to discover ways to contain the virus and treat the virus and also to prevent the virus through vaccines. So, I think vaccines and curative treatment are being looked into. But I think it will take time to develop the method and to also test the treatment to make sure that they are effective and safe for patients. So, I think it is not going to happen overnight. It may take quite a while before we see a curative treatment being determined. During this period, I think it is better for us to focus on how we can manage, contain the spread and put in the necessary measures to protect our population.

The Member said anti-PRC sentiments are showing up everywhere in the world, arising from this virus outbreak. And as I mentioned in my speech just now, we see this in Singapore too. How can we deal with this? As I mentioned just now, all of us should take a united stand to condemn such prejudices or discriminatory behaviours or actions whenever we see them.

For specific cases, let us say it is a landlord that is taking a very irresponsible action to evict a tenant without any basis, then we will see if some actions can be taken against the landlord because again, doing something like this, is not just an individual action. It can have repercussions on our whole containment efforts and can be ultimately harmful to all of us. So, for specific actions, we will look at them and we will engage the landlord and we will see if tougher action needs to be taken. But for the overall tone of society, I think we need everyone to speak up, to voice up and we need every Singaporean to do their part to condemn such behaviour.

I thank the Minister. I just have one question. I would like to ask how are the countries including China responding to the ban on all travellers with recent travel history to China.

Mr Speaker, given the way the virus is spreading and the way the situation is unravelling, I think I believe China understands why some of these restrictions are needed. China itself has restricted its own people from travelling outside of China precisely because they do not want to spread this virus to other countries. So, they too, see the need and recognise the need for travel restrictions on its own people and to contain the virus in China. So, what we and many other countries that have put in place similar restrictions are doing, are really complementary to China's own actions. It is in all of our interest, be it China, Singapore or any other country. It is in our collective interest to tackle this situation together as a global community in order to limit the spread of the virus and contain it as much as possible.

Sir, in addition to the needed domestic effort to minimise the risks of community spread, how is the Government working with our Singapore health force to find solutions to the global emergency, in terms of vaccines and the collation of medical discoveries and best practices to contain the virus? Such solutions aid Singaporeans, the region and the wider community of nations.

Secondly, while we are putting in measures to minimise the risks of a community spread of the Wuhan coronavirus, what are the protocols in place should the situation translate into serious community spread?

Thank you. There are collaborative efforts between our research institutions to look for a solution both in terms of treatment as well as vaccines. The first step is to better understand the virus and how it evolves and how it behaves so that we can then develop appropriate vaccines.

There is already on-going collaboration and we continue to explore opportunities. These collaborations are between our research institutions as well as companies who are involved in some of these development of vaccines. There are on-going platforms for this collaboration.

WHO and the various international organisations also provide platforms for sharing of knowledge and information. China, for example, has, very early on, already sequenced the virus and it was posted on the WHO website so that all the research institutions globally can have access to the sequencing, so that they are able to carry out their own research and enhance the knowledge and understanding of the virus.

This area is quite vibrant and we have quite a few entities that are involved. Some of them, of course, involves commercial undertaking and therefore, there will be some commercial sensitivity as well. There are avenues for this to continue and we want to also encourage more collaboration globally.

The second question is: what are the protocols involved in a community spread. It depends on the different types of community spread. The first possibility is a very limited community spread, meaning it could spread from person A to person B, and then person B passes it on to person C. So, person C has no direct relationship to person A. And therefore, it is a secondary transmission. It is also a form of community transmission but this transmission is likely to then be quite limited to one or two generations. If we are able to react quickly, able to contain patient C and patient B, then we will be able to contain the spread. For example, if patient C is a contact of patient B, and we are able to trace patient C once we identified patient B, even it has been transmitted to patient C, then we are still able to say that patient C is probably contained. And therefore, the likelihood of a wide spread community transmission is less likely.

But there is a also a scenario which I mentioned in my speech, where there is widespread community transmission, meaning there will be multiple clusters of infection where there is no clear links to any source of infection. And therefore, you would then assess that it may be transmitting from one person to another quite directly and there is no way for us to have contact tracing for them because they have many, many contacts.

In such a situation, you may then need to assess what is the landscape at that time, what are the risks that are involved. As I mentioned in my speech, we may have to begin to look at how we can reduce or restrict human-to-human interaction. One example is to cancel or terminate all the major gatherings where you have thousands and thousands of people, as well as to minimise the risks of transmission. There is also the possibility that we may suspend some schools or all schools, depending on the situation so as to minimise the interaction of children at schools as well as the parent interaction. These are all possibilities. But exactly which steps we are going to introduce will depend on the exact nature of the community spread.

We have a framework of various options that are available and each of them will be deployed depending on the situation prevailing at that point in time. One of the roles or duties of the Taskforce is to make an assessment as the situation evolves and decide what are the appropriate measures to introduce when the time comes.

I would like to thank the two Ministers for their Statements. Just two supplementary questions, I believe, for Minister Wong.

The first one is, there is, of course, a Price Control Act (PCA) and there were reports of traders of masks who were profiteering, charging very high prices. I understand that the Price Controller has written to some of them. And, of course, as economists all know, using price controls has its downside and its risks. You can create "black markets" and so on. But for exceptional and crisis situations like this, is deploying the PCA to actually put price controls in place, using this legislation, something that the Government will consider, in future, just for limited periods of time?

My second supplementary question is with regard to the method of distribution of masks, I would like to ask the Government to share its considerations behind why the masks were not mailed out rather than collection being made at different collection points. There has been some discussion around around this. There could be some advantages to mailing out masks in terms of not encouraging people to cluster together and so on. I believe that there was an exercise in 2014 when some organisations mailed out N95 masks during the haze period. So, there is a precedent there. I just wanted to understand the thinking a bit more and whether mailing out of masks is something that might be done in future, if such cases arise.

Mr Speaker, as the Member would have read from the media reports, the Price Controller has indeed already a letter of demand (LOD) to one platform provider requesting for more information in order to assess the need for further action under the Price Control Act. Letters of demand (LODs) have also been sent to other e-commerce platforms like Lazada and Carousell to request information on any potential profiteers on their platform. So, we will not rule out any option at this stage.

The Price Controller is pursuing, investigating, getting more information and, if need be, more actions can be taken.

But, as of now, I would say, looking at the prices, some of these platform providers have cooperated. I heard recently that some of them have even removed some of these listings with very exorbitant prices. So, anyway, the Price Controller is on top of this. It is following up on the matter and it will consider actions that need to be taken against profiteering.

On the second supplementary question, we had deliberated over this and we felt that if you were to distribute masks via post, there may well be wastage because some households will not need the masks. Like I have mentioned earlier, even in the collection exercise, when we go around and residents come to us, they say, "Actually, please, I do not need the masks. I am not going to collect it. You save it, either for your stockplile or you give it to someone else." So, in that sense, a collection exercise would be a more prudent way of distributing masks.

And to address the concern of people gathering together, we had decentralised the distribution points to void decks, RC centres. It is proceeding in a very orderly fashion. If you go to any of these collection centres now, there are no queues. There are designated times to pick up the masks so there is no large crowds at all in any of them. People are just picking up as and when they are free during the designated times. So, based on the exercise that we have done so far, I would say this distribution method is more effective.

Thank you, Mr Speaker, my question is for Minister Gan Kim Yong. He mentioned that if there is widespread community spread, we may have to close the schools and I suppose even the pre-schools. But there are actually families where both parents are working and it is very difficult for them to take time-off to look after the kids and we do not know how long this will last. So, when we announce any school closure, will we also announce what are the alternatives that will be available to these parents?

I think Minister Gan is doing the right thing to paint future scenarios that are possible that we should be prepared for, so it is not as if we are going to do it straightaway, but I think it is something we have to consider, to prepare plans taking into account the considerations that Mr Yee Chia Hsing has mentioned.

Bear in mind that when SARS was at its height, we did suspend schools for a couple of weeks. If it comes to that, if we have do it, we have to do it. But I think we have to look at the data, look at the evidence, look at the situation and take into account all considerations before making any decisions.

Mr Speaker, maybe I can just supplement what Minister Ong just said. I think the question from Mr Yee highlights an important point, that for every measure that we contemplate about introducing, there will always be an impact on the society. And therefore, we have to evaluate and assess every measure very carefully, taking into account the impact on society, as I have mentioned in my speech. None of the decisions or measures are easy. We are always weighing the pros and cons, and eventually, we have to decide what makes sense for us.

So, I would assure Mr Yee that when we make a decision, whether it is school suspension or any other decision, we will always take into account the impact on individuals, on the society, on different groups of people. We want to make sure that for those who are affected, we do our best to help them address their concerns and their problems.

I thank the Ministers. My question is: in the event if we need to step up to using N95 masks because there is wide community spread or for future viral outbreaks, how do you ensure that the public are fitted with the right model of N95 masks? Because what is being done in the healthcare institutions is we actually go for mask fitting test to ensure that there is optimal protection, because different models fit different face shapes and the public may not be aware of this.

I thank the Member. I think it is an important question. Maybe I should explain that in the event of widespread community transmission, wearing N95 masks is probably not the solution. N95 masks are generally used by the healthcare professionals. We have used it for the haze. In fact, we have kept telling people that you do not need the mask for the haze. Anyway, people still wear them for the haze. Therefore, as Ms Irene Quay has mentioned, if you do not fit it properly, the mask really does not protect you. In fact, we are most likely going to introduce social distancing, as I mentioned, manage the crowd gathering, minimising human-to-human interaction, rather than to introduce the N95 mask for general use.

If need be, we will carry out the necessary education, to reach out to Singaporeans to explain to them how to protect themselves. I think to teach each of them how to wear the N95 mask to be as effective as in the healthcare environment is going to be quite difficult and you may end up giving them a false sense of security. And as a result, you may end up with more infections, which is counter-productive. I would say that the N95 mask is not going to be the main focus for outbreak control, if there is extensive community transmission.

I have a question for Minister Gan. I read with concern the reports of infection of healthcare workers in China today. During SARS, we too had doctors and nurses working with infected patients, getting infected themselves. So, I think in today's context, can the Minister share: what measures are taken today to better protect our healthcare workers, especially those in the frontline taking care of the patients who are infected?

Healthcare workers are one of our most important resources in a disease outbreak like this, and they are right at the frontline, they are facing the disease and the patients every day, every hour, and therefore we need to make sure that they have adequate protection.

Despite the best protection, in some cases, healthcare workers are infected. In cases like in China, for example, and very often, this happens at the initial stage of the outbreak because healthcare workers are unfamiliar with the virus, they may not understand that it is infectious or it is as infectious as we are seeing, so therefore the precautions may not be adequate. As time progresses, when we get to know the virus better, I think the protection measures will be enhanced.

For us in Singapore, we have stepped up our protective measures and I think, particularly because we have gone through the experience of SARS and several other disease outbreaks. These are very painful lessons in our memory, and therefore our healthcare institutions have exercised extra caution when they deal with these infected patients.

In our National Centre for Infectious Diseases, for example, there are well-established protocols, including monitoring of how you put on your Personal Protective Equipment (PPE) or how you take it off. There is also a second person monitoring how you do it to make sure that you follow every step carefully. Once you miss a step and are exposed, you will have to be quarantined to make sure that you are not infected.

Our healthcare workers and our healthcare institutions are very mindful of the risks that are involved. Our frontline workers, those who are in the Emergency Department, our General Practitioners (GPs), they are also very alert to the potential risks. As soon as patients arrive at their clinic, they will be triaged. If they have potential risk of contamination, they will put them aside, give them a mask to wear so that they do not contaminate others.

These are the practices that have been put in place, but whatever precautionary measures we have put in place, we must be very mindful and be very cautious. If we are careless, none of these measures will help us. Therefore, we constantly remind our healthcare workers to remember to be cautious, to protect themselves, and, at the same time, protect the patients.

Thank you, Mr Speaker. I have two supplementary questions, more perhaps related to MOM and MSF. The first one is: what are we doing to encourage employers to be generous with respect to paid medical leave, paid family leave for workers who are sick, who may need to self-isolate, who may need to take care of a close family member who is sick? I am asking this because I will stand corrected but I am not sure right now that paid leave is actually mandated for self-isolation. I know it is for quarantine cases. We would not want employers to ask employees to take their own annual leave or no pay leave in such cases. That would be counter-productive.

The second question is: Mr Ang has already spoken about the financial constraints faced by self-employed persons who have to go on Leave of Absence, but I think the problem goes beyond that. Because even when self-employed persons have to go see the doctor or just take a day off work because they are not feeling well, they do not earn any income. I think this is another area where we can look into providing wage support, maybe medical cost support, because again, we do not want to be counter-productive here. We do not want people to have to choose between taking care of their health and earning a livelihood. That is an important area to look into.

Mr Speaker, the treatment for persons who are on Leave of Absence is quite clear. We have sent out an advisory to employers that because this Leave of Absence is a requirement, they will have to find ways of supporting it. Whether the person who is on Leave of Absence is provided with additional leave or that duration of Leave of Absence is treated as paid vacation leave or sick leave, there are certain suggestions on how the employers may treat it.

I think the Member's question also extends to persons who are not required to be on leave of absence, but either as their own unilateral sense that they should stay away, because they are not feeling well, or they have to look after someone who is on Leave of Absence. In those instances, I think we have to allow the employer to exercise some flexibility. If it is a situation where the employer has come into agreement with this individual, well and good. I think the employers know what to do. But there is really no requirement for a person to stay away from work if they themselves are not being asked to fulfill a Leave of Absence requirement. It is only something that they are doing on top of, so I just wanted to be clear on that.

The Member has also asked the question about self-employed persons. We are very mindful of how they could be impacted and as Minister Lawrence Wong has said earlier, we are looking at ways in which we can be helpful.

Thank you, I just want to echo and express my thanks to Minister Gan for his statement of thanks and support for healthcare workers. Two short but slightly technical questions, I apologise. The first, Minister touched about it earlier. I think many Singaporeans are looking forward to the day when the first of the novel coronavirus patients are discharged from hospital. Could I just ask what are the criteria for discharge? Because there does not seem to be an international consensus on it, as far as I know.

The second was concerning transmissibility. One of the key hallmarks of the SARS virus was that there existed these subset of patients known as "super spreaders". So, if you look at this novel coronavirus, the ratio of transmission as we reported, about 2.2, which is, on the average, one will pass to about 2.2 persons. SARS was much lower, but then there are these "super spreaders" which caused a havoc in our healthcare sector. I was just wondering whether there is any information coming up from anywhere whether there exists such "super spreaders".

I thank Dr Chia for the questions. Dr Chia knows I am not a doctor, so I can only do what I can as a Minister for Health.

First, the way I understand from my professional colleagues, that for patients, they will do two tests and both tests have to show negative, and they are usually one day apart to make sure that they are free of virus before they are considered for discharge.

But on top of that, at the end, doctors usually will make an assessment at the end of the day despite all the tests that we do, to assess and be confident that the person is well, does not look sick, does not have symptoms and generally are quite well, and maybe he will keep him for a while longer to make sure that there is no further deterioration before his discharge. Generally, our doctors are very careful. We can leave it in their hands to make a professional judgement when is the appropriate time to discharge patient.

And, Ministers, I must assure you, do not interfere in their discharge proceedings because it is purely professional judgement.

The second question on "super spreader". Dr Chia is right that we are all looking out for the risk of a "super spreader" emerging. This is where one particular patient may infect tens or hundreds of patients that come into contact with him and so on. These are potential multipliers that will cause a major outbreak in the premises, in the locality. We are all looking out for such an incidence. So far we have not received any report of such an incidence. It may happen but it is not yet being detected. But we are all looking out for them. Sometimes, the "super spreaders", the patient themselves may be quite well. And therefore he is able to go around many places and spread a lot of potential contamination in the environment. Therefore, it is something that we are looking out for.

Dr Chia is right that this would be a problem if this occurs in Singapore, in China or anywhere else, so it is something that we will continue to monitor.

Thank you, Sir, I have three supplementary questions.

First, the news on 30,000 work pass holders returning to Singapore has caused some anxiety to our residents because as the main bulk of this 30,000 work pass holders are living in our HDB flats. So, I would like to ask the Minister is there any way to monitor, to ensure that they comply to the 14 days of LOA strictly?

The second question is, for those who are returning and due to whatever reason they have no place to go back to, is there any help that is given or will be given to them? Just give an example. I receive one email from my resident. She is due to return on Wednesday but her husband does not want her to return to their home because the employer of the husband has imposed this rule that if any of your family member comes back from China, you have to stay at home as well. That is the reason, the husband does not want the wife. So, she is asking for help.

The third question, will we impose or is there any plan to impose travel restrictions for those who come from Hong Kong? Because Hong Kong is very near China and there is some concern among residents as well.

Mr Speaker, maybe the last question first. The travel restrictions that we have put in place apply to Mainland China. Hong Kong has fewer confirmed cases than Singapore. Maybe people might want to apply travel restrictions on Singapore then. I think our approach is to be looking at evidence, at the source of where the virus is, how widely it is spreading and which are the at-risk sources. Yes, I think we will not rule out more actions on travel restrictions, as we have said, but it has to be based not just on geographical proximity or distance but based on evidence on the nature of the virus, how widely it is spreading, at the risk. And if there are risks posed to Singapore and Singaporeans, we will not rule out other measures on travel restrictions.

On the 30,000 work permit holders, I should clarify they are still in China now, they have not come back. Not all of them live in our housing estates. So, we are doing a tabulation, working directly with the employers to identify who they are, which sectors, where are their places of residence today. That exercise is underway now, so that we can be ready when these workers return, be ready to engage the employers, to be ready to engage the landlords; if some of them are living in dorms, be ready to ensure that our dorms are properly fitted out to have these workers living in more isolated areas without interaction and contamination with their fellow workers. That is the work that is happening, already been happening and we are continuing with this process.

The question is what happens if employers need help because they say they are impacted by their workers who are coming back and unable to work, what happens if family members need help because somebody is in LOA within their home and then they too are impacted. I think these are all questions that we are anticipating. It is all part of the package of measures we are looking at to help companies, employers and households as well. So, we will, as I said earlier, put in place a series of measures to help those who are impacted and we will take all this into consideration in our package.

Thank you, Mr Speaker. I agree with Minister Wong that fear inflicts more damage sometimes than the virus itself. F-E-A-R is also false evidence appearing real so I am going to ask Minister Gan if I can go straight to the source of fear, which is the fear of death. Could he explain to us how death occurs from this virus? Because there is this panic and hysteria that the moment we "kena", we are just going to drop dead. So, it would be really useful if we can explain how death occurs from one who actually gets infected. What I understand is that most of the death cases right now from China have occurred in people who are elderly and who are at risk. It would be really helpful for us to know how the virus impacts us physically and that could lead to death.

The second question I have is looking at the Fear Factor that impacts the economy and employment. There have been a lot of companies that are cancelling commercial activities and projects and events. Let me declare my interest, I am a founder of Hush which is a social enterprise, the Hush TeaBar, and even for us as a social enterprise, next three months, all the projects are cancelled and we are not the only one. I am wondering if the Government or MTI perhaps think that there may be merit to issue clear guidelines to companies in terms of cancellation or postponement of commercial activities and business events, because there is definitely a knock-on effect to SMEs and social enterprises.

And also, now that I know from Minister Gan that the virus is not airborne, I really would encourage all of us to take three deep breaths every time, every day, as we calm our minds and heart.

I am not a doctor. So, it is very difficult for me to describe the process of death in medical terms, but I would try to explain how it causes death. Basically, when the virus attacks your body, your body will try to mount a response, a defence. And very often, you find that when your body is unable to respond adequately to eliminate the virus, your body will go into a shock, your organs go into overdrive and, therefore, you may begin to see organ failures and eventually, death will occur as a result. Therefore, because of this, chances are, if you already have underlying medical conditions, your body is already weak, your defences are weak and your organs may already be impaired, therefore, the risk of death is higher.

It is important for us to ensure that we continue to stay healthy. At the same time, what the hospitals will do is to provide supportive care to ensure that you have time for your body to recover, for your body to be able to fight the virus on its own until we are able to develop a definitive curative treatment. I think that is how the process will happen.

The Member is right, generally, coronavirus affect patients who have underlying conditions more, and, generally, the older people tend to have more underlying conditions and, therefore, they tend to affect the older people more. But there are also exceptions and even in this novel coronavirus situation, we see that there were some in the 30s and 40s, they are also infected, and some may not have underlying conditions.

At the end, it is also an issue of statistics. When you have large enough number of people who died, at the end of the day, there will be some who are not so typical, who not necessarily have conditions, but they have more severe reactions for a variety of reasons. So, it varies but, generally, coronavirus affects people with underlying conditions mainly because your organs tend to fail progressively as the disease progresses.

The second question is on the impact on our economy and can we provide clear guidelines on major events.

Mr Speaker, I think we have already put out the advisories based on today's situation, based on where we are today where there is no community outbreak within Singapore, community transmission. Events can continue but organisers take extra precautions. So, there is no need for cancellations; continue with the events. But if it is a large scale event, then you might want to take precautions like having having temperature screenings, which I think many event organisers are doing, and then putting out advisories to remind the participants that if they are sick, do not show up. If they have been to China recently, then make sure that they stay at home. Those sorts of precautions are useful and we continue to remind companies and event organisations of these precautions.

Mr Speaker, my question is for Minister for Health. The official communication channel to the people who subscribe to the WhatsApp group quoted the Prime Minister saying that, "Experts think that the Wuhan virus may be less deadlier than SARS". So, can we have some verification whether this is true so far?

Sir, I mentioned in my speech that the fatality rates of SARS is about 10% and the fatality rate of this novel coronavirus is about 2% to 3% today. So, numerically, statistically, it is less fatal than SARS. But as I have said, it is still at the early stage of the development of the disease, the numbers will change over time.

In fact, as more and more milder cases are detected, the denominator may tend to go up and, therefore, the number may come down. At the same time, those who are confirmed cases today and, progressively, they may die because of the progression of the disease. So, therefore, both number will change over time. But as of today, based on our statistics, it appears to be less fatal, because fatality rate for SARS was 10% whereas the coronavirus is 2% to 3%.

Thank you, Mr Speaker. Our hearts and our prayers go to those Singaporeans who are still in Wuhan. When we heard that the 92 Singaporeans are brought back to Singapore, we were very happy to hear that. But also sad to hear that the four of them who had symptoms could not be brought back.

I was just wondering what kind of medical help would they receive in Wuhan, if we leave them there. The plane capacity is big enough. Could we have brought the four of them back as well, in the first place, to receive treatment over here, even if there are symptoms, if their symptoms are not that severe? That is my first question.

The second part is that it is in times like that, we see the best of humans and we see the worst of humans. In the last two days when we go around doing the mask distribution, we see a lot of encouraging signs. We see volunteers coming down to help at the mask distribution point. We see residents coming down to give drinks, give food to the volunteers. I have a lot of new volunteers suddenly joining in, to say that they want to do their part. I also have an ex-grassroots leader whose both legs were amputated – as a result he cannot serve as a grassroots leader anymore – because of diabetes. He came in a wheelchair and he said that, "I can't walk but I can man the counter; can you let me man the mask distribution point?"

I would say that this is an opportunity, really for all Singaporeans to come together to rally. We also want to bring all our Singaporeans abroad now, who are now in Wuhan, Hubei, if they can come back, please bring them back. I hope that the Government and MFA would work harder now to see how we can bring them back.

First of all, let me say that China has been very responsible and very responsive, and is taking all necessary measures to look after our Singaporeans who are still there. I have spoken personally to the Chinese Foreign Minister and I can assure you, based on our conversation.

My next point is, I want to make an appeal to all Singaporeans who are in China to e-register with MFA. This enables us to stay in close touch with them to monitor their condition, to give them appropriate advice, recommendations and, obviously, if there is a possibility or a need, to mount further operations, this ability to communicate quickly and effectively is absolutely necessary.

The third point I want to make is, with respect to the Member's specific query about whether those with fever should have been on-board the aircraft. I think, first of all, if you look – the Member is a doctor – and we all know from a medical point of view, in the context of an epidemic and, particularly, when you are dealing with a global or a potentially global epidemic, it is most unwise to put people on commercial aircraft when they are potentially actively shedding virus. So, there was good medical rationale and that is why the Chinese authorities make, in my opinion, the right decision that these persons should not fly. If they did, it would have been contravening not only their own regulations but also WHO recommendations. So, we understand that.

I was monitoring the operation and I knew exactly how many were caught in that situation, quite apart from the others who could not evacuate for family reasons because at that point in time, the decision was that their own citizens were locked down and Singaporeans, PRs and others were considered local citizens. So, there are other considerations. But, specifically, now for the remaining Singaporeans because we will remain in touch with them, we will do our best to ensure that they have all the necessary treatment in Wuhan or in other places in China.

If additional support is needed, obviously, we will look at that. And that also brings to mind what Minister Gan said just now that this problem is not just a Chinese problem, it is not just China's problem. This is a common threat confronting all of us. This virus does not respect passports or nationalities, race or language. That is why we must all cooperate and collaborate and to resolve this problem together. I commit that we will continue to work closely with the Chinese authorities and in any way in which we can help them, it is also helping all of us collectively.

The Member has cited an example of volunteers. This is the time when you will see the best, and sometimes, you will see the worst in humanity. But I am confident that because of what we have been through 17 years ago – I recall that personally – I am confident Singaporeans will demonstrate the best of humanity and we will get through this and we will get through this together. So, rest assured, all the Singaporeans who are overseas – MFA – we will not leave anyone behind, we will look out for you.