No part of the world will be spared from coronavirus disease 2019 (COVID-19), and every part of every health system needs to adapt. Infectious diseases (ID) physicians and divisions are no longer able to perform many of their usual clinical duties, nor undertake teaching and research as they have always done. There is an urgency to innovate in order to sustainably and safely provide all these essential services while stepping up to and confronting what for many is their raison d’etre. That is the challenge of responding to an emerging infectious disease, keeping pace with the dynamic developments of a pandemic, while designing and refining a seemingly endless number of workflows and policies in partnership with hospital leadership and others beyond the hospital.
This narrative is intended as a guide for ID physicians to help that adaption and to understand the expectations and needs that evolve. The strategy in Singapore, after the initial attempt at preventing local transmission, has been to prevent as many cases as possible and flatten the epidemic curve maximally . Natural herd immunity is not a credible aim unless serological studies reveal unexpectedly high levels of asymptomatic transmission as in Iceland . The endpoint of the outbreak must be an effective antiviral treatment or a vaccine . In the meantime, lives are saved by a containment strategy with early case identification, isolation, and quarantine of close contacts, as well as having adequate hospital surge capacity to deal with spikes. This must be achieved while maintaining a high standard of care for those with COVID-19 as well ensuring our patients with non-COVID-19-related disease receive their usual care. We hope the actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other ID divisions facing the spread of COVID-19 globally .
Our colleagues in many countries may not have had the opportunity to prepare and adapt as we have in Singapore, which is a technologically advanced high-income country with a young highly mobile population. Lockdown is effective but not a permanent solution to contain the spread. Severe restriction of movements and activities will slow transmission and allow an overwhelmed health system to recover albeit slowly. Lockdown should be seen as a time to put in place the measures necessary to prevent a return to uncontrolled spread and, whether a country is early in its phase or overwhelmed, the following viewpoint may nevertheless apply.