COVID-19 Advisory

Symptoms

It is not possible to distinguish clearly between symptoms of the common cold, influenza and the COVID-19.

In an article in the Lancet, it was reported that there were three major patterns of the clinical course of infection:

  • Mild gradual illness with upper respiratory tract presenting symptoms;
  • Non-life-threatening pneumonia;
  • Severe pneumonia with acute respiratory distress syndrome (ARDS) that begins with mild symptoms for 7–8 days and then progresses to rapid deterioration and ARDS requiring advanced life support.

It has been shown that children are less likely to contract the infection with more research needed to understand why. On the other hand, severe disease and fatalities are more likely in  elderly or those with coexisting diseases, such as diabetes, pulmonary disease, and other chronic conditions.

Mode

Transmission and Infectiousness Update

Like other human coronaviruses, transmission of the COVID-19 occurs through droplets and can happen through:

  1. Coughing and sneezing
  2. Close personal contact, such as touching or shaking hands
  3. Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands
  • Preliminary studies suggest that incubation period for the COVID-19 can range from two to 14 days. Mean incubation period observed in a study: 5.2 days.
  • There are reports of asymptomatic infections (detection of virus with no development of symptoms) and pre-symptomatic infections (detection of virus prior to development of symptoms) with SARS-CoV-2.  In a local study, an analysis of exposure and symptom onset dates of 157 locally acquired cases suggests that presymptomatic transmission of COVID-19 occurred in 10 (6.4%) of such cases. The data also suggests that transmission likely occurs 1–3 days before symptom onset in a presymptomatic source patient. These findings are also consistent with studies in Chinese patients outside of Hubei province, China, which found that 12.6% of transmissions could have occurred before symptom onset in the source patient.
  • Scientists have estimated that each infected person can spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
  • Infected persons have been found to be most infectious in the first week of developing symptoms as viral levels in respiratory secretions are at their highest.
  • In terms of viral viability, Covid-19 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces. On copper, no viable covid19 was measured after 4 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours.

Diagnosis

Diagnostic testing for COVID-19 involves testing for the presence of the virus in specimens (“swabs”) obtained from patients. Almost all diagnostic testing for COVID-19 is done using PCR-based methods, which look for the genetic material (RNA)  of the SARS-CoV-2 virus, which causes COVID-19. These methods can only diagnose someone with COVID-19 if they are actively infected. Currently, these diagnostic tests for COVID-19 require nasopharyngeal or oropharyngeal specimens (nose or throat swabs).  Currently, PCR testing for Covid -19 has been used for three key purposes – one, to diagnose suspect cases to provide early treatment and isolate close contacts; two, to do screening and active case finding of individuals at risk, such as migrant workers decanted from their dormitories before they return to work; and three, to do surveillance to monitor undetected cases in the community.

The terms "serological" or "antibody" tests are generally used to refer to blood tests that detect antibodies to the SARS-CoV-2 virus that causes covid-19. Serology tests can be helpful in determining whether someone was infected in the past with the coronavirus, whether or not they ever developed symptoms of the disease. Preliminary studies done locally have found that the sensitivity of the test is low in the first 2 weeks of illness.  In contrast, the PCR tests currently being used to diagnose active cases of COVID-19 indicate the presence of viral genetic material during the period of active infection and do not indicate if a person was infected and subsequently recovered.

Treatment

Medical care of viral pneumonia is largely supportive using medication and to help relieve symptoms and address severe complications such as bacterial infections.  There are no licensed vaccines or coronavirus antivirals.The World Health Organization (WHO) has begun a large, global trial (SOLIDARITY) on the four most promising therapies identified to date to treat COVID-19, including chloroquine. The primary completion date is March 2021 with findings expected to be reported by December 2021.

Kaletra

Clinical trials have so far found that Kaletra (comprising lopinavir and ritonavir) to be  lacking in effectiveness against the infection.

Anti-malarial drugs - chloroquine and hydroxychloroquine:

There is a lack of high-quality evidence to conclude that chloroquine or hydroxychloroquine is effective and safe for the treatment of COVID-19. Several clinical trials are ongoing and are likely to report results in the months ahead which will determine whether anti-malarials should be more widely used for COVID-19 treatment.   The US Food and Drug Administration on Monday (Jun 15) revoked its emergency use authorisation for hydroxychloroquine to treat COVID-19.The move comes after several studies suggested it was not effective, including a widely anticipated trial earlier this month that showed it failed to prevent infection in people who had been exposed to the virus.

The World Health Organization (WHO) announced on Saturday (Jul 4) that it was discontinuing its trials of hydroxychloroquine and combination HIV drug lopinavir / ritonavir in hospitalised patients with COVID-19 after they failed to reduce mortality.

Convalescent plasma

This is blood plasma from a person who has recovered from an infection.  Antibody-containing plasma from a recovered patient is given by transfusion to a patient who is suffering from COVID-19. The donor antibodies help the patient fight the illness, possibly shortening the length or reducing the severity of the disease. Published articles have suggested convalescent plasma as a potential treatment option for COVID-19 citing its use and perceived efficacy in SARS, Ebola virus, H1N1, and MERS outbreaks and international news coverage has reported that it has been used in China against COVID-19.The Food and Drug Administration (FDA) in the USA has listed COVID-19 convalescent plasma as an emergency Investigational New Drug (eIND) for patients who are critically ill with COVID-19. This allows its use for the treatment of an individual patient upon FDA authorisation. Eligible patients must have confirmed COVID-19 with severe or immediately life-threatening disease and give informed consent. In Singapore, it was reported on 13 April that more than 100 patients who had recovered from COVID-19 have been screened and 11 of them were recruited and assessed for suitability to assist in the treatment.

Remdesivir

One drug that has received a lot of attention is the antiviral drug remdesivir. The coronavirus that causes COVID-19 is similar to the coronaviruses that caused the diseases SARS and MERS — and evidence from laboratory and animal studies suggests that remdesivir may help limit the reproduction and spread of these viruses. Interest in the drug remdesivir has been so great that the U.S. National Institutes of Health is boosting the size of its study.   Singapore is also taking part in the global Phase III trials and the participants include the NCID, NUH, SGH.  Recruitment of patients for the trial had started in mid February. Japan’s National center for global health and medicine and US National Institute of heath are partners in this trial. This drug has so far been administered to more than 20 critically ill patients in Singapore.

Definition

MOH definition of a suspect case of the COVID-19 infection was revised on 25 June to be:

(a) A person with clinical signs and symptoms suggestive of Community-Acquired Pneumonia

(b) A person with an acute respiratory illness of any degree of severity (e.g. symptoms of cough, sore throat, runny nose, loss of smell), with or without fever, who, within 14 days before onset of illness had:

(i) Travelled abroad (outside Singapore); OR

(ii) 1Close contact with a case of COVID-19 infection; OR

(iii) Stayed in a foreign worker dormitory; OR

(iv) Worked in occupations/environments with higher risk of exposure to COVID-19, theseinclude but are not limited to any staff (healthcare worker and non-healthcare worker) working in:

  • Public and private healthcare settings, spanning acute care, primary care, intermediate and long-term care and community care settings
  • Dormitories or involved in dormitory outbreak control operations
  • Isolation / quarantine facilities
  • Community care facilities (CCFs)/ community recovery facilities (CRFs)
  • Ambulance and dedicated patient transport (including private hire vehicles).
1Close contact is defined as: 
  • Anyone who provided care for the patient, including a health care worker or family member, or who had other similarly close physical contact;
  • Anyone who stayed (e.g. household members) at the same place as a case; or
  • Anyone who had close (i.e. less than 2m) and prolonged contact (30 min or more) with a case (e.g. shared a meal).

MOH ENHANCED SWAB-AND-SEND-HOME (SASH) CRITERIA (as of 25 June)

As part of active case finding, the following groups of persons presenting with acute respiratory symptoms of any duration , with or without fever will be swabbed by primary care clinics on-site or referred to a facility that can do so:

(a) Persons working and/or living in communal settings (e.g. residential, custodial or special care facilities, students and education staff)

(b) Immunosuppressed patients such as those with

(i) End Stage Renal Disease (ESRD) patients undergoing haemodialysis (ii) Cancer patients undergoing chemotherapy.

(c) All other persons aged 13 years old and above​

Facilities That Currently Offer Swab Tests For Covid-19?

  1. Selected Public Health Preparedness Clinics (PHPCs) performing SASH
  2. Selected Polyclinics
  3. Fever screening area at SGH, (9.00am - 5.00pm)
  4. Screening centre at NCID
  5. Regional screening centres

However, do note that the attending doctor will need to assess your condition to decide on necessity to conduct a swab test.

Pre-Departure COVID-19 Swab Test via Raffles Connect

For business travellers requiring a pre-departure COVID-19 swab testing, you can book an appointment through Raffles Connect. Find out more.

Singapore


Case Summary


DORSCON Level - Orange
What is DORSCON?