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Comment by skmurphy | Hacker News Reader

Singapore offers a compelling counter example entailing enlisting voluntary cooperation, rigorous testing and contact tracing, price controls on masks. I don't think China's fundamentally totalitarian / martial law approach is the place to start. I think Singapore offers a much much better model for dealing with Wuhan Flu.

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But Singapore also backs up its "voluntary cooperation" with a big stick that they're not afraid to use: quarantine order violations including giving false/incomplete information for contact tracing can result in $10,000 fines and 6 months in jail for a first offence, plus cancelling work visas/residency permits for non-citizens:

https://www.straitstimes.com/singapore/health/100-a-day-for-...

Apparently -- and this is unconfirmed scuttlebutt -- somebody already landed in hot water for neglecting to tell the authorities about their visits to a red light district. (Which, this being Singapore, are both legal and closely regulated.)

That's very different from the martial law that was effectively imposed in China. If you don't follow the law in most countries you will subject to sanctions, it's no different in Singapore. Typhoid Mary was subjected to forcible quarantine in the US https://en.wikipedia.org/wiki/Mary_Mallon

It’s just that the sanction in Singapore are much more harsh than in the West. When I visited I noticed that fines are about 10 times higher than in Canada for the same offense. And there is no caning as well.

that's a fascinating historical case, first time I learned of it. Do we know how exactly Mary spread the disease? Was it unwashed hands or saliva or her breath? How is typhoid transmitted exactly?

She was a cook who did not wash her hands thoroughly after defecating. Salmonella typhi bacteria causes typhoid and is excreted in feces. She transferred it into cold food--e.g. salads, peach ice cream--that she prepared (cooking kills the bacteria). The doctors of the time theorized that the Salmonella typhi had colonized her gallbladder. There were many asymptomatic carriers detected at the time but few if any persisted as cooks or preparing food once they had been warned.

Seems to me like a prison sentence when this blows over is reasonable for somebody violating a quarantine order without a good excuse. It's not outside of the legal traditions of the U.S. to have strong quarantine orders, nor is it particularly authoritarian.

Singapore is a city which acted as soon as the first case popped, with aggressive tracing and testing at entry point. US punctured and smashed that bus.

What about Vietnam? Track records so far says Vietnam did/does a much better job than Singapore in Covid-19 and previous pandemics. Yes Vietnam approach is fundamentally totalitarian (suspected can still deny quarantine, but will be pressured) and the result shows: only about 40 confirmed cases over population of 95 millions so far.

Can we trust those numbers though?

the catch is, if we're really hiding, we must have got thousands of deaths by now. Just see how quickly it spread in Korea, Italy and Iran. Hiding (thus no action can be done) for 1.5 months is a sure way to suicide, given the amount of traffic in/out of Vietnam and the population density.

Or you can see that in the past week alone we got 27 cases, starting from 2 planes. And the number is low because we vigorously chased people down to test them all and quarantine them. Had we let them go loose those 2 cases alone could spread to hundreds.

Singapore is 1/10th the size and population of most countries. Scale changes everything.

Population is about 5 million. I think a key effect is to reduce their margin for error.

Vietnam population is around 95 millions, with less confirmed cases than Singapore, despite sharing border with China. Vietnam also acted immediately since first two patients (2 Chinese tourists parent and child), rigorous contact tracing and testing, price control of masks, food and other necessities.

Level of testing / surveillance is not clear. See https://www.worldometers.info/coronavirus/covid-19-testing/ They have run about 2400 test which is 24 per million in population (on a par with US which is wretched). Italy is 1,000 per million, Hong Kong is 2,000 per million, South Korea is 4,000 per million. Vietnam may be going a good job but they are not testing enough by a factor of 10 to 100 to be sure.

Vietnam is still in containment phase, so tests per million capita is not what I would look at. Rather, about 2400 tests against about 40 confirmed cases is a factor of 60 tests per confirmed cases (this should cover F1, F2). Italy on the other hand is about 60000 tests against 12000 confirmed cases, a factor of only 5. Hong Kong's number is impressive, 120. South Korea's 30.

You make a reasonable argument. In 2003-6 I helped out Viet Cervical cancer project on screening models for Pap smears to detect cervical cancer. Vietnamese incidence was high. Vietnamese public health organization was well organized and effective. Some lessons learned were published in Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries

https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2004...

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