During the recent parliamentary debate, Prime Minister Lee Hsien Loong noted that scientists have been talking about ‘Disease X’, a highly infectious, deadly disease whose pathogen mutates easily.
“COVID-19 has been a disaster for the world, but it is not Disease X. It is not the worst new disease that can befall humankind,” said PM Lee, warning that it was only a matter of time before it happens and Singapore must build up its resilience, instincts and preparedness for when it arrives.
Vice Dean (Research), Assoc Prof Alex Cook, said that Disease X is an idea, not an actual disease, so there is some vagueness about what would count as a Disease X.
He noted that COVID-19 has some features associated with Disease X: “It is a new virus, caused a respiratory disease pandemic, and it wasn’t influenza. Its mode of transmission wasn’t known at first, nor was its symptomatology or severity profile. We still don’t know about immunity to SARS-CoV-2. It is also severe enough to cause many deaths but not too severe that it is easy to control, like SARS was.”
“All these uncertainties made it hard to know what policies to implement and when, which is why countries have been stumbling in the dark in their responses,” he added.
But Assoc Prof Cook cautioned that it would be rash to think that the next infectious disease threat will be COVID-like.
“It could be a new influenza virus, like the one that cause the 1918 pandemic, killing tens of millions of people, or something more severe, in the mould of SARS, MERS or the Nipah virus.
The worst nightmare would be a virus which has the transmissibility of influenza but the severity of SARS, like the hypothetical MEV-1 virus in the film Contagion.”
“So while COVID-19 has been a disaster for the world, with almost a million deaths, the next big one will be different — and could be worse. I think that is why the Prime Minister cautioned us not to think of COVID-19 as Disease X,” he said.
The World Health Organization introduced Disease X on its list of public health threats a few years ago to enable planning and pandemic preparedness for a worse, unknown disease threat. In this aspect, Singapore has definitely drawn valuable lessons from previous infectious disease outbreaks as well as the current pandemic.
The SARS outbreak highlighted the importance of equipping healthcare workers adequately to protect them from nosocomial infections when on the job. It also led to the setting up of a dedicated healthcare facility, the National Centre for Infectious Diseases (NCID), to look after patients with respiratory infections, as well as stockpiling essential personal protective equipment, which proved to be critical in this outbreak, said Dean, Prof Teo Yik Ying.
These have helped to keep Singapore’s COVID-19 fatalities and infection rates among healthcare workers one of the lowest in the world, added Prof Teo.
From the COVID-19 pandemic, lesson gleaned in protecting the community from a highly infectious agent include mask wearing, safe distancing, good personal hygiene, and aggressive contact tracing and ring-fencing.
“The lessons are also not solely in public health, as we have learnt a lot about the devastating economic impact that a public health crisis can have on a nation, where businesses and livelihoods are affected,” said Prof Teo.
Assoc Prof Cook added that COVID-19 also highlighted the importance of a nimble and evidence-based response, and sheds light on policies that had never been implemented before, such as the lockdown in Wuhan, China and the ‘circuit breaker’ in Singapore.
“In the years ahead, there will be a lot of research on what worked and what didn’t, though it behoves us not to over-extrapolate from the COVID-19 experience for Disease X,” he said.
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