Implications for border containment strategies when COVID-19 presents atypically.

Objectives: For a large part of the coronavirus disease 2019 (COVID-19) pandemic, Singapore had managed to keep local cases in the single digits daily, with decisive measures. Yet, we saw this critical time point when the imported cases surged through our borders. The gaps which we can and have efficiently closed, using a public health approach and global border containment strategies, are aptly illustrated through this case. This critical point of imported case surge has resulted in a large spike of daily local cases sustained through community transmission, up to 120/day within a very short time frame. We were able to rapidly bring this under control.

Study Design: This is a case study of a patient who passed through our borders, with COVID-19 masquerading as a resolved sore throat.

Methods: The events were prospectively documented.

Results: We present a case of a 21-year-old student returning from Nottingham. He presented with sore throat as the only symptom the few days prior his return, and on arrival at our border (day 7 from initial symptoms), his sore throat had already resolved. The events leading up to his COVID-19 diagnosis highlight the gaps of the international screening processes at the global border entry and the potential consequences of community chain transmission through imported COVID-19 cases.

Conclusions: An important global border control measure to implement quickly will be to expand the symptom list to isolated sore throat and/or a prior history of recent symptoms (resolved). This may capture a larger proportion of imported cases at border entry point for more effective containment. This piece will be equally relevant to the general physicians, emergency care physicians, otolaryngologists and anaesthetists, who are at higher risk of encountering a throat visualization during intubation and routine examination. This information can be useful to countries with low resources or insufficient COVID-19 testing kits.