Since the Coronavirus outbreak, the Singapore Government have worked tirelessly to ensure that the infected are isolated, contained and all contacts they may have made in recent days prior to infection are track and traced.

These efforts seem to be paying off, as Singapore being one of the first three countries to report a confirmed case of Coronavirus, has largely managed to contain the virus and prevent it from becoming a nationwide crisis.

A huge part of this success is down to the contact tracing efforts of the Governments’ Ministry of Health in collaboration with the Singapore Police Force.

What is Contact Tracing and Why is it important?

People who have had close contact with someone who is infected with the virus are at higher risk of becoming infected and potentially infecting those they have had close contact with. Finding and monitoring these contacts after exposure to an infected person will help them to get adequate care and treatment, and aims to prevent further transmission of the virus.

This monitoring process is called contact tracing, which can be broken down into 3 basic steps as explained by the World Health Organisation:

Contact identification: Once someone is confirmed as infected with a virus, contacts are identified by asking about the person’s activities and the activities and roles of the people around them since the onset of illness. Contacts can be anyone who has been in contact with an infected person: family members, work colleagues, friends, or health care providers.

Contact listing: All persons considered to have contact with the infected person should be listed as contacts. Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms.

Contacts should also be provided with information about prevention of the disease. In some cases, quarantine or isolation is required for high-risk contacts, either at home or in hospital.

Contact follow-up: Regular follow-up should be conducted with all contacts to monitor for symptoms and test for signs of infection.

Contact Tracing Procedure in Singapore

The Ministry of Health (MOH) in Singapore is overall in charge of contact tracing operations in Singapore and the police are called in to help in some cases. Where the details of activity or movements of a patient is incomplete and/or further verification is required, the police will come then support MOH in these investigative circumstances.

A recent study carried out by Harvard University estimated that Singapore was detecting three times the number of COVID-19 cases as other countries, thanks to its epidemiological surveillance and contact tracing processes.

Contact tracing starts at the hospital where a patient is admitted, with doctors and nurses drawing an activity map – a detailed breakdown of a patient’s movements from 14 days before symptoms appear and until he is isolated.

The MOH carries out what is known as “backward tracing” of the movements and activity of the infected patient for the two weeks prior to them first identifying symptoms. This then will help identify links to other cases and potential sources of transmission.

MOH officers also do “forward tracing” to identify who the infected patient had contact with after getting symptoms. These people may need to be quarantined and tested if unwell.

When there are gaps, the contact tracers might interview patients again or talk to the next-of-kin, or recruit help from third parties such as hotels and taxis to review surveillance footage and collect any other relevant information.

To help identify links between cases, a separate data management team also uses the activity maps, cross-referencing them with other cases to see if there are overlaps in locations. If such overlaps are found, the contact tracing team conducts a follow-up investigation.

Digital Footprint Assists Contact Tracing

Singapore has a huge team of contact tracers and they make use of all resources, including the police.

Another technique the authorities are using to fill in missing information on infected patients’ activities and contacts is to examine their digital footprint.

This could be to trace their steps on days prior to virus confirmation – like ATMs, shopping centres or restaurants where they have used their cards.

ATM or credit card activity is incredibly useful as it leaves digital footprints everywhere people go. It assists authorities to track and find out where the person has been, where and how they have travelled.

Digital footprint can also help those infected recall their activities and places visited better as it is not always easy to recollect when feeling very unwell or perhaps not well enough to describe their movements in detail.

Can Technology fill in the gaps in contact tracing?

The COVID-19 spread in Singapore has allowed both the government and app developers to harness technology as part of the response. Transparent, timely public information also helps allay people’s fears and anxiety.

Integrating data from the national health bodies, immigration and customs databases, generating data to trace people’s travel history and clinical symptoms, using mobile phones to track people or just keep them updated shows how technology is advantageous in efforts to control the outbreak in these unchartered times.

Ms Linda Teo, Assistant Director of the police’s Analytics Research and Technology Development said “tech tools like data visualisation and word clouds can help draw links between patients. This was how the dots were connected leading to the realisation of a cluster at The Life Church and Missions in Paya Lebar.”

Singapore’s COVID-19 tracking site

The Ministry of Health have lunch a COVID-19 live dashboard providing up-to-date information on the ministry’s website. These updates summarise the current situation in the country. This dedicated COVID-19 site gives very transparent information on each confirmed case.

The website shares the age, sex and occupation of each person who has tested positive for the virus. It reveals where they travelled recently, and when they sought medical help. It explains when they were hospitalised and when they were discharged.

The site only includes cases from Singapore, and it has been commended by other countries. It is believed that no other country has recorded such accurate data, and relentlessly tracked and traced every contact possibly linked to infected patients like Singapore has. No country has released as much detailed information about its coronavirus cases as the city-state.

Success absolutely depends on contact tracing

The goal of contact tracing is to try and keep COVID-19 from spreading. And it seems that the Singapore strategy is key to controlling the virus — test, trace, isolate and inform. And with the governments tech savvy agencies, and their resolve to invest in technology to solve current societal problems along with future thinking leadership – they will remain a step ahead of many other countries worldwide throughout this pandemic.