Nationwide Emergency Preparedness Exercise to Deal with MERS

Mr Lim Biow Chuan asked the Minister for Health whether adequate measures have been taken by the health authorities to ensure that all visitors from countries affected by

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MERS are properly screened before they are allowed entry into Singapore.

Madam, the Ministry of Health (MOH) has been closely monitoring the global situation of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) since the disease emerged in 2012. WHO's current assessment is that the transmission of the disease is mainly among households and hospital contacts, and there is no evidence of sustained community transmission. Nevertheless, we must remain vigilant to the possibility and the impact of an imported case from the Middle East, South Korea or elsewhere.

There has been very close inter-Ministry coordination and planning to prepare for such an incident. An Inter-Ministerial Committee (IMC), co-chaired by Minister Chan Chun Sing and myself, has been formed since late last year to oversee whole-of-Government preparedness against dangerous infectious diseases, including MERS and Ebola.

We have taken a multi-pronged approach and have put in place various measures to detect imported MERS-CoV cases and contain any further transmission in Singapore. Our first line of defence is on prevention and detection, through public education, border screening and vigilance among the medical community.

Let me elaborate on some of the measures. As part of public education efforts, MOH has a dedicated webpage on MERS-CoV and has published a set of FAQs to help Singaporeans understand the disease and advise them on the precautionary measures they can take to protect themselves.

At our borders, MOH has been issuing health advisories to travellers going to countries with active transmission of MERS-CoV including the Middle East and South Korea. In addition, travellers arriving from MERS-affected countries are given individual health advisories on the symptoms of the illness they should look out for and they are advised to seek immediate medical treatment if they have such symptoms. They are also reminded to inform the healthcare professionals of their travel history, so that proper infection control measures can be taken while they are being tested for MERS-CoV.

Temperature screening at the air checkpoints has been implemented to screen direct flights from the Middle East and South Korea. However, as MERS-CoV has an incubation period of up to 14 days, infected travellers may not have any fever when they pass through

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temperature screening and, therefore, they may not be picked up or detected at entry. Hence, our doctors and hospitals have been reminded to remain vigilant to the threat of MERS-CoV among travellers from the affected areas. Persons with symptoms of severe respiratory illness upon return from the Middle East or South Korea, and those with any respiratory symptoms and had visited a healthcare facility in South Korea or the Middle East, will be subjected to further investigations to rule out the possibility of MERS-CoV infection. They will be isolated until this investigation is completed. This year, up to 10 July 2015, a total of 62 such suspected cases have been investigated locally and all have tested negative for MERS-CoV.

However, it is a matter of time that the contagion will reach our shores. Therefore, beyond the preventive measures that I mentioned, Government agencies have contingency response plans in place should there be an imported case. Confirmed cases will be treated in isolation rooms and our healthcare workers taking care of them will wear the appropriate personal protective equipment (PPE), and they have been trained to minimise the risk of contagion. In parallel, MOH will conduct contact tracing and quarantine all close contacts, to prevent further spread. We will update and exercise our response plans regularly. Recently, we conducted such an exercise at the Changi Airport and the simulated patient was conveyed in a portable medical isolation unit (PMIU) to Tan Tock Seng Hospital. We will continue to carry out similar exercises from time to time involving not only MOH but also other agencies as well.

The public, too, plays an important role in national preparedness by keeping up-to-date with the Government's advisories and exercising personal responsibility and good hygiene practices. The People's Association recently launched a nation-wide programme to train grassroots leaders on preventive measures to handle MERS-CoV so that they in turn can share the information and knowledge with residents at the constituency level.

MOH and the Inter-Ministerial Committee will continue to monitor and assess the MERS-CoV situation. Our priority remains to prevent, detect and contain any imported case into Singapore so that its impact on the community would be minimised.

I would like to thank the Minister for his comprehensive response. What has happened to South Korea has been very difficult and very tragic. It is not possible to ignore the fact that South Korea, together with Singapore, is affected by SARS about a decade ago, so you cannot ignore the concerns. Just looking at South Korea's experience, it appeared to have been too laggard in its response. There was some initial confusion. That is what appeared to have led to an explosion of cases, which has led to a significant number of fatalities. Subsequently, as we see now, it appears to have imposed quite good control over the situation and the spread is now constrained.

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The reason why I ask about an emergency preparedness exercise is because the danger is that, regardless of how many systems we have, the population may not recall how difficult it is and how confusing it may be, when the initial signs first appear. So, I would like to press the Minister on this point whether it is necessary to have a wider preparedness exercise, maybe even involving the schools.

Thank you, Madam. Indeed, this is a very serious matter and MOH takes this very seriously. Therefore, we regularly remind members of the public and Singaporeans that MERS-CoV and Ebola, are real threats and we must take these threats seriously. We have also been sharing information as much as we possibly could with our Singaporeans as well as visitors who are coming to Singapore. That is why at the Airport, you would also see posters that are put up, for passengers who do not come from affected areas. We also want to remind them that should they have any difficulties, do consult our medical professionals. It is an area that we will continue to look at and we will consider various forms of exercises.

I think going beyond exercises, infectious diseases are something we will need to learn to live with. In the past, if you look back at maybe a decade or so ago, infectious diseases may not be so common. SARS was a major impact to Singaporeans. Before that, you may find that the threat of infectious diseases may come and go, and it happens from time to time.

Going forward, I am afraid that it is going to be quite a constant feature because of the increased international connectivity. We are going to see that different forms of infectious diseases will threaten Singapore from time to time. An example is that MERS-CoV emerged in 2012. Before MERS was over, Ebola emerged. And now both Ebola and MERS are threats to Singapore. Bird flu, on the other hand, is also not totally eliminated either.

So, I am afraid that going forward, we have to be constantly vigilant, so that we will be able to protect ourselves against the importation of these cases.

I take Prof Tan's point and we will look at how we can extend our public education, exercises and information, to as wide an audience as possible, including school children. We have been working very closely with MOE. MOE is one of the members of the Inter-Ministerial Committee I mentioned earlier, so they are very closely linked to what we are doing, and they themselves have also developed contingency plans and are carrying out education with their children.

Thank you, Mdm Speaker. Mdm Speaker, when SARS hit our shores quite a number of years ago, I was part of the constituency SARS

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Taskforce Committee. It was quite a difficult time to try to manage the situation.

Considering that there has been such a large number of deaths in South Korea, where the case started because of someone who was quite irresponsible, and considering that it has been spreading and there is a total of 36 people who have died in South Korea, would it not be better for MOH to be safe rather than sorry, and implement health screening at the Customs at the airport or Causeway? How much does it cost to implement such temperature health screening? So, two questions.

I have just explained that we do have temperature screening for direct flights from Korea as well as from Middle East, the affected areas. But it is also important to point out, as I had mentioned in my reply, that there is an incubation period. During the incubation period, the passenger or the visitor may not display any symptoms, but he may already be carrying the virus, so symptoms will develop over the period of up to the next 14 days.

Therefore, it is important for us, in addition to border monitoring and screening measures, that our healthcare institutions remain alert to this threat, so that they can identify passengers or patients who have travelled overseas. It is a matter of practice that all our doctors, when they see respiratory symptoms displayed among their patients, will ask about their travel history. It is something that we have always been reminding our doctors. We have also sent circulars to our doctors regularly to inform them of the latest development in the region as well as in the Middle East, so they are kept up-to-date of the development.

We do have border screening processes but it is not a 100% fool-proof system because of the incubation period. And some of them may have travelled through other countries as well, so they may not be directly travelling from the affected countries. They might have stayed a few days in other countries and, therefore, while it is important to have border screening, it is not the only measure that we should rely on. What is more important is to ensure that our healthcare facilities are on high alert, they are vigilant, they are aware of this threat, and they are looking out for these symptoms and the travel history of their patients.