Swine influenza Response System in Singapore

The MOH announced that the Disease Outbreak Response System Alert status in Singapore remains at ORANGE. Precautionary measures are in place to forestall the spread of the virus to Singapore for as long as possible.

There are no additional cases for investigation. Of the 27 cases investigated thus far, 24 cases have tested negative for Influenza A, and 3 tested positive for the usual circulating seasonal strains of Influenza A.

The Home Quarantine Order came into effect today. As of 1900 hrs, a total of 3 HQOs were issued. 1 was issued to a foreign resident and 2 were issued to Singaporeans.

DORSCON is short for Disease Outbreak Response System and it lists out the list of responses that Singapore will take as a nation when threaten by a pandemic flu or infectious agent.

The different levels of DORSCON are green, yellow, orange, red and black.
GREEN

* No novel influenza virus causing severe disease in humans OR
* Occasional animal - human infections
* No Human - Human Transmission or rare cases of spread requiring very close and prolonged contact.
* Healthcare worker/ institution’s response - current triage of patients with fever in Emergency depts and polyclinics;
* Public response - hygiene measures, mask wearing, social responsibility

YELLOW

* Inefficient human-to-human transmission. Requires sustained close contact.
* Small clusters of cases may occur.
* Isolated imported cases may occur but there is no sustained local transmission.
* Healthcare worker/ institution’s response - staff in high risk areas (Emergency Depts, ICUs, Triage stations) in PPE
* Public response - GREEN measures + contact particulars recorded when visiting hospitals & clinics.

ORANGE

* More efficient human-to-human transmission. Virus not fully transmissible. Requires close contact.
* Larger clusters of cases in Singapore.
* Healthcare worker/ institution’s response - All areas with patient contact : staff in PPE
* Public response - YELLOW measures + No visitors to hospitals
o Encourage temperature taking at schools and non healthcare establishments
o Consider closure of schools and suspension of public gatherings and events

RED

* Pandemic is underway. Virus is fully transmissible from human-to-human
* Community-level spread.
* Mild - moderate morbidity & mortality (e.g. 1957 & 1968 pandemics)
* Healthcare worker/ institution’s response - ORANGE measures + antiviral prophylaxis when local cases occur.
* Public response - ORANGE measures + social distancing when local cases occur

BLACK

* Pandemic in Singapore with high morbidity and mortality (e.g. 1918 pandemic)
* Healthcare and other social systems overwhelmed.
* Healthcare worker/ institution’s response - as in RED
* Public response - more rigorous social distancing measures
o Suspension of all schools, social gathering and institutes of higher learning
o Advise public to stay at home and even consider curfew

Management of cases under DORSCON
Pre-pandemic (Green to Orange)

* TTSH/ CDC is the designated treatment facility for any case of potentially infectious disease.
* Clinics and step down care facilities will refer suspect cases to TTSH Emergency Department for assessment and admission, if necessary
* Hospitals will isolate all suspect cases and transfer confirmed cases to TTSH/CDC. Confirmed cases, including children and pregnant patients will be centrally managed at TTSH/ CDC. Paediatric and obstetric services will be set up at TTSH/ CDC by KKH when necessary. They will be activated by MOH. When TTSH/ CDC approaches full capacity, other restructured hospitals (RHs) will also have to manage influenza cases.

Pandemic (Red to Black)

* Flu Clinics will be established at polyclinics and participating primary care clinics to provide outpatient care.
* Patients with influenza, aged 1 year and older, will be treated with anti-virals. The severe cases will be referred to restructured hospitals for treatment.
* Due to the expected large number of asymptomatic cases who could present other complications, both restructured hospitals and private hospitals will need to manage flu as well as non-flu patients. Hospitals and Flu Clinics should segregate flu and non-flu cases to minimise transmission.
* There is a dedicated ambulance service for transportation of potentially infectious cases to TTSH/ CDC.