14/09/2021

COVID-19: Endemics, Epidemics & Pandemics

How to live with endemic Covid-19? Paul Tambyah explains

Updated 2 Dec 2021: Could Omicron variant be first step towards endemic disease?

These are very early days in terms of understanding the Omicron variant. What is known is that it has a large number of mutations, particularly in the spike protein and it appears to be rapidly spreading in specific parts of the world. Very early indications from Africa suggest it does not cause particularly severe disease, though the World Health Organization has urged caution given the limited data available.

At this point, it isn’t clear whether it has any greater capacity to evade vaccines than other SARS-CoV-2 variants such as Delta. It is very common for viruses to become less virulent (that is, cause less severe disease) once they become established in a population. The classic example is myxomatosis, which killed 99 per cent of rabbits when first introduced into Australia, but which now causes much lower mortality.

Some experts have predicted COVID-19 will also become less severe as it transitions to an endemic level of disease – settling into a predictable pattern of infections in a given location. It’s possible the Omicron variant may be the first step in this process.


COVID-19 Singapore abandoning ‘Zero COVID’ strategy
Singapore is the latest country in Asia to try to live with the coronavirus

The COVID-19 pandemic is one of the major topics at this year's G-20 summit. Some countries in Asia have decided that their earlier strategy of zero COVID is futile and that they must learn to live with the virus. In Singapore, that shift has ushered in a surge of coronavirus infections.

Singapore has one of the world's highest vaccination rates at 82%, yet cases of COVID-19 are skyrocketing from just double digits in August to well over 3,000 cases a day now. Infectious disease physician Dale Fisher of the National University Hospital says Singapore is letting nature take its course.

Singapore's health experts say exiting the pandemic will mean a carefully calibrated lifting of lids and laying them back on again as needed. Fisher says it may take another year or two. Meanwhile, he says don't expect a Singapore version of the U.K.'s Freedom Day, where almost all COVID-19 restrictions were lifted.


What’s the difference between a pandemic, an epidemic, and an endemic?

Not all infectious disease terms are created equal, though often they’re mistakenly used interchangeably. The distinction between the words “pandemic,” “epidemic,” and “endemic” is regularly blurred, even by medical experts. This is because the definition of each term is fluid and changes as diseases become more or less prevalent over time.

While conversational use of these words might not require precise definitions, knowing the difference is important to help you better understand public health news and appropriate public health responses.

Let’s start with basic definitions:
  • AN EPIDEMIC is a disease that affects a large number of people within a community, population, or region.
  • A PANDEMIC is an epidemic that’s spread over multiple countries or continents.
  • ENDEMIC is something that belongs to a particular people or country.


Highly-vaccinated, but more cases than ever: Singapore shows the world what ‘endemic’ COVID might look like

Highly-vaccinated Singapore is battling a record wave of COVID-19 infections just as the city plans to re-open to the world. But Singapore's 80% vaccination rate has kept severe cases and deaths down, potentially proving that living with the virus—versus trying to eradicate it—is the surest path out of the pandemic.

On Monday, Singapore recorded 1,647 cases of COVID-19, bringing its seven-day daily average to 1,545 cases, higher than any other previous wave of the pandemic. But even as cases soar, COVID-19 deaths in Singapore have remained low. The city-state of 5.7 million people has averaged three deaths per day in the last week. Singapore’s saving grace is its high vaccination coverage.

Singapore has now fully vaccinated over 80% of its population, one of the highest rates in the world. China's fully vaccinated rate is 73%, while the European Union and U.S. have fully vaccinated 65% and 55% of their populations, respectively, according to Bloomberg.


Endemic Covid-19 Has Arrived in Portugal. This Is What It Looks Like
Portugal dropped most of its coronavirus restrictions on Oct 1

In this soccer-crazed capital of a soccer-obsessed nation, the stadiums are full again. Portugal, a country ravaged earlier in the year by the Delta variant of the coronavirus, now has the highest Covid-19 vaccination rate in Europe and offers a glimpse of a country trying to come to grips with what is increasingly looking like an endemic virus.

Tens of thousands of screaming soccer fans crammed into the Estadio da Luz here Wednesday to watch hometown favorites Benfica take on Bayern Munich. They amassed on the subway to the stadium, at the entrance as officials patted them down and, after the game, at food trucks where they downed sandwiches and beer as they tried to forget the drubbing their team had just received.

The government recently lifted a 30% capacity limit at stadiums imposed to control Covid-19. But things haven’t returned to what they were: Fans need a certificate showing they are vaccinated, recently recovered from the disease or tested negative. Masks are obligatory throughout stadiums.


Is Your City Nearing an Endemic? Here Are a Few Things to Keep in Mind
Some areas with high vaccination rates are starting to ease Covid-19 protocols. Your own company's policies will depend on the conditions on the ground and in your workplace

In areas with high vaccination rates, life is transitioning toward a new normal, which involves shrugging off some of the vestiges the depths of the pandemic--presenting an exciting, albeit measured, opportunity for some in-person businesses.

San Francisco, which has one of the highest vaccination rates in the country, lifted indoor facemask requirements on October 15 for vaccinated individuals in limited situations, such as offices, gyms, and other settings with fewer than 100 people. While New York City still faces mask mandates in public settings, illness rates are waning--drawing some health officials to consider shifting Covid-19 to an endemic, a situation in which politicians and business owners are finding ways to integrate safety measures that, at last, treat Covid-19 more like the flu.

If your city is nearing endemic status, you may be wondering what that means on a day-to-day basis. Here are answers to some frequently asked questions:
  • What is an endemic?
  • Do the rules change?
  • Should your policies change?
  • What else should you be doing?


How will Covid-19 go from 'pandemic' to 'endemic'?

Experts agree that Covid-19 will not be completely eradicated but will instead transition from a "pandemic" phase to an "endemic" phase. Writing for Vox, Sigal Samuel outlines the many factors that determine endemicity—and what might happen as Covid-19 becomes endemic.

When is a disease classified as endemic? According to Samuel, an infectious disease cannot be classified as endemic until—at the very least—the rate of infections "more or less" stabilizes over a multi-year period. "A disease is endemic if the reproductive number is stably at one. That means one infected person, on average, infects one other person," explained Eleanor Murray, an epidemiologist at Boston University. "Right now, we are nowhere near that [with Covid-19]. Each person who's infected is infecting more than one person." This is primarily because of the delta variant, which is particularly contagious, and the fact that most people around the world do not yet have immunity, either via vaccination or prior infection. And while experts hoped that the arrival of vaccines would help the world reach overall herd immunity, an insufficient number of people have been vaccinated to reach that goal, Samuel writes.

According to Murray, getting a virus's reproductive number down to one is "the bare minimum" factor in a disease becoming endemic—and the other factors are much more subjective in nature.


From Epidemic to Pandemic to Endemic
A traveler wears a face mask as she arrives at John F. Kennedy International Airport in New York City, March 20, 2020. (REUTERS/Brendan McDermid)

The World Health Organization (WHO) declared the coronavirus crisis a “pandemic” on March 11 of 2020. The WHO’s Director-General Tedros Adhanom Ghebreyesus said that day, “Pandemic is not a word to use lightly or carelessly.” He was reminding people that the word is used only for the most extreme and dangerous spreads of disease.

Since the start of the pandemic, Johns Hopkins University reports, there have been more than 228 million confirmed cases of COVID-19 among the almost eight billion people on the planet. The number of deaths from the disease is about 4.7 million.

At the same time, new versions, or variants, of the SARS-CoV-2 virus that causes COVID-19 are developing and spreading very fast. In the United States, the Centers for Disease Control and Prevention (CDC) said the Delta variant is the main cause of new COVID infections.


How you’ll know when Covid-19 has gone from “pandemic” to “endemic”
Experts say it is unrealistic to think Covid-19 will be totally eradicated

You’ve probably heard it by now: Covid-19 is not going away. The broad consensus among experts is that it’s not realistic to think we’re going to totally eradicate this virus. We will, however, see it move out of the pandemic phase and into the endemic phase.

That means the virus will keep circulating in parts of the global population for years, but its prevalence and impact will come down to relatively manageable levels, so it becomes more like the flu than a world-stopping disease. For now, “we have to remember that we are still in a pandemic with this virus,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation. “We’re not yet at a point where we’re living with endemic Covid. When we get to that point some of this will be much easier, but we’re not there.”

So, how will we know when we are there? Is there some clear threshold or some magical metric that will tell us, objectively and undeniably?


Many say Covid-19 will transition ‘from epidemic to endemic’. But what does this mean?
In an endemic future, we will need to learn what levels of disease and death to expect

During the pandemic, many scientific debates have become highly politicised. These include debates around fatality rates, the mortality impact of the pandemic, herd immunity, vaccination, and various drugs and treatments. It has been common for unlikely or absurd claims to be couched in the language of science and data.

So, it is not surprising that discussions of how the pandemic will end have political undertones too. In particular there has been much talk of the transition “from epidemic to endemic”. What exactly does this mean? Is this transition inevitable? Is it good news? And will it change how we look back at the Covid-19 epidemic?

What does ‘endemicity’ mean – and is it good news? Roughly speaking, a disease is endemic in some region if it occurs at a fairly steady level without dying away and without major flare-ups. There may be some fluctuations and seasonal variations but not large surges, namely epidemics. For example, there are four endemic human coronaviruses which tend to circulate more widely in winter, and cause symptoms of the common cold. Could SARS-CoV-2, the virus which causes Covid-19, eventually join them? There are several common misconceptions which become apparent in discussions of Covid-19 and endemicity.


Endemics, Epidemics and Pandemics

Infectious diseases are spread by either bacterial or viral agents and are ever-present in society. Usually infected cases are present in numbers below an expected thresholdA but every once in a while there may be an outbreak, a new strain or a new disease that has a significant impact at either a local or global level. The spread and rate of new cases can be classified as:
  • Endemic - describes a disease that is present permanently in a region or population
  • Epidemic - is an outbreak that affects many people at one time and can spread through one or several communities
  • Pandemic - is the term used to describe an epidemic when the spread is global
The World Health Organization (WHO) will declare a Pandemic when a disease has shown exponential growth - dramatically increasing rate of growth, each day showing many more cases than the previous day. A current example of this is the Coronavirus Disease (COVID-19). On 31 December 2019, a cluster of cases of pneumonia of unknown cause, in the city of Wuhan, Hubei province in China, was reported to the WHO. This was subsequently identified as a new virus in January 2020 and over the following months, the number of cases continued to rise but were not contained to China and showed exponential growth worldwide. Due to the rapid global rise in cases, this was declared a pandemic on 11 March and globally, as of 4:22pm CET, 9 December 2020, there have been 67,780,361 confirmed cases of COVID-19, including 1,551,214 deaths, reported to WHO.


Epidemic, Endemic, Pandemic: What are the Differences?

The novel coronavirus pandemic is the perfect model for understanding what exactly a pandemic is and how it impacts life on a global scale. Since the emergence of COVID-19 in 2020, the public has been bombarded with new language to understand the virus and the subsequent global public health response. This article will uncover the factors that make a pandemic and how it differs from epidemics and endemics:
  • WHAT IS AN EPIDEMIC? The Centers for Disease Control and Prevention (CDC) describes an epidemic as an unexpected increase in the number of disease cases in a specific geographical area. Yellow fever, smallpox, measles, and polio are prime examples of epidemics that occurred throughout American history. Notably, an epidemic disease doesn't necessarily have to be contagious. For example, West Nile fever and the rapid increase in obesity rates are also considered epidemics. In broader terms, epidemics can refer to a disease or other specific health-related behavior (e.g., smoking) with rates that are clearly above the expected occurrence in a community or region.
  • WHAT IS A PANDEMIC? The World Health Organization (WHO) declares a pandemic when a disease’s growth is exponential. This means growth rate skyrockets, and each day cases grow more than the day prior. In being declared a pandemic, the virus has nothing to do with virology, population immunity, or disease severity. It means a virus covers a wide area, affecting several countries and populations.
  • WHAT IS AN ENDEMIC? An endemic is a disease outbreak that is consistently present but limited to a particular region. This makes the disease spread and rates predictable. Malaria, for example, is considered an endemic in certain countries and regions.
The WHO defines pandemics, epidemics, and endemics based on a disease's rate of spread. Thus, the difference between an epidemic and a pandemic isn't in the severity of the disease, but the degree to which it has spread. A pandemic cuts across international boundaries, as opposed to regional epidemics. This wide geographical reach is what makes pandemics lead to large-scale social disruption, economic loss, and general hardship. It's important to note that a once-declared epidemic can progress into pandemic status. While an epidemic is large, it is also generally contained or expected in its spread, while a pandemic is international and out of control.


What happens when a pandemic becomes endemic?

In a televised address on Monday (May 31), Prime Minister Lee Hsien Loong said he believed COVID-19 would not disappear, but instead “remain with humankind and become endemic”.

The virus would continue to circulate in parts of the global population for years to come, with “small outbreaks” of the disease from time to time in Singapore, said Mr Lee. “Our aim must be to keep the community as a whole safe, while accepting that some people may get infected every now and then - just as we do with the common flu or dengue fever, which we now manage through public health measures and personal precautions, and in the case of the flu, with regular vaccinations too,” he added.

Last week, Finance Minister Lawrence Wong - co-chair of the multi-ministry taskforce tackling the pandemic - said that Singapore was already planning for the possibility that COVID-19 might become endemic. But what would it mean for COVID-19 to become endemic?


Pandemic vs endemic

Almost two years later, Covid-19 remains the dominant topic of the day. Every day.

In Singapore after months and months of restrictions, tracking applications, circuit breakers and vaccinations, cases are still rising. The government task force in charge of overseeing Singapore’s response to Covid-19 is now foreseeing more than 1,000 cases a day in the coming weeks. Up from around 500 a day now.

The totals we are seeing now are far, far higher than the 30 to 40 cases a day we saw in May when the government declared the country would go back to Phase 2 (Heightened Alert) restrictions.


How Is a Pandemic Different from an Epidemic?

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared Trusted Source the international spread of a new coronavirus, SARS-CoV-2, a worldwide pandemic.

Some news organizations and public health officials had been calling the outbreak a pandemic weeks earlier than the WHO declaration — so how do you know when an outbreak becomes an epidemic and an epidemic becomes a pandemic?

Though public health definitions shift and evolve over time, the distinctions between these terms are generally a matter of scale. In short, a pandemic is an epidemic that has gone global. In other words, a pandemic is simply a larger and more widespread epidemic.


What does endemic mean when it comes to COVID?

First the coronavirus was an epidemic, then it became a pandemic, and now we're starting to hear over and over again that it's on its way to becoming endemic. That means COVID will forever be part of our lives in some form, like how the Spanish flu of 1918 morphed over time into the common flus of today.

As we grapple with Delta rage, it's helpful to understand what endemic means when it comes to COVID both in terms of what we do in the present and what our day-to-day will look like in the future. For starters, even if COVID will eventually become endemic, it doesn't mean we should give up trying to contain the virus, public health experts have said. And if more of us get vaccinated now, and maybe one day annually, getting COVID may mean a few days of discomfort and then bouncing back to normal until we do it all again the following year.

When a disease spikes suddenly in a certain area, that's an epidemic. When that disease spreads uncontrollably into multiple countries, that's a pandemic. When it burrows so deep that it constantly hums along, albeit at controlled, predictable levels, that means it's endemic.


When -- and how -- the pandemic could become endemic

The vaccines are expected to help put the world on track to a sense of normal again and push COVID-19 into the background, but plenty of people want to know exactly when the pandemic will end.

Some epidemiologists said the COVID-19 pandemic could turn into an endemic early next year while others said it will likely be longer because the rest of the world needs vaccines. "So endemic is just when you have a disease that is at a typical level, a level that is expected within a population," explained Dr. Cindy Prins, a University of Florida associate professor of epidemiology.

Currently, COVID-19 is still infecting mass group of people, so it is nowhere near fading out to the background. But pandemics have evolved into endemics in the past.


Has Covid-19 gone from pandemic to endemic?

The delta variant is prompting a spike in coronavirus cases across the US. But the pandemic may soon take yet another turn.

On CNBC’s Squawk Box last week, former Food and Drug Administration (FDA) commissioner and current Pfizer board member Scott Gottlieb said we’re “transitioning from this being a pandemic to being more of an endemic virus, at least here in the United States and other Western markets.” Gottlieb was responding to a question about the point at which the US might claim “something close to victory” over Covid, in light of upcoming approvals for booster shots and vaccines for children under age 12.

“This is going to become more of an endemic illness where you see sort of a persistent infection through the winter, but not at the levels that we’re experiencing certainly right now,” Gottlieb said (noting that this would be less true in countries with low vaccination rates). Booster shots will play a role in getting the US to that phase, he says, as will the delta variant.


What will it be like when COVID-19 becomes endemic?

The expectation that COVID-19 will become endemic essentially means that the pandemic will not end with the virus disappearing; instead, the optimistic view is that enough people will gain immune protection from vaccination and from natural infection such that there will be less transmission and much less COVID-19-related hospitalization and death, even as the virus continues to circulate.

The expected continued circulation of SARS-CoV-2 stands in contrast with the first round of SARS in 2003 and with the Ebola virus outbreak in West Africa in 2014, when public health measures ultimately stopped spread and brought both outbreaks to an end. While there are important differences among the viruses and the contexts, this comparison underscores the critical need to improve our global public health infrastructure and surveillance systems to monitor for and help respond to the inevitable next potential pandemic virus.

Since viruses spread where there are enough susceptible individuals and enough contact among them to sustain spread, it’s hard to anticipate what the timeline will be for the expected shift of COVID-19 to endemicity. It’s dependent on factors like the strength and duration of immune protection from vaccination and natural infection, our patterns of contact with one another that allow spread, and the transmissibility of the virus. So the patterns will likely differ considerably from what we saw with the other pandemics because of the heterogeneous responses to COVID-19 across the world—with some places engaging in “zero-COVID” policies, others with limited responses, and widely variable vaccine availability and uptake.


Understanding COVID-19: Asymptomatic & Symptomatic Presentation
The COVID-19 pandemic has spread fear around the world. Life has not been the same since early 2020. However, the pandemic has also united people who want to help stop the spread of the disease. Unfortunately, asymptomatic presentation of COVID-19 makes this difficult

Experts continue their extensive research on asymptomatic and symptomatic cases of COVID-19. New findings provide a better understanding of the disease, which allows us to remain calm and cautious. Staying informed and prepared helps keep you and your loved ones healthy and safe. Because COVID-19 does not always present with symptoms, it’s challenging to determine the exact number of cases across the United States. Asymptomatic cases also make it hard to know who may or may not be infected. Therefore, always protecting yourself and your family in situations where you encounter other people is imperative.

We’re here to help you understand the differences between symptomatic and asymptomatic COVID-19 so you can keep your family safe and take the proper measures if you believe you’ve been exposed. Symptomatic & Asymptomatic COVID-19:
  • In symptomatic cases of COVID-19, people may present a wide variety of symptoms. According to the Centers for Disease Control (CDC), symptoms may present within two to 14 days of exposure. Common symptoms include fever, coughing, and trouble breathing, though the CDC also notes several others.
  • When someone is asymptomatic, they do not show any signs that the disease is present in their body. The CDC estimates that 35% of COVID-19 cases are asymptomatic. In asymptomatic cases, people don’t know they are infected. There is no way for others to know either.
  • Regardless of how COVID-19 presents, the disease is contagious and can easily transmit to others. The possibility that an asymptomatic person could infect other people is exactly the same as in symptomatic cases.
Considering so many COVID-19 cases are asymptomatic, it’s vital to continue to practice preventative measures such as social distancing, thoroughly washing your hands, and wearing a mask. Doing so will help keep you safe from others — and others safe from you — in the event that someone is unaware that they have the disease.


Singapore fully vaccinated 81% of its population. What’s next?

Back in 1959, publicity trucks roamed the streets of Singapore to encourage citizens to get vaccinated against smallpox. The nation has taken a page from history – it’s rolling out mobile vaccination drives and catchy jingles to persuade citizens to get their Covid-19 shots.

Singapore has fully vaccinated 81 per cent of its population from the virus, making it one of the most vaccinated countries in the world. “I don’t think there are many countries that have achieved such a high rate of vaccination,” says Ong Ye Kung, Singapore’s Minister for Health.

How did Singapore do it, and what’s next in the country’s reopening as infections rise? In an exclusive interview with GovInsider, Ong discusses lessons from the pandemic, the need for public trust in government, and mental health.


Tracking Singapore's Covid-19 vaccination progress
Note: Fully vaccinated individuals refer to those who have received their second doses and recovered people who have received at least one dose

A total of 8,867,170 doses have been administered in Singapore under the national vaccination programme as at Sept 12.

Both first and second doses of the Pfizer-BioNTech/Comirnaty and Moderna vaccines are currently being administered.

In addition, 176,860 doses of other vaccines recognised in the World Health Organization’s Emergency Use Listing, which includes includes Sinovac-Coronavac, Sinopharm and AstraZeneca, have been administered as at Sept 12, covering 86,614 individuals.


90 reports of suspected adverse reactions to Sinovac Covid-19 vaccine in S'pore

There have been 90 reports of suspected adverse reactions to the Sinovac-CoronaVac vaccine, including five serious ones, as of Aug 31, the authorities announced on Thursday (Sept 16). With 168,439 doses of the vaccine administered in the same period, this amounts to a rate of 0.053 per cent for suspected cases, and about 0.003 per cent for serious ones.

In its fifth safety update on Covid-19 vaccines, the Health Sciences Authority (HSA) also said 8,716,085 doses of the Pfizer-BioNTech and Moderna mRNA vaccines have been administered under the national vaccination programme as of Aug 31. A total of 11,737 suspected adverse reactions - 0.13 per cent - were reported for vaccines under the national vaccination programme in the same period. Of these, 498 reports (0.006 per cent) were classified as serious adverse events.

The most commonly reported symptoms were consistent with those typically observed following vaccination. They include dizziness, shortness of breath, chest tightness or discomfort, palpitations, injection site reactions such as pain and swelling, fever and allergic reactions (such as rashes, itching, hives and swelling of eyelids, face and lips). These typically resolve within a few days, said HSA. Among the serious cases, the most frequently reported were anaphylaxis and other severe allergic reactions.


Why vaccinated people dying from Covid-19 doesn't mean the vaccines are ineffective

Former US Secretary of State Colin Powell died on Monday of Covid-19 complications. His family announced that he was fully vaccinated. He was 84 years old, and had multiple myeloma, a blood cancer.

Health officials worry that anti-vaccine activists will seize upon Powell's death to make the claim that vaccines don't work. If you can still die after being vaccinated for Covid-19, what's the point of getting the vaccine?

What's the answer to that question? I discussed it with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of a new book, "Lifelines: A Doctor's Journey in the Fight for Public Health."


Sinovac included in Singapore's national Covid-19 vaccination programme
Under the national vaccination programme, the Sinovac vaccine will be administered for free. ST PHOTO: LIM YAOHUI

The Sinovac Covid-19 vaccine will be included in the national vaccination programme to cater to those unable or unwilling to be vaccinated with mRNA vaccines, the multi-ministry task force managing the pandemic said on Saturday (Oct 23).

This follows the Health Sciences Authority's (HSA) interim authorisation of the vaccine under the Pandemic Special Access Route (PSAR).

Three doses of the Sinovac vaccine will be required for a person to be considered fully vaccinated, said the Ministry of Health (MOH).


Unvaccinated vs vaccinated Covid-19 deaths in Singapore

Out of 5.5 million people, 500,000 children below the age of 12 are ineligible to receive the vaccine yet. But while they may be carriers of the virus, they are exceedingly unlikely to end up in hospital or suffer serious adverse effects. Among those over the age of 12, 94 per cent have already received their vaccines. Nevertheless, the remaining six per cent translates to a whopping 300,000 people — still an enormous group, which is highly vulnerable to COVID-19.

According to the Ministry of Health (MOH), individuals from among the six per cent of those who are partially or completely unvaccinated comprised 67.5 per cent of deaths in the first three weeks of October.

What’s really sad is that out of 169 deaths reported in that period, 30 were of those who received one dose of the vaccine. This suggests that they got scared some time before they ended up contracting the disease and went to receive their shot, but did not survive long enough to complete the two-dose cycle and develop necessary immunity.


Singapore confirms first case of Wuhan virus on 23 Jan 2020
Guests at Shangri-La's Rasa Sentosa Resort & Spa yesterday. A man from China who is the first to test positive for the Wuhan virus in Singapore had stayed at the resort, said the Health Ministry. ST PHOTO: TIMOTHY DAVID

A China national has tested positive for the Wuhan virus in Singapore, with another likely to have the virus.

The 66-year-old man, a Wuhan resident, arrived in Singapore with nine travelling companions on Monday (Jan 20), and stayed at Shangri-La's Rasa Sentosa resort, the Ministry of Health said at a briefing on Thursday night (23 Jan 2020).

All the rooms at the hotel where the man and his travelling companions stayed in have been sanitised and sealed off.

read more
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