HONG KONG – You would have thought the number of confirmed coronavirus cases in Hong Kong should long have exceeded those in Singapore, and by far more.

After all, the city has 13 border crossings with mainland China, where the virus – officially named Covid-19 – is thought to have originated, and three remain open. Singapore, in contrast, is more than 3,500km away and has closed its borders to all new visitors from China since Feb 1.

Yet, the number of cases that have tested positive for the virus in Hong Kong surpassed that in Singapore only on Tuesday (Feb 11). Hong Kong now has 49 confirmed cases and one death, compared with Singapore’s 47 cases.

Experts point to a difference in the two cities’ standards of detection, according to the South China Morning Post.

Singapore’s relatively high number of cases could be due to its Government’s approach of actively weeding out those affected, while Hong Kong’s relatively low number may mean there could be silent carriers within the community, healthcare experts say.

Singapore may be detecting more cases because it gives citizens an incentive to come forward when they are unwell, SCMP cited Dr Leong Hoe Nam, an infectious disease expert at Mount Elizabeth Novena Hospital, as saying.

For example, the Health Ministry is providing financial help to Singaporeans, permanent residents and work pass holders who are quarantined, such as giving $100 to the self-employed and to employers of those who are in isolation. If Singaporeans are sick with the coronavirus, they could get free medical treatment, he said.

“You are not shortchanged at all so there is no reason to stay away and hide,” Dr Leong said. “Essentially, it is a get-out-of-jail-free card, and the idea is to draw every (potential) case out into the open and get tested.”

By doing so, officials hope to ring-fence local transmission clusters and have them quarantined and tested to prevent the virus from spreading further.

Singapore authorities have identified three possible clusters: a health products shop that catered primarily to Chinese tourists; a church, and a business event at Grand Hyatt Singapore, at which a Malaysian, two South Koreans and a Briton are thought to have been infected.

“We are looking very hard for cases, and the harder you look, the more cases you’ll find. The upturn (in cases) will come down later because we are actively quarantining,” said Dr Leong, adding that Singapore’s neighbouring countries are likely to have many more cases but they are not “looking hard enough”.

There have been fears that Indonesia, which has close links with China, is under-reporting cases, with officials saying that Indonesian nationals evacuated from Wuhan, the epicentre of the outbreak, would not have to be tested for the virus.

Mr Jeremy Lim, a partner at global consultancy firm Oliver Wyman’s health and life sciences practice, said more developed nations tend to have better detection and reporting of cases, more “sophisticated” contact tracing, and a wider availability of test kits.

“It is not just because the culture of transparency is stronger and motivation for learning higher, but (also because of) the resources that can be invested in tracking events,” Mr Lim said.

Singapore’s research institutes had even developed their own test kits and sent 10,000 of these to help virus-hit communities in Wuhan, he said. “More testing means more cases.”

High level of trust

Dr Leong said Singaporeans also have a high level of trust in their Government.

The emptier-than-usual streets show that citizens are heeding the authorities’ advice to avoid crowded places, he told SCMP.

Singapore’s Health Ministry advised against large social events and gatherings after it raised its outbreak alert level last Friday to orange. The alert level indicates that while the nature of the disease is severe and can spread easily from person to person, it is being contained and has not spread widely.

Following the raising of the alert level, citizens flocked to supermarkets to hoard essential supplies, which then prompted Prime Minister Lee Hsien Loong to make a national address on Saturday, stressing that the country was well-prepared to face the outbreak and had sufficient food supplies.

A measure of calm returned on Sunday, with Ms Claire Hooker, a senior lecturer at the University of Sydney’s Centre for Values, Ethics and the Law in Medicine, describing PM Lee’s speech as a good example of risk communications.

It gave people “very concrete actions” that “handed back a measure of control to people whose sense of control will feel threatened”, she told Bloomberg.

Oliver Wyman’s Mr Lim said that Singaporeans also trust that the Government will provide quality healthcare.

“If people trust that quarantine facilities are decent and that they will receive proper care, they will be more likely to come forward,” he said.

Singapore is using its universities and chalets to house its suspected cases, which initially drew flak from undergraduates who were made to evacuate within a day. The National Development Ministry said about 370 people were at government quarantine facilities, well within its capacity of 1,000 people.

Scrambling in Hong Kong

Meanwhile, in Hong Kong, the authorities are scrambling to ensure there are adequate quarantine sites, SCMP reported.

Chief Executive Carrie Lam – in the face of public anger – has also backed down from a plan to offer free treatment in the city to mainlanders and anyone else needing hospitalisation because of the coronavirus.

Thousands of medical workers went on strike in the city last week to demand a complete ban on entries from mainland China, worried that hospitals would be overwhelmed by new cases as mainland Chinese sought to use Hong Kong’s healthcare system. There have also been protests against the use of certain housing estates as potential quarantine facilities.

Hong Kong Doctors Union president Henry Yeung Chiu-fat said Hongkongers had lost trust in Mrs Lam’s administration after the anti-government protests against the now-withdrawn extradition Bill that began last June.

Various moves by the government in relation to the coronavirus have also exacerbated the situation, he said, citing the example of the city’s ongoing clamour for surgical masks.

Mrs Lam said last Saturday that the Hong Kong government was running low on masks, and that her administration was left with 12 million, or one months’ supply. Private firms have stepped in to hand out free masks to the public, drawing crowds of people desperate to protect themselves.

In contrast, the Singapore Government has been keen to assure its citizens that it has enough masks to go around; the authorities have distributed four masks for each of Singapore’s 1.3 million households.

“It goes all the way to when the people were shouting for the closing of the borders (with China) before the Chinese New Year, and the Government turned a deaf ear to them,” Dr Yeung said.

Borders remain open

Mrs Lam shut 10 of the 13 borders with mainland China on Feb 3, but only after intense pressure from the public. Singapore, on the other hand, was one of the first countries to ban the entry of foreigners arriving from mainland China.

Even now, there are deliverymen ferrying food supplies from mainland China to Hong Kong, said Dr Yeung, adding that this posed a “danger”.

Another issue was the large number of Hong Kong citizens that had until recently been crossing the border on a daily basis, either to live, work or study, Mr David Hui Shu-cheong, a respiratory medicine expert from Hong Kong’s Chinese University, told SCMP.

Though Mrs Lam’s restrictions last weekend cut down on this practice, critics said the move was too little, too late.

Among the city’s new measures to tackle the coronavirus is implementing a two-week quarantine for all travellers entering from mainland China, including Hong Kong residents.

Dr Yeung said Hong Kong’s relatively low number of infections may be because the punishment for flouting quarantine orders was “weak”.

Hong Kong officials on Monday said nine people had breached such orders so far, and two were on the run.

“The first time they give such an order, there is just a soft reminder or warning,” Dr Yeung.

In Singapore, people who flout quarantine orders can be fined up to $10,000 and jailed for up to six months.

On Sunday, Singapore’s manpower ministry revoked the work passes of four people who were caught working while they were supposed to be in isolation.

Fewer arrivals

Experts also say Hong Kong might genuinely have fewer cases.

Arrivals from mainland China have fallen sharply over the past eight months, Chinese University’s Mr Hui pointed out.

“Very few mainland Chinese tourists have come to Hong Kong for holiday because of the social unrest,” he told SCMP, referring to the anti-government protests.

Rising anti-mainland sentiments among Hong Kong protesters have occasionally spilled over into violence and vandalism of businesses seen as having links to China, prompting many would-be tourists to reconsider visiting the city.

“Thus, more mainland Chinese would (have gone) to South-east Asian countries for holiday,” Mr Hui said.

In December, mainland Chinese arrivals in Hong Kong fell more than 50 per cent year on year to about 2.4 million.

Even so, that is far more than the 300,000 mainland Chinese who visit Singapore in an average month.

Ms Ivy Teh, global managing director of The Economist Unit’s health care arm, said the slowdown in tourism from mainland China “could have reduced Hong Kong’s exposure to Chinese visitors from [the] Hubei region”.

During the same period, Singapore gained a reputation as a “safer alternative” for mainland Chinese, she said.

Even so, Ms Teh praised the Singapore government’s “extremely quick proactive actions”.

“A multi-ministerial task force was set up quickly involving health, education, transport [ministries] even before any case was confirmed,” she said. “The efforts have so far been highly coordinated, which is why we see the faster identification and ring fencing of close contacts of suspected cases.”

Ms Teh said Hong Kong hospitals had already been struggling with the winter flu season before the spread of the coronavirus, which would further stretch health-care institutions.

Dr Leong, the infectious diseases expert, said the relatively low number of infections in Hong Kong was worrying, and showed the need for more testing.

Hong Kong Doctors Union’s Dr Yeung expected cases of “silent carriers” to emerge in the city in the coming weeks.

He said Hong Kong families were sending elderly parents and children abroad because they were afraid of the coronavirus spreading, and hoped the Lam administration would completely close the borders to stem the spread.

“At this stage, Singapore and Hong Kong have the luxury of trying to control the epidemic by identifying and quarantining,” Dr Leong said.

“If we don’t do this aggressively now, once it goes out fully in public, we will have lost.”

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