Impact of Ebola Outbreak on Singapore

Mrs Lina Chiam asked the Minister for Health (a) whether there is a necessity to detect and keep vigilant for any early signs of an Ebola outbreak from incoming and outgoing passengers travelling by air, sea or land; and (b) what are the contingency plans for such an outbreak of the virulent disease.

Mr Christopher de Souza asked the Minister for Health (a) what preventive measures and precautions has the Ministry been taking to prevent an outbreak of the Ebola virus in Singapore given Singapore's position as a key aviation hub in the region; (b) what is the Ministry's response and treatment plan should a person who has contracted the Ebola virus enter Singapore; and (c) what medical assistance will be provided to the person who has contracted the Ebola virus.

The ongoing Ebola outbreak is limited to the African region of Guinea, Liberia, Sierra Leone, Nigeria and, most recently, in Senegal, where an isolated imported case has been reported. A separate Ebola outbreak has been confirmed in a remote region in the Democratic Republic of Congo (DRC), which is not related to the outbreak in West Africa. Our current assessment is that the risk of Ebola spreading to Singapore is low due to the limited travel connectivity between Singapore and Africa. Prior to the Ebola outbreak, the number of travellers from these countries arriving in Singapore is small, with an average of about 30 travellers a month collectively from Guinea, Liberia and Sierra Leone, and between 200 and 300 travellers a month from Nigeria.

Since WHO declared the Ebola outbreak in West Africa as a Public Health Emergency of International Concern on 8 August 2014, many airlines have stopped flying to Guinea, Liberia, Sierra Leone, the three countries with widespread active community transmission. The numbers of travellers from these countries to Singapore are even fewer now. In addition,

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transmission of Ebola requires direct contact with the blood and/or fluids of an infected person. It does not spread through the air like influenza. Nevertheless, while the risk is low, we cannot rule out the possibility of an imported case to Singapore.

Hence, we have put in place measures to reduce the risk of infection to Singaporeans who travel to or are residing in affected countries, ensure early detection of cases and prevent spread in the event that we have an imported case of Ebola in Singapore.

To minimise the risk of infection to Singaporeans travelling to or residing in affected countries, the Ministry of Health (MOH) has advised Singaporeans against non-essential travel to the affected countries in Africa. For those who need to travel there, we have advised them on the precautionary measures to take, such as frequent hand washing and avoiding direct contact with blood and secretions or other body fluids of dead persons or animals. This information is available on the MOH website. In addition, health advisory posters are also displayed at our Changi Airport Departure Halls. We have also worked with the Ministry of Foreign Affairs and International Enterprise Singapore to disseminate this information through their networks.

MOH has worked with the Civil Aviation Authority of Singapore (CAAS), Changi Airport Group (CAG), Maritime and Ports Authority (MPA) and the Immigration and Checkpoints Authority (ICA) to display health advisory posters at all air, land and sea checkpoints, and to distribute Health Advisory Notices (HANs) at our immigration counters to inbound nationals and travellers from Guinea, Liberia, Sierra Leone, and Nigeria. These passengers are advised to seek medical attention early if they develop symptoms within 21 days of arrival and to inform their doctor of their travel history. Contingency plans are in place at Changi Airport to manage passengers with signs of Ebola Virus Disease (EVD). Such passengers will be isolated and transferred using a Portable Medical Isolation Unit to Tan Tock Seng Hospital for further management. MOH will also extend these measures to Senegal and the DRC to ensure early detection of suspect cases.

Healthcare staff are a key line of defence. Medical clinics and hospitals have been alerted, through professional circulars, to exercise vigilance and ensure early detection of possible suspect Ebola cases. Laboratories have also been advised of the testing procedures for Ebola.

Management of suspect Ebola cases will be centralised in Tan Tock Seng Hospital, at a dedicated facility at the Communicable Diseases Centre 2 (CDC 2). All suspect cases will be triaged at the emergency departments, and as a precaution, isolated from other patients to minimise any risk of transmission. A case that has been admitted in another hospital will continue to be managed there to minimise risk of infection during transfer. All hospitals have put in place procedures for strict infection control measures when managing a suspect or

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confirmed case of Ebola. In the event of a confirmed case of Ebola in Singapore, MOH will carry out contact tracing and all close contacts of the confirmed case will be quarantined for 21 days from the time of last exposure.

As there are no proven anti-viral drug treatments or vaccines yet available, a patient with Ebola will be given intensive supportive treatment. Healthcare workers attending to the patient will use appropriate Personal Protective Equipment in addition to the strict infection control measures that have been put in place.

Our healthcare system will continue to remain alert and prepared to manage any potential outbreaks of infectious diseases in Singapore and our hospitals have dedicated response plans, which include plans to ramp-up resources and re-deploy staff to respond to disease outbreak situations. They have also carried out regular exercise to familiarise our healthcare workers with the contingency response plans.

Thank you, Mdm Speaker. I thank the Minister of State for his comprehensive reply. Two supplementary questions. First, on 14 August, there was a brief scare. We saw a Nigerian woman who was at Gleneagles Medical Centre, subsequently placed into isolation at the Communicable Diseases Centre. The news release triggered some amount of public alarm. Can I ask what plans does the Ministry have in place to coordinate the media aspects of such a medical emergency so as to reduce and prevent undue public alarm? Secondly, it is with regard to the experimental drug ZMapp. I would like to ask if the Ministry does hold stock of such medication in case of an outbreak.

Mdm Speaker, I would like to thank the Member for the supplementary questions. On the question about the premature reporting of a suspected case in Singapore, I think, MOH is concerned about it. We have also written to the media to clarify with them and to ensure that in future reporting, they do check with the Ministry to prevent such false alarms.

With regard to the use of some of the unproven medications that have been reported in the media, one of which that has been widely reported in the media is the experimental drug ZMapp. It consists of three monoclonal antibodies produced in a plant and it is developed by Mapp Biopharmaceutical. It was first reported to be used in infected humans very recently in July 2014. It was administered to two American health workers who had been infected with Ebola, and both appeared to have positive results and have recovered. However, ZMapp was also administered to a 75-year-old Spanish priest with Ebola, who died eventually and three other Liberian health workers, who showed improvement, although

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one of them eventually succumbed to the disease.

We have been informed by the manufacturer that there is a shortage of ZMapp at this point in time. We want to let Singaporeans know that while we monitor the situation very closely, ZMapp is not the mainstay of treatment for any patient infected with Ebola. Intensive supportive treatment is still the mainstay. We will continue to monitor the research that has been going on in ZMapp and we will use it when appropriate.

Mdm Speaker, I would like to ask the Minister of State whether there are any volunteer healthcare workers from Singapore working in the Ebola-stricken areas such as Nigeria, Guinea, Liberia, Sierra Leone in West Africa, and if there are Singaporeans working there, what precautions would MOH take when they return to Singapore after their stint as volunteers and caregivers?

I would like to thank the Member for that question. Currently, we do not have any volunteers that are working in the affected areas, but we also do not prohibit or discourage volunteers from taking part in relief efforts in these affected countries. As a precautionary measure, MOH will keep very close track of these volunteers. Volunteers who have direct contact with patients will be monitored and put on phone surveillance for at least 21 days upon their return.