VZCZCXRO8664
RR RUEHAST RUEHCHI RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHGP #0603/01 1761025
ZNR UUUUU ZZH
R 251025Z JUN 09
FM AMEMBASSY SINGAPORE
TO RUEHC/SECSTATE WASHDC 6875
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUSICWP/COMLOG WESTPAC
RUEAUSA/DEPT OF HHS WASHDC
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RHMCSUU/FAA NATIONAL HQ WASHINGTON DC

UNCLAS SECTION 01 OF 02 SINGAPORE 000603 
 
SENSITIVE 
SIPDIS 
 
STATE FOR OES/IHB 
DHHS FOR OGHA 
EAP/MTS - MCOPPOLA 
BANGKOK FOR REO HOWARD 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU EAGR CASC ETRD ECON SN
 
SUBJECT: SINGAPORE: 220 H1N1 CASES; SLOW MOVE TO MITIGATION STRATEGY 
 
REF:  SINGAPORE 581 
 
¶1. (SBU) SUMMARY:  Singapore health officials have confirmed 220 
cases of H1N1 influenza as of June 24, including numerous cases of 
local transmission.  With community spread of the virus confirmed, 
the Ministry of Health (MOH) announced June 22 that Singapore would 
begin the transition from a containment policy to a mitigation 
strategy.  The Ministry outlined seven areas on which to focus its 
efforts in the new mitigation phase.  However, actions and policies 
being instituted by MOH, the Ministry of Education, local schools 
and private companies appear to contradict MOH's stated policy.  MOH 
has yet to lift travel advisories for "affected" areas, including 
the United States, and has quarantined American citizens, whether 
infected or not.  New emphasis on community efforts to control the 
spread of the disease and strongly worded public calls for social 
responsibility could lead to some misinterpretations of policy and 
make the mitigation phase more onerous than containment if not 
handled correctly.  End Summary. 
 
Singapore Moving to Mitigation Phase 
------------------------------------ 
 
¶2.  (U) There have been 220 cases of H1N1 influenza confirmed in 
Singapore as of June 24.  Growing evidence of community spread of 
the virus from June 18-21 (reftel) led the Ministry of Health (MOH) 
to announce on June 22 that Singapore would begin the transition 
from a containment policy geared toward controlling the spread of 
the H1N1 influenza virus to a mitigation strategy aimed at 
minimizing the effects of the virus outbreak.  Singapore will not 
increase its alert level.  In a June 22 press statement Health 
Minister KHAW Boon Wan praised the success of Singapore's 
containment measures, noting that they managed to keep community 
spread of the virus at bay for seven weeks.  He mentioned that in 
that period the GOS successfully tracked down 1,000 known close 
contacts of confirmed H1N1 cases and "put every one in quarantine." 
 
¶3.  (SBU) Khaw acknowledged that Singapore would not be able to 
maintain such containment measures indefinitely, particularly as 
local transmission of H1N1 increases.  He therefore outlined seven 
areas where MOH would focus its efforts under the new mitigation 
strategy.  MOH will now:  1) adopt a more focused and scaled-down 
approach to contact tracing that will consider the need for contact 
tracing on a case-by-case basis; 2) step up laboratory capabilities 
to test for H1N1; 3) ensure that all public hospitals have the 
ability to treat H1N1 cases, not only Tan Tock Seng Hospital where 
all suspected H1N1 cases are currently sent; 4) create the capacity 
to treat patients with other medical conditions that might be more 
vulnerable to H1N1; 5) prepare and identify polyclinics and a few 
hundred general practitioners to act as Pandemic Preparedness 
Clinics, specially designated to treat suspect H1N1 cases; 6)secure 
H1N1 vaccines for the Singaporean public--Singapore is currently 
negotiating with H1N1 vaccine suppliers; and 7) evaluate the genome 
of the H1N1 virus, which Khaw said appears to be the same in 
Singapore as the virus in North America, contradicting a previous 
report indicating the virus was mutating significantly. 
 
Little Evidence of a Changing Approach 
-------------------------------------- 
 
¶4. (SBU) Despite Minister Khaw's outline of the new mitigation 
strategy, the GOS has taken other contradictory steps indicating 
little will change in the immediate term.  On June 23, the day after 
Khaw's press conference, MOH expanded its travel advisory list from 
13 to 15 countries, including: Argentina, Australia, Canada, Chile, 
Dominican Republic, Japan, Mexico, Panama, Philippines, Spain, 
Thailand, United Kingdom, United States of America, Indonesia and 
Hong Kong SAR, recommending that people avoid unnecessary travel to 
those areas.  Two more local resorts have been converted for use as 
quarantine quarters, increasing the number of people the GOS can 
house from 130 to 200.  The Ministry of Education (MOE) has stated 
that the new school session will begin on June 29 as planned but MOE 
will issue a seven-day leave of absence for all students and faculty 
returning from travel to affected countries, regardless whether they 
show symptoms.  According to press reports, approximately 4,500 
first-year students at a local school, Republic Polytechnic, and 
some staff have been asked to stay home for seven days after nine 
students were found to be infected with H1N1. 
 
 
SINGAPORE 00000603  002 OF 002 
 
 
¶5.  (SBU) Private companies are instituting their own measures to 
encourage or mandate that employees with recent travel to affected 
areas stay away from the office to help control the spread of the 
disease locally.  The Straits Times conducted a survey of 27 locally 
based companies, asking whether they were quarantining staff. 
According to the report, several companies indicated they were not 
making home quarantine mandatory if someone had just traveled to an 
affected area, but the firms urge employees to stay home if they are 
unwell.  However, some Singaporean companies, such as City 
Developments and United Overseas Bank, indicated they are requiring 
employees to stay home after travel to affected areas.  The 
companies require employees to use annual leave to cover the 
quarantine period if the prior travel was personal, penalizing and 
discouraging the employees from traveling to an affected area by 
choice. 
 
¶6.  (SBU) MFA consular officer Alvin Low told Embassy Conoff on June 
24 that MOH is no longer conducting contact tracing for people 
seated in proximity to an H1N1 case on a flight.  People in contact 
with a local cluster of virus transmission will be quarantined. 
However, American citizens were still recently quarantined following 
flights.  As of June 24, approximately 13 Americans were in 
quarantine, bringing the total number of those quarantined since the 
start of the H1N1 outbreak to about 57, including Americans 
quarantined at local quarantine centers, those placed under 
mandatory home quarantine, and confirmed H1N1 cases where 
individuals were admitted to the hospital. 
 
Risk of an Overzealous Community Response 
----------------------------------------- 
 
¶7.  (SBU) Minister Khaw has encouraged Singaporeans to "carry on 
with their lives normally" and said that Singaporeans will have to 
learn to coexist with H1N1, which he likened to other seasonal flu 
strains.  However, emphasis is being placed on "social duty" and the 
responsibility of all Singaporeans to do their part to control the 
incidence of H1N1 infection.  A June 24 Straits Times piece called 
on all Singaporeans to "act responsibly" by "staying away from 
school or workplace for a week if they have been to countries with 
active community spread," and added, "Lone thoughtless acts can have 
grave social consequences."  Earlier in June, significant Singapore 
press coverage was devoted to reporting on and criticizing the 
actions of a German researcher who returned to Singapore from a 
visit to the United States and continued with his daily routine 
though he was later found to have H1N1. 
 
¶8.  (SBU) Such strongly worded public calls to action and criticism 
(in the case of the German researcher) could lead to 
misinterpretations of stated MOH policy and an overly zealous 
community response to control the spread of H1N1.  There is no MOH 
guidance requiring a well employee to stay home after travel to 
affected areas, but some local companies are instituting such 
measures.  Press quoted Education Minister Ng Eng Hen that there is 
no reason to delay the start of the school year, but he warned 
parents to be prepared for periodic school and childcare center 
closings in response to H1N1, which he described as a potentially 
"long and disruptive pattern." 
 
¶9.  (SBU) CDA raised concerns regarding GOS containment measures and 
their effect on American interests in a meeting with MFA on June 18 
(reftel), noting that nuances in GOS policies and actions may be 
missed by people outside the government. 
 
SHIELDS