How would Singapore fare in the management of Ebola?
There is no doubt in my mind that any outbreak will be contained rapidly, with minimal local transmission. The country is small, and the government has more than sufficient resources and political will to monitor or even quarantine suspected travelers and contacts of cases, as was amply demonstrated during the 2009 influenza H1N1 pandemic. However, it would be a mistake to think that there will be zero secondary transmission, either to community contacts or even to healthcare staff. The infected nurses from Madrid and Texas have already shown the high cost of even a slight lapse in infection control measures. And it is extremely tiring to work a full shift in the kind of protective suits necessary for the care of Ebola patients. When concentrations lapse, human mistakes almost inevitably occur.
Should there be a special healthcare unit (involving all levels of healthcare staff including paramedics, nurses, laboratory staff, doctors and intensivists) that undergoes routine and regular training for the management of patients with infectious and deadly diseases? This was not openly discussed even after the SARS and H1N1 outbreaks of 2003 and 2009. But it is not unthinkable today.
Screening for passengers from Ebola-affected countries has also increased at Changi Airport. This is not useful from the point of view of picking up Ebola cases – the virus has an incubation period of 3 weeks and infected travelers are unlikely to be febrile at the point of entry into Singapore – but the questionnaire database may be useful for subsequent contact tracing.