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SINGAPORE — If patients have been certified by a doctor to have acute respiratory symptoms and given a five-day medical certificate (MC), they should not leave home or their place of stay. Otherwise, they will risk getting a fine or jail time or both.

In the Government Gazette published on Wednesday (March 25), the Infectious Diseases Act was updated to state that any individual who receives an MC for acute respiratory symptoms must not leave his or her place of accommodation for a period of five days, starting from the day that the MC is issued.

Those who do may be fined up to $10,000 or jailed up to six months, or both. They can leave only to seek medical attention.

The stiff penalties are part of new measures introduced by the Ministry of Health (MOH) on Wednesday to ensure that such patients comply with the restrictions in order to contain the spread of Covid-19 in the country.

Last month, doctors were advised to grant five days of medical leave to those with respiratory symptoms such as fever, cough, sore throat and runny nose, to stem infections caused by the coronavirus, which has claimed two lives here to date.

In a MOH circular on Friday, the ministry added that doctors should issue a five-day medical certificate to such patients, even if the patient is not working.

Additionally, due to public health imperatives, doctors will no longer be given the discretion to issue medical certificates shorter than five days to these patients until further notice.

Commenting on the latest measure and penalties, doctors told TODAY that these will help to ensure that patients who are sick and who potentially have Covid-19 do not spread the virus in the community.

Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital, said that this move is “not draconian”.

“People die from this illness. And once hospitals are full, the mortality rate is going to jump by 10 per cent. If you don’t do something about it, people who could be safe will really die.”

DIFFERENT PATIENTS, DIFFERENT SYMPTOMS

While the Infectious Diseases Act does not specify what constitutes “acute respiratory symptoms”, doctors here were of the view that such symptoms referred to those usually associated with upper respiratory tract infections such as runny nose, sore throat, cough, fever or muscle ache.

Dr Leong said that although these symptoms were very “general”, it is necessary for them to be so, given that symptoms of Covid-19 cases could manifest differently in different patients.

For instance, one Covid-19 patient that he had encountered had a cough while another had no sense of smell.

The previous approach had shown that even with instructions to stay home during their sick leave, some people have continued to leave their homes, he noted.

“If everyone complied with the instructions given to date, we will have a much lower transmission than today.”

On Wednesday, Singapore saw its record one-day high of 73 Covid-19 cases to date. As of Thursday, there have been 683 cases reported.

Dr Zuraimi Mohamed Dahlan, a family physician at Banyan Clinic in Jurong West, called the update an “important move” to catch those who left their homes while on sick leave.

He knows of patients he has seen who continued to go to work even after being given MCs.

Given that Covid-19 shared similar symptoms with the common flu, such as muscle ache and runny nose, the five-day MC is necessary to weed out those who have the common flu, Dr Zuraimi said. For instance, those who do not show signs of getting better within the five-day period may have to go for tests to ascertain if they have contracted Covid-19.

“(The latest measure and penalties) help to make sure that all these people are socially isolated when they are on sick leave. It will help them to prevent passing around not just Covid-19, but also the flu virus in the community,” Dr Zuraimi added.

SOME MAY NOT WANT TO SEE A DOCTOR

However, the doctors interviewed admitted that the harsher punishment could end up deterring those who are sick from visiting a clinic in the first place.

There could also be a small group of people who will refuse to seek medical treatment out of fear of having to stay home for five days.

Dr Zuraimi said: “These patients must look at it as doing a greater good. We are trying to fight a war on Covid-19, not pry workers away from work.”

He added that the tougher measure is meant to help protect workers whose employers expect them to return to work despite being on MC.

For people who do not want to see a doctor even though they are sick, Dr Leong suggested that the updated laws be used against them as well.

Dr Victor Teo, a general practitioner at YS Teo Family Clinic and Surgery in Toa Payoh, said that with the “severe situation” now, most people will likely go to the doctor if they are sick, just to make sure that they do not have Covid-19.

The minority will continue to avoid going to a clinic because they may have fears about losing their jobs or income if they are forced to stay home on sick leave, he added.

This group should be assured somewhat by the Resilience Budget announced by the Government on Thursday, he said, which is meant to provide financial support to workers. 

Dr Jason Pang, a general practitioner at Health Partners Medical Clinic in Siglap, said that even if a small group may be turned off from visiting a doctor due to the enhanced measures, the majority is likely to comply, helping to better control the disease in Singapore as a whole.