The current outbreak of the 2019 Novel Coronavirus (2019-nCoV), or the Wuhan coronavirus, as it is more commonly known, has sparked alarm and concern cross the globe. The number of persons infected have surpassed that of SARs, with no signs of abating. Given how contagious the virus appears to be, health authorities around the world are pulling out all stops to minimise the risk of the virus spreading within their communities. One of the key strategies in fighting the contagion is to identify and isolate persons who may be carriers of the virus.
Last week, Japan came under the spotlight after it was reported that 2 of its citizens who were evacuated from Wuhan refused to undergo tests for the new coronavirus. Prime Minister Shinzo Abe told the country that there was unfortunately no legal basis to force them to do so.
Questions may arise about whether a similar situation could occur in Singapore if persons who suspected of being infected refuse to be tested or quarantined, and what the authorities can do in such a situation.
The key legislation in Singapore that gives our health authorities the power to take measures to prevent and control the outbreak of infectious diseases is the Infectious Diseases Act (the Act). The Act was enacted in 1976, and has been regularly updated over the years. Most recently, in 2019, the Government had the foresight to make amendments to further enhance the regulatory powers under the Act.
In this article, we examine some of the key provisions under the Act relating to quarantine orders and surveillance orders, and what authorities are empowered to do in the event of non-compliance.
Under section 15(1) of the Act, the Director of Medical Services (Director) may order any person who is, or is suspected to be, a case or carrier or contact of an infectious disease to be detained and isolated in a hospital or other place for such period of time and subject to such conditions as he may determine. In addition, the Director may also order such a person to remain at his own dwelling place for such period of time as may be necessary for the protection of the public.
The 2019-nCOV has been designated as an infectious disease as well as a dangerous infectious disease under the Act as of 29 January 2020. This gives the Ministry of Health (MOH) the option of detaining and isolating a person who is a confirmed or suspect case of the 2019-nCOV, or ordering the person to be quarantined at home.
So far, MOH has placed confirmed and suspect cases in isolation wards, while close contacts with confirmed cases, as well as recent travellers to the Hubei province, have been placed under quarantine.
Persons who have been ordered to be isolated are not allowed to breach their quarantine orders. The breach of a quarantine order is an offence under the Act, and the maximum penalty for non-compliance (for the first offence) is a fine of up to $10,000 or imprisonment of up to 6 months, or both. The penalty increases to S$20,000 or imprisonment of up to 12 months, or both, for a second and subsequent offence.
Under section 16(1) of the Act, the Director has the discretion to order any person who is, or is suspected to be, a case or carrier or contact of the 2019-nCOV to undergo surveillance for such period of time and subject to such conditions as the Director sees fit.
Under the Act, surveillance includes requiring the person to be subjected medical examinations or observations, including obtaining of the person’s bodily samples. This means that persons who have been ordered to undergo surveillance can be legally required to undergo a medical examination.
Persons who breach or refuse to comply with a surveillance order without reasonable excuse will be subject to similar penalties as those who breach their quarantine orders.
Compulsory Leave-of-Absence (LOA)
A LOA is, strictly speaking, not legally binding, as it is not a quarantine order under the Act. However, MOH has strongly urged those who are on an LOA to be socially responsible and to comply with the LOA to prevent possible transmissions of infections. Unlike the breach of a quarantine order, a breach of an LOA will not attract penal sanctions.
As of 31 January 2020 6pm, MOH has issued an advisory for persons who return to Singapore from mainland China to be placed on a 14-day leave of absence.
Employers should take heed and will do well to ensure that employees who have been placed on LOA do not return to work during this period of time. This is because, if there are signs that the virus has spread to the workplace, MOH has the power to order the closure of the premises and compel the owner or occupier of the premises to cleanse or disinfect the premises (at his own cost) under section 19 of the Act.
Powers given to the authorities to enforce quarantine orders and surveillance orders
The threat of penal sanctions can act as a powerful deterrence to those who have been served with quarantine orders and surveillance orders against breaching their orders.
However, for those who are undeterred and seek to blatantly breach quarantine or surveillance orders, our health officers are also given the necessary powers to enforce these orders.
Under section 56 of the Act, persons who breach their quarantine order or surveillance order may be arrested without warrant. However, placing a person who is a suspected or confirmed case under arrest may not be the most appropriate action, as such persons need to be isolated and tested or treated.
One of the amendments made to Act in 2019 was to allow police and health officers to take measures, including the use of necessary physical force, to ensure compliance with quarantine orders and surveillance orders. This gives our health authorities the power to forcibly bring back any person who absconds to his place of isolation, should he choose to breach his quarantine order.
Persons at risk who have yet to be traced
As of 2 February, 12pm, MOH has reported that out of the 182 close contacts of persons who are confirmed cases, 179 have been contacted and are being quarantined or isolated. This means that there are still 3 remaining close contacts of confirmed cases who have not been contacted.
Whilst these persons may not have been served with a quarantine order just yet, they are still subject to the general prohibition under section 21A of the Act.
Section 21A of the Act makes it an offence for a person who knows, or has reason to suspect, that he is a case or carrier or contact of a dangerous disease, to expose other persons to the risk of infection by his presence or conduct in any public place. A person who is caring for such a suspected person is also prohibited from causing or permitting that person to expose other persons to the risk of infection through that person’s presence or conduct in any such place.
As the 2019-nCOV has been designated as a dangerous infectious disease under the Act, any person who knows, or has reason to suspect, that he may have the virus has a legal duty to ensure that he does not undertake any risky behaviour that may cause the disease to spread.
A strong and robust legal framework is important to ensure that the Government has the necessary powers to effectively respond to the treat of infectious diseases such as the 2019-nCOV. The Infectious Diseases Act provides the legal basis for the Government to take the necessary measure to prevent, and contain, any outbreak of the 2019-nCOV, and Singaporeans can rest assured that there are adequate powers currently available to our Government to carry out the measures that are necessary and appropriate to prevent, and contain, any community transmission of the 2019-nCoV in Singapore.