Calm In the Face of Potential SARS-CoV-2 Infection — Reflections on Covid

(Posted on Monday, April 6, 2020)

A few days ago, I posted an interview with a friend who was moved to controlled quarantine in China. Today, I wanted to share a story from an American colleague who was just released from a mandatory quarantine in Singapore. Both stories highlight the effectiveness of testing, contact tracing, and mandatory quarantine in countries that have managed to control their outbreaks.

It’s something we have failed to do effectively in the United States and a large part of why cases in the country are soaring. I invite you to read the story below my American friend sent me and consider ways we can improve our personal response and compel our leaders to do better by all of us.

My daughter and I left our home in Singapore for the United States in early March to attend an important family function. At the time, cases of Covid-19 had been reported in both countries, but neither had major outbreaks, at least as far as health officials knew. Still, in Singapore at least they had already instituted screenings at airports for all travelers. But when we arrived in Newark, NJ there were no temperature screenings or any other kind of screening method in place for travelers — we walked straight off the plane and out of the airport without any checks.

We spent the week in Pennsylvania with family. My brother-in-law is an emergency room doctor in a rural hospital. He and his colleagues had not seen any cases of Covid-19 at the time but they were preparing for the worst. There were clusters of cases nearby, in Philadelphia, New Jersey, and New York, so the hospital had set up screening tents to ready themselves. While we were in Pennsylvania, cases across the United States rose dramatically each day. By the middle of our visit, all schools had decided to shut down until Easter break and kids were on extended holiday.

I was nervous that Singapore might block flights from the U.S. so I followed the Singapore travel restriction updates every day. Thankfully, they weren’t canceling flights. But on March 18, the Singapore government announced that they were going to would require travelers returning from every country in the world to quarantine themselves. This was not a choice, it was a government mandated directive that was legally backed by the Infectious Disease Act.

I decided we would change our flights back home to Singapore to avoid the mandatory quarantine, which was yet to go into full effect. We took a direct flight back to Singapore the following day and landed in six hours before the deadline. We were not served a quarantine notice, but we still decided to quarantine ourselves in our apartment for the next two weeks, only leaving for short walks around our neighborhood when we knew no one else was around.

One week later I received a call from a contact tracer at the Ministry of Health. These contact tracers were not technically public health officials, rather specialized consultants who had been trained on how to identify and reach people who had recently come into contact with a person who had tested positive for Covid-19. The tracer asked for my name, date of birth, age, home and work addresses, and asked if I had any pre-existing conditions. Only after I told him the information did he explain why he was asking. He said someone on our flight from Newark to Singapore had just tested positive for Covid-19. I asked whether all passengers were being contacted or just the ones near the passenger in question but that wasn’t information he was prepared to share. Instead, he wanted to let me know that I would likely be served a quarantine order in the next day or two and that I should prepare.

The following morning, two employees from a security organization that had partnered with the Ministry of Health came to my house and served my daughter and I our quarantine orders, which are technically Section 15(2) of the Infectious Disease Act. I was asked to sign a wealth of papers, including those requiring me to attest to the fact that I had received the notice, that I knew my information would be shared, and that I knew my movements would be monitored and tracked via my phone. These weren’t presented to us as voluntary options. As you can see from the copy of the orders we received, we had no choice but to comply.

The contact tracers took our temperatures and asked us a few basic questions about our health, then they provided us with a small quarantine kit, including masks and a thermometer. They never once stepped inside our house — they did all the paperwork and testing outside our home and even refused to take back the pen I signed all the papers with.

Once under quarantine, we still had to report to the health ministry. Contact tracers called us via video three times a day, every day. We had to take our temperatures three times a day and report our results, and we were required each time to report on any symptoms and confirm that we were in our homes. Sometimes they asked to see my daughter, who is only five years old and they would ask her directly if she has any symptoms. While everyone was both friendly and polite, it was clear from the beginning that only rigorous adherence to the rules would be accepted. All calls had to be answered — no excuses — and the consequences of leaving the house or not checking in were made quite clear. We could have been faced with a $10,000 fine, jail time, or a loss of our work visas, or perhaps all three together.

Others I know have been asked to move to a controlled quarantine facility, instead of being allowed to quarantine in their homes, so overall we count ourselves fortunate. Indeed, in the end we only served one week of quarantine since it had already been one week since our flight and we had not shown any symptoms. After the two weeks were up since our flight, having shown no symptoms, our order was lifted. We are lucky! My daughter and I have been practicing very good hand hygiene as well as not touching our face, which clearly made a big difference on our travel through the airports and on the planes. Besides not being able to step foot outside our front door, our week in mandatory quarantine was not all that bad. Living through the experience has been interesting on a personal level, but more broadly I am impressed by how effective the system can be.

Read the article on Medium

Originally published on Medium (April 3, 2020)