Thursday, September 29, 2005

Can NEA publish a weekly listing of cluster sites found breeding mosquitoes?

In an article in Today (29 Sept 2005 - see below), it was reported that of the 220 mosquito-breeding habitats found over the weekend, some 70% were found in public areas (like scupper drains, discarded recepticles in the open, etc.)

Over the last two weekends when intensive combing for mosquito-breeding sites was done, a total of 329 breeding sites were found. What is more worrying is that some 4,139 potential breeding sites have been found during the these two weekends (Straits Times, 29 Sept - "Shop assistant dies from dengue; third victim this month").

While the decision by the NEA to publish the weekly "Location of Active Clusters" is a step in the right direction, what is equally useful is to include another weekly listing of cluster sites found breeding mosquitoes.

Hopefully, with this new listing, residents will be more vigilant to ensure their areas are regularly maintained. Besides, it can act as a deterrent as I'm sure both residents and town councils will not want their areas to be listed too frequently?

Jeff Ho


Dengue cure's long wait
Tan Hui

ALTHOUGH dengue has been around for centuries, most health authorities only allocate resources to it when there are epidemics.
Due to this neglect, it would be some time before the world gets a vaccine for dengue, said Professor Paul Herrling, head of corporate research at Novartis International, who is in town with 300 other scientists for the second Asian Regional Dengue Research Network Meeting.
"You have to keep in mind the drug discovery or circle is more than 15 years," he said.
"So we are very much in the beginning of this process. We might have the first drug to be tested on humans after 2008. And in 2012 or 2013, we might have the first drug for patients in general."
One of the labs working on a cure is the Novartis Institute of Tropical Diseases (NITD), which was set up at the Biopolis two years ago. It aims to develop a drug that can stop the replication of the virus in the human body.
Prof Herrling said the lack of a suitable animal model for testing makes finding a solution difficult as scientists cannot ascertain the virulence of the dengue strains.
But he is confident that a cure can be found as the NITD continues researching into the basics of the dengue virus, which the world knows very little about.
Other drug companies are also working on a dengue vaccine, but Prof Herrling said it is anyone's guess if a vaccine would be available in the next six to 10 years as there are four types of dengue.
Scientists in the three-day meeting discuss strategies for vaccine and therapeutics for dengue and other diseases transmitted by mosquitoes and ticks.
Meanwhile, there were 104 cases of dengue reported between 3pm on Tuesday to 3pm yesterday, a drop from the 157 reported the previous day. There was one fatality yesterday, bringing the number of deaths from dengue this year to 12.
The National Environmental Agency yesterday reported that a total of 220 mosquito-breeding habitats were found and destroyed during its second carpet combing operation over the weekend.
This represents an average of one breeding site found for every 11 blocks of flats.
Half of the habitats were found in scupper drains, pump rooms, joss-paper burners, gully traps, manholes and telecom chamber covers.
About a third of the habitats were detected in flowerpot trays, water jars and containers found along common corridors.
Another one in five were in discarded receptacles left in the open.

Wednesday, September 28, 2005

Town Councils should terminate errant contractors for failure to clean up repeatedly

There have been many calls for tougher enforcement by NEA on errant town councils found breeding mosquitoes.

Is the fact that they have so far been exempted from penalties the reason why despite all the stepped-up efforts by households that the problem not only has not improved but has in fact got worse? Without being subjected to penalties, town councils will not act against their contractors.

Shouldn't town councils terminate their cleaning contracts if they are found to be grossly and recalcitrantly inefficient? Are yardsticks in place to measure their performance?

Town councils, being custodians of the residents' money, should award contracts to companies that can do the job best and at the most competitive price, and if the recent dengue outbreak and the subsequent clean-up efforts is any indication, then these outsourced contractors have failed miserably, even if their price may have been competitive.


Tuesday, September 27, 2005

Letter from ex-ENV (predecessor of NEA) health inspector dated 27 Sept calling for NEA to fine town councils that breed mosquitoes

Extract from Straits Times online forum, 27 Sept 2005: (link,5562,343287,00.html )

Sept 27, 2005

Yes, fine town councils that breed mosquitoes

I AGREE with Health Correspondent Salma Khalik ('Fine way to get town councils to clean up act'; ST, Sept 22) that 'town councils should be fined like any other property owner found breeding mosquitoes'.

I should know how effective this can be. From 1961 to 2001 I was a public health inspector with the then Ministry of the Environment.

Thirty-five years ago, when the late Mr Tan Teck Kim, then Commissioner of Police, was seconded by Minister Mentor Lee Kuan Yew to my ministry to clean up Singapore, I had his support to even serve notice on any government department whose properties were found to be breeding mosquitoes.

On one occasion I found mosquitoes breeding in a neglected part of a government school overgrown with thick vegetation. I served a notice on the then Permanent Secretary of the Ministry of Education at Kay Siang Road.

His secretary asked what my ministry would do if they did not comply with the notice to clear the thick vegetation and remove all discarded articles.

I told her the due process of the law would be applied against her ministry. Within a week, when I checked the site again I found that all vegetation and discarded containers had been cleared.
I was told later that the Education Ministry mobilised more than 20 school servants to do the clearing. News spread far and wide and I had no more problems with schools after that.
The National Environment Agency should take a leaf from my book.

Raymond Lo Wan Mou

Monday, September 26, 2005

Today (26 Sept 2005) - Letter questioning NEA's "selective" enforcement policy in exempting Town Councils from being fined

The following letter questioning NEA's "selective" enforcement policy in exempting Town Councils from being fined when their areas are found breeding mosquitoes was published in the Today newspaper, 26 Sept 2005:

'Selective' enforcement?

Deterrent penalties should apply to town councils and other government agencies

Letter from Jeffrey Ho Loon Poh

.JUST like Danny Chua ("Fine the town councils as well", Sept 21), I note with concern that town councils are exempted from fines should areas under their care be found to be breeding mosquitoes.

.This may explain why there is widespread breeding of mosquitoes in many of the public areas (drains, scupper drains, et cetera). National Environment Agency (NEA) chief Lee Yuen Hee was even quoted in The Straits Times as saying that town councils "are not fined for breeding mosquitoes and the agency has no plans to change that".

.While the NEA keeps harping on the fact that mosquito breeding mainly occurs inside homes, the recent anti-dengue efforts found that equally numerous, if not more, breeding places are in the public domain — many of which are under the respective town councils' responsibility.

.How then can we hope to succeed in our fight when the law is not equally applied to deter such irresponsible behaviour, when private residences or construction sites face hefty fines if found breeding mosquitoes, while areas under the town councils (and presumably other government agencies, too, such as state land under the Singapore Land Authority or Public Utilities Board premises) are exempt?

.And at the national level, what is of more concern is: What if all the other agencies with enforcement powers (such as the Building and Construction Authority, Health Sciences Authority and the Infocomm Development Authority of Singapore et cetera) practise "selective" enforcement when it comes to their fellow government-linked entities?

Kenny Lim's feedback on "Fine way to get town councils to clean up act"

Sent by Contributor, Kenny Lim:

Subject: Feedback on Fine way to get town councils to clean up act


Hi! Salma Khalik,

I fully agreed with your write up. I am trying very hard to get my Town Council and NEA and PUB to be more responsible and efficient in carrying out their duty.

Without policing, they are just as irresponsible as some members of the public. We can't rely on them confidantly.

Have our Government forgotten our sacred PLEDGE to build a democratic society based on justice and equality so as to achieve happiness? Why double standards being practice in giving out fine to offenders?

As a responsible citizen, since May I am giving feedback to clean up my neighbourhood. In the process of getting my neighbourhood clean up my wife was infected with dengue fever. She was hospitalised in 6th September and discharged on 14th September. Her platetelets went down to 3 and almost died. She is now on one month medication and need a lot of rest.

In view of the Dengue Fever Fiasco, I have contacted your counterpart in Straitstimes,Wanbao and Zhaobao to report on the clogged drains and mosquito breeding ground but was told that the Editor are not interested in these kind of news. Eventually Channelnewsasia reported it on 10pm news last night. What a shame to SPH! Since May I have been giving feedback to my Town Council on clogged up manholes and potential breeding ground.Yet in August, the common drain was found to be breeding mosquito.(see pictures on manholes)

Below is NEA reply to my feedback.

"2.Thank you for your feedback. Our records show that our field officers had found mosquito breeding in the drain next to Block 671A Klang Lane on 18 Aug 05.The breeding habitats were eliminated and the Town Council was alerted to clear the drains and spruce up the area."

Since August 19, I have also persistently wrote to National Enviroment Agency on drains that are badly clogged up and are breeding mosquito. I even collected laarvae sample and gave to NEA staff. Nothing was done.(Pictures attached)

The dengue hotline is also a joke. Refer letter attached.

In the process PUB also gave a false report to NEA for the work that they have not carry out properly. See extract of NEA letter to PUB as follows:

"We inspected the closed drain at Rotan Lane.

Contrary to your claim below, we discovered that the stone and the plank have not been cleared and stagnation of water was observed. The turbidity of water in the drain was black and murky and indicate that no flushing had been done. We also found out that the plank is actually a part of the formwork used for the construction of the covered drain. Apparently, the contractor who constructed the drain had failed to remove the formwork."

Sunday, September 25, 2005

Why is law not equally applied to Town Councils and government agencies when their areas are found breeding mosquitoes?

To: Feedback Unit - MCYS

cc: Dr Yaacob Ibrahim - Minister for the Environment and Water Resources

Extract of letter published in Straits Times online forum, 23 Sept 2005 by Mr Henry C W Suriya (in Red below or visit link,,5562,342368,00.html )
listing problem areas in Singapore's fight against dengue and suggested improvements.

However, one big area seems to have been "glossed over": Town Councils.

Why is there double standard in law enforcement - NEA fines households and construction sites who breed mosquitoes but not areas under Town Councils' management (and other government agencies)? If this anomaly is not addressed, Singapore will never be able to control the breeding of mosquitoes because town councils (who are responsible for a big chunk of the public areas in Singapore) and other government agencies can get away scot-free without punishment when found breeding mosquitoes - NEA should apply the law equally to all, including government agencies like NParks, SLA state land, MOE's schools, PUB, town councils, etc..., not just private residents and corporations whose properties are found breeding mosquitoes.

Town Councils collect conservancy fees from residents (which are quite substantial), and such fees should be used prudently to maintain their areas.


Sept 23, 2005
Change mindsets first to lick dengue problem

The Government has expressed concern about the increase in dengue transmission but this has yet to result in efficient control programmes.
There must be a heightened awareness and full public participation in vector control and preventative efforts. This can only be achieved through constant training, health education, community and intersectoral participation.

Every school, polytechnic, university, government and statutory board must form its own dengue prevention groups.
The Dengue Prevention Volunteer Group of Aljunied-Kembangan Zone 2 (RC) was formed in November 1999. Since then, we had met obstacles created by an insipid Residents' Committee administration.
The RC has failed to realign itself to meet the changing needs of its residents. Creativity is viewed as dissent. This makes it difficult for subordinates to contribute ideas or develop plans.
Notice boards can serve as a focal point for the dissemination of information. This, when well displayed, will attract people's attention.
I wrote to the Town Council some time ago requesting one for environmental purposes, especially on dengue.
I thought the common areas under void decks were managed by the Aljunied Town Council but was I mistaken. It told me to contact the Peoples' Association, which is the controlling body. I did just that but to my disappointment, I did not get a reply.
The National Environment Agency was willing to provide us with very artistic and educational materials whenever I needed them. In fact, it has given us solid support in our efforts to spread the dengue awareness message. A great partnership is in place.
Aljunied-Kembangan Zone 2 has more than thirty notice boards, some half empty, others empty. Yet, I had to face such a dilemma. So much for cooperation and coordination!
During one of our Senior Citizens' monthly gatherings, our dengue-prevention group arranged with the NEA to give a talk on dengue awareness.
Officials from the People's Association and the Constituency Office thought it to be a value-added event. An additional $50 was approved for the RC to dispense refreshment. The turnout was more than eighty people.
This was turned down by the RC at the last minute, leaving some residents without refreshments. Even a walkabout with our advisor was aborted at short notice. No reason was given.
It is ironic that money spent for dinner after an MP's walkabout is never questioned. I hope the PA could tell the RC what exactly is the vision and mission of the Residents' Committee.
I imagine a basic ingredient of good leadership is to communicate and motivate. After all, we are just volunteers trying to promote neighbourliness, harmony and cohesiveness among the residents of our zone.
The only consolation our dengue-prevention group has is knowing that Lorong Ah Soo Zone 2 is not listed on the dengue hot spot list.
Our constant surveillance and willingness to engage residents have provided some results. We shall continue to cultivate the best network to garner people's support in making our estate clean, green and dengue-free.
To meet the challenges ahead, the following areas have to be closely monitored:
- Power stations which are locked and fenced up;
- Vacant state land: a horrendous mosquito breeding site;
- Bamboo pole-holders in HDB estates;
- Landscaping: avoid plants with large leaf axils;
- Grass cutters who blow cut grass into drains and clogging them up;
- Vacant HDB flats and private properties: house owners and housing agents must do their part to maintain them;
- Litter;
- Fogging: how competent are the pest control operators? Indiscriminate fogging by untrained personnel endangers the environment and residents.
- Insecticides: resistance in mosquito population;
- Increased movement of human population within and between countries;
- Zones within constituencies: in many instances, a street demarcates them. If one zone is napping, it causes problems for others as mosquitoes are found within 25 metres of their breeding sites.
- Everyone must be able to identify the Aedes mosquitoes, with their black and white stripes on the body and legs.
Unless there is a behavioral change at the individual, household and community levels, the dengue situation may not improve.
The maxim should be 'Detect and destroy - No mosquito, no dengue'.

Henry C W Suriya
DPVG Team Leader
Aljunied-Kembangan Zone 2

Dengue deaths in Singapore so far in 2005: TEN

Extract from Today newspaper, 23 Sept:

Dengue claims two more

DENGUE has claimed two more victims in Singapore, bringing the total death toll to 10 this year. The two, a 55-year-old woman and a 61-year-old man were patients at the Tan Tock Seng Hospital.

.While the Health Ministry declined to reveal more details, it said in a statement that the latest victims were also suffering from other health problems. The woman had diabetes and chronic renal failure and died from dengue in August.

.The male patient, on the other hand, had liver cirrhosis. He is believed to be the oldest person to die from dengue this year. The youngest was a nine-year-old boy who died early this year.

.It is understood that both died from dengue shock syndrome, the more severe form of the disease.

.Meanwhile, 136 cases of dengue were recorded between 3pm on Wednesday and 3pm on Thursday. That is up slightly from Wednesday's 131.

.The number of hospital admissions of suspected and confirmed cases also nudged up, from Wednesday's 75 to 80 yesterday. – Channel NewsAsia

Friday, September 23, 2005

Did NEA fail in its task to prevent upsurge in dengue cases?

The following extracted from letter-writer, Lim Boon Hee - Straits Times Online Forum page, 22 Sept 2005:

Sept 22, 2005
Did NEA fail in its task to prevent upsurge in dengue cases?

Between the lines of all the questions and answers in Parliament as well as media coverage of the high profile weekend 'search and destroy' mozzies and 'carpet combing' missions by ministers for breeding sites, the underlying tension of fingering who is ultimately the larger culprit in this dengue epidemic is palpable.

We are told that we have to help ourselves and not depend on the government to stop this outbreak.

We are encouraged to go and tell our neighbours if we find that they are breeding mosquitoes on their grounds.

Can we really do so without causing more Everitt Road-type of neighbourhood vendetta and catfights? Who will tolerate such intrusions in their domestic affairs?

Minister Mah Bow Tan also seems to be pretty convinced that the greater responsibility lies with Singaporeans themselves in the latest dengue scourge.

If, according to the minister, littering is the main contributing factor to mosquito breeding and dengue epidemic, why hasn't enforcement been carried out so that Singapore is not on other countries' lists of dengue hotspots?

Is this also the public's fault for littering and not a blight on the NEA's poor enforcement too?
The other contributory factors brought up include HDB perimeter drains and stagnant water areas because of design flaws. Surely the town councils and HDB must take some of the rap as well?

How can it be that we are almost always reassured that our food or our environment is safe whenever other countries get hit with some environmental hazards, but when something like dengue happens here, it is the people's fault for breeding mosquitoes or their littering rather than the failure of the relevant government bodies in tackling the problem and nipping it in the bud?

I agree that the community must cooperate in fighting dengue but shouldn't we also scrutinise the NEA's role in its failure to prevent or at least curb the present dengue scourge?

Lim Boon Hee

Thursday, September 22, 2005

MP Dr Tan Cheng Bock's plea to the government in Parliament on measures to "prevent dengue patients from infecting others"

The following article extracted from Electric New Paper (21 Sept 2005). Another potential "I told you so" about the government's refusal to hospitalise/quarantine all suspected and confirmed dengue patients.

"My body was covered with tubes and drips
That's why I feel for dengue sufferers, says MP Tan Cheng Bock. He was seriously ill with meningitis in July. Yesterday, he gave hospitals an earful in Parliament for the way they treat people with dengue
HE was speaking as a doctor who had just gone through a life-and-death struggle himself.
By Clarence Chang

21 September 2005

HE was speaking as a doctor who had just gone through a life-and-death struggle himself.
Unknown to many, the affable Dr Tan Cheng Bock, 65, had been struck down by viral meningitis, an infection of the brain, in mid-July.
He was at Singapore General Hospital, his 'whole body covered with tubes and intravenous drips', for two weeks.
He lost close to 7kg, and had to learn to walk properly again before he could return to work at his GP clinic just a fortnight ago.
That was also when public fears about the dengue outbreak reached its peak.
'I remember when I was ill, I couldn't follow so well at first because my head was splitting,' Dr Tan told The New Paper.
'Initially they also thought it was dengue, but it turned out not to be so. So I have special interest in this.'
True to form, the always passionate backbencher made a heartfelt plea in Parliament yesterday for local hospitals to admit, not send home, every dengue-infected patient - even just suspected ones.
His concern: 'You are bringing in a reservoir of infection, who should be in hospitals and sheltered, back into the community... It is a very dangerous practice.'
Most of the Government's measures so far, said the veteran Ayer Rajah MP, is aimed at 'catching the mosquito'.
'But what measures are we taking to prevent dengue patients from infecting others?'
From what he's seen, he told The New Paper, even high-fever patients with a blood platelet count of about 100 are being 'released', although the all-clear should only be given once they regain a healthy level of at least 150.
And these patients, tired and weak, could still be in their five-day 'infectious' period. So one bite from an Aedes mosquito which later bites someone else is all it takes for re-infection to happen.
That's why mindful of the chronic shortage of hospital beds (see report below), Dr Tan wants the inter-ministerial committee on dengue to set aside part of its $30-million budget to build special quarantine units instead, next to the main premises.
Rather than just asking those with symptoms to go home, rest and apply insect repellent, 'I would advocate sheltering, isolating, ring-fencing all these patients'.
In fact, get the 'army chaps' to man the isolation units and doctors to monitor them daily, he added.
An over-reaction? Former patient Ho Lian-Kuang, 22, feels forced quarantine is 'too serious' a measure, and should only be reserved for the 'irresponsible' ones or those who truly need medical attention, like the elderly.
Like many others, Mr Ho, 22, had also been sent home on his first visit to SGH last month, but was admitted the next day after his platelet count dropped to 76.
But overall, he said: 'I'd much rather take my own precautions and spend time with my family at home.'
Dr Tan doesn't think that's a good idea.
Why? Because although he now spends just three hours a day at his clinic, he already sees an average of one dengue patient daily. And with islandwide numbers climbing to over 600 infections a week, the 'reservoir' is growing bigger.
'We send them to hospital. Hospital says no need to admit, go back. But he's still feverish. Next day, he comes back to me. We have to do another blood test. His platelet count falls to 50. Then we send him back to hospital.'
Add to this the cost of transport, the inconvenience of getting a loved one to take leave to accompany you, the need to fork out cash at the hospital instead of upfront Medisave payments, and you get the picture, the MP explained.
'I've been in practice for 30-plus years. I've seen dengue as a medical student... Previously, when dengue patients went to hospital, they didn't come out until they were well. So there was no chance of community spread.'
This, coming from a community doctor clearly frustrated at the re-emergence of dengue.
'I hope I haven't frightened people,' Dr Tan said. '(But) I'm just going to say it straight. I'm not going to pretend.
'In fighting any infectious disease, isolation is very important. Any leakage, we must stop it.'
His parting shot to hospitals? If you say you have no choice but to turn away patients because of lack of beds and other resources, you haven't planned enough.
'Let this be a lesson for hospital authorities. Dengue is already a national problem. Lurking around the corner is the Avian flu.'

Decision on isolation units: Leave it to the experts

WILL we soon see the return of isolation units on hospital premises?
Senior Minister of State for Health, Dr Balaji Sadasivan, believes it's a decision best left to the government-appointed panel of experts studying the sudden upsurge.
'We need some science in dealing with this problem,' he said.
So far, the panel has recommended that patients simply 'cover themselves with insect repellent'.
As to whether hospitals should admit all dengue patients, Dr Balaji says he'll defer to the World Health Organisation's 'clinical criteria'.
For now, 'the majority of patients can actually be treated as outpatients,' he said.
Between May and August alone, the percentage of beds taken up by dengue patients had gone up from 0.8 per to 3 per cent at the National University Hospital, and from 2.7 to 6 per cent at Tan Tock Seng Hospital.
Dr Balaji also said there's 'no necessity' for self-quarantine.
'Because this is not an infection that spreads directly from one person to another. So any amount of human contact is safe,' he said.
Likewise, it's safe to go to nature parks even though there are 'large mosquitoes flying around and they're the noisy variety'.
Dr Balaji explained that these are not dengue-carrying Aedes mosquitoes which usually breed in 'urban' areas and in buildings.
Earlier, Environment and Water Resources Minister Yaacob Ibrahim, who heads the inter-ministerial committee on dengue, urged all patients to heed their doctors' advice.
'They can apply mosquito repellent on themselves, wear long-sleeved clothing, sleep under mosquito nets and keep their rooms mosquito-free,' he said.
Last weekend's anti-dengue blitz across four estates, the minister revealed, had uncovered 172 breeding sites, with flower pots and litter making up more than half of the cases.
As of last Saturday, overall dengue infections this year had reached an all-time high of 10,237.

Copyright © 2005 Singapore Press Holdings Ltd. Co.
Regn. No. 198402868E. All rights reserved. "

Wednesday, September 21, 2005

Singapore government is not up to the challenge to make country dengue-free

Even at this critical juncture, the government is not confident enough to come up with a "stretch" goal in reducing dengue cases, as noted by Dr Yaacob's response to NMP Tan during parliament session on 19 Sept 2005 (exchange reproduced below). I had challenged the Prime Minister and his Ministers (refer my postings on Sept 1 and 7: Make Singapore dengue-free) to bring infection down to ZERO within a targetted time frame for the short term (6 months or even a year?) but obviously, the government is not up to the challenge. Talk about KPIs (Key Performance Indicators)!! I feel MPs (including NMP Tan) should not just accept the response without persisting that targets be set (even if it is not down to ZERO), otherwise all the momentum may be lost, and we're back to square one a year down the road....It is important that long term targets be set too as whatever measures put in place now must be sustainable.

Extract of exchange between Nominated MP Tan Sze Wee and Minister Dr Yaacob Ibrahim, Straits Times, 20 Sept 2005:

"NMP Tan: Is there any expectation of the reduction in terms of dengue infection rates? We're talking about 130 to 150 a day being reported now. What is the expectation with these measures put in?

Dr Yaacob: It's a very difficult for all of us to really put down the number because the relationship between breeding sites and the number of dengue cases is indeed very complex. .... If you ask me and members of the committee and the Government, obviously we want to reduce it as much as possible in the shortest possible time."

Choked Drains Breeding Mosquitoes - Rotan Lane/Race Course Lane

The following sent by Contributor, Kenny Lim on 20 Sept 2005:

To: M/s Nordin SULAIMAN - NEA
Wai Kwong CHOY - PUB
Wei Wei TAN - NEA

cc: Mr Lee Hsien Loong - Prime Minister

Attention: Manager NEA, Mr.Nordin Sulaiman,

I refer to my numerous previous email to you.

On the15th afternoon, I reported to the NEA hotline about the mosquito breeding places in my neighborhood. Subsequently NEA called me to confirmed that the places I reported were spruced up.

I then checked the places and found that it was not true.The hotline staff than asked me to contact you and complain to you.

Upon receiving my complain, you came down to Rotan Lane around 3:15pm and have a joint-inspection with me around the neighborhood. You confirmed that theContractor did not do the work and will be penalised.

I also showed you the drains between Race Course Lane and Blk 672B. IT WAS BREEDING MOSQUITOES.

The following day I collected larvae sample and complain why the drains was still the same. I inform you the situation and asked your staff Mr Majid to collect the larvae sample from my family member as I was leaving for Penang. The Larvae is fully grown.That was already 17th September.

On the 19th morning, I returned from Penang I again called you to complain that the drains was still the same and nothing was done. Mr Majid later called me that the Contractor Vehicle has broken down and the Contractor will clean the place in the afternoon.

This morning, 20th September I checked the places and it looks exactly the same. The drains was not covered with oil as an interim measure while waiting to be spruce up.

By then 5 days has passed, I presumed the Mosquito larvaes has become Mosquitoes and flew away to spread the Dengue Fever.

You have also written to the Senior Manager Choy Wai Kwong of PUB the horrible condition and also informthem that the drains were breeding Mosquitoes.


What is the point of our Prime Minister looking into the drains to look for breeding ground and Dr YAACOB Ibrahim going around to distribute leaflets.

They can come to my place and I can show them the breeding ground.

I am adamant to exposed the irresponsible and complacenct working attitude of NEA, PUB.

Many innocent lives have lost and many thousands have suffered and risk death. How can you guys be so irresponsible, sluggish when even the PRIME MINISTER HAS TO LOOK INTO THE DRAINS IN SEARCH OF MOSQUITOES.

Is it a Propaganda? I believe it is not because ourPrime Minister is known to be kind, caring and ON THE BALL. You guys better be the same.

I will persist until all the sunken drains and choked drains in my neighborhood be cleared than I will rest.

Kenny Lim

Tuesday, September 20, 2005

Big pool of stagnant water near Lakeside MRT (refer 19 Sept posting)

Contributor sent this email to both the Minister for Health and the Minister for Environment and Water Resources on 19 Sept:

Dear ministers,

I think the authorities are not serious about exterminating aedes mosquitoes and stopping the spread of dengue fever.

On sat morning at 8-9am while i was at the park, Itook the trouble (and money) to use my mobile to call1800-x-dengue to report about stagnant water nearLakeside MRT. Detailed location including lamp-post location was given. (see

On sat at 11+am, I received a call by a NEA officer to ask for more info. I have no extra info to give. This (mon) afternoon about 3-4pm, I received a call from a Npark officer again asking for the location of the pool of stagnant water. Whether the stagnant pool is how many metres metres away from the jogging path. This mentality of taichi-ing responsibilties from one stat board to another (NEA, Nparks, JTC, PUB) must stop if we are serious to stop the spread of dengue fever.

Cant NEA just visit the reported site ASAP and assess the situation instead of calling me up to check ? If the pool is a breeding ground for mosquitoes, from SAT morning to tomorrow, hundreds of aedes mosquitoes may have breed and spread more dengue.

Hopefully, JTC does not have to call a public tender before they can re-level this depression.

Monday, September 19, 2005

Pool of stagnant water near Lakeside MRT

Reply from NEA:

I refer to your feedback appended below.

Our officer will check on the stagnant water for any mosquito breeding. We will also liaise with the relevant authority to level the ground depression to prevent water stagnation.

Thank you for your time and interest.

Hameed Bin Masdi
Customer Relations Officer
Customer Relations, Surveillance & Intelligence
South West Regional Office
The National Environment Agency
DID : 65 64602128
Big pool of stagnant water about 1.5m by 1m found under MRT Track near Lakeside MRT station.

Exact location - along the path of Jurong ParkConnector Skretch C Lamp post C73.

Saturday, September 17, 2005

Electric New Paper (16 Sept 2005) - THIS choked drain near Lorong 8 Toa Payoh has made residents jittery.

Toa Payoh Lorong 8's Danger drain
THIS choked drain near Lorong 8 Toa Payoh (below right) has made residents jittery.
By Teh Jen Lee
16 September 2005

THIS choked drain near Lorong 8 Toa Payoh has made residents jittery.

With hundreds of new cases of dengue fever being reported every week, their fears are understandable.
The drain is about 600m from Block 227, a current dengue hot spot listed on the National Environment Agency (NEA) website.
Mosquitoes are known to fly up to 800m from their breeding sites.
Receptionist Alleena Ng, 48, contacted The New Paper after noticing choked drains on her way to work every morning.
'I walk by every day and I see a few areas where the drains are badly choked by debris.
'I e-mailed the Environment Ministry twice more than a week ago, but to date I've not received any reply,' said Madam Ng, who has been living in Toa Payoh for 20 years.
She's concerned about her family getting dengue.
She's not the first reader who has complained about choked drains.
The other complaint was from Lorong 7 Realty Park, which was also a dengue hot spot, sometime last month.
Over at Lorong 8 Toa Payoh, Madam Ng said cleaners used to keep the drains near her home free of debris, but not anymore.
'We won an award for cleanliness before, the plaque is still at our void deck. These days, there are vehicles to sweep debris on the road but what about the debris in the drains?
'If this is the state of open drains, what about those drains that are covered up?' said Madam Ng.
She said the drain opposite Block 230 and the drain facing the Toa Payoh Golf Centre are also choked.
She knows of a resident in that block who contracted dengue fever.
The drain between the golf centre and First Toa Payoh Secondary School is the most badly choked, she added.
When The New Paper checked it out yesterday, we saw a drain choked by leaves and debris such as plastic bags and bottles.
The water in the drain was too dirty for us to make out whether there was any larvae in it.
There was also a pile of rubbish near the drain which included a styrofoam box and cups that could easily collect water.
Mr Tan Boon Tian, 56, a hawker assistant who lives near the area, said most mosquitoes come out after sunset.
'Even though we close the windows, my whole family gets bitten. Luckily none of us have got dengue yet.
'But I do worry because I heard my neighbours living above us in my block came down with it,' said Mr Tan in Mandarin.
He showed us scars on his legs where he had scratched mosquito bites until they bled.
When asked if he had called the relevant authorities about the mosquitoes, he said: 'I've heard people say they have complained, but only fogging is increased.
'It doesn't seem to help much.'
His four children, aged 12 to 18, don't wear long sleeves and pants to sleep because it's too warm.
'And we don't use insect repellent because I'm afraid they will forget and rub it into their eyes,' said Mr Tan.
He and Madam Ng think the solution lies in clearing the drains.
Madam Ng said: 'Even if the environmental health officers have treated the water with insecticide, they still have to clear the debris.
'Otherwise, the rain will just wash off the chemical. The heavy downpour recently did nothing to flush away the debris.'
Mr Jeffrey Lee, a supervisor at Toa Payoh Golf Centre, said he had also contacted NEA about the choked drains.
He said: 'We had some complaints earlier about mosquitoes so we cleared all breeding sites within our premises as far as possible.
'We checked the gutters and everything. But this is outside so it's beyond my jurisdiction.'
When contacted, a spokesman for NEA said it had cleaned the drain yesterday afternoon upon receiving our queries.
She said: 'The drain comes under the maintenance of HDB Industrial estate management so we do not have records of previous complaints on the drain.
'No mosquito breeding was detected during cleansing.'

Copyright © 2005 Singapore Press Holdings Ltd. Co. Regn. No. 198402868E.
All rights reserved.

Wednesday, September 14, 2005

Mosquitoes breeding in plants and trees (eg. Alocasia, palm trees, etc)

Sent to NEA:

The following extracted from Channel News Asia report of 12 Sept 2005:

"Experts believe the mosquito has adapted its breeding skills to Singapore's high rise living and may also be breeding outdoors, such as trees, instead of the traditional breeding ground in homes."
(link, ).

There have also been reports that plants and trees (eg palm trees) may be another source of breeding. Way back in January 2004, I had written in to the press (ST, 9 Jan 2004) about the possibility of mosquito breeding in Alocasia plants found publicly throughout Singapore (because we had found larvae in the Alocasia plants in the condo where I live) but NParks dismissed such a possibility (ST, 31 Jan 2004 attached).

Please confirm which types of trees and plants are favourite breeding grounds for these mosquitoes. Thanks.

Jeff Ho

================================================================== Straits Times, JAN 31, 2004

No mosquito danger from Alocasia plants

WE REFER to the letter by Mr Jeffrey Ho about the danger of mosquitoes breeding in Alocasia plants (ST,Jan 9). Alocasia plants are indigenous plants that grow naturally in various parts of Singapore. The NationalParks Board (NParks) has also planted some in landscaped settings, and they have generally not been found to breed mosquitoes. We would appreciate it if Mr Ho could contact us on1800-471-7300 to provide more details regarding his observations. We would like to assure the public that our officers do look out for mosquito breeding in areas under NParks' charge when they carry out routine field inspections.

Director, Parks Management
National Parks Board

Ltr from Jeff Ho published in The Straits Times, 9 Jan 2004:

LAST year saw a record number of cases of dengue fever in Singapore, with some fatalities.

While efforts to curtail the breeding of mosquitoes have been directed at homes by ensuring there is no stagnant water around, there is at least one area that has been overlooked.
Recently, it was found that the Alocasia plant (a yam-like plant with giant leaves) in the condominium where I live was also another breeding ground for mosquitoes.
It contains big and deep pockets between the leaves and the stem, and if water trapped in them does not evaporate, it can remain stagnant for weeks, ideal for mosquitoes to propagate. It was cut down.

However, the plant can also be seen growing along expressways. Action is needed to curb this source of mosquito breeding.

Tuesday, September 13, 2005

Damaged drain at Langsat Road

Reply from NEA:

Thank you for your feedback.

This is being addressed by the officer from South East Regional Office, who will reply to you shortly.

Thank you for your time and interest.

Jamil Marof
National Environment Agency Call Centre

I refer to the state land in between unit 148 and 152 Langsat Rd.

The drain along this stretch of land is badly damaged, the water seems to be stangant and a potential mosquito breeding ground. Appreciate it if the authorities could also check some of the covered drains esp those in the residential houses. Most owners (esp rented out ones) do not bother to remove the heavy cement slabs to see if there is stagnant water due to blockage caused by soil or dead leaves.

Saturday, September 10, 2005

Does the Singapore government think it is possible to make Singapore dengue-free?

To: Mr S Satish Appoo, NEA
Ms Karen Tan, MOH

cc: Dr Yaacob Ibrahim, Minister for the Environment and Water Resources

Date: 9 Sept 2005

I refer to your letter to the Today newspaper, 9 Sept 2005 as attached.

I believe that lately, with increased awareness and concern, many suggestions have been put forward by various parties (mine included) in the fight against dengue, and understandably, not all are expected to be adopted. However, at the end of the day, what matters to all Singaporeans and residents is the ability of the government (NEA, MOH, etc.) to eradicate this menace. So, whichever strategies the NEA and MOH choose to fight the problem, that's fine as long as Singapore achieves dengue-free status. I am sure NEA has its own Key Performance Indicators KPIs (whether half the infection rate within 3 months or whatever), but as far as I am concerned, I will deem the fight to be a failure if we are unable to achieve zero-infection within the next 6 months or a year at the very most.

Please bear in mind this menace has been around for quite some time but yet, Singapore, despite the "small" area (hence managability) and its efficiency and ability to come up with usually reliable strategies, has not been able to overcome this tiny "vampire", (unlike Sars which came out of the blue but yet, we managed to lick it within 6 months). What made the difference during Sars then was not just the efforts of all, but also the decisive and quick actions taken by the government, including legislation where necessary. If legislation is necessary in our current fight against dengue, then so be it, but just don't wait too long. I am sure the government doesn't want to see more lives lost to dengue just because it failed to implement measures early enough!

Jeff Ho

Today (9 Sept 2005)
Where dengue and Sars differ ...
Isolating dengue patients is ineffective, but like Sars, everyone has a part to play

Letter from S SATISH APPOO
Head, Environmental Health Department, National Environment Agency (NEA)
KAREN TAN (MS) Director, Corporate Communications, Ministry of Health (MOH)

In "Dengue: Fight it the Sars way" (Sept 1), Mr Jeffrey Ho asked for drastic Sars measures to tackle the recent increase in dengue cases.

.We share Mr Ho's concerns over the increase in dengue cases and would like to assure him that the Government will spare no effort to tackle the dengue menace.

.We would like to explain that unlike the case of Sars, isolating dengue patients is ineffective in controlling the spread of dengue.

.Dengue patients may be infective before the onset of symptoms and many infected with the dengue virus may show no symptoms at all. The key to dengue control is, thus, the elimination of the Aedes mosquito to break the chain of transmission.

.Nevertheless, some of the insights obtained during Sars remain relevant. A central aspect of our approach to battling Sars was the recognition that everyone in Singapore had a role to play.

.Likewise, dengue control has been a partnership effort by Government agencies, companies and the community alike.

.It is of utmost importance that this collaboration is sustained.

.Houseowners, whether they live in landed properties or flats, can do their bit to prevent mosquito breeding by clearing blockages from roof gutters, clearing leaves and stagnant water from drains, removing water from potted plants daily, avoiding the use of pot plates and changing the water in vases everyday.

.Town Councils can also do the same in public areas in housing estates; likewise, school administrators for school properties.

.Developers and land owners need to periodically clear vacant land, while contractors need to continue their effort to check for potential mosquito breeding habitats in construction sites.

.At the same time, those suspected or confirmed with dengue can also help stop the virus from being further transmitted to their family and loved ones by using repellent during the fever stage.

.The NEA has expanded its efforts in mosquito surveillance and control, working with the variousland agencies, Town Councils and facility management to step up checks.

.The MOH is undertaking epidemiological surveillance of dengue patients, working closely with GPs and polyclinics to report possible new cases.

.This allows us to track the development of active dengue clusters, which enables teams to quickly checkfor new breeding locations. We have also published maps on the MOH and the NEA's websites to better inform Singaporeans of the location of dengue cases.

.The most effective weapon against dengue fever today is for all Singaporeans to deny the mosquito a place to breed. Working together, just like we did during Sars, would help us to win this battle against dengue fever.

Thursday, September 08, 2005

Letter to Health Minister: Singapore Can Be Dengue-free!

To : Minister for Health - Mr Khaw Boon Wan

cc: The Prime Minister of Singapore - Mr Lee Hsien Loong
cc: Minister for the Environment and Water Resources - Dr Yaacob Ibrahim

Date: 7 Sept 2005

Dear Mr Khaw,

I am indeed heartened to hear it on the radio this evening (report attached in red below) that you agree with me that we have to take the Sars approach to fight dengue (link, ), with weekly cases having gone up to 546 last week.

However, I humbly beg to differ on your statement that "...... We may not be able to eradicate dengue, but surely at least as a first target, can half the incidence rate." (as extracted from ChannelNews Asia today (link, - "Non-urgent operations delayed as hospitals cope with dengue cases"). I strongly feel that while we may not be able to eradicate the Aedes mosquitoes, it is possible to eradicate dengue, but only if the government and its leaders have the same conviction and resolve. Like I said in my 1 Sept 2005 email to Prime Minister Lee and copied to you (attached below), a wholistic approach will involve multi-ministries and departments (more than just the NEA or MOH alone), so it is imperative that the Prime Minister must believe it can be done. Like I said, Singapore may never ever be Aedes-free but certainly, it can be dengue-free!"

Yours faithfully,

Jeffrey Ho

MediaCorp News 93.8 (7 Sept 2005)
Take SARS-like approach to dengue: Health Minister

Health Minister Khaw Boon Wan has urged Singaporeans to take a SARS-like approach to the current dengue situation.
He described the recent surge in dengue fever cases as worrisome.
A total of 546 new cases were reported just last week alone.
With about 8 in 10 of those infected needing hospitalisation, this works out to some 60 admissions a day.
Ministry of Health says from January to July this year, close to 6,000 people with dengue fever need to be hospitalised.
And Mr Khaw says this is choking up hospitals here.
Several hospitals have also been forced to postpone elective surgeries as a result.
Mr Khaw called on Singaporeans to rally behind the Environment Ministry in its efforts to weed out the outbreak.
To this end, he asked Singaporeans to take precautions to rid the problem at its source

Tuesday, September 06, 2005

Stagnant water at public drain near the junction of Gentle and Buckley Road

Reply from NEA:

Dear Mr Ho

We have checked and found that there is a sump pit at the junction. The purpose of the sump pit is to trap all the silts washed down from upstream. Slight stagnation of water normally occurs at the site. This is an old design and is no longer built. Please note that our workers carry out weekly checks and ensure that the site is oiled to prevent mosquito breeding. We will request PUB to raise the level of the sum pit so as to allow water to flow through. Thank you for the feedback .

Best regards.

cc Mr Thia - We would appreciate it if you could arrange for the level of the sump pit to be raised asap. Pl contact Mr Chia if you need further clarification.

Nordin Sulaiman

Can you or contractors please check on the stagnant water (as at Monday, 5 Sept evening) at the corner public drain outside the apartment building at 5 Gentle Road, at the junction of Gentle and Buckley Roads?

I've noticedthat this corner seems to collect stagnant water easily as I've seen it happen on many occasions. Maybe there's an inherent problem with the gradient or something that doesn't allow water to flow through. (I was not able to snap photos due to unavailability of camera). Thanks

Friday, September 02, 2005

Letter to the Prime Minister - Make Singapore dengue-free

To: The Prime Minister of Singapore - Mr Lee Hsien Loong

cc: Minister for Health - Mr Khaw Boon Wan
cc: Minister for the Environment and Water Resources - Mr Yaacob Ibrahim

Date: 1 Sept 2005

Dear Mr Prime Minister Lee,

I attach below copies of my letter to the press on the above subject (sent a couple of days ago) and the subsequent publication in the Today newspaper of today (Straits Times has however decided not to publish the letter).

As I mentioned in the letter, we need strong political will from the government to attain dengue-free status as this requires efforts the different ministries. The recent newspaper reports seem to have focused on the efforts of NEA, but as outlined in my letter, the MOH's active involvement is just as important (I note in today's Straits Times the MOH is beginning to be involved). As the leader of the Cabinet, I sincerely urge you to put in place preventive strategies to eradicate this menace that is causing precious lives to be lost (eight so far this year). As I said, this can be done, but only with strong political will. Let's strive to make Singapore dengue-free. Thank you.

Yours faithfully,

Jeffrey Ho

"I refer to recent articles and letters on the significant rise in dengue cases in recent months and the various stepped-up measures being taken to fight the menace.

I am heartened to read of more measures being taken, the heightened awareness and the collective efforts of all to combat this potentially life-threatening disease.

However, I can’t help but feel that despite the above-mentioned efforts from all, something is still missing: nothing is mentioned about what needs to be done on the “real” source of the problem, the infected person. Based on recent estimates, more than 400 are infected every week, and unless they are “prevented” from being bitten by the Aedes mosquitoes, the problem will perpetuate itself. It is a known fact that dengue can only be transmitted if an Aedes mosquito bites an infected person and then passes it on to the next victim. As in all infectious cases (SARS being the recent experience), efforts should be directed at BOTH the carrier (the mosquito) and the “real” source of the virus (the infected person). It seems efforts all this while have been mostly directed at the carrier but nothing on the source, the infected person. Therefore, something must be done to isolate those already infected to prevent the disease from having the chance to multiply. (It is interesting to note that a recent study finds that an infected person with malaria is more likely to attract the malaria-causing Anopheles mosquito – refer link, for article in (9 Aug 2005) – “Mosquitoes are drawn to people with malaria”, so this may also be the case with the Aedes mosquitoes. Therefore, it would be helpful if studies are made to find if the Aedes mosquitoes have such tendencies). For such initiatives to be implemented, it will involve a multi-ministry and multi-disciplinary approach, as was the case with SARS a couple of years ago.

At the micro level, town councils, housing developers, cleaning contractors, pest control companies and home owners/residents can do their part by being vigilant in their respective efforts to prevent mosquitoes from being bred through the various means already in place – no stagnant water, fogging, mosquito coil, mosquito plants, ointment/repellent, electronic devices, etc. Besides the increased manpower, cleaning and flushing of drains, etc, the government may also consider mandating roof gutters (a source of breeding that is hard to maintain because of accessibility) be changed/improved to prevent ponding, especially the older houses – just like mandating aluminium rivets in HDB be changed to steel rivets because they endanger lives!

At the macro level, I feel the Ministry of Health (MOH) has to take responsibility and ownership to bring infection down through policies targeting the management of infected patients and vaccination. The long-term plan is of course to find a suitable vaccine for this disease (this is already being done not just in Singapore but throughout the world). However, this may take time, so a near term solution is needed. Here is where my suggestion comes in – make use of our SARS experience to bring the infection down to zero (i.e. be dengue-free) over 3 or 6 months (or shorter) from the current 414 weekly cases. We can do this by adopting the SARS strategy of requiring confirmed dengue cases to be quarantined at a designated “quarantine hospital” – either an existing hospital or free up large-enough dorms or hostels/hotels where such premises are “fortified” (enclosed - with aromatherapy/repellent, electronic anti-mosquito devices, etc.) to prevent the Aedes mosquitoes from having a chance to bite these patients. Of course, there is an “exposure” period (between infection and diagnosis/quarantine) during which the infected person may be bitten by the mosquito, but with the shortening of the diagnostic period from about a week previously to a few hours with rapid-detection kits using polymerase chain reaction or PCR, the chances of exposure of infected persons to the Aedes can now be decreased – better still if people are encouraged to go for PCR testing upon being bitten by mosquitoes (if the high cost of PCR testing is prohibitive, perhaps the government can consider providing some form of subsidy). As is the case during the SARS outbreak, all doctors (including private GPs) should be required to conduct dengue-testing on all fever patients and report all suspected cases for quarantine to ensure nothing falls through the crack. Only by preventing the Aedes (as best as we can) from biting an infected person can we hope to break the chain and get to the root of the problem – the Chinese saying, “zhan cao chu gen” – “cut the weeds and remove the roots” for complete eradication. Otherwise, the problem will keep perpetuating and we may see further increases in cases as long as these Aedes mosquitoes have access to infected persons.

Once we have achieved “zero” infection, we have to be vigilant on minimizing “imported” cases: visitors entering Singapore – again, use our tested SARS experience for fever screening at entry points, contact tracing mechanism, etc…

It is hoped that the government will not wait till dengue cases escalate to 5000/week before implementing more drastic preventive measures, by which time, irreparable damage may have been done (like tourists avoiding Singapore because it is classified “high risk”, not to mention the loss of lives and the suffering of those poor souls unfortunate enough to succumb to this highly preventable infection). Indeed, the MOH should have a vested interested to ensure zero infection as the high dengue cases are causing a strain in the hospital beds being stretched to breaking point with reported cases of patients being turned away at Tan Tock Seng Hospital because of insufficient beds. There may be pain initially if patients were to be quarantined en masse, but with total eradication of dengue cases, the hospitals will be able to free up some 400 beds for other uses in the long run.

It may be worthwhile to ponder on why malaria has not been as pervasive here – it is precisely because it has not been allowed to take root here!! So, dengue must not be allowed to take root too by bringing infection down to zero. I hope the government and its officials (especially those at the NEA and MOH) do not have the defeatist attitude that achieving dengue-free status is impossible, because if there is a will, there is a way. Singapore may never ever be Aedes-free but certainly, it can be dengue-free!"

Jeffrey Ho

Edited letter published in Today, 1 Sept, "Dengue: Fight it the Sars way"

Dengue: Fight it the Sars way

Government shouldn't wait for cases to rise before implementing drastic measures

Letter from jeffrey ho loon poh

I refer to the recent articles and letters on the significant rise in dengue cases and the stepped-up measures to fight the menace.

Nothing is mentioned about what needs to be done about the "real" source of the problem — the infected person.

Based on recent estimates, more than 400 people are infected every week, and unless they are "prevented" from being bitten by the Aedes mosquito, the problem will perpetuate itself. Therefore, more must be done to isolate those infected, as we did during the Sars episode.

(A recent study found that a person infected with malaria is likelier to attract the malaria-carrying Anopheles mosquito. I wonder if a person infected with dengue could similarly attract the Aedes mosquito.)

Town councils, housing developers, cleaners and residents can do their part to prevent mosquitoes from breeding. The Government could also consider mandating that roof gutters (which are hard to maintain because of inaccessibility) be changed or improved to prevent water pooling, especially in older houses — just like it mandated that aluminium rivets in HDB flat windows be changed to steel rivets because they endanger lives!

At the macro level, the Ministry of Health has to focus on the management of infected patients and the long-term search for a vaccination. As this may take time, a shorter-term solution is needed. Here, my suggestion is to make use of our Sars experience to become dengue-free within six months or less.

We can do this by requiring all confirmed dengue cases to be quarantined at a designated "quarantine hospital" — an existing hospital or a hostel/hotel that is "fortified" against the Aedes mosquito.

Of course, there is an exposure window (between infection and diagnosis/quarantine) during which the infected person may be bitten, but with the shortening of the diagnostic period from about a week to a few hours with rapid-detection kits, such exposure can now be minimised.

Even better, if people are encouraged to go for such testing upon being bitten by mosquitoes (if the cost is prohibitive, the Government could consider some form of subsidy). As was the case with Sars, all doctors should be required to conduct dengue-testing on all fever patients and report all suspected cases for quarantine.

It is hoped the Government will not wait until dengue cases to escalate dramatically before implementing more drastic preventive measures, by which time irreparable damage may have been done (like tourists avoiding Singapore because it is classified "high risk").

Indeed, working towards a zero-infection rate would relieve the strain on resources that has led to less severe dengue cases being turned away at Tan Tock Seng Hospital because of insufficient beds.