Singapore's Zika journey: Two months on

Oct 27 marks two months since the first locally transmitted Zika case was reported in Singapore. Channel NewsAsia’s Lianne Chia looks back at the concerns and anxiety that gripped the nation, and how Singapore has progressed in its fight against Zika.
Lianne Chia Channel NewsAsia 27 Oct 16;

SINGAPORE: It was around 7.30pm on Saturday, Aug 27 when the news broke.

An emailed press release from the Ministry of Health (MOH) announced Singapore’s first confirmed locally transmitted case of Zika: A 47-year-old Malaysian woman living at Block 102 Aljunied Crescent had developed a fever, rash and conjunctivitis two days earlier.

She had tested positive for the Zika virus – and as she had not travelled to affected areas, there could be only one conclusion.

She had caught the virus in Singapore.

Newsrooms went into overdrive and social media caught fire, as anxiety spread across the island.

Few people knew how to react to the news that Zika, especially with its reported link to microcephaly, was now circulating in the midst of Singaporeans.

But it was perhaps inevitable. Singapore had, after all, already had its first imported Zika case in May, in a 48-year-old man who had returned from Brazil.

GEARING UP

The anxiety heightened as more cases of the virus were announced. By the end of August, there were 82 confirmed cases of Zika, and authorities warned that the number of cases would likely go up as more testing was carried out.

Countries like Australia and the UK began issuing advisories about visiting Singapore. Questions were raised about whether the Zika threat would affect the upcoming Formula 1 Singapore Grand Prix.

And, not surprisingly, sales of mosquito repellent soared islandwide.

Authorities spearheaded an intensified battle against the Aedes mosquito. About 100 National Environment Agency (NEA) officers were deployed to the vicinity of Aljunied Crescent in the immediate aftermath of the first case. Thermal fogging, drain flushing and public outreach were among the actions carried out.

The area’s MP, Tin Pei Ling, began walking the ground in MacPherson almost immediately, giving out mosquito repellent and speaking to pregnant women. Aside from sharing a written advisory, she also gave her pregnant constituents contacts they could reach out to if they had feedback on mosquito breeding or questions relating to the virus.

“As a mother, of course I would be concerned but I believe that everyone is doing our best, including Government agencies like MOH and NEA,” she told reporters on the sidelines of a house visit on Aug 30. “So for now, we have to have the same faith and confidence in them.”

MPs in non-affected constituencies also geared up.

MP for Jalan Besar GRC Lily Neo said when news first broke about the virus, the first thing she did was to call a meeting with all her grassroots leaders. “The most important thing for us at the time was to make sure we could control the Aedes mosquito population,” she told Channel NewsAsia this week. “So we started planning straight away … we went house to house to give out mosquito patches, and put up posters at the lift landings and in the lifts.”

The community also rallied together in the midst of all the anxiety: One couple posted on Facebook offering pregnant women living in Zika-affected areas a place to stay.

The concern was brought up to the highest level: In Parliament on Sep 13, two ministers – Health Minister Gan Kim Yong and Minister for the Environment and Water Resources Masagos Zulkifli – delivered statements on Zika.

Mr Gan said the Government would no longer isolate or hospitalise Zika patients because Zika is a mosquito-borne disease with a majority of those infected asymptomatic.

He added that pregnant women who tested positive for Zika would be referred by their doctors to an obstetric or maternal-foetal medicine specialist for counselling and subsequent follow-up.

“Regular ultrasound scans will be carried out to monitor the development of the foetus. Zika infection does not always result in abnormal foetal development,” he said, adding that microcephaly has been tracked by the National Birth Defects Registry since 1993, and that MOH will work with doctors to monitor the outcomes of babies born to women with Zika.

By the end of September, 16 pregnant women were reported to have been infected with Zika.

ON THE DECLINE?

Two months on, the spread of the virus appears to have abated. And anxiety may have eased.

While the week of Sep 11 to 17 saw 62 reported cases of the virus, the weekly numbers fell sharply in subsequent weeks, with numbers ranging from four in the week of Oct 2 to 8, to 11 in the next week, according to NEA data. As of Oct 26, a total of 435 cases have been reported.

And the country’s first and biggest local cluster in the Aljunied Crescent/Sims Drive area, which accounts for about three-quarters of Singapore’s cases, was declared closed earlier this month.

“When news of Zika first came out, people were really anxious about it,” said general practitioner Dr Lye Tong Fong. “They would ask if it was safe for them to get pregnant, and about the chances of the baby potentially developing complications. But while some people still bring up the topic now, they aren’t too concerned about it,” he added. “It’s just like another infection.”

It was a similar experience for another GP, Dr Chew Chun Yang. “During the first few weeks of the outbreak, we received several queries asking about tests for Zika, and the availability of mosquito repellent at our clinic,” he said. “But in general, the anxiety level among the public has lessened.”

One possible reason for this could be that Singaporeans are now much more aware about Zika. “There are more avenues to read up and understand more about the virus and the situation,” said Dr Chew.

Dr Lye added that the Government’s efforts in raising public awareness has been “commendable”. “The general public is aware, but they aren’t too anxious or hyper-reactive,” he said.

“I think that’s a good thing. We want the people to be aware of the situation, but we don’t want them to go into panic mode and suddenly, tap on all the healthcare resources.”

NO LETTING UP

Even as anxiety appears to have abated, infectious diseases specialists like Gleneagles Hospital’s Dr Wong Sin Yew believe people should not become complacent.

“I don’t think we are near the end of Zika in Singapore, and I don’t think we are going to be able to eradicate the virus completely,” he said. “We continue to have three ongoing clusters in the past two weeks, and I continue to worry that Zika will remain in the community.”

Just last week, Dr Chew, whose clinic is in the Serangoon area, saw his first confirmed case of Zika.

“Although the patient was not living or working in any of the listed Zika clusters, we did not rule out the possibility of a Zika infection,” he said. “It will not be surprising if we encounter more of such cases in future.

“We are being updated regularly by MOH about the disease, and the challenge would be to keep up with all the information available, while providing patient care on a daily basis,” he added.

FUTURE CHALLENGES

Indeed, controlling the mosquito population remains the cornerstone of Singapore’s fight against Zika.

“Our key strategy for dengue control, and now Zika, is source reduction – the detection and removal of breeding habitats and larvae,” said Mr Masagos in his ministerial statement last month.

“This integrated vector management strategy is in line with the World Health Organization’s recommendations, and remains especially critical now as we are in the traditional dengue peak season,” he added.

But it is clear that there are challenges on the ground.

Dr Neo cited instances of mosquito breeding sites she has seen on her house visits. One resident left a large barrel of water outside his unit, saying that he could water his plants daily without having to go into his house. Another woman left six to eight uncovered bottles of water outside her flat for the same reason.

“Sometimes they live like that for so long, and this is their daily habit … so they’re not conscious about it,” Dr Neo said.

Within 10 days of the first case in August, Dr Neo and her grassroots volunteers had completed house visits to the more than 70 blocks under her charge. But even though there have been no confirmed cases of Zika among her residents, efforts are still ongoing.

“Every week, we have some form of outreach,” she said, highlighting block parties where residents are invited to come and meet her and her grassroots volunteers. “At least this way I can spend an hour to explain everything slowly to them, and in detail.”

“I think the virus is unfortunately going to be entrenched in Singapore, but I hope the numbers will remain persistently low,” said Gleneagles Hospital’s Dr Wong. “But I think if we continue putting in effort to control the mosquito population, I hope we can be successful.”

He is also hopeful about the Government’s project with Wolbachia mosquitoes. Last Tuesday, NEA released 3,000 bacteria-carrying mosquitoes at Braddell Heights estate in a six-month trial to tackle Singapore’s mosquito population.

“Think about our two other mosquito-borne infections in Singapore - dengue and chikungunya,” he said. “In the past three years, we’ve had an excess of 10,000 cases of dengue every year, sometimes going up to almost 20,000 cases. On the other hand, we’re getting about 20 cases a year of chikungunya.

“So obviously we hope that the Zika numbers will come down and remain at similar numbers as chikungunya.”

- CNA/lc

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