SG’s Circuit Breaker, DORSCON Orange discourage people to seek care for other infections

Singapore’s nonpharmaceutical interventions (NPIs) and public education campaigns to combat the novel coronavirus have also led to a drop in primary care attendances for other acute respiratory infections (ARIs), according to a recent study.

“The average weekly workday ARI attendances showed a steady decline throughout both Disease Outbreak Response System Condition (DORSCON) Orange and Circuit Breaker periods,” the researchers said, adding that even as NPI measures were eased, ARI attendances remained at least 50 percent lower than in the year prior.

Attendance data were retrieved from eight healthcare centres under the SingHealth Polyclinics and were assessed for presentation for four ARIs, including acute bronchitis, influenza-like illness (ILI), upper respiratory tract infection (URTI), and pneumonia.

The effect of NPIs on health-seeking behaviours was examined over three time periods: 9 weeks of DORSCON Orange, 8 weeks of Circuit Breaker, and another 9 weeks after the Circuit Breaker were eased. During all three periods, the public remained allowed to seek medical attention for conditions, including ARIs.

Just before DORSCON Orange was announced, the researchers recorded a sharp peak in ARI attendances, corresponding to an average workday attendance of 1,624 per week, a 29.0-percent increase from the week prior. This was followed by a steep 19.9-percent decline during the first week of DORSCON Orange. [BMC Public Health 2021;21:1196]

ARI attendances continued to decline slowly and steadily throughout the 9 weeks that DORSCON Orange was in place, broken briefly by a significant 11.3-percent spike towards the end of the first study period. Nevertheless, on the last week of DORSCON Orange, average weekly workday attendances were at its lowest, at 685. Compared to 2019, these figures were also much lower.

The Circuit Breaker served to only suppress ARI attendances even further, yielding 26.6- and 22.5-percent reductions in average weekly workday attendances during its first and second weeks, respectively.

During the first week of the Circuit Breaker, the researchers recorded an average attendance of 504 per workday, further dropping to 186 visits, the lowest documented value, two weeks before the Circuit Breaker was lifted. In 2019, the same 8-week time period from April to June saw an average workday ARI attendance of 1,061 per week. Under the Circuit Breaker, attendances had been reduced by at least 50 percent and by up to 80 percent on some weeks.

After the Circuit Breaker was lifted, ARI attendances started gradually climbing, but remained low, especially when compared to 2019 rates. Even after NPIs were eased, attendance was still reduced by 63.7 percent to 80.2 percent relative to the year prior.

“Changing levels of perceived susceptibility, severity, benefits and barriers, and widespread visual cues based on the Health Belief Model may account for the change in health-seeking behaviour,” the researchers said. “Understanding the impact of NPI on shifts in the public’s health-seeking behaviour and ARI transmission will be relevant and helpful in the planning of future pandemic responses.”