A Tale of Two Cities
Wearing Masks in Public Should Be Mandatory-Now!
The two cities are HongKong SAR and Singapore. This is a tale of the progression of COVID-19: What happened in Singapore? What happened in Hong Kong? The tale is captured in Figure 1.
There is a drastic difference between the two: cases in Hong Kong SAR have reached a steady low plateau of 138 per million while those in Singapore keep on shooting up over 1,000 per million.
Early February this year after the coronavirus SARS-CoV-2 set foot on the two cities, both have been hailed as models in the world that have done a great job of containing the spread of COVID-19. These two are quite comparable: Hong Kong SAR has a population of 7.4 million and Singapore 5.84 million people. Both had gone through a gruesome carnage of SARS (Severe Acute Respiratory Syndrome) in 2003. So this time both their residents and their governments were psychologically ready and well prepared to deal with the situation [2]. They did everything right this time: from immediately activating a government led rapid response infrastructure, enforcing travel restrictions, closing borders and doing aggressive but targeted quarantine, to widespread free PCR testing and treatment, contact-tracing and isolation, implementing social distancing, to keeping all who test positive in hospital, to giving strong and regular communication to educate the general public on know-how’s [8][10]. On February 26, the number of confirmed cases was only 89 and 93 in Hong Kong SAR and Singapore respectively. The results were so good that people considered them as safe havens from the epidemic. They began repatriation of their students and citizens from abroad, requiring a 14 days’ quarantine upon arrival. Though resulting in a finite increase of imported cases the situation was quite manageable and limited. The inflection point at which the daily increase is constant seemed to have been reached on March 29, 2020 in both cities. Unfortunately thereafter the two cities diverged, with Hong Kong SAR coasting to a plateau on April 9, attaining 95% of its final value of 138 per million, and Singapore exploding exponentially!
The number of death in Singapore is no better. In Figure 2, the death count per one million people is plotted vs. the confirmed case count per one million people for Hong Kong SAR and Singapore.
The number of death per capita in Singapore is over 3 times that of Hong Kong SAR now. The separation between two adjacent points in this graph indicates the progression of COVID-19 in just two days.
On Saturday, April 18 there was an alarming single day increase of 942 confirmed cases in Singapore. As if all of a sudden, cases appeared spiking up in Singapore. Some attributed this spike to new clusters connected to Singapore’s vast migrant worker population, most of which resided in clamped quarters. Another possible reason was suggested that Singapore was so confident on the effectiveness of widespread testing and vigorous contact-tracing that it did not shut down schools and workplaces [3].
While these two reasons appeared as specific causes of the spike, an underlying fundamental is due to the fact that the majority of residents in Singapore no longer wore masks in public. Close examination of this graph actually shows that the change is not a single spike but a continuing exponential increase all the time. In a previous article it has been shown that, along with other established measures, wearing masks in public by the general public is highly effective on preventing the spread of COVID-19. This assertion is supported by analytically comparing regions whose residents wearing masks in public with regions whose residents not wearing masks in public. The efficacy was further explained in terms of a mathematical principle as due to a “multiplying reduction effect” [4]. This effect is the essence of why mask wearing by the general public works.
On January 30, 2020 a reporter in Singapore for Business Insider wrote “Over the past week, people living in Singapore, Shanghai, and Hong Kong claim masks have sold out at most local shops” [5]. At first residents in both cities were eager to wear masks. The two governments since then took on entirely opposite approaches.
In Hong Kong mask wearing was encouraged and surgical face masks were made available to the general public, with a government sponsored Local Mask Production Subsidy Scheme of HK$1.5 billion for the local mask manufacturers [6a] in addition to efforts by private entrepreneurs [6b].
On the other hand, in Singapore mask wearing by the general public was actively discouraged so as to give priority to the front line defenders. The authority even used a cartoon to preach “Not to mask by the general public if you are not sick” [7]. Fortunately, or unfortunately, this campaign was so successful that even inside a contact-tracing center no one wore a mask [9]. As a result, the case count curve has been suffering an exponentially increasing trend, which remained largely unnoticed until recently.
This tale of two cities conclusively demonstrates the striking difference between wearing and not wearing masks in public by the general public.
It is now well known that asymptomatic and pre-symptomatic COVID-19 carriers can be up to 25% to 50% of the confirmed patients [11]. These “silent” carriers are capable of transmitting the virus. Faced with overwhelming evidences, the US CDC has finally made a slow turn-around on Friday, April 3rd on its policy of recommending not wearing masks by the general public. The slow turn-around was featured with its voluntary nature, an Achilles’ heel in this advice.
To reverse the trend and to make it truly effective on curbing the spread of COVID-19, wearing masks in public must be mandatory for the general public and a campaign to get buy-ins from the general population should be launched, otherwise it will leave half of the population not wearing masks and thus nullify the “multiplying reduction effect” [4], the essence of its effectiveness.
Furthermore, as Federal and state leaders are anxious in contemplating plans to re-open the economy, allowing much closer human interactions, mandatory mask wearing in public must be part of the necessary pre-conditions. There are two opposite paths in front: the path that Hong Kong took and the path that Singapore took.
Which one are we going to choose?!
References
[1] https://www.worldometers.info/coronavirus/ (Its data is collected from official reports, directly from Government’s communication channels or indirectly, through local media sources when deemed reliable. Its data is trusted by UK Government, Johns Hopkins CSSE, Financial Times, The New York Times, BBC…)
[2] https://www.axios.com/sars-hong-kong-and-singapore-ready-for-covid-19-46444868-2550-4d90-ab92-a3cc90635cb4.html B Walsh, “SARS made Hong Kong and Singapore ready for coronavirus”, March 25, 2020.
[3] https://www.cnn.com/2020/04/18/asia/singapore-coronavirus-response-intl-hnk/index.html J Griffith, “Singapore had a model coronavirus response, then cases spiked. What happened?” April 19, 2020.
[4] https://medium.com/@chiupwong/wearing-masks-in-public-should-be-mandatory-now-337d8f4cdf24 C Wong, “Wearing Masks in Public Should Be Mandatory-Now”! April 15, 2020.
[5] https://www.businessinsider.com/wuhan-coronavirus-photos-people-queuing-up-face-masks-across-asia-2020-1. R G Chia, “Photos Show Hundreds of People Queuing up for Face Masks across Asia, as Coronavirus Spreads”, Jan 30, 2020.
[6a]https://www.news.gov.hk/eng/2020/03/20200327/20200327_115645_207.html “6 mask production lines approved”, March 27, 2020
[6b] https://www.reuters.com/article/us-china-health-hongkong-factory/hong-kongers-set-up-face-mask-factory-amid-coronavirus-panic-buying-idUSKBN20F0VD “Hong Kongers set up face mask factory amid coronavirus panic buying”, February 21,2020.
[7] https://theconversation.com/why-singapores-coronavirus-response-worked-and-what-we-can-all-learn-134024 YL Lin, “To Mask or Not to Mask”? March 18, 2020
[8] https://www.statnews.com/2020/03/23/singapore-teach-united-states-about-covid-19-response/ LY Hsu and M Tan “What Singapore can teach the U.S. about responding to Covid-19”, March 23, 2020.
[9] https://www.tnp.sg/news/singapore/contact-tracing-begins-mapping-out-virus-patients-movements “Contact tracing begins with mapping out virus patient’s movements”. See inset photo.
[10] https://www.nytimes.com/2020/03/17/world/asia/coronavirus-singapore-hong-kong-taiwan.html H Beech “Tracking the Coronavirus: How Crowded Asian Cities Tackled an Epidemic”, March 18, 2020
[11] https://www.sciencealert.com/here-s-what-we-know-so-far-about-those-who-can-pass-corona-without-symptoms A Woodward, “It’s Estimated 1 in 4 Coronavirus Carriers Could Be Asymptomatic. Here’s What We Know”, April 3, 2020.
