How Singapore beat Covid-19

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On March 20, Singapore became the first country in the world to release a Covid-19 contact tracing app. At the time, just 240,000 cases of the virus had been reported and the death toll had crept above 10,000.
Ten months later, around 50 countries have developed and deployed contact tracing apps. But Singapore remains an outlier. For one, its app is less privacy focussed than others that use underlying technology from Apple and Google. Singapore’s app is also used by more than half the population and will be made mandatory in 2021.


It’s also much more than just an app. People can also carry around a physical ‘token’. “We had thought that more people would want the app because it seemed like a little bit of a hassle to go down and collect a physical token and then to carry that token around,” says Kok Yam Tan, the deputy secretary of Singapore’s smart nation programme. “Many people do want the token,” he adds.
The tokens are small, Tamagotchi-sized devices – essentially a battery and Bluetooth sensors housed inside a plastic casing – that work in the same way as the contact tracing app. The tokens also have a QR code on the back that can be scanned as part of Singapore’s SafeEntry system at restaurants and shops. To get a token people have to hand over their name and a contact number – if someone tests positive then data can be downloaded from the device by health workers.
“You have to be a little bit more conservative in terms of power and you also have to be a little bit more conservative in terms of memory,” Tan says of the token. The main difference is the app scans for other Bluetooth devices around it more frequently than the token, he adds.
The tokens were introduced as an alternative option for people who didn’t want the app on their phones or didn’t have phones compatible with the Bluetooth contact tracing system. As of November, more than 570,000 physical tokens have been handed out, primarily from community centres. More than half the tokens were collected by people aged 51 and above and 26 per cent of the tokens have been adopted by people aged above 65. When combined with 2.7 million app downloads, around 65 per cent of Singapore’s 5.7 million residents are using Bluetooth contact tracing in some form. (The government has set a target of 70 per cent by the end of this year).


By many metrics, Singapore has had a successful pandemic. As of December 14, the city-state has recorded 58,320 positive Covid-19 cases and just 29 deaths. There are 86 active cases in Singapore right now, according to its Ministry of Health. Since mid-October the seven-day rolling average for new cases has not risen above ten – the majority of its cases are imported from outside its borders rather than being spread internally. And, overall, it has some of the world’s lowest levels for cases-fatalities and deaths per 100,000 people in the population.
The vast majority of Singapore’s positive coronavirus cases – 54,505 of 58,320 – have happened within its migrant worker dormitories. More than 320,000 migrants in jobs such as construction and engineering live in cramped employer-provided accommodation, sleeping in bunk beds and sharing facilities. The government has pledged to give each worker their own living space by the end of this year following concerns from human rights groups about the conditions of workers. As the majority of these workers are relatively young, only two of them have died from Covid-19 – with just 25 being placed in intensive care.
No country that’s effectively dealt with the pandemic has relied upon one measure alone. Technology is just one tiny part of Singapore’s pandemic response. Controlling the virus is a mixture of getting lots of things more or less right at the same time. Successfully snubbing out spikes and keeping cases low can be attributed to previous epidemic experience, effective contact tracing, well-resourced healthcare systems and widespread testing, limited lockdown measures, individual social responsibility (such as mask-wearing and social distancing), and high-levels of compliance with quarantine restrictions.
The city-state got many of these things right. Official information in Singapore has been widely distributed with dashboards displaying detailed information on testing and cases, and people being able to sign-up to WhatsApp and Telegram updates from the Ministry of Health. Masks were made mandatory in Singapore in April. Its experience dealing with SARS and H1N1 influenza meant it closed its borders early and focused on human-led contact tracing. Similar measures were taken by South Korea, Japan, China and Taiwan. Early in the pandemic Singapore’s human contract tracing was recognised as highly effective.


Establishing whether this effectiveness has translated to digital contract tracing is more of a challenge – and has been a problem with the tech since the start of the pandemic. One meta-study, published in The Lancet, found “no empirical evidence” of automated contact tracing systems being effective from January 2000 to April 2020.
Since the TraceTogether app was launched back in March it has identified 25,000 people that have been exposed to people with Covid-19 for prolonged periods – also known as close contacts. In Singapore’s app, people are classed as close contacts when they’ve spent 30 minutes near the person who tested positive – the UK and other countries use 15 minutes for the time period on their exposure notifications.
Ultimately, of those 25,000 people who were told to quarantine by the digital contact tracing system, 160 tested positive for Covid-19. (New data from Australia says its app identified 20 people who were Covid-positive). Do these numbers mean the technology has been worth it?
“In terms of actual value, we can see that it has an impact,” Tan explains. “It is, however, not as large a number as we want.” He says that the speed at which the app has been able to identify people potentially exposed to Covid-19 has been useful as human-led contact tracing can take longer. But human-led contact tracing is still the primary contact-tracing system and is likely to be so for any future public health emergencies.
To understand why, you need to look at the limitations of the technology. The Bluetooth contact tracing system doesn’t provide data about who close contacts are. Anecdotally, Tan says that there aren’t any surprises in who is being identified. They tend to be your family members, maybe your colleagues and a small minority of cases people that are unknown to the person who tests positive. This last group could include people on public transport. “We don’t have very good data,” Tan adds. “That’s a feature, not a bug.”
As approaches 2021, Singapore is re-opening large parts of society. From December 28, the Ministry of Health says social gatherings of up to eight people will be allowed (up from five people), more people can gather inside and the arts and culture industries will be able to run events with up to 250 people attending. TraceTogether forms a big part of this reopening plan. Primarily this will be through making the SafeEntry check-in system mandatory and requiring the app or a token for people to enter venues. Since mid-October, people wanting to enter cinemas have only been allowed to do so using the check-in system and this is set to expand to more businesses.
“It is hard to fault the intended purpose of the latest digital contact tracing measures,” says John Tan, the vice-chairman of the city-state’s opposition Singapore Democratic Party. “Who doesn’t want to contain Covid-19? However, as with all things Singapore, when you think beyond the government’s narrative, there are invariably unanswered or even disturbing issues.”
Privacy concerns have been a consistent criticism of Singapore’s contact tracing system – both through human-led efforts and technology. One study that praised the effectiveness of Singapore’s manual contact tracing system highlighted the large amount of data that could be accessed. “ATM withdrawals and credit card activities, such as through ridesharing applications, credit card payments at restaurants or shopping centres, movement on public transportation, leave digital footprints and these can assist the authorities in finding out where the person has been and how they have travelled,” the study found.
Analysis from the National University of Singapore, which was completed in May, found 49 per cent of people were okay with having their phones tracked during a circuit breaker lockdown, while the figure rose to 58 per cent for CCTV tracking. Despite this, almost 55,000 people have signed a petition saying Singapore shouldn’t use contact tracing wearable tokens and there have been reports of people hacking and tampering with the devices.
“Even if one accepts prima facie the good intention of the administration, it is difficult for Singaporeans to forget the data breach debacles that shocked us in recent years,” says John Tan. “It is a tall expectation for an authoritarian government to now ask an increasingly educated and critical populace to blindly trust a centralised data system and a proprietary non-transparent app.” More broadly, Rachel Chhoa-Howard, an Amnesty International researcher focusing on South East Asia, says there are concerns about how Singapore has been developing surveillance technology in recent years. In particular, the deployment of facial recognition.
The TraceTogether Bluetooth technology isn’t as privacy-focused as other systems around the world. Unlike protocols developed by Apple and Google, information is stored in centralised databases that can be accessed when someone tests positive. Kok Yam Tan says that the overall system has been set up for the public health authority to know when someone tests positive and be able to run contact tracing effectively.
“We’re quite clear that this data is only to be used for contact tracing purposes. There’s the public health job that is to be done,” he says. “We want to collect the minimum amount of data to allow us to meet that mission. And this is the configuration you come up with.” So is there any life for the Bluetooth contact tracing system once the pandemic is over? Kok Yam Tan says not. “Beyond dealing with Covid-19, we see absolutely no use of the token and the app”.
Matt Burgess is WIRED’s deputy digital editor. He tweets from @mattburgess1
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