This letter to the editor in the Journal of the American Geriatrics Society describes ways Singapore has avoided nursing home transmission of COVID-19 including the restriction of visitors to all healthcare institutions, prescreening of visitors, and reduction in unnecessary transfer of patient.
In the two months that Singapore has had cases of COVID-19, there is only one reported transmission in an acute care hospital and none in any nursing homes. Instead of taking a conservative approach, in view of the public health consequences of COVID‐19, nursing homes now refer all patients with fever and respiratory symptoms to acute hospitals to rule out the virus. All nursing home patients admitted with acute respiratory infections to a hospital are isolated in negative pressure rooms and tested once for COVID‐19 if the clinical suspicion is low and twice if clinical suspicion is high. Contingency plans have been made to cohort patients with respiratory symptoms and pneumonia in designated wards if cases exceed the capacity of isolation facilities. On discharge, nursing homes have begun to request letters from hospitals to certify that returning residents do not have COVID‐19. Such heightened vigilance has prevented the spread of a single COVID‐19 case to nursing homes in Singapore.