Is nCOV the same as SARS? H1N1? Or is it something else? Depending on who one asks, and which perspective you seek, one will get different answers. The dynamic nature of a crisis is such that there are information gaps, which I will spend some time to opine on.

Medical Facts

First, let us lay some factual content.

According to the Centers for Disease Control and Prevention (CDC), nCOV has a wide variance of symptoms. Some report little or no symptoms and recover well, but a small minority of cases result in death. The novelty of nCOV also suggests the difficulty in drawing analogies to other coronaviruses such as MERS and SARS.

For nCOV, there is no known “cure” for it; symptom management is usually prescribed. These may include life support for the most serious of cases. Prevention of virus transmission is similar to other contagious illnesses such as influenza; good hygiene and self-isolation on suspicion of being a nCOV carrier.

Beyond Medical Facts

An individual often asks, “What should I do?” This is a different question from the society at large, where the questions are more macroscopic in nature. In brief, the macroscopic responses in an epidemic are based on virulence, ease of detection and lethality. These usually result in containment and mitigation strategies. With the dynamic nature of a health issue, these can change with time, often making it difficult for an individual to react accordingly. The gaps in information to the individual are a fertile ground for havoc.

Making Up Opinions in the Information Space

Facts in a crisis are incomplete. Hence, we have to rely on our opinions and judgements to make decisions. The decisions we arrive at an individual level are often determined by our differing biases. Some of these individual decisions result in effects that reverberate across communities and trigger others to do the same, hampering macroscopic efforts.

Unlike SARS (2003) and H1N1 (2009), the crisis this time is discussed about largely through social media. Anybody can create and propagate information. This leads to reinforcing loops becoming viral (pun unintended), regardless of the accuracy or use of said content. One of these reinforcing loops is the panic buying episodes we have witnessed.

Let us use the panic buying episodes (first, masks and sanitisers, and second, food and toilet paper) as illustrations. One example that could lead to panic buying is as follows:

• Concerned citizen reads an article of medical workers donning hazmat suits in a hospital.
• The first impression of a hazmat suit that comes to mind is “serious medical condition”.
• Given the interpretation of a “serious medical condition”, concerned citizen reads up on preventive methods along the lines of a hazmat suit.
• Concerned citizen heads off to buy protective personal equipment (PPE) like masks, hand sanitisers and so on.
• Concerned citizen then spreads this message to his entire Whatsapp chat group, fuelling the same cycle.

The consequence of this example is a horde of people buying all sorts of PPE without checking if said PPE is necessary. None of these actions, on their own, look incorrect in the face of a crisis at the individual level, but this results in a problem at the macroscopic level. They can further compound, such as in this list:

• Primary problem: Shortage of PPE in shops.
• Follow-up problem: Will people who need PPE have enough PPE to last a crisis of unknown time?
• Perception management issue 1: What will others think if they see empty shelves of PPE (and then fuelling the panic buying cycle all over).
• Perception management issue 2: How do we communicate with people who have been triggered to respond in “panic-buying mode”?

A medical crisis can quickly evolve into a perception management crisis because of virulent spread of information that does not aid the macroscopic response. Obviously, a mask shortage happens because people overbuy them! In a state of panic, rational communication becomes difficult. The subject of risk assessment is also difficult to communicate about, leading to gross overreactions because of an inaccurate assessment of risk level. That is odd, considering that Singapore has a risk assessment matrix in 2020.

Disease Outbreak Response System Condition (DORSCON)

After SARS in 2003, it was clear that communicating actionable information was important. DORSCON was set up to communicate preventive measures to the public in the event of a public health issue such as this.

Bite-size information in a chart like DORSCON should help in the event of panic. But why did we overreact?

One shortcoming with DORSCON is that many of us are not familiar with its contents. Most of the time, DORSCON status is green, and hence is taken for granted. In low probability events such as epidemics, we are often untrained to think under panic, unlike people who are trained to react calmly to emergencies, such as firefighters, specialist military troops and negotiators. Hence, people overreact when they think not so much of the actual DORSCON chart when the status changed from “yellow” to “orange” as it is the colour change. (Orange is only one step away from red alert! Oh dear!) However, we shall leave this to an after-action review.

Total Defence is a Useful Paradigm — Use It!

If DORSCON is the “process”, the “principle” that helps us rationalise our collective defence is Total Defence that comprises of military, psychological, civil, social, economic and digital defence. I shall confine my focus on psychological defence, which is defined as the “commitment and confidence in our future”

As a Singaporean, I value my home because there exists nowhere else that I can call myself home in. Because of that, I feel disappointed when we start spreading fake news to spread panic unwittingly. I feel anguished because I want to try to stop the reinforcing loop of panic build-up. We can do better than overly panic about our future. How can we do that? Simple ways:

• Keep calm and carry on with life: We have DORSCON to guide us. We can continue to obtain food supplies reliably, so please do not overreact and cause another crisis. Wouldn’t you feel silly if you look back at the year and bemoan that so much time was wasted “bitching about a virus”?
• Follow the health advisories. PPE is for high risk profiles such as healthcare workers. We do not know how long nCOV will last. Hence, we need to ensure we are well-equipped for the long run. We don’t want our healthcare workers to themselves get infected and become super-spreaders.
• Stay healthy. Eat well and exercise well, and upkeep personal hygiene. Soap and water is still best. No one will blame you for repeated trips to the washroom. Free walking exercise too.
• Keep the information space clean. Do not spread news that will aggravate panic. If we all claim that the government should have anticipated panic buying, we should also do our part to not be part of a panic-induced decision. No point finger-pointing when more fingers point back at ourselves.
• Look out for everyone’s psychological well-being. As the epidemic progresses, healthcare services will take a toll, and our heroes will be psychologically burdened. Keep their spirits up. They work overtime, and will receive abuse due to panic. No one wants to be abused.
• Do not try to speculate. Besides spreading even more panic, speculation only makes one look like a gossip monger. We need actionable information, not information to scare ourselves. This is not Halloween.
• Stop being xenophobic. While humans can tell apart nationalities, viruses do not care. Viruses spread regardless of race, language or religion. Nationality too.

The fight is all of ours, healthy or sick. We can triumph over this just like how we did against SARS. But it takes a whole-of-country approach to be confident in our future. I am, because we are far more prepared compared to 2003. Are you?