COVID-19 Health System Response Monitor

Singapore

February 2021

Updated July 2021

Author 

Jacinta I‐Pei Chen 

Khin Chaw Ko 

Amelia Leow  

Jason CH Yap 

Jeremy Lim 

 

Chapter 7 update in July 2021 : 

Nikita Kanumoory Mandyam 

Jeremy Lim 

 

All the authors are from the Saw Swee Hock School of Public Health, National University of Singapore 

 

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World Health Organization Regional Office for South‐East Asia COVID‐19 health system response monitor: Singapore 

ISBN 978‐92‐9022‐852‐3 

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Suggested citation: Chen J, Ko KC, Leow A, Yap J, Mandyam NK and Lim J. COVID‐19 health system response monitor: Singapore. New Delhi: World Health Organization Regional Office for South‐East Asia; 2021. 

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Acknowledgements

The Asia Pacific Observatory on Health Systems and Policies (APO) would like to thank the European 

Observatory on Health Systems and Policies (OBS) for their active engagement and collaboration on 

this project. OBS, along with and for the WHO Regional Office for Europe, developed the initial concept 

for the country COVID‐19 health system response monitor and used it to capture the situation in most 

Member  States  of  the  European  Region.  APO, OBS  and  the WHO Regional  Office  for  the  Eastern 

Mediterranean collaborated to update the template/guidance for capturing information suitable for 

other regions and this was used by the author team to guide the writing process. This publication was 

edited by APO Secretariat.   

 

Funding for this project was provided by the UHC partnership.   

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Abbreviations and acronyms ARI  acute respiratory infection 

ART  antigen rapid test 

CCF  community care facility 

CRF  community recovery facility 

CTMA  COVID‐19 (Temporary Measures) Act 2020 

DORSCON  Disease Outbreak Response System Condition 

ED  emergency department 

EDB  Economic Development Board 

FAST  forward assurance support team 

FET  fast and easy test 

FSS  Flu Subsidy Scheme 

GP  general practitioner 

GST  goods and services tax 

HCW  health‐care worker 

HSA  Health Sciences Authority 

ICU  intensive care unit 

ID Act  Infectious Diseases Act 

MHCP  MoH Healthcare Claims Portal 

MoH  Ministry of Health 

MoM  Ministry of Manpower 

MSF  Ministry of Social and Family Development 

MTI  Ministry of Trade and Industry 

NCID  National Centre for Infectious Diseases 

NEA  National Environment Agency 

PBD  purpose‐built dormitory 

PCR  polymerase chain reaction 

PET  pre‐event testing 

PHPC  public health preparedness clinic 

PPE  personal protective equipment 

PSAR  Pandemic Special Access Route 

QO  quarantine order 

RGL  Reciprocal Green Lane 

RRT  rostered routine testing 

SAF  Singapore Armed Forces 

SAR  special access route 

SARS  severe acute respiratory syndrome 

SASH  Swab and Send Home (programme) 

SHN   stay home notice 

SIF  swab isolation facility 

TCM  Traditional Chinese Medicine 

TOC  Testing Operations Centre 

RT‐PCR  reverse transcriptase polymerase chain reaction

1

 

Contents 

Acknowledgements ............................................................................................................ ii 

Abbreviations and acronyms ............................................................................................. iii 

Contents ............................................................................................................................. 1 

Overview ............................................................................................................................ 2 

Introduction ....................................................................................................................... 3 

1 Preventing transmission .................................................................................................. 4 

1.1 Health communication ................................................................................................... 4 

1.2 Physical distancing ........................................................................................................ 9 

1.3 Isolation and quarantine .............................................................................................. 17 

1.4 Monitoring and surveillance ......................................................................................... 18 

1.5 Testing ......................................................................................................................... 20 

2 Ensuring sufficient physical infrastructure and workforce capacity ................................ 25 

2.1 Physical infrastructure ................................................................................................. 25 

2.2 Workforce .................................................................................................................... 27 

3 Providing health services effectively .............................................................................. 30 

3.1 Planning services and maintaining essential services ................................................. 30 

3.2 Managing cases .......................................................................................................... 33 

4 Paying for services ......................................................................................................... 39 

4.1 Health financing ........................................................................................................... 39 

4.2 Entitlement and coverage ............................................................................................ 41 

5 Governance ................................................................................................................... 45 

5.1 Pandemic response planning ...................................................................................... 45 

5.2 Private sector involvement and medical devices/aids ................................................. 47 

5.3 Vaccination policy ........................................................................................................ 48 

6 Measures in other sectors ............................................................................................. 50 

7 Update as of July 2021 ................................................................................................... 54 

7.1 Situation overview ....................................................................................................... 54 

7.2 Policy and decision making ......................................................................................... 55 

7.3 Re-opening in phases ................................................................................................. 56 

7.4 Vaccination .................................................................................................................. 58 

7.5 Testing and contact tracing ......................................................................................... 60 

7.6 Border controls ............................................................................................................ 62 

7.7 Economy ..................................................................................................................... 63 

7.8 Pandemic preparedness for the future ........................................................................ 64 

References........................................................................................................................ 65 

 

2

Overview The Health System Response Monitor (HSRM) is designed to collect and organize up‐to‐date 

information on how countries are responding to the coronavirus disease‐19 (COVID‐19) outbreak. 

This will be updated periodically (as and when there is a change in COVID‐19‐related measures) by 

the respective country contributors. The HSRM focuses primarily on the responses of health systems 

but also captures wider public health initiatives. The HSRM presents information under six headings: 

1. Preventing local transmission. This section includes information on key public health measures 

that aim to prevent the further spread of the disease. It details how countries are advising the 

general public and people who (might) have the disease to prevent further spread, as well as 

measures in place to test and identify cases, trace contacts and monitor the scale of the 

outbreak. 

2. Ensuring sufficient physical infrastructure and workforce capacity. This section considers the 

physical infrastructure available in a country and where there are shortages. It describes any 

measures being implemented or planned to address them. It also considers the health 

workforce, including what countries are doing to maintain or enhance capacity, the 

responsibilities and skill‐mix of the workforce, and any initiatives to train or otherwise support 

health workers. 

3. Providing health services effectively. This section describes approaches to service delivery 

planning and patient pathways for suspected COVID‐19 cases. It also considers efforts by 

countries to maintain other essential services during periods of excessive demand for health 

services. 

4. Paying for services. Health financing describes how much is spent on health and the distribution 

of health spending across different service areas. The section also describes who is covered for 

COVID‐19 testing and treatment, whether there are any notable gaps (in population coverage 

and service coverage), and how much people pay (if at all) for those services out of pocket. 

5. Governance. This discusses governance of the health system regarding COVID‐19‐related 

pandemic response plans and the steering of the health system to ensure its continued 

functioning. It includes emergency response mechanisms, how information is being 

communicated, and the regulation of health service provision to patients affected by the virus. 

6. Measures in other sectors. This section contains information on measures undertaken in non‐

health sectors (such as border and travel restrictions, economic and fiscal measures) to tackle 

the pandemic. 

   

3

Introduction 

Singapore is an island country with a population of 5.6 million. It used to receive a large number of 

tourists from mainland China, with more than 400 flights between Singapore and mainland China 

per week. In 2019, a total of 3.6 million tourists from mainland China visited Singapore [1].  

Singapore was one of the first countries to report imported cases of COVID‐19 and had the highest 

number of cases outside mainland China for a time in early February 2020, ranging from 5 to 10 new 

cases per day and cumulatively crossing 70 cases by mid‐February. The rise in cases plateaued 

towards the end of February but shortly after, daily reported new cases rose to double‐digit figures 

and cumulative cases reached 1000 on 1 April 2020. From 7 April 2020, in view of widespread 

community transmission, Singapore implemented a suite of significantly stricter islandwide 

measures, termed the Circuit Breaker (see 7 and 21 April in Table 1 for details of the measures). As 

the country shifted into Circuit Breaker, large clusters emerged in foreign worker dormitories [2]. 

Daily new cases averaged hundreds per day in the subsequent months, driven mainly by cases in the 

dormitories, and cumulative cases crossed 50 000 in August 2020. New cases subsequently dropped 

and, since October 2020, new local community cases and cases in dormitories have ranged between 

0 and 3 per day. New daily imported cases have been in the double digit range but are managed 

with test/quarantine/isolation protocols [3]. See Fig. 1.  

Fig. 1: Epidemic curve of COVID‐19 outbreak by press release date 

 

Source: https://www.moh.gov.sg/docs/librariesprovider5/local‐situation‐report/situation‐report‐‐‐20‐feb‐

2021.pdf  

   

4

1 Preventing transmission 

1.1 Health communication 

Health communication plays an important role in Singapore’s COVID response. Since the start of the 

pandemic, frequent press briefings and public announcements were made by ministers and the 

Prime Minister on pandemic developments, policies and new measures. They also emphasized the 

behavioural changes the population should adopt to inhibit spread in the community. The press 

briefings and announcements are televised nationwide and live streamed on social media channels 

in the four official languages of English, Mandarin, Malay and Tamil. Their contents are also reported 

on traditional media platforms (print and online/digital news reporting) and available as documents 

on various government/government agency websites.  

Updates on the epidemiological situation, policies and new measures are communicated daily in the 

four languages through official websites, traditional and social media channels, and mobile 

applications. A list of the official information sources/platforms for COVID‐19 and specific COVID‐19‐

related topics (e.g. air travel‐related information, contact tracing, crowd density at public places, 

mental health support, employment opportunities, etc.) are available at 

https://www.gov.sg/article/covid‐19‐resources. A central source of information on WhatsApp 

messaging was also set up through which notifications and updates on new COVID‐19‐related 

information can be received directly and promptly (see Fig. 2) [2]. Accompanying illustrative posters 

and explanations in the media by experts and experienced personnel are a common feature in 

Singapore’s health communication. 

Fig. 2: Example of messages sent through the WhatsApp gov.sg subscription service 

 

 

5

Community hygiene 

Community hygiene practices and socially responsible behaviour featured regularly in the press 

briefings and information updates, especially in the earlier months of January to March 2020. These 

accompanied a national campaign (from January 2020) advocating such behaviour and practices, 

where personal/hand hygiene instructions and socially responsible behaviour were also 

communicated through posters and even comics islandwide via newspapers or at strategic locations 

(e.g. lift lobby areas, common commuting points). Local celebrities further advocated for them on 

social and traditional media platforms [2].   

A participatory approach addressing community feedback was sometimes adopted to reassure the 

public and promote voluntary compliance. For example, from January to March, because the 

evidence for the use of face masks by the general public was uncertain, the limited supplies were 

prioritized for health‐care workers (HCWs), and there was as yet no widespread community 

transmission, the national guidance was to don masks only when one was feeling unwell. This 

prompted public concern and several rounds of explanation were conducted by ministers at press 

briefings on the rationale for the guidance. However, there remained widespread concern about the 

shortage of face masks and, in response, a set of four surgical masks was distributed to each of the 

1.37 million Singapore households from 1 February.  

With the arrival of the Circuit Breaker in April, in view of the widespread community transmission 

and more definitive evidence of asymptomatic transmission, a change was made to the national 

guidance on mask‐wearing outside of home, which became a requirement by law from 14 April. The 

guidance was announced at a press briefing and issued in a press release as part of a suite of more 

stringent Circuit Breaker measures [4, 5]. Official guidance on the use of masks and face shields was 

issued on 1 June [6], and the government and Temasek Foundation1 have been distributing reusable 

and surgical masks to every Singapore resident since April on a bi‐monthly basis on average. The 

masks were offered in four different sizes and  could be collected at public locations such as 

community centres, bus interchanges and migrant workers’ centre recreation club and, from May 

2020 onwards, self‐collected from 1200 vending machines (see Fig. 3 and 4) [7‐10].  

Fig. 3: A Singapore resident collecting his free reusable mask 

 

Source: https://www.temasek.com.sg/en/news‐and‐views/news‐room/news/2020/a‐pair‐of‐reusable‐

antimicrobial‐masks‐free‐to‐every‐singapore‐resident  

1 A Singapore‐based non‐profit organization under the philanthropic arm of the Singapore State sovereign fund. 

6

Fig. 4: Poster illustrating mask sizes available 

 

Source: https://www.facebook.com/TemasekFoundation/photos/pcb.3221652914727883/3221652824727892/ 

Physical distancing 

Official orders on physical distancing were issued from 27 January 2020. These started out as 

mandatory “stay‐at‐home notices” for individuals at varying levels of severity depending on the risk 

profile of a suspected infected case, and then extended to include broader distancing measures at 

the community level from February 2020. (See Table 1 for the detailed measures, their 

corresponding timelines and legal enforcement.) The measures were communicated in the four 

languages via the official channels and sometimes also announced in press briefings, depending on 

their level of significance. Most of them were also promulgated as regulations under the Infectious 

Diseases Act (ID Act) [2, 11‐13].  

Outbreak situation and response 

Information on the severity of the outbreak and responses to it were communicated through daily 

updates via official channels. The information communicated included the number of imported, 

community and worker dormitory cases, the clusters and locations that the community cases are 

linked to, the number of unlinked cases, the number of discharged cases and cases in the intensive 

care unit (ICU), and deaths. Such information was accompanied by measures taken to address the 

outbreak, such as how imported cases were placed under stay‐home notice (SHN), how contact 

tracing was being undertaken for community cases, and how public health measures were instituted 

in affected cluster locations [14]. 

At important junctures, ministers and, at times, the Prime Minister, provided updates on the 

epidemiological situation. For example, the Prime Minister addressed the nation the day after 

Singapore’s outbreak risk assessment was raised to the Disease Outbreak Response System 

7

Condition (DORSCON) orange (on 7 February 2020) to assure the public and prevent continued panic 

buying of groceries in the supermarkets (see Fig. 10 for DORSCON levels) [2, 15]. He also announced 

the Circuit Breaker and its extension in April when local transmission cases continued to rise [16] 

[17], provided an update on the emerging outbreak situation in foreign worker dormitories [18], and 

addressed the nation on the outlook for the next year as Singapore entered Phase 3 of its COVID‐19 

reopening. These were interspersed with and complemented by more detailed briefings by 

ministers in the Multi‐Ministry Taskforce2 (see also page 46) on changes to existing measures, new 

measures instituted, and improvements in or worsening of the epidemiological situation [19]. These 

included details such as the activities/businesses that could resume with Phases 2 and 3 of 

reopening, setting up of an inter‐agency task force, efforts implemented to tackle the situation in 

the dormitories, and the upcoming vaccination plan for Singapore with the arrival of vaccines [20, 

21].  

The near‐ and longer‐term outlook for the nation and reminders of continued vigilance featured 

regularly in these press briefings by the Prime Minister and ministers. 

Misinformation 

With misinformation typically common in epidemics and leading to substantial public anxiety [22], 

the government made special efforts to counter fake news. Clarifications on inaccurate news were 

frequently posted on the government’s website and conveyed through traditional media. Correction 

directions under Singapore’s Protection from Online Falsehoods and Manipulation Act (POFMA) 

required parties communicating falsehoods to put up clarification notices or be subject to fines and 

imprisonment. Several POFMA correction directions were issued to online sites for dissemination of 

inaccurate COVID‐19‐related information during the period (see Fig. 5) [2, 23, 24]. 

Fig. 5: A reported case of POFMA correction 

 

 

 

 

 

 

 

 

 

 

 

 

Source: https://www.todayonline.com/singapore/health‐minister‐asks‐pofma‐office‐issue‐correction‐ direction‐states‐times‐review‐over  

2 On 22 January 2020, the government set up a multi‐ministry task force to oversee the national response to COVID‐19.  It  comprised  ministers  across  multiple  ministries,  including  health,  trade,  communications, manpower and transport. 

8

There is also a dedicated hotline for the public to call for information on the COVID‐19 situation. The 

hotline number is displayed prominently on a fixed banner on the Ministry of Health’s (MoH) 

website, with a cautionary statement to the public to be aware of scam calls and emails from people 

impersonating MoH officers and to verify their authenticity by calling the hotline [14, 25]. Singapore 

has also introduced Factually, a website that clarifies common or viral falsehoods (see Fig. 6). 

Fig. 6: Factually website, which clarifies common or viral falsehoods 

 

Source: https://www.gov.sg/factually  

Communications around long‐term care 

Long‐term care featured in official government communication, with new measures for the sector 

announced in broad terms to the general public (sometimes as part of a suite of nationwide 

measures) and their details communicated through more targeted channels such as sector‐specific 

websites and government agencies with whom the providers typically work with [26‐28]. For 

example, while the reopening of residential and community‐based facilities was announced as part 

of Phase 2 reopening, detailed precautionary measures for the facilities were issued in advisories to 

the heads of homes and centre supervisors, and posted on the National Council of Social Services’ 

website. Detailed measures included headcount limits for staff/volunteer‐led activities/visitors, split 

zone/team operations, and guidelines for outreach activities [27, 29].  

Communications on the availability of health services 

The government announced on 12 February that coverage for COVID‐19‐related inpatient treatment 

and services would be extended to all patients at public hospitals [30]. On the same day, Singapore’s 

insurance associations issued a joint statement confirming member companies’ provision of 

coverage for COVID‐19‐related hospitalization expenses under their policies. These early efforts 

helped to address concerns on financial affordability and fewer potential barriers for infected 

persons coming forward [31]. The provision of subsidized treatment, investigations and medications 

to patients with respiratory symptoms at Singapore’s network of over 900 public health 

preparedness clinics (PHPCs)3 was also communicated on 24 February [32], encouraging those who 

were unwell to seek health‐care advice/treatment [2]. Similarly, the availability of swab tests at all 

3 Public health preparedness clinics (PHPCs) are private primary care GP clinics that have been registered and prepared to be activated during public health emergencies to perform roles such as dispensing medications, administering vaccinations, and triaging or supporting acute care hospitals. 

9

polyclinics4 and selected private general practitioner (GP) clinics from April 2020 was communicated 

to the public, together with the preconditions to test, expected wait time for results, and the need 

for patients to stay at home until the results are communicated to them [33, 34]. 

Similar communications have been made on health care for other medical conditions. It was 

announced that health‐care subsidies at private GP clinics and use of Medisave5 had been extended 

on a time‐limited basis to video consultations for follow up of chronic conditions from 3 April 2020. 

The uptake and efficacy of telemedicine were discussed on traditional media platforms to generate 

public awareness and discourse on the nation’s evolving longer‐term health‐care strategy and 

delivery model [35‐38].  

1.2 Physical distancing 

Physical distancing measures in the community started in January 2020  with the implementation of 

14‐day mandatory social distancing, at varying levels of severity, depending on the risk profile of a 

suspected infection case (see Table 1). Legal enforcement of these orders has been strong, even to 

the deprivation of permanent residency status, barring of re‐entry into Singapore and charging 

under the ID Act [2]. At the same time, financial assistance was also provided to residents and work‐

pass holders serving the distancing orders to alleviate concerns regarding impact on livelihood, 

which could prevent close contacts from coming forward. Self‐employed individuals or employers 

whose employees were serving social distancing orders could claim S$ 100 per day [2, 39, 40]. 

These distancing orders to individuals were later extended to the suspension of larger group 

gatherings and communal activities, with the permitted gathering size (number of persons) reduced 

as the number of COVID‐19 cases increased around April 2020 [27, 41‐44]. Initial urging of 

employers by the government to facilitate telecommuting by staff, where possible, eventually 

became compulsory under the ID Act [45, 46]. Orders were also issued to retailers and food and 

beverage operators to limit and space out their patrons [47]. 

As locally transmitted cases continued to rise, with daily new cases moving into double digits and 

then in the hundreds, the Circuit Breaker involving the closure of most workplaces and full home‐

based learning for schools was announced on 3 April 2020 [48, 49]. A week into the Circuit Breaker, 

public transport usage and traffic volume dropped by more than 70%, foot traffic at popular 

parks/wet markets came down by up to 50%, and close to 80% of the workforce were working from 

home [50].  

In terms of enforcement, nearly 3000 enforcement officers and ambassadors from over 30 agencies 

were deployed daily to public spaces across the island to ensure that safe distancing measures were 

observed. Public spaces, including stadiums, playgrounds and fitness corners, were cordoned off to 

prevent gatherings. Drones were also deployed in selected parks and nature areas to monitor 

visitors. As of 14 April 2020, more than 6200 warnings and over 500 fines were issued to individuals 

4  Public  one‐stop  health‐care  centres  for  general  curative  treatment,  screening,  immunization  and  dental services (for some). These are sited at public housing estates for accessibility to Singaporeans/residents in the community. 5 MediSave is a compulsory individual savings scheme for Singapore citizens and permanent residents. It is used for  one’s  health‐care  expenditure,  and  workers  and  their  employers  contribute  a  specified  percentage  of monthly  wages  to  it.  It  is  mainly  for  use  to  cover  hospitalization  expenses,  selected  preventive  care,  and outpatient services and long‐term care for certain chronic conditions.

10

who flouted the safe distancing measures. Consequences for individuals included financial penalties 

of S$ 300 for the first offence and S$ 1000 for the second offence, and prosecution in court for 

egregious cases. Meanwhile, the Ministry of Manpower (MoM) and other enforcement agencies 

carried out inspections and took enforcement actions against non‐compliant workplaces. First‐time 

offences by workplaces were issued fines of S$ 1000, with repeat offenders facing higher fines or 

prosecution in court. Even essential services had to suspend their operations when any of their staff 

working on the premises became infected [4]. On 23 April, the government announced an extension 

of the Circuit Breaker period, tighter measures and further closure of less essential workplaces to 

reduce the proportion of workers still commuting daily to work to around 15% [50]. 

With community infection rates generally stable, decline in cases among migrant worker 

dormitories, and no new large clusters emerging, the Multi‐Ministry Taskforce announced 

Singapore’s move to Phase 2 from 18 June, where selected activities and businesses could resume 

and reopen [20]. With further progress made on adherence to safe management measures, testing 

capacity and contact tracing, the Multi‐Ministry Taskforce announced the further reopening of 

activities in the community with Phase 3 from 28 December.  

See Table 1 for details on the timeline and physical distancing measures effected.  

Table 1: Timeline of physical distancing measures and enforcement 

Date  Physical distancing measures  Enforcement 

27 January  Leave of absence (LOA) effected. A precautionary measure to prevent the possible transmission of infections. Those on LOA should stay at home, minimize contact with other people in the home, and monitor their health closely. They may leave home briefly to get meals and necessities [13]. 

Mandatory 

28 January  Quarantine order (QO) effected. Issued to suspect cases and required isolation from other people in the home or in a suitable government facility. A QO is a directive with legal force. It has severe penalties for non‐compliance [13]. 

Mandatory 

5 February  Large group and communal activities were also suspended in schools 

and social and elder‐care facilities [27, 41, 44].  Mandatory 

7 February  Business continuity planning (BCP) and work‐from‐home guidelines issued. BCP guidelines were issued by government agencies such as Enterprise Singapore for small‐ and medium‐sized enterprises [51]. Similar sector‐specific advisories are currently available at https://www.gov.sg/article/covid‐19‐sector‐specific‐advisories.  

Recommended 

14 February 

GPs to issue 5‐day medical leave to patients with respiratory symptoms [52] 

Mandatory 

18 February 

Stay‐home notice (SHN) effected. Stricter than the LOA but one can stay with one’s family members. Those on SHN must remain in their place of residence at all times during the SHN period and avoid interaction with other people in the home. (SHNs were introduced when it was found that some persons issued with LOA 

Mandatory 

11

Date  Physical distancing measures  Enforcement 

had continued to go out of their homes regularly and infected a number of new cases as a result.) [12] 

11 March  All social activities for seniors organized by government agencies were suspended [42].  

Mandatory 

13 March  Health and manpower ministries urged employers to adopt telecommuting where feasible [45]. 

Recommended 

20 March  Suspension of events/gatherings with 250 or more participants [43]. Retailers and food and beverage operators had to put in place markings (for example, on the floor, or on tables and chairs) and limit the number of patrons to ensure sufficient space (at least 1 metre apart) between them [47]. 

Mandatory 

20 March   Recommendation for seniors to avoid crowded places, stay in well‐ventilated areas when outdoors, and engage in more home‐based activities [53]. 

Recommended 

24 March  Tighter distancing measures for the general population: 

Bars, night clubs, discos, cinemas, theatres and karaoke outlets were closed. 

Malls, museums and attractions reduced their operating capacity to no more than one person per 16 sq.m of usable space, with groups not exceeding 10 people. Shows, group tours and open atrium sales were suspended. 

Tuition and enrichment centres were suspended. 

Religious services and congregations were suspended. Places of worship could stay open for private worship/essential rites, subject to group sizes of less than 10 people at a time. 

All events and mass gatherings were deferred or cancelled. 

Private celebrations/gatherings were limited to 10 people or fewer. 

Funerals and wakes had to limit attendance as far as possible to family members only, and to gatherings of 10 people or fewer at any point [11, 43, 54].  

Mandatory 

27 March  Patients issued with medical leave certificates for acute respiratory symptoms were asked to self‐isolate at home for 5 days [55]. 

Mandatory 

2 April  Employers had to facilitate telecommuting by staff where possible [46]. 

Mandatory 

7 April  Circuit Breaker (7 April to 4 May) measures: 

Education – schools and institutes of higher learning moved to full home‐based learning. Preschools and student‐care centres suspended services. (Schools, preschools and student‐care 

Mandatory 

12

Date  Physical distancing measures  Enforcement 

centres provided limited services for children of parents who are workers in essential sectors.)  

Public – members of the public were strongly advised to stay home except to purchase daily necessities, or seek essential services or urgent medical care. Reusable masks were distributed to all Singapore residents. 

Businesses/social activities – all such activities that could not be conducted via telecommuting from home were suspended. 

Attractions/recreation facilities – all attractions, theme parks, museums, casinos, and sports and recreation facilities were closed. Restaurants/cafes/dining outlets operated only for takeaways. 

Essential sectors – essential services and those in economic sectors critical for local and global supply chains remained open. Essential services included the following: 

health, social and selected care services; 

energy, petrol and gas services; 

public and private transport services, and logistics providers; 

security, facilities management and critical public infrastructure; 

banking and finance, insurance and asset management; 

food retailers, supply and delivery (open for takeaway and delivery services only); 

water, waste and environmental management; 

information and communications services and providers; 

manufacturing, pharmaceutical and biomedical sciences; others: electricians, plumbers, vehicle repair and veterinary services. 

Across sectors – fiscal measures to support households and businesses under the Solidarity Package [48, 49, 56, 57] 

14 April  For workplace premises that remained open, cross‐deployment or movement of workers across different workplace premises (e.g. different branches) was disallowed. No physical interaction was allowed between teams working in different locations. 

 

15 April  Employers in essential sectors were required to work out telecommuting arrangements for older workers or redeploy them in roles requiring minimal interaction with others [58]. 

Recommended 

21 April  The Multi‐Ministry Taskforce announced extension of Circuit Breaker until 1 June, allowing fewer businesses to be permitted to operate: 

Suspend operations of less critical consumer services: stand‐alone outlets that sold only beverages, packaged snacks, confectioneries or desserts were required to close their outlets.  

Mandatory 

13

Date  Physical distancing measures  Enforcement 

Additional restrictions on selected consumer‐facing businesses: businesses such as optician shops, pet supplies stores and retail laundry services could operate by appointment only. Traditional Chinese Medicine (TCM) establishments could open for consultation only by appointment and dispensing of related medication. 

Reduce businesses allowed to operate at work premises: businesses less critical for daily living/maintaining essential supply chains, e.g. hairdressing and barber services [59] 

Visiting: one could enter another person’s house only to deliver essential goods/services, provide assistance to a senior/person with disability, or seek help in an emergency. One should not “drop off” their children with their grandparents on a daily basis for childcare needs (exemptions were made for essential service workers and HCWs) [60]  

5 May  TCM establishments could resume businesses, with some therapies still disallowed [61].   

Mandatory 

9 May  Requirements for safe management measures at the workplace issued, including work‐from‐home being the default mode of working, staggered start times and flexible workplace hours and shift/split team arrangements [62].  

Mandatory 

12 May  Gradual resumption of selected activities and services: 

manufacturing and on‐site preparation of all food 

retail outlets of food, including cakes, confectionery and packaged snacks/desserts (for takeaway/deliveries only) 

home‐based food businesses 

retail laundry services 

barbers and hairdressers (basic haircut services only) 

retail of pet supplies [63] 

Mandatory 

2 June  Students resumed school on a weekly rotation schedule; some levels of students went to school for the week while others did home‐based learning [64]. 

People, in groups of up to two visitors, could visit their parents/grandparents living elsewhere. Each household could receive up to only two visitors (who must live together in another house) once a day [65]. 

Mandatory 

19 June  Small group gatherings of up to five people allowed. Each household could receive up to five visitors per day [65]. 

Mandatory 

1 July  Patients aged 13 years and above who presented with acute respiratory infection (ARI) and met the suspect case definition had to undergo a COVID‐19 polymerase chain reaction (PCR) swab test. These patients would be required to stay home only until their swab test result was negative [66]. 

Mandatory 

14

Date  Physical distancing measures  Enforcement 

19 June  Resumption of activities from Phase 2 of Circuit Breaker (starting 19 June): 

Cinemas – allowed to reopen from 13 July with safe distancing restrictions [67] 

Tourism – permitted to resume operations in stages from 1 July. Domestic tour operators, children recreation areas and hotels (for staycation bookings) could apply to reopen 

Public libraries – reopened from 1 July with shorter opening hours   

Places of worship – permitted to resume congregational and other worship services from 26 June 2020, starting at 50 persons at a time and subject to safe management measures 

Public libraries – reopened from 1 July with shorter opening hours [20] 

Education – students from all levels returned to school daily from 29 June 2020. Institutes of higher learning (IHLs) would progressively increase the number of students allowed back on campus at any one time for face‐to‐face learning, while maintaining a significant amount of online learning. Schools and campuses would continue to adhere to safe management measures [64]. 

Dining out – diners could sit in groups of five or fewer at a table, with tables spaced 1 metre apart [68]. 

Key life events – marriage solemnizations/receptions could be held at places of worship and other external venues with a maximum of 20 persons (excluding the solemnizer). 

For wakes and funerals, up to 30 persons could be present at any one time, subject to the venue’s capacity limit based on safe management principles [69]. 

Visiting – one could visit their parents/grandparents, or “drop off” their children with their grandparents, but subjected to limit of up to two visitors from one household each day [70]. 

Mandatory 

4 August  Marriage solemnizations/receptions could be held at a larger variety of venues (both indoor and outdoor) with a maximum of 10–50 persons, depending on the type of venue, its capacity limit based on safe management principles.  

For wakes and funerals, up to 30 persons could be present at any one time, subject to the venue’s capacity limit based on safe management principles [69]. 

Mandatory 

1 September 

Public facilities available for those conducting outdoor exercise classes, subject to class sizes of up to 50 people and with safe distancing measures [68] 

Mandatory 

15

Date  Physical distancing measures  Enforcement 

28 September 

Enhanced safe management requirements for workplaces [62]  Mandatory 

28 December 

Moving into Phase 3 of reopening: 

Social gatherings – allowed to comprise up to 8 persons. Households could also receive up to 8 visitors at any point in time. 

Retail and tourism – increased capacity limit from 10 sq.m per person to 8 sq.m per person. Attractions could also start applying to the Singapore Tourism Board to increase operating capacity from up to 50% to 65%. 

Religious organizatons – allowed to increase capacity for congregational and other worship services to up to 250 persons (in zones of up to 50 persons each for congregational services). 

Marriage solemnizations – higher visitor limits for marriage solemnizations held in the home  

Live performances – outdoor live performances allowed up to 250 persons in zones of up to 50 persons each [71]  

Mandatory 

 

Foreign worker dormitories 

As Singapore shifted into the Circuit Breaker, large clusters emerged in foreign worker dormitories. 

There are about 300 000 migrant workers employed in low‐wage jobs (mainly in the construction, 

marine shipyard and process sectors) living in purpose‐built dormitories and factory‐converted 

dormitories across the island [72, 73]. Dormitories were progressively gazetted as isolation areas to 

stem transmission in the community in April [74, 75]. An inter‐agency taskforce was also set up to 

tackle this situation, and a three‐pronged strategy was adopted to contain the spread of the virus in 

the dormitories, to enforce safe distancing measures on the premises, and to move healthy workers 

in essential services to other facilities to minimize further cross‐infection [76,77].  [77]. 

See Table 2 for lists physical distancing measures implemented as part of this strategy. By end July 

2020, purpose‐built dormitories, the largest sites for housing migrant workers, saw a 25% drop in 

occupancy [78]. These accompanied the deployment of medical facilities/triage clinics to ensure that 

workers got prompt and adequate medical care, and a broad‐based testing strategy to separate 

infected/suspect cases from uninfected cases (see pages 24 and 32) [76, 79]. 

Table 2: Timeline of physical distancing measures for the foreign worker population 

Date  Physical distancing measures 

5–22 April  Dormitories with clusters of cases were gazetted as isolation areas under the ID 

Act, eventually totalling 21 gazetted dormitories [74, 75].  

From 9 April  Distancing measures as part of “dedicated strategy”, with staff from the 

government stepping in to help dorm operators: 

implement safe distancing measures (e.g. workers stay in their rooms 

and leave their rooms only for essential needs); 

16

reduce the number of workers in each dorm; 

arrange for foreign workers who are not sick and working in essential 

services to be temporarily housed separately in other accommodation 

(e.g. military camps, exhibition centres, etc.) from those quarantined in 

dormitories [76]. 

22 April  Daily movement of workers in and out of all dormitories no longer allowed [79]. 

20 April to 4 

May  

180 000 construction work permit and S pass holders (and their dependents) 

have been placed on mandatory Stay Home Notice from 20 April to 4 May 2020 

[79]. 

9 June  Foreign workers cleared of virus and fulfilling requirements were permitted to 

resume work. 

From 1 August 

(in Phase 2)  

Workers cleared of COVID‐19 infections were allowed to run errands outside 

their dorms during staggered rest days and time slots, and with necessary 

submission of errands/location details by employers/dormitory operators [80].  

From 28 

December 

(Phase 3) 

Preparations made to allow workers to visit recreational centres more often in a 

safe and regulated manner [77, 81].  

 

Progressively, migrant workers were considered cleared of COVID‐19 infections when they (i) tested 

negative, or (ii) tested positive but had fully recovered and been discharged, and were residing in 

accommodation where fellow residents had been cleared of the virus. By 1 June, as Singapore 

moved into Phase 2, a total of 40 000 migrant workers had been cleared of COVID‐19 infections. This 

increased to 89% of dormitory‐dwelling migrant workers by August, and more than 98% by early 

November [82, 77]. Some “cleared” workers in essential services continued working throughout the 

Circuit Breaker period, and others were progressively permitted to resume working from June if 

they, their dormitory operators and employers had made necessary “safe living and working” 

preparations such as arrangement of staggered pick‐up/drop‐off timings, updating of workers’ 

residential addresses on the MoM’s database, and downloading of FWMOMCare and TraceTogether 

mobile apps for health status reporting and contact‐tracing purposes [83‐85]. FWMOMCare is 

complemented by a digital system (AccessCode), which integrates information from multiple 

government bodies and grants a “traffic light” status on whether a worker can resume work. 

AccessCode facilitates broad‐based monitoring and regulation of workers’ resumption of work [86]. 

By August, 86% of foreign workers in the construction, marine and process sectors were allowed to 

resume work [87]. From October, contact‐tracing tokens that were purpose‐built for the dormitory 

and worksite environment (compact, water‐resistant and able to be worn at all times), were 

distributed progressively to the workers. These were interoperable with and complemented the 

TraceTogether app on their smartphones, which they may not always be able to carry with them at 

work or at the dormitories. By December, these tokens had been distributed to more than 450 000 

workers living in dormitories or working in the construction, marine and process sectors [77, 88].  

As safe living and safe working measures were being instituted within dormitories and worksites, 

the workers were progressively permitted to leave their dormitories on rest days to visit designated 

17

locations in the community. With the outbreak in dormitories under control, safe measures 

instituted at all dormitories and worksites, and a multi‐layered and broad‐based accompanying 

testing strategy for the population (see page 24), the government prepared to return the workers to 

the community in a controlled manner and with strict measures in place [77]. 

 

1.3 Isolation and quarantine 

Close contacts (those who had been in close proximity – about 2 m – for 30 minutes or more to the 

infected case) with COVID‐19 symptoms are isolated in a separate facility and tested while those 

without symptoms are served with quarantine orders (QO) for up to 14 days from date of last 

contact with the confirmed case. Those served with a QO are given the choice of staying at home or 

staying in a government quarantine facility if his/her home premises are not suitable. Home‐based 

quarantine required those serving the QO to be isolated from others living in the same household 

with a dedicated room and toilet (compared to those with SHN where dedicated room and toilet is 

not needed). Moderate‐risk contacts (those who may have come into contact with the patient but 

were not in close proximity or for a prolonged period) were put under phone surveillance but were 

not made to stay home or be quarantined [40, 89‐93].  

Those under quarantine are required to monitor their temperature and report their health status to 

a QO agent at least three times a day. For those serving out QOs at home, spot checks are carried 

out by officers and if found to be non‐compliant, may be required to wear an electronic tag or be 

detained and isolated in a hospital. Under the ID Act, anyone flouting a QO for the first time may be 

fined up to S$ 10 000, jailed for up to six months, or both, with higher penalties for subsequent 

breaches. If the person issued with a QO is an employee, the employer will be informed of the QO 

by a QO agent, and qualifying employers (self‐employed citizens/permanent residents/Singapore‐

registered companies whose employees under QO are Singaporean citizens/permanent 

residents/workpass holders) can claim QO allowance (S$ 100 per day) after the employee has 

completed his/her QO. The person under quarantine receives the QO allowance form at the end of 

the quarantine, which he/she passes on to the employer to submit to the MoH for processing of the 

claim.  

People serving SHNs (see Table 1) will not require a dedicated room and toilet but should remain at 

their place of residence at all times and should also not receive visitors at their residence. Similarly, 

breach of SHN can be prosecuted under the ID Act with first‐time offenders fined up to S$ 10 000, 

jailed for up to six months, or both. Permanent residents and pass holders can have their permits or 

passes revoked or validity shortened, and students can also face disciplinary action, including 

suspension or dismissal [94‐96]. 

Travellers who are granted entry to Singapore, with the exception of those from lower‐risk 

countries/regions with which Singapore has special established arrangements (see page 52), are 

issued SHNs. Travellers can serve their SHNs at a hotel that has been designated as an SHN‐

dedicated facility, bearing the cost themselves. Depending on the country the traveller departed 

from and the suitability of his/her place of residence, travellers can also serve their SHN at a place of 

residence they or their family members own or are the sole tenants of. SHNs for travellers also 

accompany testing protocols that vary according to their residency status and the country they 

departed from (see also page 50) [95, 97].  

18

All confirmed infected cases are isolated in public hospitals, isolation wards in a private hospital, 

community care facilities (CCFs) or community recovery facilities (CRFs). In the earlier months of 

February to March 2020, all infected cases were isolated at the National Centre for Infectious 

Diseases (NCID) or another public hospital. These extended to include a wider range of dedicated 

facilities as COVID‐19 patients who were more stable and with milder symptoms were 

transferred/admitted to CCFs and CRFs from March 2020 (see pages 30 and 40). 

Persons awaiting the results of their swab tests were also initially isolated at NCID/public hospitals in 

the earlier months of the pandemic. They could later do so at swab isolation facilities6 (see page 7) 

and also at their places of residence under the “Swab and Send Home” (SASH) programme as testing 

capacity and accessibility expanded . 

In April 2020, when large clusters emerged in foreign worker dormitories, entire dormitories with 

clusters of cases were gazetted as isolation areas to prevent COVID‐19 transmission to the larger 

community (see page 15). 

1.4 Monitoring and surveillance 

The MoH follows WHO’s definition of COVID‐19, describing it as “the infectious disease caused by a 

strain of coronavirus, SARS‐CoV” [1]. From 2 January 2020, the MoH has alerted all medical 

practitioners to look out for suspected cases.  

A suspect case of COVID‐19 is defined as:  

a person with clinical signs and symptoms suggestive of pneumonia or severe respiratory 

infection with breathlessness AND who within 14 days before onset of illness had travelled 

abroad (i.e. to any country outside of Singapore);   

a person with an acute respiratory illness of any degree of severity who, within 14 days 

before onset of illness:  

i. had been to any of the areas requiring heightened vigilance as listed on the health‐

care professionals portal; OR  

ii. had been to any hospital abroad; OR  

iii. had close contact with a case of COVID‐19 infection [98, 99]. 

Close contact was defined as anyone who provided care for the patient, including a health‐care 

worker (HCW) or family member, or who had other similarly close physical contact; and anyone who 

stayed (e.g. household members) at the same place as a case; and anyone who had close (i.e. less 

than 2 m) and prolonged contact (30 min or more) with a case (e.g. shared a meal). Criteria and 

areas requiring heightened vigilance were updated periodically according to new information about 

the virus and developments in its epidemic spread. For example, areas requiring heightened 

vigilance extended from provinces within mainland China to the Republic of Korea, and then to parts 

of Europe as the source epidemic extended to autochthonous infections outside of Wuhan and 

China. 

6 These facilities are for patients awaiting the result of a swab test, to prevent the potential spread of COVID‐19 in the wider community [142].  

19

Contact tracing 

From February 2020, rapid testing, isolation of cases, contact tracing and quarantine of suspect 

cases were quickly initiated and scaled up to identify and separate infected individuals from the 

larger community. Once an infected case is confirmed, contact tracers will interview the patient and 

map out his/her history of movements over the last 14 days. The contact‐tracing team under the 

MoH comprise communicable diseases and epidemiology experts and volunteers from across 

various government departments/agencies. They work in teams of 10, two shifts a day, and seven 

days a week, to verify the information provided through telephone calls and identify close contacts 

of confirmed cases. 

The MoH worked in partnership with the Singapore Police Force to track down contacts that could 

not be reached or whose identities were not known. Analytic tools helped pick out common 

keywords from different patients’ activity logs and flagged possible links between cases for further 

investigation through interviews, ground inquiries, activity mapping, and use of flight manifests and 

CCTV footages [40, 89‐93].  

As the number of local cases climbed in the lead up to Circuit Breaker, with daily new cases moving 

from single digits to double digits and then in hundreds, Singapore’s contact‐tracing teams 

expanded from 3 to 20 to prepare for an expected surge in COVID‐19 cases as cumulative cases 

crossed 500 [93]. Two contact‐tracing applications, TraceTogether and SafeEntry, were launched in 

March and April, respectively, to support Singapore’s contact‐tracing efforts. TraceTogether, 

downloadable as a mobile app or in the form of a token, allows contact tracers to easily identify 

other users who an infected case has been in close contact with; while SafeEntry is a national digital 

check‐in system that logs the identification and mobile numbers of individuals visiting venues. Both 

systems work together to increase the speed and accuracy of the MoH’s contact‐tracing efforts 

[100, 101].  

The TraceTogether application is contingent on community‐driven contact tracing and helps the 

MoH to “identify people who were in close proximity with COVID‐19 cases during the infectious 

period”. When phones with TraceTogether installed or TraceTogether tokens are in close proximity 

to one another, anonymised proximity information is exchanged using Bluetooth. This information is 

stored securely on the phone and shared with the MoH if a user tests positive for COVID‐19. As of 

January 2021, TraceTogether has been adopted by 4.2 million users [102]; and it was reported in 

November 2020 that about 25 000 close contacts of COVID‐19 cases had been identified through 

TraceTogether [103]. Any Bluetooth data shared with MOH can only be used for the purpose of 

contact tracing with the only exception being when the data is needed for investigations or criminal 

proceedings relating to series offences. The MoH has publicly stated that the TraceTogether app will 

be deprecated after the outbreak [104].  

SafeEntry uses QR codes unique to each location, which Singaporeans can scan to indicate that they 

have been to that particular place [100, 101]. These two technologies work together to improve the 

accuracy, speed and breadth of Singapore’s contact‐tracing efforts. Efforts to integrate both systems 

are also under way. It was announced in October that integrated use of TraceTogether to fulfil 

SafeEntry digital check‐in will be progressively implemented at popular venues across Singapore by 

the end of the year [103]. 

20

The contact‐tracing process, criteria for those deemed to be at risk and monitoring mechanisms are 

frequently communicated to the public through the MoH’s website, and traditional and social media 

platforms [89, 90, 103, 105, 106]. 

Surveillance and monitoring 

Such contact‐tracing measures are part of a broader national and “multipronged surveillance 

strategy” that include “applying the case definition at medical consults” where regular circulars are 

issued by the MoH to all medical practitioners with updates on the suspect case definition for 

COVID‐19 and the follow‐up triage protocols for possible infected cases [107]. Enhanced surveillance 

is also applied to certain patient groups – all patients with pneumonia, hospitalized patients in ICUs 

with possible infectious diseases, primary care patients with influenza‐like illness and deaths from 

possible infectious aetiologies [107]. This includes routinely swabbing patients with influenza‐like 

illness by selected PHPCs (this was part of regular sentinel surveillance but included COVID‐19 from 

February 2020) [108], testing of all pneumonia cases in acute hospitals, and testing of all 

community‐acquired pneumonia diagnosed clinically at PHPCs and polyclinics [2]. The MoH also 

allows for clinician discretion in the process, granting medical practitioners discretion and the option 

to order a test based on clinical suspicion, even if the case definition is not met [107].  

Surveillance and active case‐finding efforts are further bolstered with the use of new surveillance 

methods and testing strategies (use of rostered routine testing [RRT], controlled and expanded 

testing accessibility, etc. (see section on “Testing”) to rapidly ring‐fence cases of infection. The MoH 

has piloted/explored wastewater testing. The National Environment Agency (NEA) conducts 

wastewater testing in densely populated residential premises, such as the migrant worker 

dormitories. Wastewater testing is currently being implemented at 34 such dormitories [109]. The 

NEA is monitoring wastewater in other locations and plans to “progressively expand such 

surveillance to include more workers’ dormitories and other populous living quarters such as 

nursing homes and hostels” [109]. 

1.5 Testing 

In pre‐COVID years, a culture of preparedness had led to the set‐up of a new and purpose‐built 

National Public Health Laboratory [110]. At the start of the pandemic, the capability of SARS‐CoV‐2 

reverse transcriptase polymerase chain reaction (RT‐PCR) testing was scaled up rapidly from the 

National Public Health Laboratory to all public hospitals [108, 111]. This was subsequently further 

expanded through the progressive approval of clinical laboratories to provide RT‐PCR testing (also 

known as PCR testing).  

During the COVID‐19 pandemic, laboratory testing has been identified as a critical enabler in 

Singapore’s COVID‐19 response, supporting clinical diagnosis so that appropriate treatment can be 

provided to those who are unwell, and enabling active case‐finding and regular community 

surveillance so that community transmissions can be ring‐fenced quickly to prevent the formation of 

large clusters. To build up Singapore’s COVID‐19 testing capacity and to utilize it strategically as a 

critical national resource, the MoH set up the Testing Operations Centre (TOC) to aggregate the 

national testing demand and centrally manage the allocation of testing capacity. The TOC works 

with requestors, prioritizes needs and balances demand across laboratories. This ensures that 

critical national needs are met, and helps laboratories manage workloads so that capacity is not 

overwhelmed by sudden surges in demand. Clinical laboratories approved to provide COVID‐19 

21

testing need to operate under licensing terms and conditions. These ensure that they conduct 

COVID‐19 testing only for indications and subpopulations/groups permitted by the Ministry, conduct 

tests in approved operating volumes and commensurate with their resources (e.g. equipment and 

reagents), and adhere to reporting procedures and prevailing requirements, and biosafety 

guidelines. (See Fig. 7 for an illustration of the workflow between the TOC, laboratories and 

requesting institutions [112]). 

Fig. 7: Workflow of the Testing Operations Centre [112] 

 

PCR testing 

In the early stages of the pandemic, PCR tests could be ordered only for cases fulfilling the criteria of 

a suspect case. Then, tests could be performed only in accredited laboratories, which were mainly 

public hospital laboratories, and suspect cases had to be sent to hospitals for testing. From April, 

polyclinics and some private GP clinics could perform the swab tests, and this was progressively 

extended to more GP clinics and for a wider range of needs basis. (See Table 3 for key stages in the 

extension of testing accessibility.) From 1 December, the government expanded testing availability 

as part of efforts to support a larger range of needs as Singapore resumed more economic and 

community activities, and anyone who required a coronavirus test would be able to get one from an 

approved provider. COVID‐19 tests are now widely available in Singapore, but testing for the 

“worried well” is not currently allowed, according to the COVID‐19 information bot created by 

gov.sg [113]. However, one who needs a test can visit their GP, who will evaluate his/her contact 

and travel history and need for testing accordingly. If the patient is deemed to have symptoms 

suggestive of COVID‐19 infection, the GP will perform a swab test at the clinic as long as they are 

participating in the SASH initiative. If not, the GP will refer the patient to another PHPC where SASH 

is available for further review by the next day [114]. The targeted testing approach means that 

people with symptoms or at higher risk of contracting the virus are prioritized for testing. 

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Table 3: Timeline of stages in extension of testing accessibility 

Date  Institutions that could order tests  Qualifying needs 

From 

January 

2020 

Public and private hospitals only  Patients presenting with ARI and who fulfil 

the MoH’s suspect case criteria [115] 

From April 

2020 

Public and private hospitals, all 20 

polyclinics, selected GP clinics 

Patients presenting with ARI and who fulfil 

the MoH suspect case criteria or SASH 

criteria [115] 

From June 

2020 

Patients presenting with ARI and who fulfil 

the MoH suspect case criteria or SASH 

criteria 

Members of the public needing to meet 

specific testing requirements – 

predeparture/arrival testing for travellers, 

specific sector workers needing to undergo 

rostered routine testing (see page 26)  

Migrant workers returning to work in the 

construction, marine and process sectors 

[116, 117] 

From 

December 

2020 

Public and private hospitals, all 

polyclinics and expanded list of 

approved providers (mostly private 

clinics and other health‐care 

providers/laboratories). The current 

list of approved providers is 

available at: 

https://www.moh.gov.sg/docs/libra

riesprovider5/covid19_test_provide

rs/approved‐covid‐19‐pcr‐swab‐

provider_2_feb.pdf  

Anyone who requires a COVID‐19 PCR test 

will be allowed to get it done at approved 

private clinics. As of 1 December 2020, those 

seeking PCR tests may be companies and 

those requiring predeparture testing before 

travelling. For the latter group, approval 

from the MoH is no longer necessary and 

they can get tested of their own accord 

[117]. 

Expanded accessibility of COVID‐19 tests in Singapore has involved the establishment of testing 

centres in places near work and school. For instance, university dormitories offer free COVID‐19 

swab tests for residents in an effort to minimize the likelihood of potential cases. When infection 

clusters arise, the MoH also swiftly quarantines and tests those in close contact with these clusters. 

The MoH also conducts swab operations to test those at retail sites visited by positive cases. For 

added convenience, the MoH has set up regional screening centres (RSCs) to conduct COVID‐19 

testing. These centres are primarily located in accessible locations in the community, such as sports 

halls, Marina Bay and the Old Police Academy. (Marina Bay is near the heart of Singapore’s financial 

district and downtown area.) One Farrer Hotel also offers a drive‐through testing facility. Both these 

testing facilities do not accept walk‐ins for screening, and require people to consult their doctors 

before being referred for testing where necessary [118].    

At the end of 2020, Changi Airport could handle up to 10 000 laboratory samples by working with 

external laboratories. A new COVID‐19 testing facility has been set up at Changi Airport in early 2021 

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to enable arriving travellers to undergo the COVID‐19 PCR test smoothly and quickly after 

disembarkation [119, 120]. 

Engagement of the private health‐care sector has also facilitated the expansion of testing capacity 

and accessibility in Singapore. With Singapore’s Phase 3 reopening, private clinics and hospitals are 

preparing to ramp up capacity in anticipation of an expected rise in private sector demand for 

COVID‐19 testing for situations such as return‐to‐work. The Raffles Medical Group, for example, has 

launched a Raffles Connect app for customers to book test appointments, make payment and 

receive PCR test results. It has also invested in increased laboratory capacities that will ramp up daily 

testing capacity to between 8000 and 10 000 tests [121]. 

The list of MoH‐approved providers for PCR tests is available at 

https://www.moh.gov.sg/docs/librariesprovider5/covid19_test_providers/approved‐covid‐19‐pcr‐

swab‐provider‐(08‐jan‐2021).pdf.  

Singapore has been steadily building up its capacity to conduct swab tests for COVID‐19. While an 

average of 2900 tests was conducted per day in early April 2020 [122], Singapore was able to 

conduct about 13 000 tests a day by June 2020 [123], and more than 27 000 individuals were tested 

daily as of September 2020 [122, 124, 125]. As of 8 February 2021, the average daily number of 

swabs tested in the past week was about 34 700. As of 13 July 2020, Singapore conducted about 177 

000 swabs per million population [126], and this increased to 1.193 million as of 8 February 2021 

[14]. A total of 6.8 million COVID‐19 swabs have been tested in Singapore as of 8 February 2021 [14].  

Antigen rapid test  

Use of antigen rapid test (ART) is increasingly being explored to complement the more sensitive but 

slower PCR tests, and enable more extensive and convenient testing to support reopening of 

borders and resumption of economic activity. On 12 October 2020, in order to quickly detect and 

isolate asymptomatic cases among migrant workers, the MoM and MoH started piloting the use of 

ARTs, which could provide results within half an hour. The new tests will also form part of the 

existing RRT of workers staying in dormitories [127]. Singapore has also been conducting pilots on 

pre‐event testing using ARTs to enable more large‐scale events to resume in a safe manner [128]. 

Starting 22 January 2021, all cargo drivers entering Singapore from Malaysia via the major 

checkpoints will be tested using COVID‐19 ART [129]. The authorities are also studying the feasibility 

of introducing less sensitive but quicker tests for travellers from countries deemed to have a lower 

risk of COVID‐19 infection [119]. The list of MoH‐approved providers for ART tests is available at 

https://www.moh.gov.sg/licensing‐and‐regulation/regulations‐guidelines‐and‐circulars/details/list‐

of‐covid‐19‐swab‐providers   

Serology tests 

In view of the limited sensitivity of serology tests during the initial weeks of the illness, the national 

position is that serology tests have no role in the clinical diagnosis of recent‐onset COVID‐19 

infections. Given the limited knowledge on serology tests and their period of limited sensitivity in 

the early months of the pandemic, the initial guidance then was that it should not be used for any 

form of clinical diagnosis of COVID‐19 infection. Use of serology tests was then explored in local 

seroepidemiological studies and piloted in a testing exercise (coupled with PCR testing) within the 

migrant worker dormitories (see below). With more concrete understanding of its reliability and 

limitations, from June 2020, national guidance permitted the use of serology tests to determine past 

24

infections, especially for predeparture or RRT. Accompanying guidance on the required days of 

isolation (stay‐at‐home medical certificate) for serology‐tested positive cases, which varied as 

understanding of the tests evolved, was also provided to medical practitioners [130‐133]. 

Targeted testing of “higher‐risk” groups 

Testing is also used in a targeted way for selected population groups. These include health‐care 

personnel, care staff at nursing homes, frontline officers managing COVID‐19 cases and dormitory‐

based migrant workers. In April 2020, “health‐care workers, staff in nursing homes and other 

workers in essential services, in particular those working with vulnerable groups”, got tested for the 

virus first. The rationale was to ensure the well‐being of Singapore’s core workforce and also to 

protect the more vulnerable members of society. This was also part of Singapore’s broader national 

strategy to move out of the Circuit Breaker in a cautious and sustainable manner [134]. Singapore’s 

universal testing of nursing home staff was cited as a success story in a review article for the low 

transmission rates and deaths recorded in nursing homes as in June 2020 [135]. Use of new 

methods, such as pooled testing and introducing robots to conduct swab tests so as to reduce the 

risk of transmission for medical personnel, were also piloted and explored [124].      

A multilayered and broad‐based testing strategy was also part of the response strategy to tackle the 

large outbreak of COVID‐19 in migrant worker dormitories in April. By August 2020, migrant workers 

residing in all dormitories had been tested for COVID‐19 at least once, allowing most of them to 

resume work [77]. From June 2020, the MoM started to systematically test migrant workers living in 

dormitories, whether symptomatic or not, by coupling serology and PCR testing. In dormitories with 

a high incidence of infections, workers were screened with a combination of serology as well as PCR 

tests: 

a. If the workers tested serology‐positive, it meant that they had been infected earlier. These 

workers underwent a seven‐day period of isolation, at the end of which the MoM could be 

confident that they were no longer infectious, and did not need to be tested further. 

b. Those who tested serology‐negative were separately isolated for a longer period of 14 days, 

in case they were incubating the virus despite being asymptomatic. They were given a PCR 

test at the end of the isolation period to confirm that they were free from infection [77]. 

For the marine and offshore sector, under the COVID‐Safe Restart Criteria for Shipyards, resident 

contractors and common contractors (marine and offshore) released on 2 June 2020, employers 

were to ensure that all employees undergo RRT every 14 days, with the exemption of non‐dormitory 

workers working in non‐production sites or those working from home [136].   

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2 Ensuring sufficient physical infrastructure and workforce capacity 

2.1 Physical infrastructure 

Quarantine/isolation facilities  

Singapore’s limited land availability means that being able to repurpose spaces and optimize land 

use has been a priority. The spike in COVID‐19 cases in foreign worker dormitories presented 

challenges in testing, quarantine and isolation operations. Broad‐based and mass testing techniques 

were adopted, and isolation was carried out of entire dormitories and movement of mildly 

symptomatic workers to other repurposed isolation facilities (e.g. exhibition centres) and 

accommodation (e.g. military camps).  

To meet the demand for quarantine operations, Singapore has also repurposed more than half of all 

hotel rooms to serve as isolation/quarantine facilities and accommodation for returning 

residents/travellers serving their SHNs [137, 138]. 

Singapore has also readily converted other multiple locations for quarantine facilities. For instance, 

in the National University of Singapore, several blocks of student housing have been converted to 

quarantine zones. Students vacated their rooms within one day, quickly freeing up room for inbound 

travellers and probable cases who needed to be quarantined. Other repurposed government 

quarantine facilities include retreat sites for gatherings or stayovers with family and friends, such as 

the Heritage Chalet in Pasir Ris, SAF Changi Chalets and the HomeTeamNS Sembawang Chalets 

[139]. 

The culture and practice of pandemic readiness in pre‐COVID years had spurred the design and set 

up of the NCID in September 2019, a 330‐bed purpose‐built facility whose capacity could be 

increased to 500 beds, and with integrated clinical, laboratory and epidemiological research 

functions. NCID and its neighbouring hospital have been managing up to 70% of the national COVID‐

19 patient workload. Since 2014, all public acute care hospitals had also been undergoing national 

simulation exercises of outbreak situations to train for pandemic preparedness and the expansion of 

isolation capacity [110, 140]. These prepared the hospitals, which were able to switch from 

“peacetime” to “outbreak” mode quickly in the COVID‐19 pandemic, to scale down from “business 

as usual” work and increase the capacity of beds, ventilators, personal protective equipment (PPE), 

drugs, etc. and human resources for COVID‐19 testing/treatment. Normal wards were converted to 

COVID‐19 wards once NCID capacity was reached [40, 110, 111, 141]. 

In the Singapore General Hospital, for example, the Ward@Bowyer (the newest ward built on a 

former car park) was added on to the hospital’s isolation ward at the height of Singapore’s outbreak 

in April 2020. This enabled the hospital to take in 200–300 COVID‐19 cases during the period [111].  

Collaborations were also established with private and community hospitals, and non‐health‐care 

entities (such as exhibition centres) to convert their wards or spaces to isolation and care facilities in 

the community. These facilitated the transfer of mildly symptomatic patients who did not require 

hospital care to these facilities, reducing the patient load in hospitals. Singapore’s health‐care 

systems have not been overwhelmed since the start of the COVID‐19 outbreak [40, 110, 111, 141]. 

The conversion of hotels and recreation centres into swab isolation facilities (SIFs), which are 

facilities for patients awaiting the result of a swab test, was also done to  prevent the potential 

spread of COVID‐19 in the wider community [142]. 

26

As of 28 April 2020, there was a capacity of 4000 beds in SIFs in locations such as hotels and the Civil 

Service Club. CCF capacity had also rapidly increased, following the spike in cases in foreign worker 

dormitories. CCF capacity, which started with around 500 beds at D’Resort NTUC, grew to about 10 

000 spaces by end April, in places such as the Singapore EXPO and Changi Exhibition Centre [143].  

Specifically, the 10‐hall 100 000 sq.m Singapore EXPO space was used to establish “8000 beds, 

medical consultation rooms, pharmacies, 150 self‐monitoring stations, shower and toilet facilities, 

WiFi access, self‐monitoring stations, and laundry facilities”. For the first month, between 10 May 

and  9 June, clinicians observed “3758 patients admitted to the facility. Daily admissions were 121.2, 

while discharges were 124.4 – giving them a mean bed occupancy count of 2593.5 at a time” [143, 

144]. 

In addition, with the shift to a time‐based discharge criterion (see page 38), patients who remained 

well at the end of day 14 after diagnoses and who did not require further medical care, were moved 

to a step‐down CRF, converted from various Singapore Armed Forces (SAF) camps [142, 143]. As of 

April 2020, there was a capacity of over 2000 beds in CRF sites, with plans to scale up to more than 

10 000 beds by end June [143]. 

Public health preparedness clinics 

A network of private primary care clinics, the PHPCs, had been registered in pre‐COVID times and 

were prepared to be activated during public health emergencies to perform roles such as dispensing 

medications, administering vaccinations, and triaging or supporting acute care hospitals. During the 

COVID‐19 outbreak, the PHPCs helped to screen and triage cases to the hospitals for diagnostic 

testing and isolation. From June, they also supported the nationwide effort of diagnostic testing of 

suspect cases and those who needed to test (see page 21). More recently, they are roped in to 

support the national vaccination programme. As a network, PHPCs play an important role in 

supporting activation of additional health‐care resources and infrastructure during the outbreak to 

enhance surveillance capacity and management of possible cases in the community [2, 110].  

PPE and medical supplies 

In terms of health‐care supplies, prior to the pandemic, the government had ensured adequate 

national stockpiles of PPE and essential medicines for up to 6 months [40, 111, 146]. To facilitate the 

importation of medical devices, including PPE, masks and thermometers, the HSA allowed waivers 

on importers’ licences to meet the increase in local demand since 31 January 2020 [147]. 

Concurrently, in view of the global shortage, local researchers and manufacturers participated in 

their local production, initiating mask manufacturing and donations to increase mask supplies [148]. 

For example, Singapore’s Defence Science and Technology Agency (DSTA) created a specialized face 

shield for frontline workers. DSTA also worked with a local medical device manufacturer to produce 

the face shields and supplied them to various public agencies [149]. Some local private companies 

also initiated mask manufacturing lines [148]. In February, when it was difficult for providers to 

secure new shipments of PPE items, the MoH distributed PPE on a regular basis to the GP clinics 

islandwide [150]. In a ministerial statement in October, it was explained that Singapore was able to 

enter the pandemic with sufficient medical supplies and essential goods for the public and HCWs as 

a strategic national stockpile was in place. This was further supported by “a combination of local 

production of essential supplies, and a diverse network of trading partners” [151]. 

27

2.2 Workforce 

Planning and redeployment 

Efforts were made to meet the surge in demand for HCWs. Collaborations were established with the 

private sector to increase surveillance, testing and isolation capabilities. Singapore’s network of 

PHPCs enabled the swift activation of nationwide surveillance and detection from the start and over 

the course of the outbreak (see pages 20 and 30). As early as March 2020, the MoH had also tapped 

into private sector hospital capacity to help care for existing patients with chronic medical 

conditions and transfer COVID‐19 patients who were "well and stable" for monitoring and isolation. 

This freed up capacity in the public sector to manage more severe COVID‐19 cases [152]. The 

progressive extension of the availability of swab tests/serological tests at GP clinics and private 

hospitals, and gradual expansion of a network of licensed testing laboratories (see page 21) also 

allowed the government to tap existing private sector human resources to scale up testing capacity 

[117]. 

During the Circuit Breaker, when intermingling of households was disallowed (see Table 1), essential 

workers and HCWs who were unable to work from home were allowed to depend on grandparents 

for childcare arrangements. The flexibility was introduced to facilitate the smooth continuation of 

health‐care workforce availability during the Circuit Breaker period [153].  

Containment and management of the large clusters that emerged in migrant worker dormitories in 

May 2020 required significant health‐care resources. Volunteers were recruited to form medical 

teams that went into the dormitories to assist in testing and implementation of safe management 

measures. For example, nursing students from the National University Health System responded to 

the MoH’s call for volunteers, and undertook serology testing of migrant workers at dormitories 

with higher levels of infection [154].  

The SAF also participated in the COVID‐19 containment efforts in migrant worker dormitories. In 

April 2020, the SAF deployed 70 of their medical personnel to migrant worker dormitories that 

housed more than 20 000 workers [155]. The SAF medical personnel formed forward assurance 

support teams (FAST) to manage the daily needs of the isolated migrant workers, such as ensuring 

that their meals were delivered on time and that their well‐being was maintained [156].  

With the contraction of the global aviation industry, opportunities were created for airline crew to 

be directed to appropriate training and subsequent jobs in supporting roles in hospitals and the 

public health response. The supporting roles in hospitals involved providing administrative support 

and attending to non‐COVID patients who required routine medical care in a non‐clinical role, such 

as repositioning patients in bed, monitoring their vital signs and noting meal orders [157]. This 

helped to lighten the workload of nurses and other hospital staff who could focus on the COVID‐19 

patients. By May 2020, Singapore Airlines had committed to “provide at least 300 care ambassadors, 

500 transport ambassadors and 150 contact‐tracing ambassadors, and continues to work with other 

organizations to explore other avenues where its employees can help” [158]. From September 2020, 

opportunities were also created for Singapore Airlines cabin crew members to work at a nursing 

home as "care ambassadors", assisting senior residents in their basic daily activities [159]. 

Concurrently, over the course of the pandemic, the MoH has also been conducting open calls for 

nurses who are not practising, practising as an agency nurse, or in a non‐nursing related area, to 

support the health‐care workforce by helping out in non‐COVID capacity [160]. 

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At the same time, appropriate training was provided to nurses from non‐COVID wards who were 

redeployed to care for COVID patients. For example, in April 2020, Tan Tock Seng Hospital trained 

more than 380 nurses to support operations at the NCID, which expanded its capacity from 330 to 

586 beds. The newly deployed nurses had to undergo special training, such as the handling of 

patient specimens or safe transportation of patients [161]. 

With the need for strong enforcement of infection control measures in health‐care institutions, 

workflow changes involving precautions such as PPE use and regular disinfection of the 

equipment/environment were also implemented across non‐COVID wards. These also necessarily 

accompanied training of staff working in a non‐COVID capacity [162]. 

With the gradual reopening of borders from June 2020, enhanced measures were set out for HCWs 

returning to Singapore from overseas, regardless of the scheme they had travelled under (e.g. 

Reciprocal Green Lane arrangements (see page 50). These included restriction of their duties to non‐

patient‐facing work for up to 14 days from their date of return (actual days of non‐patient‐facing 

work depended on their days of SHN, which depended on the country they had travelled from). 

HCWs do not need to undergo additional swab tests on top of the prevailing requirements when 

returning to Singapore from their respective countries of travel [163].  

To strengthen infection control surveillance, some hospitals set up dedicated teams to monitor 

HCWs’ sick leave records for indications of increase in absenteeism and possible clusters of upper 

respiratory tract infections. Additional physical distancing measures where HCWs were divided into 

smaller care teams responsible for dedicated patient groups were also instituted [164]. 

Impact on medical/nursing students 

Infection control and workforce planning measures impacted the education, training and placement 

of medical/nursing students to a certain degree. Singapore’s postgraduate medical training is 

modelled after the US residency training system. Measures to minimize unnecessary contact 

between HCWs and directives to step up human resources at health‐care institutions impacted 

residency training by way of delaying specialist accreditation for final‐year senior residents (with 

postponement of examinations). It also affected training in programmes involving rotations across 

multiple subspecialties in different institutions (with cessation of cross‐institutional rotations), 

preventing achievement of target case log numbers (with cancellation of non‐urgent surgeries and 

outpatient clinic visits), and redeployment to outbreak management roles [165]. A survey seeking to 

understand the impact of COVID‐19 on residency training observed that 61% of survey respondents 

agreed that the current outbreak had adversely affected their training and/or career [166]. 

There is currently an increased focus on residency programmes and institutions to manage anxieties 

caused to trainees by the outbreak and the resultant disruption to their education. Emerging 

academic articles have proposed that “personnel rosters and work schedules for deployed residents 

should be overseen with care to ensure trainees do not spend excessive amounts of time away from 

core work that is specific to their training” [166]. 

Singapore also suspended clinical attachments for medical, nursing, pharmacy and allied health 

students enrolled in tertiary institutions in February 2020, and lifted the suspension after 3 months, 

nearing the end of the Circuit Breaker. This was done for safety reasons and to minimize exposure of 

students to the virus. Students largely volunteered in their personal capacities during the period. 

HealthServe, a non‐profit organization of volunteer doctors providing medical care to migrant 

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workers, received large numbers of student volunteers, which enabled it to keep their clinics for 

migrant workers running. Universities and hospitals later devised “coordinated preparation plans 

and strategies” to “safely resume clinical placements within national and hospitals’ risk control 

measures against COVID‐19 transmission” between February and May. For example, a contingent 

module was quickly developed and launched to replace on‐site community pharmacy training 

requirements in the Department of Pharmacy, National University of Singapore, paving the way for 

uninterrupted completion of pre‐employment clinical training for interns’ graduation and progress 

on to pre‐registration pharmacist training [167, 168]. Elective programmes for medical students who 

are currently overseas, and attachment programmes for Junior College‐level students/pre‐university 

entrants who are interested in finding out more about the medical/allied health education and 

profession, have been suspended (since February 2020) until further notice [169, 170]. 

Support for HCWs 

The MoH has publicly emphasized the heavy workload and stress HCWs faced during the pandemic. 

The increase in patient load with COVID‐19 meant that some were taking on longer shifts, while 

others were required to take on additional roles. A March 2020 statement by the MoH stressed that 

health‐care institutions were to make sure that their staff were well‐rested and put in place a series 

of measures to reduce staff burnout, such as counselling services and peer support 

programmes [171]. Hospital support helplines were readily available and information on how to 

access support was publicized via emails and posters in the hospital environment. Arrangement of 

on‐campus accommodation was also offered to residents who were concerned about possibly 

infecting their family members and felt that they needed to isolate themselves from their families 

during the period [164, 165]. Human resource support was rendered through internal staff 

redeployment, such that staff from services with decreased workloads (e.g. due to the 

postponement of elective services) were redeployed to services with increased workloads (e.g. 

emergency department [ED], respiratory medicine, etc.). This helped to balance workloads between 

services and prevent staff burnout. Temporary staff were also recruited to augment existing staff. 

Adequate supply of PPE to staff was ensured to provide reassurance of protection against 

unnecessary virus exposure. At the hospital level, regular and supportive communications in the 

form of weekly CEO email memos to staff, sharing of staff narratives/interviews on their 

experiences, regular CEO dialogue sessions with staff/head of departments, and display of gifts of 

appreciation from the public, were carried out to encourage staff and build a sense of shared 

purpose and resilience [161, 172, 173]. On a national level, Clap for #SGUnited campaigns were 

organized, where Singapore’s residents showed their appreciation for health‐care and frontline 

workers by applauding from their windows at pre‐scheduled timings [174]. 

There are as yet no publicly announced targeted mental health programmes/support measures for 

female or other specific health‐care workforce groups. A recent local study observed that women 

HCWs faced higher exhaustion scores, likely due to longer work hours and travel restrictions that 

limited their return to their families. It pointed out that female‐dominated health‐care roles 

included nurses (88.4%), allied health‐care professionals (73.7%) and administrative professionals 

(71.1%), and recommended special attention be paid to these groups when implementing 

supportive measures for the health‐care workforce [175].    

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3 Providing health services effectively 

3.1 Planning services and maintaining essential services 

Following severe acute respiratory syndrome (SARS) in 2003 and then H1N1 in 2009, Singapore had 

been systematically strengthening its ability to manage another emerging infectious disease 

outbreak [176]. Since then, Singapore had developed a national pandemic preparedness plan, which 

included the construction of the NCID (see page 25). The NCID was officially opened in September 

2019 [40, 108, 110] and, since 2014, all public acute care hospitals had also been undergoing 

national simulation exercises of outbreak situations to train for pandemic preparedness and the 

expansion of isolation capacity [2].   

The network of PHPCs had also been registered and prepared in pre‐COVID times to be activated 

during public health emergencies to support health services in the response (see page 26). In 

January 2020, the MoH reviewed the plan for PHPCs and polyclinics, and availability of PPE and 

masks [177]. On 18 February, the network of PHPCs was activated to work alongside the polyclinics 

[2, 40, 108]. PHPCs performed roles such as screening and referring cases to hospitals for diagnostic 

testing and isolation, advising patients with mild influenza‐like symptoms to isolate at home, and 

providing subsidized treatment for respiratory illnesses (under the Flu Subsidy Scheme [FSS]) [40]. 

Some of these clinics had also been routinely swabbing patients with influenza‐like illness as part of 

regular sentinel surveillance. In March, such national surveillance was enhanced from 30 to 90 

clinics with the introduction of swab testing for COVID‐19 in more PHPCs (SASH) to detect 

community transmission. In April, this SASH programme was expanded to 198 clinics [177].   

In accordance with the comprehensive medical strategy for COVID‐19, new capacity in isolation 

wards and ICUs have been created by repurposing existing beds/hospital facilities and acquiring 

additional medical equipment [143]. The pre‐COVID national simulation exercises had also prepared 

public hospitals to be able to expand isolation capacity quickly. Management of COVID cases was 

originally centralized at the NCID and its neighbouring hospital earlier on in the pandemic. Normal 

wards in public hospitals were later converted to COVID‐19 wards once NCID capacity was reached 

[40, 110, 111]. To scale up COVID‐19 treatment capacity and maintain care for existing patients with 

chronic medical conditions, public hospitals established collaborations with private health‐care 

providers in March [141, 143]. Private hospitals supported public hospitals by admitting and treating 

COVID‐19 patients with less serious acute clinical conditions, as well as helping to care for existing 

patients with chronic medical conditions. To further facilitate efficient use of hospital resources, the 

MoH announced on 24 March that patients who were well enough to be discharged from medical 

care but still tested positive for the virus would be moved to CCFs. CCFs are large‐scale institutional 

isolation units (converted from public spaces such as exhibition centres) supported by telemedicine 

and a low health‐care worker–patient ratio7 [178, 179]. At the same time, the government worked 

collaboratively with private hospitals to staff the CCFs with the necessary HCWs (doctors, dentists, 

health‐care assistants, etc.) [180]. With the execution of its national medical strategy for COVID‐19, 

Singapore has not seen the overwhelming of its health‐care systems since the start of the COVID‐19 

outbreak [40, 110, 111]. 

7 A study estimated the health‐care worker–patient ratio to be 98 health‐care workers for 3200 beds [179].  

31

To ensure that there is available hospital capacity to care for COVID‐19 patients, on 6 April 2020, in 

conjunction with start of the Circuit Breaker, the MoH issued notice on compliance with safe 

distancing measures and the deferment of non‐essential services to all health‐care institutions and 

practitioners. Guidance on what constituted essential and non‐essential services, and which 

community care services could continue to operate, was provided by the MoH [181] and are 

available at https://www.moh.gov.sg/news‐highlights/details/continuation‐of‐essential‐healthcare‐

services‐during‐period‐of‐heightened‐safe‐distancing‐measures. These measures were incorporated 

under the COVID‐19 (Temporary Measures) Act and Regulations 2020 and the MoH Health 

Regulation Group enforced their compliance [182]. Consequently, during the Circuit Breaker, 

hospitals postponed non‐urgent elective procedures and could attend to only acute conditions. To 

maintain core health service capabilities while encouraging safe distancing and infection control 

practices, the MoH encouraged health‐care institutions to start teleconsultation services for follow‐

up care [143]. Doctors providing teleconsultation services had to attend a telemedicine e‐training 

course and adhere to the National Telemedicine Guidelines (issued in 2015). By 13 April, 955 

medical practitioners and health‐care staff had completed the government‐mandated telemedicine 

e‐training course, and 115 clinics had been approved to provide Medisave‐claimable video 

consultations [183]. The private medical community also initiated/expanded efforts in telemedicine. 

Doctor Anyway, a regional on‐demand video consultation platform connecting patients to doctors 

for medical consultations, saw a 60% increase in its panel of GPs from Singapore. Getting 

medications to patients was done through the use of third‐party dispatch service providers, clinic 

dispatch services, or having patients’ family members pick up their medications [183]. At hospitals, 

outpatient clinic appointments of patients with chronic conditions were postponed during the 

Circuit Breaker, except for cases that required immediate medical attention [184]. Provisions were 

made for these patients to refill medication for chronic illnesses without clinic consultation and 

through home delivery [185].  

As the Circuit Breaker ended on 1 June 2020, there was gradual resumption of health services 

through three phases. In Phase 1 (from 1 June 2020), health‐care providers had to triage and 

prioritize the resumption of health‐care services based on medical necessity. For hospitals, only 

specialist outpatient services, medical procedures and allied health services for patients with higher 

needs could resume. Primary, preventive and dental care facilities, chronic disease management, 

including the provision of ancillary services, could resume for patients, prioritized by health‐care 

providers based on medical necessity and available capacity. This included vaccination and pre‐

enlistment screening. Ongoing dental procedures (scaling, fillings, crowns, etc.) could resume with 

appropriate precautions. For community‐based health services, home‐based visits could resume for 

existing clients needing the services with safe distancing measures in place. Listing of examples of 

services that could continue during the Circuit Breaker period and in the lead‐up to and during 

Phase 1 can be found at https://www.moh.gov.sg/docs/librariesprovider5/pressroom/press‐

releases/annex‐a‐‐‐examples‐of‐essential‐services‐that‐have‐not‐been‐deferred‐during‐circuit‐

breaker‐period.pdf and https://www.moh.gov.sg/docs/librariesprovider5/pressroom/press‐

releases/annex‐b‐‐‐examples‐of‐services‐for‐resumption.pdf, respectively.  

Most health‐care services resumed by Phase 2, with services for medically necessary treatment 

prioritzed. Services allowed to resume included recommended screening for chronic disease and 

cancer, statutory and pre‐employment medical examinations, and selected community‐based 

services delivered on a one‐to‐one basis. Resumption of these services was subject to the need to 

32

minimize physical visits whenever possible, with teleconsultation and medication delivery being the 

preferred mode of review [186].  

Vulnerable populations 

The government also prioritized improved access to COVID‐19 services for vulnerable populations, 

especially for migrant workers and senior citizens. During the period when all foreign worker 

dormitories were placed under isolation, workers who were sick and presented with symptoms of 

ARI were isolated and treated [77, 187]. The MoH and MoM distributed thermometers and >25 000 

oximeters to complement testing and identify potential new cases quickly [77]. Every migrant 

worker from the dormitories had to check and report his temperature and oximeter readings twice a 

day to medical teams [77]. By the end of April, medical support was set up at the dormitories to 

provide health services to migrant workers who were unwell [77] .This included medical posts with 

teams of doctors, nurses and technicians at all 43 purpose‐built dormitories (PBDs), as well as eight 

medical posts with roving medical teams for non‐PBDs. Migrant workers living in the community had 

access to the nationwide network of more than 900 PHPCs and polyclinics. Concurrently, as 

evidence of asymptomatic transmission and transmission from never‐symptomatic cases emerged, a 

broad‐based and systematic testing strategy with the use of both PCR and serological testing 

enabled more accurate and targeted isolation of infected workers, such that those who were 

previously infected but were no longer infectious, and those who had never been infected, could be 

differentiated from those who were currently infectious (see page 24). After containment of the 

spread of COVID‐19 in the dormitories, the focus shifted to clearance of infection in the dormitories, 

and the establishment of comprehensive preventive structures to facilitate safe resumption of work 

by the workers (see page 15). These included establishing medical support plans for migrant workers 

after the dormitories were cleared of the virus. In August 2020, the government launched a three‐

pronged medical support system for migrant workers, which consisted of development of dedicated 

medical centres islandwide, accessibility to telemedicine via the FWMOMCare mobile application, 

and mobile clinical teams that could be activated for quick intervention in the event of emerging 

clusters [188, 189]. From June to November, migrant workers staying in dormitories were 

progressively cleared to resume work (see page 15) and, since October, the number of new 

infections detected in the dormitories has remained very low [77].  

In Singapore, on May 2020, nearly one in six (16%) seniors who were infected with COVID‐19 

suffered from severe symptoms and required intensive care in the hospital [190]. In addition, 95% of 

all deaths due to COVID‐19 in Singapore involved seniors. To protect vulnerable seniors and reduce 

the likelihood of COVID‐19 occurring in residential care homes, the Multi‐Ministry Taskforce 

implemented measures to safeguard the health and well‐being of senior citizens. Since January 

2020, a range of preventive measures were instituted in the homes, including heightened infection 

control and prevention practices, access to a steady supply of PPE for nursing home staff, safe 

distancing measures, split‐zone arrangements, and suspension of visitors [190, 191]. The MoH, the 

Agency for Integrated Care, and the Ministry of Social and Family Development (MSF) also initiated 

widescale testing for all 30 000 residents and staff of nursing homes, welfare homes, sheltered 

homes and adult disability homes from April to June 2020 to detect COVID‐19 infections [190, 192, 

193]. Where there was a positive case in the homes, the task force prioritized support for them to 

thoroughly disinfect affected areas, conduct contact tracing and quarantine close contacts [190, 

194]. From June, all homes/centres that were closed during the Circuit Breaker period could reopen 

33

for service users with moderate‐to‐high needs while ensuring compliance with safe management 

measures and minimal staff strength on‐site [195]. Some senior‐centric activities could resume with 

complementary preventive measures. These included size and duration limits for group‐ and 

volunteer‐led activities. Visits with limits on duration and visitor number could also resume for 

homes serving non‐elderly residents [191]. Starting from 19 June 2020, visits to nursing homes could 

resume. All nursing homes would need to put in place additional precautionary measures to protect 

their residents. These included safe distancing, limiting group interactions, visitor control, setting 

aside dedicated visitation areas, and ensuring good infection control practices such as hand hygiene 

and wearing of masks [196]. Size and duration limits for visits, outings and group activities gradually 

eased with Phase 2 and then Phase 3. Details of relevant measures for the long‐term care sector and 

how they varied over the post‐Circuit Breaker phases can be found in the advisories issued by the 

MSF and are available at https://www.ncss.gov.sg/Press‐Room/COVID‐19/Past‐COVID‐19‐

Advisories.   

3.2 Managing cases 

From point of first contact with patients with ARI 

From 2 January 2020, all medical practitioners had been alerted to look out for suspected cases 

according to the suspect case criteria issued by the MoH (see page 20). All clinic attendances should 

be provided with screening questions on travel history and respiratory symptoms, and cases 

presenting with ARI symptoms and fulfilling the suspect case criteria should be referred to the ED/ 

PHPCs for further triage. For patients presenting with ARI symptoms at the PHPCs or polyclinics, the 

following were done [2]:  

patients who were medically unstable with severe ARI symptoms should be referred to an 

ED via ambulance; 

patients with mild respiratory symptoms who fulfilled the suspect case criteria should be 

sent directly to the NCID or acute hospitals [177]; 

patients with mild ARI who did not fulfil the suspect case criteria should be provided with  5 

days of stay‐at‐home medical leave. If the symptoms worsened, patients were advised to 

return to the same doctor for evaluation and referral for testing [2, 55, 108, 177]. 

Variations and fine‐tuning of the above protocols were done to tighten or refine the case 

management structures as the pandemic situation evolved and reduce disruptions to workplace 

operations as testing capacity increased. From April 2020, a web‐based COVID‐19 Symptom Checker 

was also launched to support the public in navigating care options based on their symptoms, age 

and travel history [40, 197]. The timeline of adjustments to triage protocols are listed in Table 4.  

Table 4: Timeline of workflow changes to patient triage 

Date (wef)  Workflow changes to patient triage 

5 March  Dental clinics, practitioners and oral health therapists instructed to refer all 

patients presenting with ARI (whether fulfilling the suspect case criteria or not) 

to PHPCs/polyclinics for medical assessment and follow up. 

Patients with ARI (whether fulfilling the suspect case criteria or not) and 

requiring urgent/emergency dental management to be referred to designated 

hospitals for treatment [198] 

34

Date (wef)  Workflow changes to patient triage 

27 March  Medical practitioners asked to emphasize legal enforcement of 5 days’ medical 

certificates (MCs) for stable patients presenting with any degree of ARI and not 

fulfilling the suspect case criteria [55]   

1 June  Guidance issued to medical practitioners on evaluation of patients with a history 

of COVID‐19 infection and presenting with ARI, and protocols on testing and 

triaging [199]  

1 July  Implementation  of  enhanced  SASH  criteria  for  clinics  participating  in  the  SASH initiative to include patients with ARI >13 years of age, persons working and/or living in communal settings (e.g. residential, custodial or special care facilities), and immunosuppressed patients. See Fig.8 for the workflow [200].   

ARI: acute respiratory infection; PHPC: public health preparedness clinic; SASH: Swab and Send Home 

(programme) 

As the network of clinics participating in SASH expanded, the predominant triage workflow evolved 

to be test‐based, with the majority of persons presenting with ARI needing to undergo a PCR swab 

test, and requiring to stay home only until their test results were negative. (See Fig. 8 for the current 

patient triage workflow.)   

35

Fig. 8: Referral pathway for COVID‐19 patients to obtain care and treatment 

ARI: acte respiratory infection; HR: heart rate; MC: medical certificate; MoH: Ministry of Health; PCR: 

polymerase chain reaction; RR: respiratory rate; SASH: Swab and Send Home (programme) 

Vulnerable populations/higher‐risk groups 

Additional directives or protocols are applied to vulnerable/higher‐risk groups to tighten the existing 

surveillance and triage structures in the community. Directives are issued to long‐term care 

residential homes to ensure that staff or residents with ARI symptoms sought medical advice from 

the nearest PHPC or polyclinic immediately. Following a confirmed case, homes have to immediately 

prepare information on the case’s health history, date of symptom onset, location of bed/areas 

visited two days prior, and staff/visitors/residents who have been in contact with the case [27, 195].  

Similarly, senior citizens and migrant workers living in the community have access to the nationwide 

network of more than 900 PHPCs and polyclinics [77]. The health of migrant workers living in 

dormitories is monitored through the FWMOMCare App, which facilitates prompt medical attention 

with its 24/7 telemedicine service for those who were unwell. Employers are also tasked to ensure 

that unwell workers seek medical attention and, where necessary, to work with dormitory operators 

36

to book an appointment and arrange for transport for them to visit the nearest dedicated medical 

centre [188, 201]. These medical centres treat all migrant workers for a range of conditions, 

including ARIs, and refer patients requiring specialist care to appropriate care providers for further 

management [188]. Migrant workers in dormitories are tested by dormitory medical teams, SIFs or 

screening centres in acute care hospitals [177].  

Treatment at hospitals 

In Singapore, the majority of cases are isolated and treated at the NCID. Its capacity increased from 

330 to over 500 during the outbreak and, together with its neighbouring hospital, has been 

managing up to 70% of the national COVID‐19 patient workload [40, 108, 110]. In the NCID, patients 

are admitted to individual negative‐pressure isolation rooms and are reviewed daily by medical 

teams [202]. At public hospitals, all admitted suspected COVID‐19 cases receive a chest radiograph 

and RT‐PCR testing from respiratory specimens over two consecutive days [107, 111]. To monitor 

patient parameters, the ViSi Mobile® wearable continuous patient monitoring system is used, which 

also reduces exposure risk for HCWs and their PPE consumption [202]. Complete blood count, 

kidney and liver function tests, C‐reactive protein and lactate dehydrogenase levels are analysed as 

part of standard investigations [202].  

Treatment guidelines for COVID‐19 were developed, provided by the NICD on 4 January 2021, and 

regularly updated since. Recommendations for each treatment were based on analysis of published 

clinical trials, cohort studies, society and professional guidelines related to the treatment of COVID‐

19, discussion with an expert committee,  and screening for conflicts of interest [203]. Clinical 

evidence summaries for various therapeutics for COVID‐19 from the MoH‐Agency for Care 

Effectiveness are also available at https://www.moh.gov.sg/covid‐19/clinical‐evidence‐summaries 

[204].    

According to this treatment guideline, the cornerstone of clinical management of COVID‐19 is early 

supportive care and monitoring, including oxygen supplementation, organ support and prevention 

of complications, especially acute respiratory distress syndrome (ARDS), organ failure and secondary 

nosocomial infections [204]. As such, most COVID‐19 patients do not need specific antiviral 

treatment. However, patients who progress to more severe disease may benefit from treatment 

with medications that have antiviral and/or immunomodulatory activity [204]. Although there was 

no proven or licensed therapies for any coronavirus (CoV) infection as on April 2020 [203], there are 

currently more meta‐analysis data on corticosteroids for the treatment of severe COVID‐19 and 

remdesivir has been approved by the HSA for use in hospitalized patients with severe COVID‐19 

[204]. Convalescent plasma is available in Singapore as part of a monitored expanded access 

programme. The current guidelines (as of January 2021) restrict its use in the context of 

contraindications to other approved medication and as salvage therapy [204].  

In hospitals, to provide proper treatment of COVID‐19 infection, persons are classified as being at low 

versus  high  risk  of  disease  progression  for  COVID‐19,  which  is  important  in  helping  to  prevent 

worsening of the disease in high‐risk patients. The classification is shown in Table 5 [204]. Furthermore, 

in  Singapore,  the  treatment  algorithm  for  COVID‐19  infection  depends  on  the  clinical  severity  of 

COVID‐19,  which  is  classified  into  asymptomatic  or  presymptomatic,  mild,  moderate,  severe  and 

critical stages [204]. The detailed staging of severity is shown in CRP: C‐reactive protein; LDH: lactose 

dehydrogenase; SpO2: oxygen saturation of the blood 

37

Table 6. Mild (non‐severe/critical) patients who do not need supplemental oxygen require only 

supportive therapy with observation. Severe patients obtain treatment according to the 

requirement of oxygen with remdesivir alone (or) together with dexamethasone or baricitinib (see 

Fig. 9).  

Table 5: Classification for persons at low versus high risk of disease progression for COVID‐19 

Low risk (fulfilling all criteria below)   High risk (fulfilling any of the criterion below)  

Age <30 years  Age >30, particularly >50 years 

No chronic comorbidities  

 

Chronic comorbidities (chronic lung, heart or 

kidney disease, diabetes mellitus, 

immunosuppression, body mass index >25 if age 

<60)  

Reassuring clinical features  

No dyspnoea  

Respiratory rate <20 breaths/min  

Normal SpO2  

Not requiring oxygen therapy  

Worrisome clinical features  

Dyspnoea 

Respiratory rate >20 breaths/min  

Abnormal SpO2 (<94%)  

Requiring oxygen therapy  

Normal chest X‐ray   Chest X‐ray shows pneumonia  

Reassuring laboratory results 

CRP <20 mg/L  

LDH <550 U/L  

Lymphocytes >1 x 10^9/L  

Neutrophils <3 x 10^9/L  

Worrisome laboratory results  

CRP >20 mg/L  

LDH >550 U/L  

Lymphocytes <1 x 10^9/L  

Neutrophils >3 x 10^9/L  

Source: Updated treatment guidelines for COVID‐19, Version 5.0, dated 4 January 2021 

CRP: C‐reactive protein; LDH: lactose dehydrogenase; SpO2: oxygen saturation of the blood 

Table 6: Clinical staging of the severity of COVID‐19 

COVID‐19 severity 

Asymptomatic or 

presymptomatic 

Tests positive for SARS‐CoV‐2 with a virological test but has no symptoms 

consistent with COVID‐19  

Mild  Any signs/symptoms of COVID‐19 (e.g. fever, cough, sore throat, malaise, 

headache, myalgia, nausea, vomiting, diarrhoea, loss of taste/smell) but 

does not have shortness of breath or clinical signs of pneumonia or 

abnormal chest X‐ray 

Moderate  Shows evidence of lower respiratory tract disease during clinical 

assessment or imaging and has an SpO2 of >94% on room air  

Severe  Individuals who have an SpO2 of <94% on room air, or PaO2/FiO2 (P/F) 

ratio of <300 mmHg, respiratory rate of >30 breaths/min or lung 

infiltrates occupying >50% of the lung fields  

Critical  Individuals with respiratory failure, septic shock and/or multiple organ 

dysfunction  

38

Source: Updated treatment guidelines for COVID‐19, Version 5.0, dated 4 January 2021  

FiO2: fraction of inspired oxygen; PaO2: partial pressure of oxygen; SARS‐CoV‐2: severe acute respiratory 

syndrome coronavirus‐2; SpO2: oxygen saturation of the blood 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source: Updated treatment guidelines for COVID‐19, Version 5.0, dated 4 January 2021 

SpO2: oxygen saturation of the blood 

Earlier on in the pandemic, patients who tested positive were managed as inpatients until their 

symptoms had resolved and two nasopharyngeal swabs were negative for SARS‐CoV‐2 on two 

consecutive days [202]. Since March 2020, to reduce the load on public hospitals, patients with mild 

symptoms are transferred to CCFs (see page 30) [40]. If patients in these facilities need better 

management and support, they are transferred to hospitals [143]. If patients remain well on day 14 

of the illness and are clinically stable without the need for further medical care, they are transferred 

to a stepped‐down CRF [143]. With effect from 29 May 2020, the MoH revised the discharge criteria 

to a time‐based one where COVID‐19 patients assessed to be clinically well by day 21 of the onset of 

illness could be discharged from isolation without the need for further PCR tests. They are given 

leave to remain at home for a further 7 days after that [111, 205].    

Severe illness (SpO2 less than or equal to 94% on room air, requiring supplemental oxygen, either via

A. low-flow devices (less than or equal to 15 L/min of O2) or

B. high-flow devices (>15 L/min of O2) e.g. high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV)

Any amount of oxygen: may consider dexamethasone (or equivalent steroid) alone

Low-flow oxygen (less than or equal to 15 L/min of O2) May consider remdesivir alone

High-flow oxygen ((>15 L/min of O2, e.g. HFNC, NIV)

May consider: I) dexamethosone (or equivalent steroid) + remdesivir OR II) baricitinib + remdesivir

Mild (non-severe/critical) illness, not requiring supplemental oxygen

Observe till recovery

COVID-19 diagnosis

Severity of illness

Critical illness

(mechanical ventilation, extracorporeal membrane oxygenation [ECMO])

Dexamethasone (or equivalent steroid) alone OR

Dexamethasone (or equivalent steroid) + remdesivir

Fig. 9: Treatment algorithm for COVID‐19

39

4 Paying for services 

4.1 Health financing 

While national reserves were drawn on to fund stimulus packages to cushion the economic impact 

of COVID‐19 (see page 52), recurrent expenditure, such as health‐care spending, was paid for with 

recurrent revenues, such as taxes. This is also the government’s plan for health‐care spending 

moving forward [206]. As a pre‐emptive measure, the government intends to raise the goods and 

services tax (GST) to “help fund growing health care and social spending needs, but will carefully 

monitor the timing of such moves including the state of the economy and spending needs”. The 

current plan is that GST rate increases will not take effect in 2021 [207].  

The Singapore government recognized the importance of increasing accessibility to health‐care 

services and treatment. Early on in the outbreak (on 12 February), the government provided 

assurance that it would finance treatment costs incurred by patients with COVID‐19 in public 

hospitals [208]. Coverage for COVID‐19 inpatient bills was extended from the regular health‐care 

financing channels of government subsidies, MediShield Life8 and integrated shield plans9 for 

qualifying beneficiary groups. Singapore’s insurance associations concurrently issued a joint 

statement confirming member companies’ provision of coverage for COVID‐19‐related 

hospitalization expenses under their policies [31]. After collaboration was established with private 

sector hospitals on the care of patients with COVID‐19, the same government and national 

insurance coverage for COVID‐19 inpatient bills was extended to treatment at private hospitals.  

To deter non‐compliance with guidelines and reduce further risk of importation from returning 

travellers, residents and long‐term pass holders who disregarded travel advisories would not be 

subsidized at public hospitals, if admitted as suspected or confirmed cases of COVID‐19 within 14 

days of return with effect from 27 March 2020 [209].  From June 2020, as Singapore reopened its 

borders to more international travel, all travellers entering Singapore were required to self‐fund 

their COVID‐19 tests and stay at dedicated facilities if necessary [210]. (See Table 8 for more details.) 

To support safe distancing measures and the continuation of health‐care services for non‐COVID 

conditions, the CHAS10 (Chronic Subsidy and Medisave) could be tapped into for video consultations 

of selected chronic illnesses for a limited time from 3 April 2020 (this subsidy is still ongoing). The 

current scope of coverage includes diabetes, hypertension, bipolar disorder, among other chronic 

illnesses [38]. The conditions applicable for subsidy and list of approved private health‐care 

institutions providing video consultations for chronic conditions are available at 

https://www.moh.gov.sg/covid‐19/vc. In addition, the government also introduced special COVID‐

19 subsidies for the first two years to offset MediShield Life premium increases (70% of the increase 

in the first year and 30% in the second year). The COVID‐19 subsidy applies for Singaporeans, while 

permanent residents are entitled to them at half the rate provided to Singaporeans [211].  

Since the SARS outbreak in 2003, Singapore has instituted a fund for Singaporeans who face loss of 

income, additional caregiving duties and need for essential items. The Courage Fund was first 

8 A catastrophic national health insurance, where premiums can be deducted from MediSave accounts 9 An additional private insurance coverage portion on top of MediShield Life payable from MediSave subject to yearly withdrawal limits 10 Means‐tested portable State subsidies to offset out‐of‐pocket payment for citizens when they visit private GPs

40

established in 2003 when Singapore was hit by the SARS outbreak. Fellow Singaporeans donated 

generously to the Fund to support those who were affected by the outbreak. In this same spirit of 

uniting the community to support one another through difficult times, Community Chest has been 

rallying the community to provide relief and support to those affected by the current COVID‐19 

situation [212]. 

The Fund’s qualifying criteria for lower‐income households affected by COVID‐19 include having at 

least one household member as a citizen or permanent resident, having contracted COVID‐19 or 

being issued SHN/leave of absence (LOA)/QO and having the household income affected by this, and 

having a gross monthly income of ≤S$ 6200 or gross monthly per capita income of ≤S$ 2000 prior to 

being affected by COVID‐19 [212]. 

Under the Courage Fund’s COVID‐19 relief schemes, grants are disbursed under the Scheme for 

HCWs who have contracted COVID‐19 in the line of duty and Scheme for Frontline Workers and 

Community Volunteers who have contracted COVID‐19 in the line of duty. Dependants of individuals 

who have succumbed to the virus are also eligible for relief and grants. Families of HCWs will receive 

a larger amount of S$ 30 000 and an education grant if eligible, which covers education and living 

expenses. For non‐HCWs, the amount ranges from S$ 10 000 to S$ 20 000 [212]. 

Under the FSS (see page 30), PHPCs charge flat subsidized rates for patients diagnosed with ARI and 

the MoH reimburses these PHPCs at flat rates (see Table 7). Foreigners are not eligible for the FSS.  

Table 7: PHPC patient charges and reimbursement under the FSS 

Beneficiaries  Patient charge (not inclusive of 

GST) 

Reimbursement by the MoH 

(flat rate per visit) 

Public Assistance (PA) 

cardholders 

$0  $60 

Pioneer Generation (PG) 11/ 

Merdeka Generation (MG) 

cardholders12 

$5  $55 

Non‐Pioneer Generation/non‐

Merdeka Generation 

Singapore citizens and 

permanent residents 

$10  $50 

 

To expedite the claims process, PHPCs can make FSS claims by logging into the MoH Healthcare 

Claims Portal (MHCP) and submit the claim.  

Funding was also extended to PHPCs to support their efforts at surveillance and triaging of patients 

during the pandemic. The Health Minister had shared that the MoH would offer a one‐off COVID‐19 

11 Introduced in 2014 for citizens born before 1950. This group receives additional subsidies for some outpatient services at polyclinics and public hospitals, at GP clinics under the Community Health Assist Scheme (CHAS), and also receives some other additional healthcare‐related payouts [272].  12 Introduced  in  June 2019 for citizens born between 1950 and 1959.  It  is  similar  to the Pioneer Generation Package but has more limited benefits in the form of additional outpatient care subsidies and other additional health‐care‐related payouts [273, 274].  

41

grant of $10 000 for all PHPCs to mitigate any additional costs they may be facing. Funding was also 

set aside to support collaborations with the private sector to expand testing capacity and 

accessibility. The MoH has been providing a one‐time SASH start‐up grant of $1200 to PHPCs under 

the SASH programme to “help these clinics cover the additional startup costs” [213].  

Reimbursements to private hospitals for COVID‐19 treatment and isolation wards were provided 

through the same funding channels of government subsidies, MediShield Life and integrated plans 

as per that for public hospitals. 

Funding for all COVID‐19‐related health care for migrant workers admitted to hospitals, FAST and 

dedicated medical centres for migrant workers’ dormitories and their testing efforts have been 

provided by the government. The government is in the process of passing the financial costs of RRT 

to employers. 

4.2 Entitlement and coverage 

The government provided assurance early on in the pandemic (from early February) that it would 

cover expenses related to testing and treatment for COVID‐19 for eligible suspect cases. Coverage 

was initially limited to services at public hospitals, with the centralized testing, management and 

isolation of cases at the NCID and public hospitals. Coverage for other COVID‐19‐related services 

(e.g. SHN facilities, testing, etc.) was later extended to specified groups of people, in line with their 

extended capacity and availability. Entitlement and exclusions were adjusted over the course of the 

pandemic in response to outbreak developments and to complement changes in containment 

measures. Coverage for complementing services supporting existing containment/surveillance 

measures, such as subsidies for ARI consultations and video consultations, has been concurrently 

instituted.   

Table 8: Timeline on entitlement to COVID‐19‐related care services 

Period  COVID‐19‐related care  Eligible groups  Exclusions 

From 

February 

2020 

Subsidized treatment, 

investigations and 

medications to patients with 

respiratory symptoms at 

public health preparedness 

clinics (PHPCs) 

Citizens and permanent 

residents (PRs) [32] 

Others. Consultations at 

non‐PHPC clinics 

From 

February 

2020 

COVID‐19‐related hospital bills 

in public hospitals, including 

COVID‐19 tests  

All patients suspected of being 

infected and who must be 

admitted to hospitals for 

isolation and management to 

prevent community 

transmission 

Outpatient treatment at 

GP clinics or polyclinics, 

and treatment at private 

medical facilities (all 

confirmed COVID‐19  

cases were treated at 

public hospitals during 

this period.) [30, 214]  

42

Period  COVID‐19‐related care  Eligible groups  Exclusions 

From 7 

March 

2020 

COVID‐19‐related hospital bills 

in public hospitals, including 

COVID‐19 tests  

Only Singapore citizens, 

permanent residents (PRs) and 

long‐term pass holders are 

eligible for the COVID‐19‐related 

bill coverage  

All other inbound 

foreigners will have to 

pay unsubsidized rates 

for inpatient stay at 

public hospitals, bearing 

the full cost. This includes 

tests for COVID‐19, stay 

home notice (SHN) at a 

dedicated facility and 

medical expenses should 

they be infected with 

COVID‐19 [214]. Fees 

incurred in private 

hospitals are not covered 

by any COVID‐19‐related 

bill coverage.  

From 24 

March 

2020 

Subsidized hospital and 

testing rates for returning 

travellers 

Singaporeans, PRs and long‐

term pass holders who departed 

from Singapore before 27 March 

2020 

Those who departed after 

27 March 2020 will be 

charged unsubsidized 

rates at public hospitals if 

they are admitted as 

suspected COVID‐19 

patients within 14 days of 

returning. These people 

will also not be able to 

claim from their 

MediShield Life or 

Integrated Shield Plans 

for these treatments at 

both public and private 

hospitals [215]. 

From 3 

April 

2020 

Tapping on the Community 

Health Assist Scheme (CHAS) 

Chronic Subsidy and MediSave 

for video consultations of 

consultations for selected 

chronic illnesses [38]   

All CHAS Chronic Subsidy‐ and 

MediSave‐qualifying 

beneficiaries 

Others 

From 

April 

2020 

COVID‐19 PCR tests  For all people in Singapore, as 

long as they are referred by a 

registered doctor under current 

surveillance and patient triage 

protocols 

Others who need the test 

and are eligible for it, e.g. 

travellers 

43

Period  COVID‐19‐related care  Eligible groups  Exclusions 

Government‐ordered targeted 

testing for specified/higher‐risk 

groups (e.g. migrant workers, 

nursing home staff, etc.) 

From 

April 

2020 

CHAS subsidies and use of 

MediSave for regular follow 

ups on chronic conditions 

through video consultation. 

Qualifying chronic conditions 

are listed at: 

https://www.moh.gov.sg/covi

d‐19/vc  

All eligible CHAS and MediSave 

users 

Others 

From 17 

June 

2020 

Cost of SHN facilities   Singaporean citizens and PRs All incoming travellers 

who are not Singapore 

citizens or PRs will have 

to pay for their stay at 

dedicated SHN facilities. 

From 7 

August 

2020 

Tap on regular health‐care 

financing, such as government 

subsidies, MediShield Life and 

integrated shield plans, for 

inpatient medical bills.  

Singaporeans, PRs and long‐

term pass holders who are 

travelling abroad under 

permitted travel arrangements, 

such as bilateral travel 

arrangements with Malaysia and 

China. Should they have COVID‐

19 symptoms within 14 days of 

their return, they are eligible to 

tap on such regular health‐care 

financing [216]. 

Those who travel abroad 

without being under 

permitted travel 

arrangements will not be 

able to tap on these 

regular health‐care 

financing arrangements 

[216]. 

27 

October 

2020 

Serving SHN at a suitable 

place of residence, instead of 

government designated, 

dedicated SHN facilities  

Travellers from selected low‐risk 

countries/ regions [217] 

Selected countries/regions and 

required SHN period can be 

found at: 

https://safetravel.ica.gov.sg/arri

ving/overview 

https://www.moh.gov.sg/news‐

highlights/details/updates‐to‐

stay‐home‐notice‐and‐charging‐

policy‐for‐travellers 

All other travellers 

From 

Decembe

r 2020 

COVID‐19 PCR tests [218]    For all people in Singapore, as 

long as they are referred by a 

registered doctor under current 

All others who would like 

to take the test (they can 

44

Period  COVID‐19‐related care  Eligible groups  Exclusions 

surveillance and patient triage 

protocols 

Government‐ordered targeted 

testing for specified/higher‐risk 

groups (e.g. rostered routine 

testing [RRT] for migrant 

workers, etc.) 

order for the test at their 

own cost ) [218]   

   

45

5 Governance 

5.1 Pandemic response planning  

Planning and leadership 

The 2003 SARS experience gave rise to a culture and practice of readiness for future outbreaks in 

the pre‐COVID‐19 years. After the SARS experience, the government developed a disease outbreak 

response plan with response levels correlating with the WHO Pandemic Alert Response system 

[219]. The colour‐coded “Disease Outbreak Response System Condition” (DORSCON) levels 

incorporated progressive degrees of border controls, community‐based measures, infection control 

in hospitals, and other containment/mitigation measures (see Fig. 10). The response plan was 

intended to raise awareness nationwide, and facilitate a cross‐sector coordinated response to 

varying stages of spread of infectious diseases [2]. On 7 February 2020, with the discovery of several 

cases of COVID‐19 with no links to previous cases or travel history to China, Singapore raised the 

DORSCON level to orange [182]. 

Fig. 10: DORSCON alert levels 

  Green  

Yellow 

Orange 

Red 

Nature of disease 

Disease is mild  

OR 

Disease is severe but does not spread easily from person to person (e.g. MERS or H7N9) 

  Disease is severe and spreads easily from person to person but is occurring outside Singapore 

OR 

Disease is spreading in Singapore but is: 

a) typically mild i.e. only slightly more severe than seasonal influenza. Could be severe in vulnerable groups (e.g. H1N1 pandemic) OR  b) being contained  

  Disease is severe AND spreads easily from person to person, but disease has not spread widely in Singapore and is being contained (e.g. SARS experience in Singapore) 

  Disease is severe AND is spreading widely 

Impact on  daily life 

Minimal disruption, e.g. border screening, travel advice 

  Minimal disruption e.g. additional measures at border and/or healthcare settings expected. Higher work and school absenteeism likely 

  Moderate disruption e.g. quarantine, temperature screening. Visitor restrictions at hospitals  

  Major disruption e.g. school closures, work from home orders, significant number of deaths 

Advice to public 

Be socially responsible: If you are sick, stay at home 

Maintain good personal hygiene 

Lookout for health advisories  

  Be socially responsible: If you are sick, stay at home 

Maintain good personal hygiene 

Lookout for health advisories 

  Be socially responsible: If you are sick, stay at home 

Maintain good personal hygiene 

Lookout for health advisories 

Comply with control measures 

  Be socially responsible: If you are sick, stay at home 

Maintain good personal hygiene 

Lookout for health advisories 

Comply with control measures 

Practise social distancing: avoid crowded areas 

Source: Ministry of Health and www.gov.sg  

H1N1: a type of influenza virus; H7N9: a type of avian influenza virus; MERS: Middle East respiratory 

syndrome; SARS: severe acute respiratory syndrome 

46

As a small‐sized island nation, Singapore did not face the added complexity of coordination of policy 

implementation across states or provinces. However, learning from the SARS experience that an 

outbreak response necessitated a coordinated response across sectors, the government set up the 

Multi‐Ministry Taskforce on 22 January 2020 to oversee the national response to COVID‐19. It 

comprises ministerial rank members from across the ministries of health, trade, national 

development, education, communications and information, manpower, environment and water 

resources, social and family welfare, and transport [2, 220]. This facilitated swifter and more tightly 

coordinated multisectoral responses to the evolving pandemic situation.  

The ministries comprising the Multi‐Ministry Taskforce work together to coordinate surveillance, 

communications, international reporting and testing. When the outbreak in foreign worker 

dormitories necessitated a more dedicated strategy and effort, an interagency task force was set up 

to facilitate closer cooperation between the ministries of health and manpower (sectors directly 

related to the crisis), as well as involve more deeply relevant expertise from the Singapore Armed 

Forces and civil defence. The interagency task force is co‐led by the Chief Guards Officer from the 

Army and the Senior Minister and Coordinating Minister for National Security [76, 221]. 

Legislation 

Singapore has not invoked emergency laws to deal with the COVID‐19 outbreak. In the earlier 

months of the pandemic, it relied on powers provided under the Infectious Diseases Act (already 

strengthened during the global SARS outbreak in 2003) and border control powers under the 

Immigration Act. When this was no longer adequate, the new COVID‐19 (Temporary Measures) Act 

2020 (CTMA) was passed and came into effect on 7 April 2020. The CTMA grants the executive 

greater powers to issue control orders when transmission of COVID‐19 in the community constitutes 

a serious threat to public health and a control order is required to existing written laws [56, 222].  

Compliance with safe distancing measures in health‐care institutions (e.g. the limitation of cross‐

institution movement of HCWs), and the deferment of non‐essential services for all health‐care 

institutions and practitioners were incorporated under the CTMA. Guidance on the type of services 

that are regarded as essential and non‐essential was provided by the MoH on 6 April, and the MoH 

expressed that, where possible, services that were suitable for teleconsultation should be delivered 

remotely [56, 182, 223]. Accompanying reimbursements for qualifying remote consultations came 

into effect (see page 39). 

Other coordinating/supporting bodies 

In planning the response, the government also harnessed the academia and research institutes. 

Epidemiological models were co‐created at the Saw Swee Hock School of Public Health, National 

University of Singapore, with the MoH, to project disease spread and simulate the reduction in cases 

and infection rate under different intervention scenarios. Interventions modelled included 

community approaches (quarantine, school/workplace distancing, stand‐alone or combined 

approaches, etc.) [224, 225], home‐based versus institutional isolation policies [226] and border 

quarantine‐test protocols (combinations of pre‐departure and post‐arrival testing with varying 

quarantine periods for travellers) [227, 228]. Geospatial network analysis of the COVID‐19 outbreak 

in the foreign worker population was also conducted to understand frequently visited community 

locations anchoring worker mobility networks, which facilitated cross‐dormitory spread of COVID‐19 

across the country [229]. 

47

The large amount of academic literature emerging on COVID‐19 also meant that it was challenging 

for the government to digest relevant information that could inform policy‐making. The School 

conducted rapid and weekly evidence synthesis on the key topics of vaccines, diagnostics, 

therapeutics, clinical characteristics, containment measures and national responses/exit plans 

adopted by other countries to support the government [230]. 

On diagnostics and surveillance, the Agency for Science, Technology and Research (A*STAR) and Tan 

Tock Seng Hospital have developed a test kit (the Fortitude Kit) that can detect the presence of the 

SARS‐CoV‐2 quickly and with high accuracy [231, 232]. The test kit has received Singapore HSA’s 

provisional authorization for clinical use, and has been implemented in 13 Singapore hospitals and 

laboratories, public and private. A rapid point‐of‐care test, which could potentially expand the 

availability of testing in locations such as immigration checkpoints, is in the pipeline [232]. The use 

of new serological testing from the Duke‐NUS Medical School also helped uncover missing links 

between clusters in contact‐tracing operations [233]. Such collaborative efforts with universities and 

research institutes facilitated the availability of scientific and evidence‐guided information for the 

government’s response planning.  

5.2 Private sector involvement and medical devices/aids 

Involvement and regulation 

Collaboration with the private sector was an important component in the workforce and capacity 

planning that supported surveillance and accessibility of health‐care services during the pandemic 

(see sections on “Testing”, “Physical infrastructure” and “Providing health services effectively”). 

Regulation and control of private sector operations was achieved through centralized licensing, 

registration and regular policy guidance/advisories on components of the national COVID‐19 

response to the respective subsector players of the health‐care system involved. This included 

preregistration and preparation of the PHPC network during pre‐COVID times, regular advisories 

issued by the MoH and MSF to all licensed practitioners and long‐term care providers, required 

training and adherence to the National Telemedicine Guidelines by all doctors practising 

telemedicine, MoH‐approved licensing of all test kits and PCR and ART test providers, and the 

provision of regularly updated COVID‐19 treatment guidelines by the NCID. Where relevant, these 

regulatory levers were further supported with reimbursement mechanisms, such as 

reimbursements to PHPCs under the FSS for subsidized ARI consultations and to clinics for 

MediSave‐claimable video consultations.  

Medical devices/aids  

The urgent need for medical devices, aids and treatment during the pandemic prompted local 

research and manufacturing efforts to develop more cost‐effective and scalable testing/treatment 

equipment, importers’ licence waivers for medical devices/aids, and faster track or provisional 

approval for COVID‐19‐related treatment or devices (e.g. remdesivir and locally developed devices 

such as ART test kits and the Fortitude Kit (see pages 49). Other examples include the potential 

invention of a faster breathalyser test for diagnosing COVID‐19 that a local company is currently 

working on [234], and approval from the HSA in July 2020 for another local medical device 

company’s Alpha ventilator, which is the world's first telehealth ventilator ideally suited for treating 

patients with COVID‐19 and other infectious diseases [235].  

48

5.3 Vaccination policy 

With vaccination being one of the key strategies to reduce the number of people susceptible to the 

disease and chances of transmission, and to enable further exiting from the Circuit Breaker, a 

Therapeutics and Vaccines Expert Panel was formed in April 2020. It comprised 18 scientists and 

clinicians to advise the government on therapeutics and vaccines, and assessed the suitability of 

vaccine candidates for the population, taking into consideration safety, efficacy, vaccine tolerability 

and data adequacy of clinical trials. All vaccines must also be authorized by the HSA before being 

deployed [236]. In evaluating vaccine options, given the lack of certainty regarding the success of 

the vaccines, due consideration was given to diversifying choices across different vaccine technology 

platforms. There was also the need to find a balance between established options and those fastest 

on the market [237]. 

Singapore purchased the first vaccine, Moderna (mRNA vaccine), in June 2020, and two more 

vaccines, Sinovac (inactivated vaccine technology) and Pfizer‐BioNTech (mRNA vaccine), in August 

2020, under Advance Purchase Agreements [237]. On 14 December 2020, the HSA granted 

authorization of the Pfizer‐BioNTech COVID‐19 vaccine via the Pandemic Special Access Route 

(PSAR) for active immunization to prevent COVID‐19 disease in Singapore [238, 239]. At the time of 

writing this publication, Moderna vaccine is undergoing review prior to granting of authorization to 

use. 

An expert committee was convened by the MoH in October 2020 to make recommendations to the 

government on Singapore’s COVID‐19 vaccination strategy, including ensuring the safe and effective 

use of COVID‐19 vaccines in Singapore’s population groups [238]. The Expert Committee submitted 

detailed recommendations specific to the use of the Pfizer‐BioNTech COVID‐19 vaccines to the 

government on 24 December 2020 [238], which were accepted by the government. It announced on 

27 December its national plans to vaccinate all Singaporean and long‐term residents by end‐2021 

[238]. More than S$ 1 billion has been set aside under the national vaccine strategy so that all 

Singaporeans and long‐term residents will be able to be vaccinated for free by end‐2021 [236, 240]. 

Vaccination is voluntary but strongly encouraged by the government for all who are medically 

eligible to be vaccinated. From 30 December 2020, the MoH began vaccinating HCWs and staff in 

health‐care institutions [238]. Vaccination for the elderly aged 70 years and above will start in 

February 2021, followed by vaccination for other medically eligible Singaporeans and long‐term 

residents [238].  

Seniors who are 70 years old or above will receive personalized letters inviting them to sign up for 

vaccination, and those who sign up will be vaccinated at a polyclinic or vaccination centre near their 

home. Plans are under way to set up vaccination centres in each town by mid‐March [241]. The sign‐

up process will include reading through an information sheet that provides information on the 

vaccine, and who should or should not get vaccinated, followed by completion of a form which 

screens for conditions that make vaccination inadvisable. The screening process is repeated (going 

through the screening process with a medical staff/health‐care assistant) at the vaccination site 

prior to vaccination [242, 243]. An MoH circular providing information on the indications and 

contraindications to COVID‐19 vaccination, frequently asked questions (FAQs) and 

recommendations for persons to be vaccinated with the Pfizer‐BioNTech COVID‐19 vaccine has been 

circulated to all medical practitioners, specialists and general medical clinics to guide and align their 

management of consultations to the national policy. The current national vaccine policy does not 

49

recommend vaccination for pregnant women, severely immunocompromised persons, persons with 

bleeding risk and persons who have ever had severe allergies. Recommended criteria (e.g. low 

platelet levels) defining such groups are provided in the screening process and in the MoH circular to 

medical professionals/clinics [244]. 

Prior to the vaccine roll‐out, panel discussions and webinars held with MoH personnel and relevant 

experts on the vaccine’s safety and efficacy were made accessible to the public to build public 

confidence in the vaccine. Information on Singapore’s COVID‐19 vaccination programme is also 

available at https://www.moh.gov.sg/covid‐19/vaccination. The Prime Minister and his Cabinet 

colleagues were among the first to receive their COVID‐19 vaccination early in a vote of confidence 

for the Pfizer‐BioNTech vaccine and approval from experts in Singapore [245]. 

The Economic Development Board (EDB) is also investing about US$ 45 million (S$ 61 million) into 

the manufacture of a vaccine by Arcturus Therapeutics co‐developed with local researchers [231]. 

The EDB will have the option and right to purchase up to US$ 175 million (S$ 236 million) worth of 

the vaccine at prenegotiated prices, with shipments expected to begin in the first quarter of 2021 

[231]. There are also ongoing efforts to establish vaccine production facilities in Singapore. Thermo 

Fisher Scientific, one of the world’s largest life sciences company, recently announced that it would 

establish a new US$ 130 million facility in Singapore in 2022 [237]. Several other companies are also 

in the final stages of talks to invest in new vaccine production plants in Singapore [237].  

   

50

6 Measures in other sectors 

Border controls 

As early as 2 January 2020, temperature screening and issuance of health advisory notices were 

instituted for travellers on inbound flights from Wuhan. This was later extended to inbound flights 

from China, land and sea checkpoints, and all flights into Singapore. Travel advisories issued to 

Singaporeans to avoid travelling to specific countries and denial of entry/transit of travellers from 

these countries were later instituted and progressively adjusted as the epidemic situation in China 

evolved, and the source epidemic extended to autochthonous infections outside of Wuhan and 

China [145, 246]. On 23 March, entry denial was extended to travellers from all countries, while 

returning travellers from specified regions were issued SHNs. (See Fig. 11 for timeline of border 

measures instituted up until Singapore’s closure of borders.) 

From June, Singapore progressively resumed some degree of restricted air travel and established 

Reciprocal Green Lane (RGL) arrangements with select countries. These are limited to business and 

essential travel and subject to quarantine‐test protocols, mostly involving 14‐day SHN, and/or with 

restricted itinerary. Travellers are also required to use the TraceTogether app during their stay. The 

first RGL started on 8 June with China, and gradually extended to some other countries. By October, 

Singapore had RGL arrangements with a total of seven countries (Brunei, China [six provinces], 

Germany, Indonesia, Japan, Malaysia, Republic of Korea) and by December, had unilaterally opened 

its borders to travellers from Viet Nam, Brunei, New Zealand and Australia (excluding Victoria state) 

and Taiwan, China. The risk of importation from the latter group of countries/regions, where the 

virus was well under control, was comparatively lower. Unlike RGLs, all forms of short‐term travel, 

including for leisure, are permitted between Singapore and these countries. Travellers will also not 

be required to serve SHNs but will need to take a swab test upon arrival and can go about their 

activities with the use of TraceTogether after they receive a negative test result [247‐249]. In 

addition, Singapore and Hong Kong reached an in‐principle agreement to establish a bilateral air 

travel bubble on 22 November, where those travelling under the bubble will have no restrictions on 

their travel purpose and will not need to have a controlled itinerary. Due to a spike in COVID‐19 

cases in Hong Kong in November, the air bubble arrangement has been deferred [250, 251]. On 26 

December, RGLs with Indonesia and Japan have also been temporarily suspended as both countries 

announced a temporary ban on the entry of foreign nationals into their countries [252].  

As of February 2021, RGLs with the rest of the countries and unilateral opening of borders to 

travellers from Viet Nam, Brunei, New Zealand, Australia (excluding Victoria state) and Taiwan, 

China remain unchanged [252, 253]. However, due to epidemiology of the disease in different 

countries, state of RGLs are subject to change and latest updates on Singapore’s official travel advice 

for external travellers and residents can be found at https://safetravel.ica.gov.sg/arriving/overview 

and https://www.mfa.gov.sg/Services/Singapore‐Citizens/COVID‐19‐Travel‐Restrictions.       

51

Fig. 11: Timeline of border measures (January to April 2020) [2] 

 

52

Economy 

Fiscal measures were introduced to alleviate the impact on businesses and citizens’ livelihoods. A 

total of almost $100 billion amounting to 20% of the country’s gross domestic product (GDP) was 

delivered from February to May in the form of four stimulus packages to cushion the impact of the 

pandemic and Circuit Breaker on the economy and employment [254, 255]. These included co‐

payment of portions of local workers’ wages and wage increases, corporate income and property tax 

rebates, and cashflow‐assisting measures, which extended in magnitude and duration as the 

outbreak situation evolved and its economic impact deepened. There has also been increased focus 

on generating new jobs, entrepreneurship and training opportunities in the packages over the 

course of the months (see Table 9). These measures are estimated to have substantially cushioned 

the economic impact. The Monetary Authority of Singapore has estimated that the combined 

budgets will prevent the economy from contracting by a further 5.6% of GDP in 2020, and 4.8% in 

2021, and offset some of the rise in resident unemployment rate by about 1.7 percentage points in 

2020 [206]. 

Shortly after the announcement of the first set of fiscal measures, the president and ministers took 

a three‐month pay cut and senior management of several government‐owned and government‐

linked companies announced pay cuts as well [217, 256‐258]. 

The government drew on national reserves to fund a large part of these budgets, an extraordinary 

move that had happened only once prior in Singapore’s history – during the 2008–2009 global 

financial crisis. To date (since June 2020), the government had drawn on S$ 52 billion from the past 

reserves [259]. 

Table 9: Fiscal measures introduced to alleviate the impact of COVID‐19 on the economy 

Date  Fiscal measures 

18 February 

2020 

(announced) 

A $4 billion stabilization and support package, which copays portions of local 

workers’ wages and wage increases, grants corporate income and property tax 

rebates, and provides additional cashflow‐assisting measures for the more badly 

hit sectors of tourism, aviation, retail, food and beverage, and point‐to‐point 

transport services [260, 261]. 

26 March  The Resilience Budget worth $48.4 billion introduced to further alleviate the 

deepening impact on businesses. Earlier fiscal measures were enhanced with 

higher co‐funding of local employees’ monthly wages (up to 75% for 9 months 

subject to a salary cap for the hardest hit sectors) and wage increases, extended 

corporate tax treatments (rebate of 25% of tax payable), enhanced financing 

schemes for Singapore‐based enterprises (increased maximum loan quantum 

and increased government’s risk‐share to 80%), and additional rebates for the 

aviation, land transport and aviation sectors. The budget also sought to create 

new jobs (10 000) and training (8000) opportunities [260, 261].  

6 April 

(announced) 

The Solidarity Budget (worth $5.1 billion) extended the 75% co‐funding of wages 

to every local employee for one month, increased government risk‐share of 

financing loans to businesses to 90%, rental waiver for one month, non‐

residential property tax rebates (up to 100%), waiver of foreign worker levy due 

in April and issued cash pay‐outs to Singaporeans [262]. The COVID‐19 

53

Date  Fiscal measures 

(Temporary Measures) Bill ensures pass‐through of property tax rebates from 

property to tenants [263]. 

26 May 

(announced) 

The Fortitude Budget (worth $33 billion) extended co‐funding of wages to local 

employees by another month or up until when the firm concerned can reopen, 

extended levy waivers and rebates, provided $2 billion in cash grants to support 

businesses with rental costs, rental waivers for tenants of government 

properties. It also creates and supports close to 100 000 jobs, traineeships and 

training opportunities. In addition, financial support in terms of matching private 

investments and pay‐outs was extended to encourage entrepreneurship 

activities and efforts to digitalize food services/retail sectors [264]. 

Cross‐border collaboration and movement of goods 

Since the start of the pandemic, the Ministry of Trade and Industry (MTI) issued three 

announcements on commitments with other countries to secure supply chains and facilitate cross‐

border movement amid the COVID‐19 pandemic. The countries included the Asia‐Pacific Economic 

Cooperation (APEC) nations, Lao People’s Democratic Republic, Myanmar, Nauru, the United Arab 

Emirates (UAE), Uruguay and the United Kingdom (UK) [265‐267]. Commitments include ensuring 

that trade lines remain open to facilitate the flow of goods, and refrainment of export 

controls/tariffs/non‐tariff barriers. Commitments with some countries include agreement to 

facilitate the resumption of essential cross‐border travel while balancing public health 

considerations, investment protection, and development of digital trade and business.   

During the Malaysian border lockdown, the government worked with companies and provided 

subsides on the arrangement of accommodation to Malaysian workers who used to commute daily 

by land to and from Johor to Singapore. An in‐principle agreement was worked out with Malaysia on 

the continuation of smooth transport of necessities such as food across both countries’ land 

checkpoints. These helped to prevent disruption to essential services and supplies in Singapore 

while safeguarding the livelihoods of Malaysian workers [268, 269]. 

To manage and anticipate any disruption to supply lines for essential goods, the MTI integrated 

public and private sector trade data, such as bill of lading data, on a central platform. This enhanced 

surveillance capability and enabled a sharper strategic response in the event of supply chain 

disruptions [270]. 

To bolster Singapore’s resilience to potential supply chain disruptions and resource constraints, 

there has been increased focus on producing essential supplies locally. These can support both local 

consumption and export needs. Such supplies include medical supplies (see page 26) and food. 

Singapore has set a goal of producing 30% of nutritional needs locally by 2030, up from less than 

10% just prior to the onset of COVID‐19, to strengthen the resilience of the agri‐food sector to food 

supply disruptions [151].  

As an increasing share of global trade takes place digitally, Singapore has also formalized digital 

trade rules and collaborations with different countries through digital economy agreements. For 

example, the Singapore–Australia Digital Economy Agreement facilitates cross‐border transfer of 

data from data storage centres by businesses. This also enables cross‐compatible e‐payment 

frameworks [270, 271]. 

54

7 Update as of July 2021 

7.1 Situation overview 

The Singapore government continues to monitor the local and global COVID‐19 situation closely and 

has been taking swift pre‐emptive and proactive measures in response to the constantly evolving 

situation. Singapore has adopted the approach of focusing on the health and wellbeing of citizens, 

while cautiously re‐opening the economy. Since the start of 2021, the COVID‐19 situation in 

Singapore has been most notably characterized by the emergence of variant strains from other 

countries and the rollout of a robust national vaccination program.  

The DORSCON level continues to remain at orange and will do so until the global situation improves 

[275]. As of 25 July 2021, Singapore had a total of 64,142 COVID‐19 cases; of which, 1,537 were 

active cases and 62,605 cases were discharged [276]. Of the 1,537 active cases, 522 patients were 

stable in hospitals, 1,013 patients were in community care facilities (houses patients who are 

clinically well but still test positive for COVID‐19), and 2 patients were in critical conditions in the 

ICU. Singapore has reported 37 deaths related to COVID‐19 complications in total, and currently has 

the lowest case fatality rate in the world at 0.06% [277]. 

Since the start of 2021, cases among migrant workers and dormitory residents have been negligible, 

while the majority of cases in Singapore have been imported and placed on quarantine. The COVID‐

19 condition stabilized in early 2021 and for a while, there was no new local transmission; however, 

community cases started to rise in April potentially due to the introduction of COVID‐19 variants 

from other countries [278]. Tackling unlinked and asymptomatic cases in the community has been 

an additional challenge recently. See Fig. 12. 

Fig. 32: Epidemic curve of COVID‐19 outbreak by press release date (Data updated as of 19 July 

2021) 

Source: https://www.moh.gov.sg/docs/librariesprovider5/local‐situation‐

report/ceg_20210719_daily_report_on_covid‐19_cabinet.pdf 

55

7.2 Policy and decision making 

At the outset of the pandemic, the government set up a Multi‐Ministry Taskforce to oversee the 

national response to COVID‐19. On 23 April 2021, the Prime Minister announced that reshuffling of 

the cabinet would take effect from 15 May 2021 so that cabinet members could gain new 

experience and exposure by handling different portfolios [279]. Most notably, Minister Ong Ye Kung 

moved from the Transport Ministry to take over as Minister for Health. Minister Gan Kim Yong, who 

had been the Health Minister for almost a decade, moved to the Ministry of Trade and Industry. 

Minister Lawrence Wong shifted from the Minister of Education to the Minister for Finance. 

Minister Ong joined Minister Gan and Minister Lawrence as co‐chair of the Multi‐Ministry Taskforce, 

and they have collaboratively defined the government’s pandemic response since then.  

After approximately 18 months of tackling the pandemic, the Singapore government is now 

developing its transitional roadmap to the post COVID‐19 era. On one hand, there is an inherent 

desire to re‐open borders and the economy. The island‐nation thrives on trade and cannot afford to 

remain closed for long like more domestic‐focused economies. In addition, Singapore is recognized 

as an attractive tourist and business hub but risks eroding its competitiveness as other economies, 

such as Hong Kong SAR and the US, start to open sooner. However, on the other hand, the 

government is concerned that any relaxation of rules will compromise the hard‐won success against 

the virus. The emergence of variant strains, such as the delta strain, and the close proximity to and 

frequent business done with India and other ASEAN countries, which have or are experiencing 

record‐breaking upsurges in COVID‐19 cases, are factors of concern. Re‐opening prematurely could 

lead to another wave, further pressure on healthcare systems, and waning confidence in the ruling 

political party. Therefore, Singapore is in a stalemate situation where re‐opening the economy is an 

existential dilemma [280]. On the ground, individuals and businesses are getting fatigued with the 

unpredictably changing regulations and demand more clarity on the future.  

In response to these sentiments, the Prime Minister delivered a national address on 31 May 2021 

followed by a ministerial commentary from the 3 co‐chairs of the Multi‐Ministry Taskforce on 24 

June 2021 which collectively laid out a broad plan for Singapore’s COVID‐19 roadmap [281, 282]. The 

government intends to transit into a “new normal” where COVID‐19 will shift from being pandemic 

to endemic. Endemic COVID‐19 means the pandemic will transform into something less threatening, 

such as influenza, chickenpox, or dengue, which means borders can progressively open but small 

outbreaks of the disease will occur from time to time. In this “new normal”, Singaporeans will need 

to adapt to live with the virus which will be kept under control through testing, contact tracing and 

vaccinating but the battle may continue to be fraught with uncertainty as the virus mutates. The 

majority will recover if infected and can carry on with daily activities as long as they take general 

hygienic precautions but a minority may become severely ill. Singapore's priority is to get through 

this pandemic and position itself strongly for the future, even as the virus continues to evolve. 

The “new normal” will be enabled by three key initiatives: more and faster vaccinating, testing and 

contact tracing. Endemic COVID‐19 is envisioned to include: 

Allowing infected people to recover at home without the need to be admitted to community 

care facilities or hospitals, as done with the common cold 

56

Transitioning from massive contact tracing and quarantining of people to instead allowing 

people to test regularly and self‐isolate as needed 

Shifting focus away from measuring daily case totals to the number of people that are very 

sick or in the ICU, like Singapore’s flu monitoring system 

Progressively easing safe management rules (including resuming major events) and 

increasing certainty for businesses  

Resuming travel to countries that have controlled the virus and turned it into an endemic 

norm 

7.3 Re‐opening in phases 

Singapore’s eventual goal is to live in a world where COVID‐19 is endemic. Currently, the country is 

still transitioning from pandemic to endemic COVID‐19 and as a result, the physical distancing 

measures put in place in the last few months are a reflection of this progressive shift. The 

unpredictable COVID‐19 situation locally has prompted government policies and responses that 

constantly adapt, giving rise to re‐opening the country in phases (see Table 10). After the island wide 

Circuit Breaker lockdown in April 2020, the Multi‐Ministry Taskforce implemented a three‐phased 

approach to resume activities safely [283]. Phase 1 started on 2 June 2020, Phase 2 started on 19 

June 2020, and Phase 3 lasted from 28 December 2020 to 7 May 2021. However, the country 

reverted to Phase 2 (heightened alert) between 8 May and 13 June 2021 due to the spike in 

community cases in April. This was followed by Phase 3 (heightened alert) which is expected to last 

until the end of 2021 as Singapore gets closer to its goal of a “new normal”. The defence capabilities 

built over the past year in terms of testing, contact tracing and vaccinating have enabled Singapore 

to re‐open in phases without the need for another Circuit Breaker [284].  

Table 10: Timeline of physical distancing measures 

Date  Rationale  Physical distancing measures 

From 8 

May 2021 

 

Phase 2 (heightened alert) 

implemented due to increase 

in community cases and 

outbreak of clusters emerging 

after long periods of very few 

cases, potentially driven by 

variants of the virus  

Prime Minister emphasized 

that Singapore should not 

“celebrate too early, relax too 

fast, let the guard down and 

cause another wave to come” 

[285] 

Social gatherings – Allowed to comprise up to 5 

people. Households could also receive up to 5 

visitors per day.  

Workplace, museums, public libraries – 

Operating capacity reduced to 50%. 

Gyms and fitness studios – Indoor studios 

closed as they are virus transmission hotspots. 

Outdoor classes capped at 30 people. 

Congregational services, funerals, cinemas, 

marriage solemnizations, wedding receptions, 

live performances – Operating capacity reduced 

and pre‐event testing (PET) made mandatory. 

[286, 287] 

57

16 May 

2021 – 13 

June 2021 

Phase 2 (heightened alert) 

extended with tighter 

measures due to growing 

clusters at Changi Airport, 

Tan Tock Seng Hospital, and 

several institutes of 

education [288] 

Social gatherings – Reduced to 2 people.  

Food &Beverages – Dining at restaurants 

prohibited given that being in closed 

environments within close proximity to others 

without masks made it a risky activity. 

Personalized services – Services that required 

masks to be removed, such as facials, halted. 

Malls, public libraries, museums, attractions – 

Operating capacity reduced to 25%. 

TraceTogether‐only SafeEntry – Combined use 

of these tools reduced time of contact tracing 

from 4 to less than 1.5 days. Use of these tools 

progressively made mandatory for all 

Singaporeans to enter venues [289]. 

Masks – Singaporeans highly encouraged to 

wear masks with good filtration capabilities, 

such as surgical or double‐layered masks, to 

protect from more contagious variant strains. 

Education – Full home‐based learning at schools 

and tuition centres. Lectures capped at 50 

students in universities. [290, 291] 

From 14 

June 2021 

Phase 3 (heightened alert) 

Stage 1 implemented 

following a decline in 

community cases 

Social gatherings – Increased to groups of 5 

people. 

Malls, public libraries, museums, attractions, 

events – Operating capacity increased to 50% 

with PET [290]. 

Education ‐ In‐person tuition and enrichment 

classes resumed with enhanced safe 

management measures. [292] 

From 21 

June 2021 

Phase 3 (heightened alert) 

Stage 2 implemented  

Some physical distancing 

relaxation measures re‐

calibrated because unlinked 

cases continued to emerge in 

the community  

Mask‐off activities – Dining at restaurants and 

indoor mask‐off sports allowed to resume in 

group sizes of up to 2 people, instead of up to 5 

as previously announced. 

Testing – Fast and easy testing (FET) capacity 

ramped up for routine testing of staff in higher‐

risk activities. 

Wedding receptions – Prohibited till further 

notice. [293, 294] 

 

58

7.4 Vaccination 

Singapore has a robust vaccination policy in place, with the aim to provide vaccines to all 

Singaporeans and long‐term residents by the end of 2021. As of 18 July 2021,  2,747, 489 residents 

were fully vaccinated, while an additional 4,153,143  people received their first vaccine dose [276]. 

Singapore currently has one of the best vaccination rates in Asia. The government’s approach is to 

marry re‐opening phases with vaccination milestones: 50% of the population is expected to be 

vaccinated by the second half of July and so further opening is expected to occur from then 

onwards; similarly two‐thirds of the population is expected to be fully vaccinated by 9 August 

(Singapore’s National Day) which will also coincide with the relaxation of more rules [295].  

In December 2020, Singapore authorised the Pfizer‐BioNTech vaccine for individuals aged 16 and 

above, and this was extended to individuals aged 12 to 15 years on 18 May 2021 [296]. On 3 

February 2021, the Expert Committee on COVID‐19 Vaccination welcomed the interim authorisation 

of the Moderna COVID‐19 vaccine, for use in Singapore in individuals aged 18 years and above [297]. 

On 16 June 2021, the government announced that certain private healthcare institutions would be 

allowed to administer the Sinovac‐CoronaVac COVID‐19 vaccine [298]. This vaccine remains 

unregistered and is not authorised by the HSA for use under PSAR but is provided through the 

Special Access Route (SAR). The MoH opened up the SAR to allow for the import and supply of 

unregistered medicines to address unmet medical needs, as there has been interest to access 

alternate vaccines, mostly due to medical reasons which prevent individuals from taking the two 

authorised mRNA vaccines. In June 2021, insurers extended their coverage of hospitalisation 

resulting from COVID‐19 vaccine complications to include vaccines brought under the SAR [299].  

Singapore rolled out a progressive vaccination system, with priority for vaccination given to those at 

greater risk first, including healthcare and frontline workers as well as vulnerable groups such as the 

elderly. The vaccination policy was gradually extended to those at higher risk of exposure and with 

multiple community touch points, such as educators, delivery staff, and taxi drivers. Concurrently, 

the nation‐wide vaccination drive was first offered to more senior age groups and eventually trickled 

down to the youth, with first preference given to Singapore citizens. On 31 May 2021, the 

vaccination guidelines were updated based on the latest scientific evidence: vaccinations, which 

were previously not available to certain groups, are now offered to pregnant and breastfeeding 

women, cancer patients on active treatment, and people with Severe Cutaneous Adverse Reactions 

[300, 301]. 

Singapore’s vaccine registration and administration process is efficient. Individuals will be 

nominated by the government to be vaccinated when they are eligible or can register their interest 

to be vaccinated at vaccine.gov.sg. A SMS with a personal booking link to book a vaccination 

appointment on the National Appointment System will then be sent to invite eligible individuals. 

Singapore has transformed many public spaces, such as community centres and halls, into 

vaccination centres. Upon arrival at a vaccine centre, individuals are screened and briefed, receive 

their vaccine, and then are monitored for side‐effects for 30 minutes [302].  

Singapore’s top priority in its race against COVID‐19 is to speed up vaccinations. The government 

highly encourages vaccination because it reduces the probability of getting the virus and even if 

infected, symptoms are mild. To encourage vaccination specifically among the elderly, vaccination 

59

centres began to accept walk‐ins, without the need for prior registration, for individuals aged 60 and 

above from 31 May 2021 [303]. To facilitate the vaccination of people confined to their homes,  who 

are unable to travel to a vaccination site, MoH has worked with the Health Promotion Board and the 

Agency for Integrated Care to deploy home vaccination teams, comprising a doctor and a nurse, to 

vaccinate these people at their homes [304]. In addition, to provide vaccines to more people, the 

Multi‐Ministry Taskforce announced on 18 May 2021 that it will be prioritising first doses of the 

vaccines and extending the interval between the first and second doses from 3 or 4 weeks, to 6 to 8 

weeks, as other stocks of vaccines fly in by mid‐June [305]. This approach would quickly provide the 

maximum number of people with good protection, instead of a good number of people with 

maximum protection. On 26 June 2021, the Health Minister announced that the vaccination 

program will be ramped up from administering 47,000 doses daily to 80,000 doses daily as the 

delivery of vaccine supplies were brought forward. From 2 July 2021, the vaccine program was 

extended to the rest of the population [306] with the interval between doses being reduced back to 

4 weeks to speed up vaccination coverage. The government provides resources online with factual 

data and frequently asked questions about vaccines and updated policies, so that Singaporeans can 

make well‐informed decisions about their vaccinations and health. See Fig. 13 for Singapore’s 

vaccination journey. 

To realize its vision of an endemic COVID‐19 era, Singapore is taking inspiration from Israel which 

has achieved a high vaccination rate and has brought the clinical outcomes of COVID‐19 close to that 

of a seasonal flu. The government predicts that a minimum vaccination coverage of 70‐80% is 

required, ideally with higher vaccination rates among the elderly and the vulnerable, to reach herd 

immunity and further open the country’s borders [307]. The government is being very cautious and 

does not want to prematurely open the economy as it could result in overwhelming healthcare 

systems and higher mortality among vulnerable groups. In the future, booster shots may be 

required to defend against new mutant strains, vaccinated individuals may enjoy more relaxed 

regulations than unvaccinated individuals, and health and urban policies may be reformed to include 

measures such as vaccine passports as the country transitions to its “new normal” [308]. 

60

Fig. 43: Singapore’s vaccination journey 

 Source: By authors based on information from Strait Times: https://www.straitstimes.com/singapore/tweaks‐

to‐health‐and‐urban‐policies‐needed‐in‐new‐covid‐19‐normal‐say‐experts 

7.5 Testing and contact tracing 

In addition to vaccinations, testing and contact tracing are the other key pillars of Singapore’s 

strategy to control the infection. Singapore is continuing to enforce stringent monitoring and 

surveillance measures, such as contact tracing for identifying close contacts, instructing those who 

live with people under QO to self‐isolate, and testing people who visit COVID‐19 hotspots on same 

days as confirmed cases [309]. Positive individuals or close contacts are assessed through a 

combination of tests and clinical observations before determining the public health action to be 

taken.  As of 12 July 2021, Singapore recorded a total of 14,751,144 swabs tested [276].  

Antigen rapid test (ART) 

From May 2021 onwards, the government increased surveillance testing using ARTs. ARTs are meant 

to complement existing testing regimes, such as RT‐PCR testing, because they are cheaper, faster, 

and more convenient to administer even though they are less sensitive. This allows for expanding 

the scale of testing. As a result, ARTs were deployed for regular testing of workers in dorms, 

construction sites, airports, marine shipyards, student hostels, workplaces, elderly home care 

Sinovac vaccine is offered in 24 private centres

16 Jun

Private clinics can offer Sinovac

18 Jun

53% of population have had at least 1 dose of COVID-19

i

23 Jun

2/3 of residents to be fully vaccinated

9 Aug 2021

MoH allows access to all WHO approved vaccines

31 May

Students can sign up for vaccination

1 Jun 2021

Sinovac’s COVID-19 vaccine is

approved for

2 Jun 2021

Vaccination expanded to include residents over 45 years of age

June 2021

Vaccination expanded to include 12-39 years

old Singaporeans

11 Jun

1st shipment of Sinovac vaccine

prior to HAS authorization

23 Feb

Moderna vaccination started. Financial

assistance plan for vaccine i j ll d t

17 Mar

Vaccination expanded to include over

45’s

24 Mar

Pfizer vaccine approved for

12-18 year olds

18 May

Vaccination expanded to 40-44. The interval between 1st & 2nd dose is increased to 6-8

k

19 May

1st batch of Pfizer vaccine

arrives

21 Dec

1st person (a senior nurse)

i t d

30 Dec

Senior citizen vaccination

commences in 2 localities

27 Jan

Nationwide vaccination for over 70’s starts

22 Feb

Arrival of first

Moderna

17 Feb

61

centres, and selected malls [310]. On 10 June 2021, the HSA encouraged companies to provide 

clinical and efficacy data of their ARTs in order to attain approval under PSAR, in an attempt to 

rollout more ART self‐test kits and expand their usage [311]. From 16 June 2021 onwards, four types 

of ART self‐test kits gained HSA approval and were available in retail pharmacies. Individuals who do 

not have ARI symptoms but are concerned they may have COVID‐19 can procure a self‐test kit over 

the counter, and if positive, should immediately approach a SASH PHPC to get a confirmatory PCR 

test. They are then required to self‐isolate until they receive a negative PCR test result. Individuals 

who have ARI symptoms are instructed to visit a doctor for a full diagnosis and get a PCR test instead 

of relying on an ART self‐test kit. 

Fast and easy test (FET) 

From June 2021 onwards, there has also been a phased roll out of regular FETs, which include ARTs, 

for staff involved in higher‐risk activities. From mid‐July 2021, staff who work at settings with 

unmasked clients, such as restaurants, personal care services like facial services, gyms, and fitness 

studios, will be required to start a 14‐day FET regimen [312]. To support this, the government is 

launching training programs for employers and employees on the supervision and administration of 

self‐swabs. The government has also made provisions through the setup of Quick Test Centres for 

small businesses that are unable to organize supervised self‐swabs on their own.  

Research & development 

The local R&D players, including A*STAR and the National University Health System, are working 

together to boost the national capacity for larger‐scale COVID‐19 testing and are exploring other 

testing possibilities such as saliva tests, sniffer dogs and wastewater surveillance [313].  In addition, 

A*STAR and the Singapore government are exploring partnerships with other ASEAN countries to 

ramp up regional preparedness [314]. The Temasek Foundation is also actively supporting national 

preparedness efforts; for instance, by providing a free oximeter to all households in Singapore to 

allow residents to monitor their blood oxygen regularly [315]. Furthermore, local universities and 

start‐ups have collaborated to develop breathalyzers (see Fig.14). In particular, there are 2 players in 

the field: Silver Factory Technology is a spin off from Nanyang Technological University and 

Breathonix is a start‐up from the National University of Singapore [316, 317]. Breathalyzers provide 

immediate results and have been deployed in Changi Airport and at other borders.  

 

62

Fig. 54: Working of breathalysers developed by Silver Factory Technology 

 

Source: https://www.straitstimes.com/singapore/health/how‐singapore‐made‐covid‐19‐breathalyser‐works 

Testing and contact tracing in the “new normal” 

As the delta variant continues to circulate, the government is adopting an aggressive ring‐fencing 

strategy to minimize the risk of large clusters forming by casting a wide net to isolate contacts of 

infected people and testing extensively especially at borders. The approach to testing and contact 

tracing will shift from being reactive to proactive. Instead of only testing when a new case appears, 

routine and regular testing will also occur in normal settings, such as at workplaces, events, and 

social gatherings. This will eventually enable overseas trips and large‐scale events to take place in 

the future. Therefore, routine, large‐scale, fast, and simple testing will be part of Singapore’s “new 

normal”. 

7.6 Border controls 

Singapore actively monitors the global situation before deciding upon border controls and travel 

restrictions. As of end‐June 2021, travel restrictions differ based on the traveler’s nationality and 

travel history. Singaporean citizens and permanent residents may return to Singapore from any 

country but will have to follow certain health measures upon entry depending on where they come 

63

from. Long‐term pass holders and immediate relatives of citizens/permanent residents, except for 

those from Bangladesh, India, Nepal, Pakistan, and Sri Lanka due to the upsurge in cases in these 

countries, can apply for entry approval to enter Singapore. Short‐term business visitors and short‐

term travelers from Australia (excluding Victoria State), Brunei, Mainland China (excluding 

Guangdong province) and New Zealand can enter via the Air Travel Pass travel lane. In addition, the 

RGL is open to travelers from certain provinces in Mainland China but travelers have to follow 

controlled itineraries within Singapore as part of this travel lane. Finally, travelers from all countries 

may enter Singapore on a short‐term basis to attend to a family crisis, such as death or critical illness 

of a family member in Singapore [318, 319].  

Singapore primarily opens borders only to countries that have kept the pandemic under control 

through the use of RGLs and travel bubbles. For example, in late 2020, Singapore and Hong Kong 

reached an agreement to establish a travel bubble between the countries in which travelers would 

face no restrictions. However, due to the constantly evolving situation in both countries, the bubble 

has been deferred until further notice [320]. The country constantly tweaks border controls based 

on the evolving situation, but the eventual goal is to open up more based on the country’s 

vaccination, testing and contact tracing capabilities. The Prime Minister hopes doors can start to 

open by the end of 2021 or early 2022. In the “new normal”, individuals may not be able to 

spontaneously make travel plans but will have to carefully plan for it and provide vaccination 

documentation if they wish to travel. 

7.7 Economy 

In 2020, Singapore faced one of its worst recessions with the economy shrinking by approximately 

5.4%. However, the Monetary Authority of Singapore projects that the economy will expand by 6% 

or more by the end of 2021. Employment figures have inched up and the unemployment rate is 

falling; however, the recovery is disparate across sectors. For instance, strong growth is expected for 

the manufacturing sector which is experiencing rising global demand while prospects for sectors like 

the aviation industry are deteriorating [321].  

The tourism industry has also been hit. Several local and global events were cancelled in Singapore 

due to the pandemic. For example, the World Economic Forum was scheduled to happen in 

Singapore from 25 to 28 May 2021, instead of its traditional home in Switzerland which was battling 

a rise in cases, but the event was eventually cancelled with the World Economic Forum citing global 

uncertainties due to the pandemic [322]. In addition, the Formula 1 Singapore Grand Prix was 

cancelled for the second year in a row [323] and the Football Association of Singapore announced 

cancellation of the 2021 Singapore Cup [324].  

Singapore has continued to provide several schemes and economic support to various industries to 

strengthen them. Business support includes eased terms for loan repayments for high growth 

enterprises, skill‐based training workshops for leaders from mature enterprises, and co‐investments 

from the government and Temasek Foundation for strengthening large local companies. For 

households and families, the government provides various types of vouchers and additional support 

to the elderly, low income families, and children with special needs [325]. For workers and job 

seekers, the COVID‐19 recovery grant financially supports workers who lost their jobs due to the 

pandemic and are facing income difficulties. In addition, the government has extended the Jobs 

64

Support Scheme for individuals until mid‐July 2021 due to the continued tightened safe 

management measures in place during Phase 3 (heightened alert). To provide targeted support to 

hawkers who are self‐employed, the government also extended the subsidies for fees for table‐

cleaning and centralised dishwashing services as well as rental waivers till mid‐July 2021. The COVID‐

19 Driver Relief Fund was also extended for taxi and private hire car drivers with financial stipends 

for a few more months [326].  

7.8 Pandemic preparedness for the future 

Singapore prides itself on efficiency and strong leadership. The government is forward‐looking with 

the priority to not only rise out of this pandemic in the present but to also plan for the future. Local 

ministers believe lessons learnt from the COVID‐19 pandemic should be leveraged on to build future 

preparedness and resilience. In particular, three key lessons have been highlighted by the 

government so far.  

The first key insight is that countries cannot afford to slacken their pandemic responses and 

prematurely relax rules. Infectious diseases can be challengingly unpredictable since microorganisms 

can mutate. As a result, each time a country thought it had the COVID‐19 situation under control, 

the virus reappeared in a new direction. In Singapore’s case, it reappeared as a variant strain or in a 

new avenue, such as at migrant worker dorms or institutes of education. To combat this, 

Singapore’s approach has been to survey the constantly evolving COVID‐19 situation very closely 

and to tweak its safe management measures in response to this, enabling a very cautious re‐opening 

[327].  

The second incontrovertible fact is that preparedness and prior experience helps. In Singapore’s 

case, dealing with SARS in 2003 helped prime the country’s healthcare systems and collective 

response during pandemics. The cost of investing upstream to prevent a pandemic is miniscule 

compared to the cost of failing to invest. Strengthening health systems and implementing an 

effective surveillance and alert system are key defences to prevent pandemics. As a result, 

Singapore is investing in new capabilities, such as digitalisation efforts and R&D investments. An 

Emerging Stronger Taskforce was also set up to chart Singapore’s economic recovery post COVID‐19 

[328]. Additionally, the government announced plans for an after‐action review to analyse the 

government’s response to COVID‐19, acknowledge shortcomings and successes, and learn valuable 

lessons to improve future pandemic responsiveness [329]. The Prime Minister acknowledged that 

COVID‐19 is not the worst pandemic to come and pandemic preparedness should be sustained 

during peace time to allay fears during pandemics. 

The third lesson is about the importance of international cooperation. As countries scrambled for 

personal protective equipment and vaccine doses, global supply chains and manufacturing capacity 

became vital. The Singapore government believes that beyond individual efforts, regional and 

international partnerships are required to fuel international scientific cooperation and initiatives like 

COVAX. The fates of countries are intertwined and only a concerted global effort can overcome 

pandemics. Hence on 21 May 2021, Singapore’s ministers attended the Global Health Summit where 

they supported the Rome Declaration of principles to strengthen global health infrastructure and 

collective resilience through multilateral collaborations [330]. 

   

65

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