Why Quarantine Orders should replace SHN for new returnees



The increase in imported cases in March has been alarming.



From March 4 to March 23, there are now imported cases. To assess the magnitude of the situation. Prior to the 1st imported case in March, we have a total of 110 confirmed cases with 11 unlink cases.




Today, the narrative paints an entirely different picture. Not only the numbers of imported cases are staggering, but the number of unlink cases had also correspondingly increased. It may be at a slower pace compared to the imported cases but as we know carriers can be asymptomatic. Given that imported cases are not issued SHN unless they arrived from certain regions prior to March 21, there is a likelihood that community spread has occurred.


IMPORTED CASES AND UNLINKED CASES FROM MARCH 5
Dates
Imported Cases
Unlink Cases
Official Unlink Tally
5
1
0
12
6
2
1
12
7
0
1
13
8
1
1
14
9
3
0
14
10
0
1
9
11
8
2
10
12
5
0
9
13
9
1
10
14
9
1
11
15
9
0
11
16
11
2
12
17
17
4
16
18
33
5
17
19
24
6
23
20
30
3
24
21
39
6
31
22
18
2
31
22
48
6
31


It is noted that the official tally remains low despite the increase in daily unlinked case. Kudos to the robust tracking system that is able to connect the dots. Nonetheless, recent reports did not indicate whom the previous unlink cases are related to. Without the information, it could infer that some of the cases are related to the new unlink cases which indicate secondary infection.

Difference between Quarantine Orders (QO) and Stay Home Notice (SHN)
The main difference is that quarantine orders cannot have physical interactions with others on the same premises. It can be done at home and the individuals would be monitored closely. In addition, quarantine orders can be served on dedicated facilities if necessary.

Going forward, given the higher number of people required to serve the notice, it may be better to place them on dedicated QO for better surveillance. This would require less manpower and at the same time minimizing exposure to family members.



Essential reading: Difference between Quarantine Orders, Stay Home Notice and Leave of Absence


Why Quarantine Orders?

Limitation of Stay Home Notice
Although Stay Home Notice does not allow the person serving to leave the premises, they can share the same room/home/apartment. Social interaction and contract are supposed to be minimised but given that this is base on self-monitoring, it may not be fully effective.

Family members of SHN are still allowed to venture outside for work, school or other needs. This may potentially result in them being carriers as they are not affected by SHN.

Exposure is high given the increase in imported cases
Most of the imported cases started to arrive after major cities were either lockdown or the number of confirmed cases rise exponentially in the host countries. Given the scenario, there is a high chance of being infected prior to returning to Singapore. With 90% seen as asymptomatic, it is difficult to assess if one is ill.

In addition, exposure in flight would multiply the risk, especially from High-risk countries. That said, it is better to be cautious and issue quarantine orders instead.

Risk of Travel from the airport to SHN location
Personal Travel from airport to SHN location would still be a risk be it public transport or personal transport (unless self drive). With dedicated quarantine facilities, transportation can be provided for such incidences.

Less resources use to track Quarantine Travellers in quarantine facilities
As quarantine travellers are housed in one location, there will be a need for lesser surveillance and thus freeing up manpower for other purposes. Given the expected increase in Singapore residents making their way back, it will be less taxing effort to monitor all of them.

Limitations to Quarantine Orders

We do also understand the limitations of such orders. To impose Quarantine at dedicated facilities would have a big social impact on Singapore. It will also affect Singapore's reputation as a travel destination. Moreover, returnees may choose not to return due to QO. Although QO facilities had been identified, there might not be sufficient capacity given the anticipated load. Base on reports, there were  13900 SHN served between Mar 12 to Mar 19. If similar numbers are expected, it would overwhelm the quarantine facilities.

However, it may be worth considering for the following reasons
1) Since there is a ban on short term visitors from March 24, such measures would only affect local residents and LTP holders.

2) Returnees will still be encouraged to return especially if the host countries cases accelerate or measures taken in host countries such as lockdown affect their livelihood.

3) Numbers are expected to be lower as ST Visitors are now banned from coming to Singapore.

To stem the spikes and to flatten the curve in order for our healthcare services to remain robust for new cases as well as other unrelated illness, draconian measures might be needed. It is a step that we should not compromise especially if we want a sense of normalcy in our lives. So far, the government had done a great job in curbing local transmission. For now, a different tact would be required to manage this new wave.






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