The COVID-19 pandemic in Singapore was a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case in Singapore was confirmed on 23 January 2020. Early cases were primarily imported until local transmission began to develop in February and March. In late March and April, COVID-19 clusters were detected at multiple migrant worker dormitories, which soon contributed to an overwhelming proportion of new cases in the country.
To stem the tide of infections, strict "circuit breaker" lockdown measures were implemented from 7 April to 1 June 2020, after which restrictions have been gradually lifted as conditions permitted. A mass vaccination campaign was launched, and has been successful in achieving a very high vaccination rate, with more than 96% of the eligible populace having completed their vaccination regimen as of June 2022. Various measures have been taken to mass test the population for the virus and isolate infected people. Contact tracing measures SafeEntry and TraceTogether were implemented to identify and quarantine close contacts of positive cases.
The last record of COVID-19 cases was on 4 June 2023, which was at 2,481,404 confirmed cases, 2,456,295 recoveries and 1,727 deaths, with a case fatality rate of 0.08%, one of the lowest in the world. It introduced what was considered one of the world's largest and best-organised epidemic control programmes.
Government response
In response to the emerging threat, a committee known as the "Multi-Ministry Task Force" (often shortened to MMTF) was formed on 22 January 2020, comprising Minister for Education Lawrence Wong, Minister for Health Gan Kim Yong as co-chairs, along with Prime Minister Lee Hsien Loong and Deputy Prime Minister Heng Swee Keat as advisors. On 23 April 2021 in a cabinet reshuffle, Lee announced the appointment of Ong Ye Kung as the new Minister for Health, who would serve in the committee as co-chair alongside the other incumbents. Singapore had also contributed US$500,000 to support the World Health Organization's (WHO) efforts against COVID-19.
"Circuit breaker" measures and gradual re-opening
In response to the first wave of COVID-19, Singapore enacted the "COVID-19 Control Order", announced on 3 April 2020 a stringent set of preventive measures collectively called the "circuit breaker lockdown". Initially planned to be applied from 7 April to 4 May, the "circuit breaker lockdown" was extended to 1 June on 21 April following continued untraced transmission within the community. The Multi-Ministry Taskforce on 19 May announced the three-phased approach to resume activities safely with the gradual re-opening of economic activities in each phase.
Phase 1 lasted for 17 days from 2 June and ended on 18 June, with Phase 2 lasting for 6 months and 8 days from 19 June to 27 December. Singapore was in Phase 3 from 28 December 2020 until 7 May 2021; following the rise of the Delta variant, it temporarily reverted to Phase 2 on 8 May, which was raised to "Phase 2 Heightened Alert" from 16 May to 13 June, "Phase 3 Heightened Alert" from 14 June to 21 July and "Phase 2 Heightened Alert" from 22 July 2021 to 9 August 2021. This was followed by "Preparatory Stage of Transition" from 10 August 2021 to 26 September 2021, reverting to Phase 2 Heightened Alert measures (dubbed the "Stabilisation Phase") from 27 September to 21 November 2021, after which it entered the "Transition Phase" from 22 November 2021 to 25 April 2022, followed by the "COVID-19 Resilient Nation/Acute Phase" from 26 April 2022 to 12 February 2023.
As of 13 February 2023, Singapore is currently in the "Endemic Phase", with the vast majority of COVID-19 restrictions lifted.
Technological solutions to facilitate contact tracing efforts were rapidly developed and deployed by the government. SafeEntry, a check-in system that logs the entry and exit of visitors to public places, was first introduced at selected wet markets on 24 April 2020 and subsequently expanded to include a wide range of venues in May. It was later augmented by compulsory use of TraceTogether, a system originally launched on 20 March 2020 that uses Bluetooth signal strengths to track the proximity and duration of encounters between people with a smartphone app or physical token. With the relaxation of most countermeasures on 26 April 2022, both systems were phased out except in the case of large events with 500 participants, food and beverages outlets, and nightlife entertainment establishments with dancing facilities. On 9 February 2023, it was announced that the use of TraceTogether and SafeEntry would be discontinued from 13 February.
Vaccination campaign
A mass vaccination programme is currently under way following the approval and acquisition of the Pfizer–BioNTech and Moderna COVID-19 vaccines; in late 2021, Singapore became the world's most-vaccinated country, with more than 85% of its total population fully-vaccinated. As of June 2022, over 92% of the total population have completed their vaccination regimen, representing over 96% of the eligible populace.
Epidemiology
Background
On 31 December 2019, health authorities in China reported to the World Health Organization (WHO) a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei, and an investigation was launched in early January 2020. On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), after mounting evidence that the novel coronavirus had spread to 18 countries and completion of investigation in Wuhan.
Cases
Throughout the COVID-19 pandemic, cases were traced to clusters that several cases had visited during a particular time period in the whole of Singapore. In 2020, new cases are only at foreign worker dormitories and construction sites while Singapore had followed zero-COVID strategy. while local cases formed the bulk of new cases from April 2021, driven by SARS-CoV-2 Delta variant, and rose rapidly to 4-digit numbers. At the final recording dated 31 January 2023, there were 2,124,199 local cases and 92,911 imported cases. 22 February 2022 saw its highest daily count at 26,032 cases, with 24 February 2022 seeing its highest active case count at 73,540 cases; 20 October 2021, 16 November 2021 and 4 March 2022 saw its highest daily fatality count at 18 deaths. The last recorded date of any patient in the ICU was 12 February 2023. It was only on 14 August 2020 that there were no reported community cases for the first time since June, while 1 October 2020 was the first time since April that the daily number of imported cases exceeded that of dormitory cases. 13 October 2020 was the first time in over six months that no dormitory cases were reported, with 15 June 2021 being the first time in over eleven months that no imported cases were reported. At the end of September 2021, the number of confirmed cases in Singapore exceeded the number of confirmed cases in China, with the country also reaching the first grim milestone of 100,000 cases on 2 October 2021. The total number of community cases exceeded that of dormitory cases on 14 October 2021, and passed 100,000 cases on 27 October 2021. Singapore also broke its monthly death record in October 2021 with 312 deaths, breaking its previous monthly death record of 40 in September 2021. The total death count exceeded 1,000 on 27 February 2022, with the total case count crossing the 1-million mark on 19 March 2022. Singapore reported its first death of a patient under 12 years old on 27 June 2022.
Internationally, the case fatality ratio (CFR) for COVID-19 has been much lower than SARS in 2003. The transmission of the SARS-CoV-2 virus powering the COVID-19 pandemic has been significantly greater, with a significant total death toll. However, Singapore's death rate has been one of the world's lowest, both in terms of CFR and per capita. This may be attributed to the fact that the bulk of the cases are restricted to the migrant workers living in dormitories away from the general population. These migrant workers tend to be younger, with an average age of 30 years and 2 months old when surveyed in 2015, and the healthcare system was never overwhelmed. The authorities also tested the entire dormitory population for COVID-19 infection, leading to many otherwise asymptomatic infections being picked up. Research by the European Commission suggests that the CFR for SARS-CoV-2 virus picks up in cases 50 years of age and above. The elderly in the general population in Singapore have been advised to stay at home as much as possible, while resident-facing staff in old folks homes are being housed on site or separately in hotels.
Other factors contributing to Singapore's exceptionally low CFR include the country's use of extensive contact tracing and testing to identify cases, mandatory mask-wearing, and hospitalisation of all high-risk patients. Singapore has comparatively strict criteria for classifying COVID-19 deaths, counting patients who were infected with COVID but died of other causes as non-COVID deaths.
Prevalence studies on the population have shown that 4 in 1600 in the community, or about 0.25%, have previously been infected with COVID-19, while at least 47% of migrant workers living in dormitories have tested positive by PCR or serological tests.
Initial wave of COVID-19 (2020)
National authorities began reporting suspected cases on 4 January, however the first confirmed case was reported on 23 January, a tourist from Wuhan. Until 30 January, there were a total of 13 confirmed cases, all of whom were visitors to Singapore from China. The first case involving a Singaporean was confirmed on 31 January after returning from Wuhan. Contact tracing procedures were put in place to identify close contacts of the confirmed cases who were placed under 14-day quarantines to ring-fence the potential spread of the virus.
These imported cases eventually lead to clusters of local transmissions being formed. The first local cluster was reported on 4 February at Yong Thai Hang, a Chinese health products shop. It was identified as the locus of the infection where four women without recent history of travel to China contracted the virus. The shop was affected when a tour group from Guangxi, China visited it along with other locations such as the Diamond Industries Jewellery Company at Harbour Drive, where another case occurred, while touring Singapore. The tour group had returned to China and the Chinese authorities had confirmed that two of the group was infected. Authorities raised the DORSCON level to Orange with the impending COVID-19 cases of infection, with Prime Minister Lee expressing his worry about some cases with no known chain of transmission of the infection directly from Wuhan or indirectly via cases traced in Singapore. He suggested that it might become "futile to try to trace every contact". More clusters emerged at various locations, where there were large scale gatherings such as a business conference, Chinese New Year dinner gatherings and church-related activities. Two clusters were linked when several cases in each cluster was found to have infected each other through serological tests, the first such successful test in the world.
In March, as the number of cases began to rise exponentially around the world, the Ministry of Foreign Affairs (MFA) and the Ministry of Education (MOE) began to encourage Singaporeans to return home. Various institutes of higher learning recalled their students currently on overseas internship or exchange, and the MFA began liaising with airlines to facilitate flights to key cities when necessary during this period, to cater to demand for return flights to Singapore. This led to an increase in number of imported cases, in which over 70% of cases from 16 to 19 March were Singaporeans and long-term pass holders returning from overseas.