title: Amniocentesis

text: The Rh factor is an inherited protein found on the surface of red blood cells. If the mother is Rh negative and the father is Rh positive, a fetus has at least a 50% chance of being Rh positive. Rh incompatibility occurs when a mother has Rh-negative blood and her baby has Rh-positive blood. If the red blood cells of an Rh positive fetus cross into their Rh negative mother's blood flow, the mother is at risk of Rh sensitization, a process in which maternal antibodies form against red blood cell Rh antigens. Events causing fetomaternal hemorrhage, such as miscarriage, trauma to the abdomen during pregnancy, ectopic pregnancy, induced abortion, invasive pregnancy procedures, labor, and birth can lead to fetal Rh positive red blood cells entering the Rh negative maternal circulation. Rh sensitization typically does not cause problems during the first pregnancy of an Rh negative woman. However, in a subsequent pregnancy with an Rh positive fetus, the formed antibodies can cross the placenta and attack the red blood cells of the fetus, a process called Rh isoimmunization that can result in a condition known as Rhesus disease or hemolytic disease of the fetus and newborn.


title: Amniocentesis

text: Hemolytic disease of the fetus and newborn can lead to varying degrees of fetal anemia, which can potentially have devastating consequences including newborn jaundice, kernicterus, hydrops fetalis, and intrauterine fetal demise. RhD immune globulin (RhoGam) is administered to prevent maternal Rh sensitization in Rh negative patients that are non-sensitized to Rh antigens.


title: Amniocentesis

text: In the past, serial amniocenteses has been used to monitor isoimmunized pregnancies by measuring the levels of bilirubin, a byproduct of red blood cell breakdown, present in amniotic fluid using spectrophotometry. However, ultrasound detecting middle cerebral artery peak systolic velocity has now replaced serial amniocenteses for the management of isoimmunized pregnancies.


title: Amniocentesis

text: Amniocentesis is an invasive prenatal test that has the potential to cause maternal and fetal blood cell mixing, which can worsen Rh isoimmunization.


title: Amniocentesis

text: Polyhydramnios is an excessive accumulation of amniotic fluid that can lead to serious perinatal and maternal outcomes such as intrauterine fetal demise, preterm labor, premature rupture of membranes, and cesarean delivery. Physicians have used the process of inserting a needle transabdominally into the uterus to extract excess amniotic fluid, also known as a reductive amniocentesis or decompression, for the management of polyhydramnios as early as the late 1800s.


title: Amniocentesis

text: Twin oligohydramnios-polyhydramnios sequence is a rare condition that may occur when twins sharing a single placenta develop significant vascular cross-connections, known as anastomoses, resulting in blood flowing away from one twin to the other. This process can result in polyhydramnios in one twin and oligohydramnios in the other twin. Amniocentesis has been employed to reduce the volume in the sac with polyhydramnios in order to relieve amniotic fluid pressures, a process that may improving fetal circulation and outcomes.


title: Amniocentesis

text: Amniotic fluid, which is easily collected, cultured, and stored through cryopreservation, can be a rich source of pluripotent and multipotent mesenchymal, hematopoietic, neural, epithelial, and endothelial stem cells. A potential benefit of using amniotic stem cells over those obtained from embryos is that they address the ethical concerns among anti-abortion activists by obtaining pluripotent lines of undifferentiated cells without harm to a fetus or destruction of an embryo. In addition, the use of embryonic cells has been shown to develop into tumors such as teratocarcinomas and frequently acquire chromosomal errors, underscoring the benefits of utilizing amniotic stem cells.


title: Amniocentesis

text: Research has shown that cells from second trimester amniotic fluid are successful at differentiating into various cell lines.


title: Amniocentesis

text: Artificial heart valves, working tracheas, as well as muscle, fat, bone, heart, neural and liver cells have all been engineered through use of amniotic stem cells. Tissues obtained from amniotic cell lines show significant promise for patients with congenital diseases/malformations of the heart, liver, lungs, kidneys, and cerebral tissue.


title: Amniocentesis

text: There are no absolute contraindications to amniocentesis. Relative contraindications to the procedure include failure to discontinue anticoagulation therapy 48-72 hours prior to amniocentesis, infections such as hepatitis B, hepatitis C, or human immunodeficiency virus (HIV), and oligohydramnios. These patients are at a higher risk of complications if they undergo amniocentesis and should be counseled appropriately. In some cases, the advantages of obtaining the results of an amniocentesis may outweigh the increased risk of complications.


title: Amniocentesis

text: Patients on oral anticoagulation therapy have an increased risk of bleeding from the procedure and may be switched to low-molecular-weight heparin, which carries a lower risk for bleeding complications, prior to amniocentesis. There is an increased risk of mother-to-child (vertical) transmission of bloodborne infections in patients with hepatitis B, hepatitis C, or HIV after amniocentesis. Patients with high viral loads are at a greater risk of vertical transmission of hepatitis B compared to patients with low viral loads. In patients living with HIV, amniocentesis should be deferred until a combined antiretroviral therapy (CART) regimen is established and the patient achieves a low or undetectable viral load.


title: Amniocentesis

text: While not a contraindication, an amniocentesis may be postponed if fusion of the amnion and chorion has not yet occurred. Performing an amniocentesis prior to the fusion of the amnion and chorion is more likely to lead to procedure failure that may require further sampling attempts.


title: Amniocentesis

text: Amniocentesis performed for the purpose of prenatal diagnostic testing for genetic disorders has been established as a safe and accurate procedure. The risks and complications associated with amniocentesis include pregnancy loss, preterm labor and delivery, preterm premature rupture of membranes (PPROM), fetal injuries, Rhesus disease, and amniotic fluid embolism. Oligohydramnios, fetomaternal hemorrhage, cell culture failure, multiple amniotic fluid extraction attempts, and infections are also possible complications. Additional maternal complications include vaginal bleeding, hematoma of the skin, damage to surrounding internal organs, procedural pain including stinging, pressure, and cramping, and post-procedure discomfort.


title: Amniocentesis

text: A serious risk of amniocentesis is pregnancy loss. The American College of Obstetricians and Gynecologists note that the pregnancy loss rates attributable to amniocentesis are very low. The mechanism for pregnancy loss following amniocentesis is unknown but may be a consequence of bleeding, infection, or trauma to the fetus or the amniotic sac as a result of the procedure. Studies from 2000 to 2006 estimated the procedure-related pregnancy loss at 0.6-0.86%. The most recent systematic review of the literature and updated meta-analysis on the risk of pregnancy loss following amniocentesis was published in 2019. This study cites the amniocentesis-related pregnancy loss to be 0.30% (95% CI, 0.11–0.49%).


title: Amniocentesis

text: The incidence of amniocentesis-related complications, including pregnancy loss and procedure failure, may be mitigated when performed by experienced practitioners who complete 100 or more amniocenteses per year. Experienced practitioners are more likely to complete the procedure with only one puncture attempt. Multiple needle insertion attempts are associated with an increased risk of pregnancy loss. Early amniocentesis, defined as performing the procedure between 10 and 13 weeks' gestation, is associated with significantly higher rates of pregnancy loss following amniocentesis. Early amniocentesis also has higher rates of other complications, including membrane rupture, clubfoot, and amniotic fluid culture failure. For these reasons, the American College of Obstetricians and Gynecologists and other similar professional associations recommend against undergoing amniocentesis prior to 14 weeks' gestation.


title: Amniocentesis

text: In the past, twin pregnancies have been noted to have a higher rate of pregnancy loss (estimated at 3.07%) following amniocentesis. Past literature has shown that twin pregnancies increase the background risk of fetal loss following amniocentesis before 24 weeks' gestation by 1%. Although data on complications following amniocentesis in twin pregnancies continues to be limited, the American College of Obstetricians and Gynecologists note that rate of pregnancy loss due to amniocentesis in this population is estimated to be around 2%. A 2020 systematic review and meta-analysis showed similar findings, noting that pregnancy loss following amniocentesis may be lower than previously reported in twin pregnancies. The study also found no significant difference in rates of pregnancy loss between twin pregnancies that underwent amniocentesis and those that did not before 24 weeks of gestation.


title: Amniocentesis

text: Maternal factors that may further increase the risk of pregnancy loss following amniocentesis include:


title: Amniocentesis

text: Undergoing amniocentesis in the third trimester has been associated with an increased risk of preterm labor, as defined as the onset of labor between 20 and 37 weeks' gestation, and preterm delivery. Preterm premature rupture of membranes (PPROM) and subsequent leakage of amniotic fluid are additional possible complications, with the procedure-related PPROM rate following amniocentesis estimated to be between 1–2%. When compared to cases of spontaneous PPROM, patients with amniocentesis-related PPROM experience better outcomes and lower rates of pregnancy loss. Leakage of amniotic fluid can result in oligohydramnios, or an amniotic fluid volume that is less than the minimum expected for gestational age. Adequate amniotic fluid volumes are essential for fetal lung development. Therefore, possible consequences of oligohydramnios include infant respiratory distress and small, underdeveloped lungs known as fetal lung hypoplasia.


title: Amniocentesis

text: Needle injuries to the fetus are increasingly rare due to the practice of using continuous ultrasound-guidance, including during needle insertion and amniotic fluid extraction. Reported needle injuries include cord bleeding, ocular injuries, fetal brain and cutaneous injuries, and deformities such as clubfoot. The risk of fetal injury increases with increasing number of puncture attempts.


title: Amniocentesis

text: Maternal and fetal blood cells may mix during an amniocentesis and, as a result, patients with rhesus (RhD) negative blood types carrying a RhD positive fetus are at risk of Rh sensitization. Rh sensitization is a process in which maternal antibodies form against red blood cell RhD antigens. In subsequent pregnancies with RhD positive fetuses, maternal presence of these antibodies can attack and destroy fetal red blood cells, a process called Rh isoimmunization that can result in a condition known as Rhesus disease or hemolytic disease of the fetus and newborn. Maternal blood type is assessed prior to undergoing amniocentesis and RhD immune globulin (RhoGam) is typically administered within 72 hours of the procedure to prevent maternal Rh sensitization in RhD negative patients that are non-sensitized to RhD antigens.


title: Amniocentesis

text: Amniotic fluid embolism, a condition in which amniotic fluid or other fetal debris enters the maternal circulation, is an extremely rare and catastrophic complication of amniocentesis. Amniotic fluid embolism can result in cardiovascular collapse and has a poor maternal prognosis. However, amniotic fluid embolism following amniocentesis has been reported infrequently in the literature in the last 60 years, mostly in the context of case-reports.


title: Amniocentesis

text: Chorioamnionitis and uterine and maternal skin infections are potential complications of amniocentesis that can occur as a result of bacterial introduction throughout the course of the procedure. The risk of amniocentesis-related chorioamnionitis and uterine infections is less than 0.1%. Performing the procedure using sterile techniques can help prevent infection.


title: Amniocentesis

text: Fetomaternal hemorrhage, or the entrance of fetal blood into the maternal circulation, is another complication of amniocentesis. It can result in anemia that can have consequences of varying severity. The procedure-related risk of fetomaternal hemorrhage attributable to amniocentesis is 2.6%.


title: Amniocentesis

text: Amniotic fluid cell culture after amniocentesis has a failure rate of 0.1%. Later gestational ages at the time of the procedure and amniotic fluid samples contaminated with blood increase the risk of amniocyte culture failure.


title: Amniocentesis

text: While recognizing the aforementioned risks, the American College of Obstetricians and Gynecologists recommend that prenatal screening, or diagnostic testing for aneuploidy via procedures like amniocentesis or chorionic villus sampling, be discussed with and offered to all patients regardless of maternal age or risk profile.


title: Amniocentesis

text: An amniocentesis is typically performed in the second trimester between the 15th and 20th week of gestation; however, it can be done at any later gestational age. It is an outpatient procedure typically performed by an obstetrician-gynecologist with additional amniocentesis training.


title: Amniocentesis

text: Genetic counseling should be provided to the pregnant patient and informed consent should be obtained prior to the procedure.


title: Amniocentesis

text: Prior to the onset of the amniocentesis, the pregnant patient will undergo ultrasound evaluation to assess fetal viability and position, gestational age, amniotic fluid volume, maximum vertical pocket, umbilical cord insertion site, and any obvious fetal deformities. This information is utilized to determine the needle used and how the procedure should be performed. The fetus should be at least 15 weeks' gestation and the chorion and amnion should be fused.


title: Amniocentesis

text: Amniocentesis is a sterile procedure, therefore medical personnel performing and assisting with the procedure will scrub with antiseptic solution, use sterile gloves, clean the maternal abdomen with antiseptic solution, cover the ultrasound probe with a sterile cover, and use sterile ultrasound gel.


title: Amniocentesis

text: Ultrasound guidance is used continuously throughout the course of the procedure so that the needle is always visualized. A sterile 20–22 gauge spinal needle is firmly inserted perpendicular to the maternal abdomen. After puncturing the maternal abdomen, the operator punctures the uterus, gains access into amniotic cavity by puncturing the amniotic membrane while taking care not to cause membrane tenting, and proceeds to advance the needle into the amniotic cavity. The needle should be guided into the region of the maximum vertical pocket, where the single largest area of amniotic fluid devoid of fetal parts, umbilical cord, and placenta is available for sampling. Amniotic fluid is composed of fetal cells, urine, and lung secretions. 18-20 mL of amniotic fluid is slowly aspirated, with the first 1-2 mL typically discarded due to higher risk of maternal cell contamination. The remaining sample is submitted for laboratory testing. Fetal viability after the procedure should be confirmed by observing adequate fetal cardiac activity. The number of needle puncture attempts should be documented.


title: Amniocentesis

text: There is little scientific data supporting administration of prophylactic antibiotics prior to an amniocentesis and therefore, it is currently not recommended. Similarly, there is little scientific support for the placement of a local anesthetic prior to amniocentesis.


title: Amniocentesis

text: Maternal blood type is assessed prior to undergoing amniocentesis and RhD immune globulin (RhoGam) is typically administered within 72 hours of the procedure to prevent maternal isoimmunization in RhD negative patients that are non-sensitized to RhD antigens.


title: Amniocentesis

text: Amniocentesis technique differs in twin pregnancies and requires additional operator training. The two different approaches are the single-needle technique and two-needle insertion technique.


title: Amniocentesis

text: If used for prenatal genetic diagnosis, fetal cells may be separated by centrifugation from the extracted sample and grown in a culture medium in order to perform genetic tests. The types of tests performed on the sample will be determined by the patient's indications for undergoing amniocentesis. Fluorescent in-situ hybridization (FISH) and quantitative fluorescence polymerase chain reaction (QF-PCR) are two tests commonly performed on uncultured cells after amniocentesis, with results available within two days. These tests can accurately identify trisomy 13, trisomy 18, and trisomy 21. FISH is capable of providing a limited karyotype and, along with the aforementioned trisomies, can also detect aneuploidies in the X and Y sex chromosomes. Abnormal results from FISH studies should be confirmed with other cytogenetic testing, as false positives and negatives are possible Karyotypes are another common test performed on amniotic fluid to visualize chromosome number and characteristics, with a result turnaround of up to three weeks. Another test that may be performed is a chromosomal microarray, which can detect chromosomal imbalances, such as small- and large-scale deletions and duplications. Chromosomal microarray can be performed on cultured or uncultured fetal tissue, with results available as early as 3 days. The American College of Obstetricians and Gynecologist recommends that patients who choose to undergo invasive diagnostic testing have access to chromosomal microarray analysis.


title: Amniocentesis

text: After an amniocentesis, patients may resume their routine activity level while withholding from strenuous exercise. Some sources recommend house rest for the initial 24 hours after the procedure, though data supporting this recommendation is limited. Follow-up one week after the procedure is recommended to undergo ultrasound evaluation for fetal viability and assess healing of the puncture site. Post-procedural pain and discomfort should be minimal and temporary and may be managed with acetaminophen. Patients will be instructed to report to an emergency room if they experience vaginal bleeding or leakage of fluid, intense uterine pain, or a fever greater than 38°F.


title: Amniocentesis

text: Physicians have used the process of inserting a needle transabdominally into the uterus to extract amniotic fluid for the management of hydramnios, or excess amniotic fluid, as early as the late 1800s. In 1930, needle insertion into the amniotic sac was used to inject contrast dye for the purposes of amniography, or radiographic visualization of the fetal, placental, and uterine outlines. Beginning in the 1950s, amniocentesis was used to diagnose and determine the severity of Rhesus disease. In the mid 1950s, Fritz Fuchs and Povl Riis used fetal cells cultured from extracted amniotic fluid to determine fetal sex based on the presence of Barr Bodies. They postulated that this technique could provide information on the risk for X-linked disease in fetuses with carrier mothers. By the 1960s, this technology was being applied to X-linked conditions such as Duchenne muscular dystrophy and hemophilia. In 1966, M. W Steele and W. R Breg Jr. were able to culture amniocytes that could undergo karyotyping. Their work opened the door to the prenatal diagnosis of aneuploidies. In 1972, R. G. Sutcliffe and D. J. H. Brock found that higher amniotic alpha-fetoprotein levels were associated with neural tube defects.


title: Amniocentesis

text: In 1972, ultrasound-guided amniocenteses began replacing free-handed taps following J. Bang and A. Northeved's initiative to employ ultrasound technology to improve amniocentesis. Up until the 1980s, static B-scan ultrasound-guidance was used for the procedure, a process that did not permit visualization of the needle in the amniotic cavity.


title: Amniocentesis

text: Eventually, real-time ultrasound scanners improved the ultrasound-assisted amniocentesis. Given its prenatal diagnostic accuracy for a range of fetal conditions and its relative safety profile, amniocentesis has become the most common invasive fetal testing procedure.


title: Amniocentesis

text: As stated in the history section, amniocentesis can be used to determine the sex of a fetus. This can be medically relevant in families that carry X-linked genetic conditions, since parents may want further genetic testing if the fetus is determined to be male (XY), and therefore has a higher likelihood of having the inherited disease. However, sex discernment is also used for social and cultural reasons. In some cultures, male children are more desirable than female children. This leads some parents to use amniocentesis and other forms of prenatal genetic testing (like chorionic villus sampling and preimplantation genetic diagnosis) to determine the sex of the child with the intent of terminating the pregnancy if the fetus is determined to have two X chromosomes. Sex-selective abortion is particularly common in countries such as China or India, among others. Sex-selective abortion is one of the causes for low child sex ratios in countries in Asia, Africa, and Eastern Europe. There are also significantly skewed child sex ratios in the Caucasus region. Naturally, the human sex ratio is approximately 105 males for every 100 females, and any significant deviations from these values is usually considered evidence for sex selective abortion.


title: Amniocentesis

text: India and China have made prenatal sex determination illegal in an effort to prevent sex-selective abortion. In India, this happened through the 1994 Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition Of Sex Selection) Act (PCPNDT Act). However, this has not necessarily affected the widespread practice of sex-selective abortion as abortion is generally legal, and this law has been inconsistently enforced. In China, the societal preference for male children was exacerbated by the historical one-child policy, where in many regions of China, parents were limited to having only one child. As with India, prenatal sex determination is banned in China but remains a widespread practice, with enforcement also proving to be difficult.


title: Betsy Blair

text: Betsy Blair (born Elizabeth Winifred Boger; December 11, 1923March 13, 2009) was an American actress of film and stage, long based in London.


title: Betsy Blair

text: Blair pursued a career in entertainment from the age of eight, and as a child worked as an amateur dancer, performed on radio, and worked as a model, before joining the chorus of Billy Rose's "Diamond Horseshoe" in 1940. There she met Gene Kelly; they were married the following year, when she was age 17 and divorced sixteen years later in 1957.


title: Betsy Blair

text: After work in the theatre, Blair began her film career playing supporting roles in films such as "A Double Life" (1947) and "Another Part of the Forest" (1948). Her interest in Marxism led to an investigation by the House Un-American Activities Committee, and Blair was blacklisted for some time, but resumed her career with a critically acclaimed performance in "Marty" (1955) for which she was nominated for an Academy Award for Best Supporting Actress.


title: Betsy Blair

text: She continued her career with regular theatre, film and television work, mainly in Europe, until the mid-1990s.


title: Betsy Blair

text: Blair was born in Cliffside Park, New Jersey. Her father, William Kidd Boger, was a partner in a small insurance brokerage firm; her mother, Frederica Ammon, was a schoolteacher. Both were Episcopalians. At the age of eight, she was enrolled in the Swift Sisters School of Dance, and recalled performing before Eleanor Roosevelt in 1933, winning an amateur contest shortly thereafter, joining a touring amateur show and performing on local radio, as motivating influences in her desire to pursue a dance career. She joined the John Robert Powers modeling agency and by the age of 12 was in regular demand. She enrolled in the Professional Children's School but, as it was not accredited, her mother returned her to her local school so that she might eventually attend college. She graduated at 15, securing a scholarship to Sarah Lawrence College. However, the board of admission considered her too immature for entry and requested she wait one year.


title: Betsy Blair

text: In the interim, Blair joined the chorus at the International Casino in Times Square, and when it closed down, worked in the chorus of Billy Rose's Diamond Horseshoe from January 1940 where Gene Kelly was working as choreographer. "Gene fought for me. He said I could dance, and he needed some good dancers," she wrote in her autobiography. Blair and Kelly's relationship blossomed, culminating in their marriage in October 1941. She and Kelly remained married for 16 years and had one daughter, Kerry Kelly Novick (b. 1942), together before divorcing in 1957.


title: Betsy Blair

text: Blair left Rose's show to accept an offer from choreographer Robert Alton to join the chorus of "Panama Hattie", an illustrious line-up which included June Allyson, Doris and Constance Dowling, and Vera-Ellen. Alton—who previously discovered Gene Kelly—had spotted her when she unsuccessfully auditioned for a part in "Louisiana Purchase". During this period, she developed a strong interest in Marxism, having been introduced to Lloyd Gough by Kelly, and attended Gough's weekly Marxist study group, which Kelly did not attend. "And it was very serious. Our textbook was "The History of the Communist Party of the Soviet Union"... I was completely enthralled by the ideas."


title: Betsy Blair

text: In early 1941, Blair secured her first role in a stage play when Kelly's friend William Saroyan chose her to play the female lead role of St. Agnes of the Mice in his play "The Beautiful People" at the Lyceum Theatre, playing opposite Eugene Loring, and securing excellent reviews from leading critics George Jean Nathan and Richard Watts, Jr. Watts stated, "The gently sweetly sincere and completely moving gravity and innocence of Miss Blair's utterly right performance is so infinitely touching and beautiful than any studied portrayal could be, that her contribution to the work is gracefully enchanting."


title: Betsy Blair

text: Blair was featured in such films as "A Double Life" (1947), "Another Part of the Forest" (1948), and "The Snake Pit" (1948). She continued to hold left-wing political views and admittedly attempted to join the Communist Party. In her autobiography, she revealed her application was rejected as the party felt she would be more valuable as the wife of the progressive Kelly. Kelly himself was not a Communist and his status as a valuable star provided the couple some protection.


title: Betsy Blair

text: In the 1950s, Blair was under investigation from HUAC and blacklisted for several years. She almost lost one of her signature roles, that of Marty's girlfriend in "Marty" (1955), but was restored to the role after Kelly threatened to pull out of "It's Always Fair Weather". For her performance, she received an Academy Award nomination for Best Supporting Actress and prizes from the Cannes Film Festival. Her film career, nonetheless, was damaged during the "red scare" era and she had to seek work on stage in New York and in Europe.


title: Betsy Blair

text: Following her divorce from Kelly, Blair moved permanently to Europe where she paired with French actor and director Roger Pigaut, and continued to appear in films, including Juan Antonio Bardem's "Calle Mayor" (1956) and Michelangelo Antonioni's "Il Grido" (1957). By these years, she self-confessedly became a conspicuous member of the avant la lettre European gauche caviar.


title: Betsy Blair

text: Blair married Czech-born British director/producer Karel Reisz in 1963 and performed sporadically in later years, working with Costa-Gavras in 1988 on the film "Betrayed" and on the mini-series "Scarlett" in 1994. Reisz died in 2002.


title: Betsy Blair

text: Blair filmed scenes for Stephen Daldry's "The Hours" (2002), initially playing the older version of Julianne Moore's character. It is unclear if she was dropped or if she withdrew from the project. In 2003, she published her autobiography "The Memory of All That".


title: Betsy Blair

text: Blair died of cancer in London on March 13, 2009. She was survived by a daughter, three stepchildren and several grandchildren.


title: Chin

text: The chin is the forward pointed part of the anterior mandible (mental region) below the lower lip. A fully developed human skull has a chin of between 0.7 cm and 1.1 cm.


title: Chin

text: The presence of a well-developed chin is considered to be one of the morphological characteristics of "Homo sapiens" that differentiates them from other human ancestors such as the closely related Neanderthals. Early human ancestors have varied symphysial morphology, but none of them have a well-developed chin. The origin of the chin is traditionally associated with the anterior–posterior breadth shortening of the dental arch or tooth row; however, its general mechanical or functional advantage during feeding, developmental origin, and link with human speech, physiology, and social influence are highly debated.


title: Chin

text: Robinson (1913) suggests that the demand to resist masticatory stresses triggered bone thickening in the mental region of the mandible and ultimately formed a prominent chin. Moreover, Daegling (1993) explains the chin as a functional adaptation to resist masticatory stress that causes vertical bending stresses in the coronal plane. Others have argued that the prominent chin is adapted to resisting wishboning forces, dorso-ventral shear forces, and generally a mechanical advantage to resist lateral transverse bending and vertical bending in the coronal plane. On the contrary, others have suggested that the presence of the chin is not related to mastication. The presence of thick bone in the relatively small mandible may indicate better force resistance capacity. However, the question stands of whether the chin is an adaptive or nonadaptive structure.


title: Chin

text: Recent works on the morphological changes of the mandible during development have shown that the human chin, or at least the inverted-T shaped mental region, develops during the prenatal period, but the chin does not become prominent until the early postnatal period. This later modification happens by bone remodeling processes (bone resorption and bone deposition). Coquerelle et al. show that the anteriorly positioned cervical column of the spine and forward displacement of the hyoid bone limit the anterior–posterior breadth in the oral cavity for the tongue, laryngeal, and suprahyoid musculatures. Accordingly, this leads the upper parts of the mandible (alveolar process) to retract posteriorly, following the posterior movement of the upper tooth row, while the lower part of the symphysis remained protruded to create more space, thereby creating the inverted-T shaped mental relief during early ages and the prominent chin later. The alveolar region (upper or superior part of the symphysis) is sculpted by bone resorption, but the chin (lower or inferior part) is depository in its nature. These coordinated bone growth and modeling processes mold the vertical symphysis present at birth into the prominent shape of the chin.


title: Chin

text: Recent research on the development of the chin suggests that the evolution of this unique characteristic was formed not by mechanical forces such as chewing but by evolutionary adaptations involving reduction in size and change in shape of the face. Holton et al. claim that this adaptation occurred as the face became smaller compared to that of other ancient humans.


title: Chin

text: Robert Franciscus takes a more anthropological viewpoint: he believes that the chin was formed as a consequence of the change in lifestyle humans underwent approximately 80,000 years ago. As humans' hunter-gatherer societies grew into larger social networks, territorial disputes decreased because the new social structure promoted building alliances in order to exchange goods and belief systems. Franciscus believes that this change in the human environment reduced hormone levels, especially in men, resulting in the natural evolution of the chin.


title: Chin

text: Overall, human beings are unique in the sense that they are the only species among primates who have chins. In the novel "The Enduring Puzzle of the Human Chin", evolutionary anthropologists James Pampush and David Daegling discuss various theories that have been raised to solve the puzzle of the chin. They conclude that "each of the proposals we have discussed falter either empirically or theoretically; some fail, to a degree, on both accounts… This should serve as motivation, not discouragement, for researchers to continue investigating this modern human peculiarity… perhaps understanding the chin will reveal some unexpected insight into what it means to be human."


title: Chin

text: The terms cleft chin, chin cleft, dimple chin, or chin dimple refer to a dimple on the chin. It is a Y-shaped fissure on the chin with an underlying bony peculiarity. Specifically, the chin fissure follows the fissure in the lower jaw bone that resulted from the incomplete fusion of the left and right halves of the jaw bone, or muscle, during the embryonal and fetal development. It can also develop during the later mandibular symphysis, due to growth of the mental protuberance during puberty, or as a result of acromegaly. In some cases, one mental tubercle may grow more than another, which can cause facial asymmetry.


title: Chin

text: A cleft chin is an inherited trait in humans and can be influenced by many factors. The cleft chin is also a classic example of variable penetrance with environmental factors or a modifier gene possibly affecting the phenotypical expression of the actual genotype. Cleft chins can be presented in a child when neither parent presents a cleft chin. Cleft chins are common among people originating from Europe, the Middle East and South Asia.


title: Chin

text: There is a possible genetic cause for cleft chins, a genetic marker called rs11684042, which is located in chromosome 2.


title: Chin

text: In Persian literature, the chin dimple is considered a factor of beauty and is metaphorically referred to as "the chin pit" or "the chin well": a well in which the poor lover is fallen and trapped.


title: Chin

text: A double chin is a loss of definition of the jawbone or soft tissue under the chin. There are two possible causes for a double chin, which have to be differentiated.


title: Chin

text: In overweight people, commonly the layer of subcutaneous fat around the neck sags down and creates a wrinkle, creating the appearance of a second chin. This fat pad is occasionally surgically removed and the corresponding muscles under the jaw shortened (hyoid lift).


title: Chin

text: Another cause can be a bony deficiency, commonly seen in people of normal weight. When the jaw bones (mandible and by extension the maxilla) don't project forward enough, the chin in turn will not project forward enough to give the impression of a defined jawline and chin. Despite low amounts of fat in the area, it can appear as if the chin is melting into the neck. The extent of this deficiency can vary drastically and usually has to be treated surgically. In some patients, the aesthetic deficit can be overcome with genioplasty alone, in others the lack of forward growth might warrant orthognathic surgery to move one or two jaws forward. If the patient suffers from sleep apnea, early maxillomandibular advancement is usually the only causal treatment and necessary to preserve normal life expectancy.


title: COVID-19 pandemic in Singapore

text: The first case in :Singapore was confirmed on 23 January 2020. Early cases were primarily imported until local transmission began to develop in February and March. In late March and April, COVID-19 clusters were detected at multiple migrant worker dormitories, which soon contributed to an overwhelming proportion of new cases in the country.


title: COVID-19 pandemic in Singapore

text: To stem the tide of infections, strict circuit breaker lockdown measures were implemented from 7 April to 1 June 2020, after which restrictions have been gradually lifted as conditions permitted. A mass vaccination campaign was launched, and has been successful in achieving a very high vaccination rate, with more than 96% of the eligible populace having completed their vaccination regimen as of June 2022. Various measures have been taken to mass test the population for the virus and isolate infected people. Contact tracing measures SafeEntry and TraceTogether were implemented to identify and quarantine close contacts of positive cases.


title: COVID-19 pandemic in Singapore

text: As of 19 December 2022, Singapore has a total of 2,190,057 confirmed cases, with 2,185,085 recoveries and 1,710 deaths. The country currently has a case fatality rate of 0.08%, one of the lowest in the world. It introduced what was considered one of the world's largest and best-organised epidemic control programmes.


title: COVID-19 pandemic in Singapore

text: In response to the emerging threat, a multi-ministerial task force committee was formed on 22 January 2020 with Minister Lawrence Wong and Minister Gan Kim Yong as the co-chairs with Prime Minister Lee Hsien Loong and Deputy Prime Minister Heng Swee Keat as advisors. On 23 April 2021 in a cabinet reshuffle, Lee announced the appointment of Ong Ye Kung as the Minister for Health, another committee co-chair alongside incumbents Minister Lawrence Wong and Minister Gan Kim Yong from 15 May 2021. Singapore had also contributed US$500,000 to support the World Health Organization's (WHO) efforts against COVID-19.


title: COVID-19 pandemic in Singapore

text: In response to the first wave of COVID-19, Singapore enacted the "COVID-19 Control Order", announcing on 3 April 2020 a stringent set of preventive measures collectively called the "circuit breaker lockdown". Initially planned to be applied from 7 April to 4 May, the circuit breaker lockdown was extended to 1 June on 21 April following continued untraced transmission within the community. The Multi-Ministry Taskforce on 19 May announced the three-phased approach to resume activities safely with the gradual re-opening of economic activities in each phase.


title: COVID-19 pandemic in Singapore

text: Phase 1 lasted for 17 days from 2 June and ended on 18 June, with Phase 2 lasting for 6 months and 8 days from 19 June to 27 December. Singapore was in Phase 3 from 28 December 2020 until 7 May 2021; following the rise of the Delta variant, it temporarily reverted to Phase 2 on 8 May, which was raised to "Phase 2 Heightened Alert" from 16 May to 13 June, "Phase 3 Heightened Alert" from 14 June to 21 July and "Phase 2 Heightened Alert" from 22 July 2021 to 9 August 2021. This was followed by "Preparatory Stage of Transition" from 10 August 2021 to 26 September 2021, reverting to Phase 2 Heightened Alert measures (dubbed the "Stabilisation Phase") from 27 September to 21 November 2021, after which it entered the "Transition Phase" from 22 November 2021 to 25 April 2022; Singapore is currently in the "COVID-19 Resilient Nation Phase".


title: COVID-19 pandemic in Singapore

text: Technological solutions to facilitate contact tracing efforts were rapidly developed and deployed by the government. SafeEntry, a check-in system that logs the entry and exit of visitors to public places, was first introduced at selected wet markets on 24 April 2020 and subsequently expanded to include a wide range of venues in May. It was later augmented by compulsory use of TraceTogether, a system originally launched on 20 March 2020 that uses Bluetooth signal strengths to track the proximity and duration of encounters between people with a smartphone app or physical token. With the relaxation of most countermeasures on 26 April 2022, both systems were phased out except in the case of large events with 500 participants, food and beverages outlets, and nightlife entertainment establishments with dancing facilities.


title: COVID-19 pandemic in Singapore

text: A mass vaccination programme is currently under way following the approval and acquisition of the Pfizer–BioNTech and Moderna COVID-19 vaccines; in late 2021, Singapore became the world's most-vaccinated country, with more than 85% of its total population fully-vaccinated. As of June 2022, over 92% of the total population have completed their vaccination regimen, representing over 96% of the eligible populace.


title: COVID-19 pandemic in Singapore

text: On 31 December 2019, health authorities in China reported to the World Health Organization (WHO) a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei, and an investigation was launched in early January 2020. On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), after mounting evidence that the novel coronavirus had spread to 18 countries and completion of investigation in Wuhan.


title: COVID-19 pandemic in Singapore

text: Throughout the COVID-19 pandemic, cases were traced to clusters that several cases had visited during a particular time period in the whole of Singapore. In 2020, new cases are only at foreign worker dormitories and construction sites while Singapore had followed zero-COVID strategy. while local cases formed the bulk of new cases from April 2021, driven by SARS-CoV-2 Delta variant, and rose rapidly to 4-digit numbers. As of 15 December 2022, there are a total of 2,099,630 local cases and 86,584 imported cases. 22 February 2022 saw its highest daily count at 26,032 cases, with 24 February 2022 seeing its highest active case count at 73,540 cases; 20 October 2021, 16 November 2021 and 4 March 2022 saw its highest daily fatality count at 18 deaths. There are currently 6 critically ill and intubated patients warded in the intensive care unit, as of 19 December 2022. It was only on 14 August 2020 that there were no reported community cases for the first time since June, while 1 October 2020 was the first time since April that the daily number of imported cases exceeded that of dormitory cases. 13 October 2020 was the first time in over six months that no dormitory cases were reported, with 15 June 2021 being the first time in over eleven months that no imported cases were reported. At the end of September 2021, the number of confirmed cases in Singapore exceeded the number of confirmed cases in China, with the country also reaching the first grim milestone of 100,000 cases on 2 October 2021. The total number of community cases exceeded that of dormitory cases on 14 October 2021, and passed 100,000 cases on 27 October 2021. Singapore also broke its monthly death record in October 2021 with 312 deaths, breaking its previous monthly death record of 40 in September 2021. The total death count exceeded 1,000 on 27 February 2022, with the total case count crossing the 1-million mark on 19 March 2022. Singapore reported its first death of a patient under 12 years old on 27 June 2022.


title: COVID-19 pandemic in Singapore

text: Internationally, the case fatality ratio (CFR) for COVID-19 has been much lower than SARS in 2003. The transmission of the SARS-CoV-2 virus powering the COVID-19 pandemic has been significantly greater, with a significant total death toll. However, Singapore's death rate has been one of the world's lowest, both in terms of CFR and per capita. This may be attributed to the fact that the bulk of the cases are restricted to the migrant workers living in dormitories away from the general population. These migrant workers tend to be younger, with an average age of 30 years and 2 months old when surveyed in 2015, and the healthcare system was never overwhelmed. The authorities also tested the entire dormitory population for COVID-19 infection, leading to many otherwise asymptomatic infections being picked up. Research by the European Commission suggests that the CFR for SARS-CoV-2 virus picks up in cases 50 years of age and above. The elderly in the general population in Singapore have been advised to stay at home as much as possible, while resident-facing staff in old folks homes are being housed on site or separately in hotels.


title: COVID-19 pandemic in Singapore

text: Other factors contributing to Singapore's exceptionally low CFR include the country's use of extensive contact tracing and testing to identify cases, mandatory mask-wearing, and hospitalisation of all high-risk patients. Singapore has comparatively strict criteria for classifying COVID-19 deaths, counting patients who were infected with COVID but died of other causes as non-COVID deaths.


title: COVID-19 pandemic in Singapore

text: Prevalence studies on the population have shown that 4 in 1600 in the community, or about 0.25%, have previously been infected with COVID-19, while at least 47% of migrant workers living in dormitories have tested positive by PCR or serological tests.


title: COVID-19 pandemic in Singapore

text: National authorities began reporting suspected cases on 4 January, however the first confirmed case was reported on 23 January, a tourist from Wuhan. Until 30 January, there were a total of 13 confirmed cases, all of whom were visitors to Singapore from China. The first case involving a Singaporean was confirmed on 31 January after returning from Wuhan. Contact tracing procedures were put in place to identify close contacts of the confirmed cases who were placed under 14-day quarantines to ring-fence the potential spread of the virus.


title: COVID-19 pandemic in Singapore

text: These imported cases eventually lead to clusters of local transmissions being formed. The first local cluster was reported on 4 February at Yong Thai Hangs, a Chinese health products shop. It was identified as the locus of the infection where four women without recent history of travel to China contracted the virus. The shop was affected when a tour group from Guangxi, China visited it along with other locations such as the Diamond Industries Jewellery Company at Harbour Drive, where another case occurred, while touring Singapore. The tour group had returned to China and the Chinese authorities had confirmed that two of the group was infected. Authorities raised DORSCON level to Orange with the impending COVID-19 cases of infection, with Prime Minister Lee expressing his worry about some cases with no known chain of transmission of the infection directly from Wuhan or indirectly via cases traced in Singapore. He suggested that it might become "futile to try to trace every contact". More clusters emerged at various locations, where there were large scale gatherings such as a business conference, Chinese New Year dinner gatherings and church-related activities. Two clusters were linked when several cases in each cluster was found to have infected each other through serological tests, the first such successful test in the world.


title: COVID-19 pandemic in Singapore

text: In March, as the number of cases began to rise exponentially around the world, the Ministry of Foreign Affairs (MFA) and the Ministry of Education (MOE) began to encourage Singaporeans to return home. Various institutes of higher learning recalled their students currently on overseas internship or exchange, and the MFA began liaising with airlines to facilitate flights to key cities when necessary during this period, to cater to demand for return flights to Singapore. This led to an increase in number of imported cases, in which over 70% of cases from 16 to 19 March were Singaporeans and long-term pass holders returning from overseas.


title: COVID-19 pandemic in Singapore

text: Plans for the lockdown began in February but waited until late of March. Various mask-off activities were prohibited such as dining in and all exercise activities and many people were remote working starting from early April; and from 5 May, gatherings and social visits were only allowed up to two per day, until 1 June. The bulk of cases began to shift from imported cases to migrant workers living in dormitories, resulting in the authorities imposing a mandatory quarantine of 20,000 migrant workers in two dormitories gazetted as isolation areas, namely the S11 Dormitory and Westlite Toh Guan. Following which, the number of cases in migrant worker dormitories began to soar as more clusters were detected in other migrant worker dormitories, reaching a single-daily high of 1,426 cases recorded amongst migrant workers on 20 April. On 21 April, MOM announced that all foreign workers in dormitories were to stop work until 4 May to curb the rising spread of the coronavirus among the groups that were hit the hardest. The number of daily cases amongst migrant workers living in dormitories gradually decreased but continued to remain in the hundreds until early August, with aggressive testing by the authorities. April also marked a shift in policy. The government stopped automatically admitting the infected in hospitals and instead created community care facilities for those who were at low risk, which allowed hospitals to focus only on those in higher risk categories. At the peak on 12 May, there were 19,667 patients in community care facilities. This allowed hospitals to reduce bed take up related to COVID-19 from more than a thousand to several hundred in a few weeks. 18 September saw the first time since the crisis spread to work dormitories that the daily dorm case number fell into single digits.


title: COVID-19 pandemic in Singapore

text: From May onwards, the vast majority of cases were reported in dormitories, with community cases never rising above 24 cases, which was reported on 11 July. Nevertheless, while numbers in the dorms remained elevated in May, 20 April in fact represented the peak of daily cases reported among dormitory workers. By August, it was clear that the situation in dormitories was being brought under control, with new daily cases among dorm workers finally falling below 100 on 11 August. On 11 August, Ministry of Manpower announced that all dormitories had been declared cleared of COVID-19 (except for those blocks that were being used for quarantine facilities). By 1 October less than 300 people were being housed in community care facilities, down from the almost 20,000 from the May peak. However, it also became clear that controlling the disease was going to be extremely difficult. While total case numbers had continued to decline, unlinked community cases had begun to edge up and some dorms that had been cleared of infection were once again put on lockdown. A significant milestone was achieved on 13 October when it was announced that, for the first time since March, there were no local cases of infection. This was followed shortly by 16 October, when the number of active cases fell to less than 100the first time since 12 March, and by 25 November, when it was announced that there were no active clusters for the first time since the pandemic began.


title: COVID-19 pandemic in Singapore

text: On 24 December, Singapore confirmed its first case of the Alpha variant. With Singapore entering the COVID 2020 Phase 3 on 31 December 2020, 2 new clusters were formed out of the 5 community cases reported that day, all of whom were linked to the marine sector. Two additional clusters were formed on 17 and 19 January 2021; the first was from 2 community cases linked to a para-vet working with the Singapore Police Force's K-9 unit, with the second from 2 community cases linked to a worker at Golden Bridge Foods Manufacturing. Another cluster consisting of four community cases linked to an employee at BS Industrial & Construction Supply was formed on 20 January.


title: COVID-19 pandemic in Singapore

text: After banning short term arrivals in March, imported cases fell dramatically. However, since the beginning of July, there was a steady trickle of imported cases as the government loosened arrival requirements, with the majority of cases arriving from India, Indonesia, and the Philippines. January 2021 saw a sharp spike in imported cases, of which foreign domestic workers formed the bulk due to the high demand for them amidst the pandemic.


title: COVID-19 pandemic in Singapore

text: On 23 April 2021, Singapore tightened restrictions due to the rising Delta wave of COVID-19. 2 new localised clusters were identified on 21 and 24 April; the first was a household cluster of 3 community cases linked to a 43-year-old Indian national and work pass holder who was possibly re-infected, while the second was a group of 4 community cases who were linked to a 39-year-old Indonesian sailor. On 29 April, a new household cluster was formed out of 7 community cases that were linked to a 38-year-old Singaporean ICA officer working at Changi Airport, with another cluster formed out of 8 community cases linked to a 46-year-old Filipino nurse working at Tan Tock Seng Hospital. It was announced that Singapore would temporarily revert to Phase 2 from 8 May, but because of the rising Delta variant at Changi Airport Terminal 3, Jurong East (Jem) and several institutes of education, it was tightened to Phase 2 Heightened Alert from 16 May to 13 June. Dining-in would no longer be allowed, and the maximum number of persons in a social gathering would be further reduced to two, among other restrictions. MOE also announced that all Singapore primary schools, secondary schools and junior colleges were to move to full home-based learning starting on 19 May.


title: COVID-19 pandemic in Singapore

text: After a decline in community cases, it was announced that Singapore would re-enter "Phase 3 Heightened Alert", with re-opening to commence in two stages. The first stage would begin on 14 June with the limit on social gatherings increased to 5 people, while the next stage would begin on 21 June with the resumption of dining-in with 5 people. MOE further announced that Primary 4–6, Secondary 3–5, and junior college and Millennia Institute students would be able to return to school on 28 June, and Secondary 1–2 students on 1 July; all students from other levels would return on 6 July. However, a new cluster was formed at the 115 Bukit Merah View Market and Food Centre that was linked to a 74-year old store owner who tested positive on 9 June, which resulted in a fresh surge of community cases. Consequently, the second stage of re-opening was adjusted so that only 2 persons would be allowed for dining-in. With the stabilisation of community infections in early July 2021, it was announced that dining-in with groups of up to 5—along with wedding receptions—would resume on 12 July.


title: COVID-19 pandemic in Singapore

text: In mid-July 2021, a new cluster was formed at several KTV lounges out of 3 community cases linked to a short-term visit pass holder from Vietnam who first tested positive on 11 July, leading to another massive surge in cases. Another new cluster that contributed to the surge was formed on 16 July at Jurong Fishery Port, thereby it reverted to the semi-lockdown called "Phase 2 Heightened Alert" from 22 July to 10 August.


title: COVID-19 pandemic in Singapore

text: On 6 August 2021, it was announced that due to Singapore having successfully vaccinated 66% of its population, restrictions would be eased in two phases; from 10 August, dining-in at restaurants would resume with a limit of up to 5 fully-vaccinated persons, while the limit for non-vaccinated persons and dining-in at hawker centres would remain at 2. From 19 August, half of employees currently remote working could return to offices. The following weeks saw another steep rise in dormitory and community cases with the formation of new clusters at North Coast Lodge on 23 August and Bugis Junction on 24 August, as well as 8 bus interchanges. In this situation, Singapore has only been able to toggle between 2 and 5 person gatherings and are unable to ease back to 8 person gatherings from 8 May 2021 all the way to 28 March 2022. Singapore has removed restrictions relating to Variant of Concern from 29 March 2022.


title: COVID-19 pandemic in Singapore

text: Just after Singapore's COVID-19 vaccination rates increased to 80%, cases rose rapidly by 500 - 1,000 on 30 August 2021, after the public feedback, MOH has announced that Singapore will enter the Stabilisation Phase, dining-in group size at F&B outlets are reduced to two vaccinated people from the current five. Singapore has abandoned the zero-COVID strategy. When the situation improved, dining-in were reverted to five persons who are from the same household, then from 22 November, Singapore had entered Transition Phase after two months, dining-in were reverted to five vaccinated persons and hawker centres and coffeeshops joined the five vaccinated persons strategy, if checks took place. The government did not ease any remote work until the introduction of Workforce Vaccination Measures (WVM), those coming back to work were complemented by ART testing on weekends only. In addition, Singapore has changed the "clusters" to "Health Risk Warning (HRW)", where those who are close contact will have to take Antigen Rapid Testing (ART) under Protocol 3, those who took 5-day MC and on self-isolation/quarantine, hence those who are under Protocol 2.


title: COVID-19 pandemic in Singapore

text: From 1 October 2021, MOH announced that it would unveil COVID-19 maps daily showing where COVID-19 cases have visited frequently. The first map released on 1 October, had 12 sub-zones shown which were frequently visited by infected cases.


title: COVID-19 pandemic in Singapore

text: On 4 January 2022, the week-on-week infection increase rate crossed 1 in Singapore. This has happened for the first time in approximately two months since the COVID-19 Omicron variant cases increased in the city-state. As per statistics, most of the cases detected on each day have entered Singapore from abroad, precisely, 502 out of 842 cases. Despite the increase in cases, hospitalization in Singapore has remained low, with more ICU beds available than in use. Following reports that the current wave was subsiding, MOH announced that COVID-19 safety measures would be streamlined, effective from 15 March 2022 onwards. On 29 March 2022, the measures were further eased, with the limit on group sizes and dining-in increased to 10, masks made optional outdoors and the full reopening of borders for fully-vaccinated travellers, as well as the lifting of restrictions on live performances.


title: COVID-19 pandemic in Singapore

text: On 22 April 2022, MOH announced that due to the stabilising situation, it would lower the DORSCON level to Yellow from 26 April onwards; limits on group sizes would be removed, and TraceTogether and SafeEntry would cease operations at most settings. In addition, the Ministry of Sustainability and the Environment (MSE) announced on 24 April that it would gradually reduce the number of safe-distancing ambassadors on patrol.


title: COVID-19 pandemic in Singapore

text: On 15 May 2022, three cases in the community were found to be infected with the new BA.4 and BA.5 sub-variants. Health Minister Ong Ye Kung predicted that the next wave would arrive in July or August 2022. As the situation stabilised in late August, it was announced that safety measurements would be further eased, with masks only required for transportation that is meant for public access (e.g. Mass Rapid Transit, Light Rail Transit, Causeway Link, SBS Transit, SMRT Buses, Tower Transit, ComfortDelGro, Strides Transportation, TransCab, Sentosa Express, Changi Airport Skytrain and those shopping mall services) and healthcare facilities; non fully-vaccinated travelers to Singapore would also no longer be required to serve a 7-day SHN.


title: COVID-19 pandemic in Singapore

text: The authorities took cautious measures as the economy began to reopen to more regular outside travellers in August. Travellers who did not quarantine in a dedicated facility would have to wear an electronic tag throughout the 14-day period. Singapore also implemented a Reciprocal Green Lane (RGL) and Periodic Commuting Arrangement (PCA) with Malaysia, allowing limited travel between the two countries. Later in the month, arrivals from certain countries had their 14-day quarantine reduced to 7 days; those arriving from Brunei and New Zealand who were tested negative upon arrival would be allowed in without any quarantine. On 30 September 2020, the Singapore government announced that the country will lift border restrictions for some visitors from Australia, excluding Victoria state, and Vietnam, beginning from 8 October 2020; quarantine requirements for Victoria state and mainland China were cancelled on 6 November. In October 2020, then-Minister of Transport Ong Ye Kung suggested that Singapore would be looking to open travel bubbles with various countries such as those with similar risk profiles, but also for those countries from higher risk locations. One such travel bubble between Singapore and Hong Kong was to have started on 22 November; initially postponed to 2021 due to the resurgence of COVID-19 cases in Hong Kong, it was eventually cancelled in August 2021 due to conflicting strategies between the city-state. Singapore cancelled the quarantine arrangement for Hong Kong and Macao, allowing all arrivals quarantine-free under the Air Travel Pass (ATP). This came 9 months after Singapore cancelled the quarantine requirement for China.


title: COVID-19 pandemic in Singapore

text: To stop the spread of COVID-19, the COVID-19 (Temporary Measures) Act 2020 and its Control Order Regulations 2020 was brought into force. These rules banned gatherings and led some to be charged in court, fined or even jailed for offences related to these laws. A number of people who were on work passes have had their passes revoked and have also been permanently banned from working in Singapore.


title: COVID-19 pandemic in Singapore

text: Due to the COVID-19 pandemic, there was an unofficial moratorium on all executions in Singapore for two years, although there are still new death sentences imposed in several capital cases (including convicted murderer Teo Ghim Heng) during the moratorium. The first person to be sentenced to death during the COVID-19 pandemic in Singapore was Punithan Genasan, a 37-year-old Malaysian who was also the first to be sentenced to death on 15 May 2020 via a remote court hearing on Zoom. Punithan, who was convicted of drug trafficking, was later acquitted on 31 October 2022 upon appeal. Eventually, the Singapore government carried out its first execution on 30 March 2022 by hanging 68-year-old Singaporean drug trafficker Abdul Kahar Othman, thus ending the city-state's moratorium on capital punishment. So far, eleven executions were carried out as of 7 October 2022.


title: COVID-19 pandemic in Singapore

text: Also, as a result of the COVID-19 pandemic (especially during the lockdown), virtual court hearings were made through digital video-conferencing platforms (notably Zoom) to hear court cases, which replaced physical court hearings for some cases. The first fully virtual court hearing was made via Zoom on 23 April 2020, when the Court of Appeal acquitted 27-year-old Mohammad Azli Mohammad Salleh of drug trafficking and overturned his death sentence.


title: COVID-19 pandemic in Singapore

text: The ongoing pandemic is likely to have a significant impact on the local economy. On 17 February 2020, the Ministry of Trade and Industry (MTI) downgraded Singapore's forecast GDP growth to between −0.5% and 1.5%. This is largely due to the fall in tourism and social distancing restrictions. On 26 March, MTI said it believed that the economy would contract by between 1% and 4% in 2020. This was after the economy shrank some 2.2% in the first quarter of 2020 from the same quarter in 2019. On 26 May, the Singapore economy contracted 0.7%YoY, which was better than the expected contraction of 2.2%. However, MTI said that it was revising down its expectation for the Singapore economy in 2020 to shrink by 4% to 7%. Economists were behind the curve in downgrading their numbers. The IMF for example, predicted in October 2019 that growth in 2020 would be 1%, but as a result of COVID-19, had changed their expectation in October 2020 to a contraction of 6%. Other institutions initially expected the economy to expand but had to revise their numbers.


title: COVID-19 pandemic in Singapore

text: On 2 April 2020, the rating's agency Moody's downgraded the Singapore banking sector from "stable" outlook to a "negative" outlook on the back of rising bad loans and deteriorating profitability as a result of the COVID-19 pandemic. It was estimated by the economist Chua Hak Bin, the lockdown "circuit breaker" beginning on 7 April could impact the economy to the tune of S$10 billion. With the lockdown imposed on foreign workers, there were concerns that there could be delays in construction work of up to six months. Senior Minister of State Chee Hong Tat announced that some 3,800 companies had closed in April 2020, only slightly higher than the 3,700 reported on average for the same month in the past 5 years. Though he warned that this would likely rise in the coming months. Despite this only small increase in companies shutting down, the number of companies starting up had declined by about a third from the average April since 2015.


title: COVID-19 pandemic in Singapore

text: On 6 April 2020, it was announced in Parliament that Changi Airport Terminal 2 would be suspended from 1 May 2020 for 18 months due to the ongoing pandemic. Terminal 4 would later be suspended on 16 May indefinitely as well, with the aim to restart operations when travel demand returns. The suspension of Terminal 2 would also allow the ongoing expansion work which was announced in January 2020 to be completed up to a year ahead of schedule in 2023 instead of 2024. The airlines which were operating from these two terminals were largely consolidated into the remaining Terminals 1 and 3, with some airlines remained suspended until further notice.


title: COVID-19 pandemic in Singapore

text: In November 2020, the MTI announced Singapore's economy contracted 5.8% in the third quarter from the same period in 2019. It also expected the economy to shrink contract by between 6% and 6.5% in 2020, though in 2021 it expected an expansion of between 4% and 6% next year.


title: COVID-19 pandemic in Singapore

text: Data released by the Ministry of Manpower showed that total employment contracted by 57,000 in 2020, which was the biggest drop since SARS in 2003. Foreign workers were vulnerable to being let go during the crisis as support measures such as the Jobs Support Scheme were primarily targeted as subsidising the wages of local staff not all employees. There were some 22,200 fewer foreign employees (excluding domestic workers) between December 2019 and March 2020. Ministry of Manpower reported that unemployment in the first quarter of 2020 rose to 2.4 per cent from 2.3 per cent the quarter previously, the highest in a decade, while among Singaporeans it rose from 3.3 per cent to 3.5 per cent.


title: COVID-19 pandemic in Singapore

text: As a result of the COVID-19 pandemic, various companies like Resorts World Sentosa reduced a significant amount of its workforce.


title: COVID-19 pandemic in Singapore

text: Local firms had to take aggressive action to deal with effects of the pandemic. For example, on 10 September 2020, Singapore Airlines announced that it would cut around 4,300 positions across its group. On 15 September 2020, United Overseas Bank announced that it was limiting hiring.


title: COVID-19 pandemic in Singapore

text: The overall inflation dropped to 0.3% in February 2020 on a year-by-year basis. Core inflation, which excludes the costs of accommodation and private road transport, dropped to −0.1%, the first time this decade that core inflation turned negative. This was also due to supply chains being disrupted due to COVID-19.


title: COVID-19 pandemic in Singapore

text: On 9 March 2020, the Straits Times Index fell 6.03% owing to the impact of COVID-19, made worse by the oil price war. The Index dropped again three days later by 3.8% after more measures were announced with the World Health Organization declaring a pandemic.


title: COVID-19 pandemic in Singapore

text: The Monetary Authority of Singapore (MAS) brought forward its twice year meeting from some time in April to 30 March 2020. The MAS has since decided to ease the Singapore dollar's appreciation rate to zero per cent, as well as adjust the policy band downwards, the first such move since the Global Financial Crisis. This makes it the first time the MAS had taken these two measures together. Unusually, on 6 April, the central bank also announced that it would bring forward its disclosure of foreign exchange intervention to 9 April. It was previously scheduled to be published in June. In September, Citi argued that a downward re-centring for the MAS SGD NEER in October 2020 could still take place.


title: COVID-19 pandemic in Singapore

text: As one of the highly affected by the pandemic, tourism in Singapore has fallen, with the Singapore Tourism Board experiencing its best increase in visitor arrivals from the previous year. Several countries have imposed travel restrictions on Singapore. Prime Minister Lee Hsien Loong encouraged Singaporeans to go on a local 'staycation' to mitigate the fall in demand for tourism, but this was not possible during the circuit breaker from 7 April 2020 to 1 June 2020. Retail industry was also affected by the pandemic, though it has been steadily recovering since the transition to phase 3. Connect @ Changi, located at Singapore Expo, was launched on 1 April 2021 to support the revival of Singapore's air hub status and hospitality sector.


title: COVID-19 pandemic in Singapore

text: On 8 May 2021, the UK announced that it would allow people in England to resume international travel from 17 May, but would limit the number of destinations open for quarantine-free holidays to just a handful of countries as it cautiously eases lockdown restrictions. Singapore is among a few countries which made the green list for travel in a system that will be reviewed every three weeks.


title: COVID-19 pandemic in Singapore

text: Travel bubbles, also called travel bridges or corona corridors, do away with that waiting period for a select group of travelers from certain countries where the coronavirus has been contained. "In a 'travel bubble' a set of countries agree to open their borders to each other, but keep borders to all other countries closed.


title: COVID-19 pandemic in Singapore

text: On 1 September 2020, applications for "green lane" travel bubbles for travellers from New Zealand and Brunei were opened. Visitors from those 2 countries would be required to take a COVID-19 test on arrival at Changi Airport and self-isolate until they received a negative test result, but otherwise did not have to stay in quarantine upon arrival in Singapore. This was provided they have remained in the country for the last consecutive 14 days prior to their visit to Singapore.


title: COVID-19 pandemic in Singapore

text: Following a resurgence in COVID-19 cases in Singapore, Brunei suspended its "green lane" travel bubble on 20 May 2021. In August 2021, it was announced that Singapore's would launch its first quarantine-free travel lanes for vaccinated passengers from Brunei and Germany on 8 September.


title: COVID-19 pandemic in Singapore

text: On 11 November 2020, Hong Kong and Singapore have agreed to launch a travel bubble to restart tourism without needing to quarantine at the other end. It was hoped that having a quarantine-free travel would boost tourism and business between the two Asian hubs cities, though anyone travelling between the two cities will have to undergo a compulsory COVID-19 test before they flew. The travel bubble was scheduled to start on 22 November 2020. However, the day before the launch, both cities announced that it would be deferred by two weeks until early December. This was due to a sudden spike in new infections in Hong Kong. On 1 December, the launch date was deferred again to beyond December 2020. On 14 December, Singapore increased Hong Kong's quarantine duration to 14 days, up from the previous 7 day arrangement. This showed the complexities involved in opening up, even between countries which had coronavirus infections under control. On 29 March 2021, Singapore resumed discussions with Hong Kong after the latter city experienced a significant decline in its daily local COVID-19 cases. On 26 April, both Singapore and Hong Kong confirmed that the air travel bubble would officially re-launch on 26 May. However, after a spike in local infections triggered fresh restrictions in Singapore in late April, Singapore's government stated on 6 May that it would assess any potential changes to the travel bubble. It was eventually announced in August 2021 that the travel bubble would be cancelled, though quarantine requirements for travelers from Hong Kong and Macao would be cancelled on 26 August. This also came 9 months after Singapore had cancelled the quarantine requirement for arrivals from China. Tourists from Hong Kong and Macao who have spent three consecutive weeks in those cities could apply to enter Singapore under the Air Travel Pass. They also would not need to quarantine if they test negative on arrival and isolate themselves until the test results are available.


title: COVID-19 pandemic in Singapore

text: Singapore introduced the ATP in late 2020, the predecessor to the VTL. It allowed all travellers who have stayed in specific regions to enter quarantine-free regardless of vaccination status.


title: COVID-19 pandemic in Singapore

text: The ATP was given to China, Hong Kong, Macau, Taiwan, and Victoria State (Australia) due to the low cases in the region. Hong Kong received it after the travel bubble was cancelled in August 2021. However, Hong Kong's ATP was later cancelled in early 2022 and replaced with the VTL (tightening restrictions), while China, Macau, and Taiwan retained the ATP until Singapore retired the VTL and allowed all vaccinated travellers to enter without being on a designated flight.


title: COVID-19 pandemic in Singapore

text: As part of Singapore's efforts to reopen its borders safely, fully-vaccinated Singaporean citizens and permanent residents would now be allowed to return to Singapore via the Vaccinated Travel Lane (VTL). On 9 October 2021, it was announced that Singapore would open up more VTLs with other countries, including South Korea and the United States. On 24 March 2022, the Civil Aviation Authority of Singapore (CAAS) announced the retirement of all VTLs and the reopening of borders to all vaccinated travellers from 1 April 2022.


title: COVID-19 pandemic in Singapore

text: Singapore announced that it would be opening a new VTL arrangement for fully-vaccinated travellers from Germany and Brunei from 8 September 2021. Under this arrangement, travellers could enter Singapore without the need to serve a SHN upon arrival. Instead, they would undergo multiple COVID-19 polymerase chain reaction (PCR) tests during their stay in Singapore.


title: COVID-19 pandemic in Singapore

text: On 8 November 2021, Prime Ministers Lee Hsien Loong of Singapore and Ismail Sabri Yaakob of Malaysia announced that a VTL would be opened between Changi Airport and Kuala Lumpur International Airport from 29 November.


title: COVID-19 pandemic in Singapore

text: Subsequently, both nations have agreed to a phased opening of a second VTL through the Johor–Singapore Causeway beginning on 29 November using designated bus lanes, marking the reopening of the land border between the two countries since its closure in March 2020. Only citizens, permanent residents (PRs) and long-term pass holders of the country they are visiting can access this VTL scheme. The second phase, which would allow citizens of both countries to travel between them, began on 20 December.


title: COVID-19 pandemic in Singapore

text: Singapore has also included Sweden and Finland in its quarantine-free travel-lane programmes, which comes into effect on 29 November.


title: COVID-19 pandemic in Singapore

text: On 15 November, Singapore announced plans to establish "vaccine travel lanes" with Indonesia and India from 29 November 2021. Singapore also plans to expand the VTL scheme to Qatar, Saudi Arabia and the United Arab Emirates from 6 December 2021. From 16 March 2022, Singapore will open VTL access to all Indian cities. Following reports of the circulation of the new Omicron variant, the planned VTLs with the Gulf States was deferred; it was later announced that they would be launched on 25 February 2022. Bi-directional quarantine-free sea travel between Singapore and Indonesia would also resume.


title: COVID-19 pandemic in Singapore

text: A VTL between Singapore and Hong Kong was launched on 25 February 2022, due to the rise in cases. It differs from other VTLs as this was one-way; Hong Kong still imposed a quarantine on all arrivals. This VTL actually tightened restrictions as the previous arrangement, the Air Travel Pass (ATP), allowed all arrivals to enter Singapore quarantine-free regardless of vaccination status.


title: COVID-19 pandemic in Singapore

text: The retail industry has been significantly affected by the COVID-19 pandemic, together with the food industry. Foot traffic at shopping malls had dropped, with some shops choosing to shorten their opening hours or face massive closures like Esprit Holdings, Isetan Westgate, Liang Court, H&M Tampines Mall, Topshop, Robinsons and Hotwind. Tenants are pushing landlords for rental rebates, citing significant drops in revenue.


title: COVID-19 pandemic in Singapore

text: Several malls and landlords including Jewel Changi Airport and CapitaLand have implemented rental rebates. The National Environment Agency (NEA) has also implemented rent waivers and rebates for all stallholders in hawker centres operated by NEA or NEA-appointed operators.


title: COVID-19 pandemic in Singapore

text: According to CapitaLand in February 2020, foot traffic at malls were almost back to normal, before being reduced in late-March to early-April 2020 due to social distancing restrictions and circuit breaker measures. Retail sales fell during the COVID-19 pandemic from March to June, citing circuit breaker as a reason. The April and May figure was the worst since records began in 1986. However, retail sales reinstated gradually in July, August and September but the process was interrupted by public places visited by cases in the community. Foot traffic will again resume back to normal fully once Singapore moves to Phase 3. Retail sales and foot traffic again fell during Phase 2 (Heightened Alert) from 3 May 2021 to 14 June 2021.


title: COVID-19 pandemic in Singapore

text: In response to the government's lockdown measures, Suntec City announced that it would waive rent for all tenants for the month of April, May and June.


title: COVID-19 pandemic in Singapore

text: Panic buying and price gouging of personal protective equipment (PPEs) such as masks began with the first confirmed case of COVID-19 in Singapore on 23 January 2020. By 24 January, both N95 and surgical masks had run out at retail outlets. This has prompted local retailers including NTUC FairPrice, Watsons and Guardian to originally impose limits, but had a surge in demand. Many areas have began wearing of masks; but on 1 April, the number of people wearing masks have grown up to 93%, with masks made mandatory by the government on 14 April. In addition, mask wearing continues to remain until the pandemic has subsided to endemic levels, with the gradual easing of masks done only in the safest outdoor and common housing environment first. The first phase of mask easing which includes outdoors settings came into force on 29 March 2022. The second and final phase of mask easing comes on 29 August 2022; which involves the remaining settings.


title: COVID-19 pandemic in Singapore

text: The shortage of masks and other PPEs has caused many retailers to engage in profiteering by price gouging and scalping. This included both local brick-and-mortar stores as well as retailers on ecommerce platforms. The government has applauded platforms Carousell and Qoo10 for threatening to suspend profiteers. The governmental price controller has also issued warnings to retailers who engage in price gouging and requested information from e-commerce platforms on potential profiteers.


title: COVID-19 pandemic in Singapore

text: Panic buying and hoarding of essentials such as rice, instant noodles and toilet paper occurred with the raising of the DORSCON level from yellow to orange on 7 February 2020, with empty shelves at supermarkets within hours. Local supermarket chain NTUC FairPrice imposed limits on the amount of essentials each consumer can buy, with these limits initially set for paper products, rice products, instant noodle packets and vegetables. NTUC FairPrice and Dairy Farm Singapore announced that it would introduce specific hours for those members of the community who were more vulnerable such as Pioneer Generation members. Following the review, supermarkets are considered essential services, therefore there is no need to hoard items, it must be opened every day.


title: COVID-19 pandemic in Singapore

text: A second wave of panic buying and hoarding occurred on 17 March when Malaysia announced its lockdown from 18 March, sparked by fears of food shortages. The government has clarified that the flow of goods, cargo and food supplies between Singapore and Malaysia will continue, urging the public not to panic buy. They added that Singapore has diverse sources of essential goods and was not facing an immediate shortage of food or essentials. NTUC FairPrice has expanded its list of items that are limited per consumer to include eggs, vegetables and poultry. 10 days later, NTUC FairPrice expanded its list to include canned food, cooking oil and frozen meat, with reduced purchasing limits for paper products.


title: COVID-19 pandemic in Singapore

text: To deal with the massive increase in online shopping orders, RedMart (Part of Lazada) on 2 April said that it would prioritise daily essentials such as milk powder, flour, eggs and rice while limiting orders to 35 items and reducing its range of goods to focus on the essentials. It also said that it would stop taking orders until 4 April to implement additional measures.


title: COVID-19 pandemic in Singapore

text: Ahead of tighter measures on 7 April, shoppers queued at shopping malls despite government requests for people to remain at home.


title: COVID-19 pandemic in Singapore

text: Egg distributors were reporting in June that they now had an oversupply of eggs and were throwing away supplies or culling laying stock.


title: COVID-19 pandemic in Singapore

text: As a result of COVID-19 pandemic, many event organisers and organisations, including places of worship have switched events virtually with more than 250 persons and moving on to 50 persons in the second phase. These include COMEX, IT Show, PC Show and SITEX. Thaipusam procession had carried on but with up to 500 persons in 2020.


title: COVID-19 pandemic in Singapore

text: Mediacorp postponed its Star Awards ceremony to 2021 and held it at the Jewel Changi Airport due to the COVID-19 pandemic. The Shangri-La Dialogue defence summit, which had been held every year in Singapore, was cancelled during the COVID-19 pandemic. On 12 June 2020, it was announced that the Singapore Grand Prix, would be cancelled in both 2020 and 2021. Organisers of the Marina Bay Singapore Countdown had announced on 5 November 2020 that there will be no fireworks display and countdown at Marina Bay, instead, light shows will be held instead together with heartland fireworks and that the event would be streamed online and on television by Mediacorp.


title: COVID-19 pandemic in Singapore

text: On 7 December 2020, organisers of the annual World Economic Forum event announced that they have decided to hold its 2021 annual meeting in Singapore, from 25 to 28 May, instead of its traditional home of Switzerland, which is battling a rising number of coronavirus infections. On 3 February 2021, the organisers postponed the annual meeting to 17–20 August due to pandemic-related challenges. It was eventually cancelled on 17 May, with the World Economic Forum's (WEF) citing global uncertainties caused by COVID-19 as the reason. It was added that the next annual meeting will take place in the first half of 2022, with the final location and date to be decided later.


title: COVID-19 pandemic in Singapore

text: On 4 May 2021, the President's Office announced that the Istana Open House on 13 May would be cancelled. While it was initially announced that it would reopen on 1 August, it was later decided that the event would be postponed to 28 August, in the wake of the rise of community cases in July.


title: COVID-19 pandemic in Singapore

text: On 30 June 2021, Ng Eng Hen announced that the annual National Day Parade at The Float @ Marina Bay would proceed as planned. Following the return to Phase 2 (Heightened Alert), MINDEF stated that it would be postponed to 21 August, with a ceremonial parade held on 9 August. On 12 July 2022, it was announced that live performances and open houses would return to the Istana.


title: COVID-19 pandemic in Singapore

text: Wedding ceremonies were also adversely affected by COVID-19. In Risk Level 0 (Heightened Risk), all wedding receptions are not allowed. In Risk Level 1, it was allowed with up to 50 persons without pre-event testing and 250 persons with pre-event testing. In Risk Level 2, it was allowed with up to 100 persons without pre-event testing and 250 persons with pre-event testing. Wedding ceremonies were revamped since the return to P2HA in 2021, to allow wedding receptions for all fully vaccinated persons, up to 100 guests, before raising back to 250 guests.


title: COVID-19 pandemic in Singapore

text: Taxi and private hire vehicles were hit by the impact of COVID-19. A S$77 million package was provided to help them tide through this period, co-funded by the Government, taxi and private-hire companies. In addition, a S$2.7 million fund was set up by the Government and National Trades Union Congress (NTUC) for drivers who are not eligible. In view of the worsening coronavirus impact, the package will be enhanced from May 2020, extending until September 2020. This will cost an additional $95 million. On 6 April, directors of the ComfortDelGro Group (ComfortDelGro, SBS Transit and VICOM) announced its board of directors would take a voluntary 20 per cent cut in directors' fees until the end of 2020.


title: COVID-19 pandemic in Singapore

text: Various banks have suggested that Singapore Airlines will have a loss in FY21, with OCBC credit analysts Ezien Hoo and Wong Hong Wei arguing that the airline will have to tap the markets for more funds and possibly even need state support.


title: COVID-19 pandemic in Singapore

text: Singapore Airlines, SilkAir and Scoot have announced plans to slash their capacity. Singapore Airlines slashed nearly all of the capacity until August. The news resulted in STI crashing down by 164.63 (6.83%). Scoot will ground 47 out of the 49 planes they have in their fleet. It was reported on 27 March 2020, SIA received a rescue package of S$19 billion to get over the difficult period. Its major shareholder Temasek Holdings will underwrite the package which contains S$5.3 billion equity and S$9.7 billion convertible note. Singapore's biggest bank DBS will also lend it S$4 billion to help it get over the crisis and position itself for expansion. With the significant reduction in flights, Singapore Airlines agreed to provide some 300 staff to help with possible manpower shortages at hospitals in Singapore and provided some staff to deal with transport ambassadors. It was announced that the airline would consolidate all their Changi Airport operations from 1 May 2020 to Terminal 3. On 14 May 2020, Singapore Airlines announced a full year loss for Financial Year 2019–2020 of S$212 million, this was the first loss in its 48 years of operation. On 1 September 2020, Singapore Airlines have announced to reinstate several destinations that have opened up travel such as Bandar Seri Begawan, Auckland, Christchurch, Taipei, Hong Kong, Macau, Hanoi, Brisbane, Perth and Sydney. For airlines, regulations for social distancing are not applicable to save costs. Mask wearing continues to be mandatory and airlines will upgrade their apps to include contact tracing. Overnight flights will also be re-introduced which allows even quieter rides. On 25 June Jetstar Asia Airways announced that it was cutting up to 180 people, almost a quarter of the workforce in Singapore. At the same time they would allow the retirement of five of their A320 fleet, bringing the total down to 13.


title: COVID-19 pandemic in Singapore

text: The Land Transport Authority announced that all certificate of entitlement (COE) bidding during the COVID-19 lockdown periods would be suspended.


title: COVID-19 pandemic in Singapore

text: Transport services were gradually reduced in stages. Last train timings were brought forward to early, and transport frequencies were remained to allow safe distancing. Measures also involve imposition of queuing at station exit points.


title: COVID-19 pandemic in Singapore

text: Cross-border bus services were impacted by Malaysia's Movement Control Order all the way until 30 April 2022, with services 160 and 170 amended to serve only local sectors of its route, while services 170X and 950 were suspended entirely.


title: COVID-19 pandemic in Singapore

text: As many Singaporeans have worked from home as default, all City Direct and Express services were temporarily suspended from 8 April 2020 to 1 June 2020, and certain services such as 12e, 43e, 518, 661 and 666 were suspended during the impact of COVID-19 manpower, 518 resumed on 27 September 2021. Bus service 401 was suspended from April 2020 all the way to 4 June 2022, and all remaining leisure services such as Chinatown Direct, Night, 188R, 963R and 926 were discontinued on 30 June 2022 due to duplication with the MRT and low demand. Train and bus services are no longer extended except for New Year's Eve whereby last train departs City Hall at 1.15 am.


title: COVID-19 pandemic in Singapore

text: Bus services also experienced disruptions when clusters of COVID-19 infection occurred among public bus drivers, forcing both patients and colleagues who were close contacts to self-isolate. In August and September 2021, "slightly under 10%" out of a total of 9,500 bus drivers were affected, resulting in some express services being withdrawn, while waiting times increased for other routes that had to run at a reduced frequency. Bus operators sought to minimize the impact by prioritising high-demand routes, reassigning available drivers as needed. In February 2022, another shortage of drivers occurred due to a wave of infections, and SBS Transit was forced to reduce the operating frequency of some routes, with double-decker buses deployed to replace single-deckers in some instances to compensate for capacity.


title: COVID-19 pandemic in Singapore

text: The quarantine and testing of all foreign workers in dormitories has caused delays in the construction of various MRT projects, including the delay of the Thomson–East Coast line's Stage 2 opening on 28 August 2021, after a few extensions. The LTA has been yet to fully assess the length of delays on the other stages of the line and of other MRT projects.


title: COVID-19 pandemic in Singapore

text: Several parties have engaged in scams related to the pandemic. For instance, scammers have pretended to be MOH officials engaging in contact tracing. The MOH and police clarified that no financial details or transfer of money will be requested during contact tracing. The police have also arrested scammers on e-commerce platform Carousell. On 4 April, SPF announced that they had arrested a man for suspected money-laundering offences in relation to a COVID-19 linked scam which saw an overseas pharmaceutical company defrauded to the tune of €6.636 million (S$10.3 million) over the purchase of surgical masks and hand sanitisers. The Ministry of Social and Family Development (MSF) and SPF were investigating possible abuses of the COVID-19 Temporary Relief Fund (TRF), which is supposed to provide financial assistance to those eligible. There were cases of scammers impersonating the Chinese police force asking for many personal details. A total of 394 COVID-19-related scams occurred between January and April, with losses totalling S$1.4 million. There have also been false rumours of National Environment Agency and police officers actively checking residential units to ensure that people were complying with circuit breaker rules.


title: COVID-19 pandemic in Singapore

text: In 2021, SPF warned about a new type of scams involving oxygen machines. The scammers use compromised WhatsApp accounts to solicit donations for the purchase of oxygen concentrator machines to be sent to India.


title: COVID-19 pandemic in Singapore

text: On 16 March 2020, the Malaysian government announced the movement control order (MCO) that took effect on 18 March 2020, preventing Malaysians from leaving the country. With approximately 300,000 Malaysians, or almost a tenth of Singapore's labour force working in Singapore, the MCO would have been expected to significantly affect Singapore's economy, including sectors providing essential services.


title: COVID-19 pandemic in Singapore

text: The MCO caused long queues at immigration checkpoints as Malaysian workers in Singapore scrambled to collect their belongings and return to Singapore, while Singaporeans returned home. Various firms across Singapore rushed to find temporary accommodation for their workers before the MCO took effect. The Singapore government advised workers to try to stay with relatives, friends, and colleagues, and seek housing in hotels, dormitories and rental flats if this was not possible. The government also provided $50 for each worker per day, up to 14 days to support employers finding accommodation. As of 17 March, the government announced that 10,000 Malaysian workers had been matched with temporary housing. Some workers could not immediately find accommodations and resorted to sleeping in public areas. In response, Ministry of Social and Family Development repurposed Jurong East Sports Hall into a temporary relief area for remaining Malaysian workers who were unable to find temporary accommodations immediately after the MCO took effect, while the Ministry of Manpower stepped up patrols to look out for such stranded workers. A number of residents also stepped up to offer their spare rooms to accommodate Malaysian workers at little to no cost.


title: COVID-19 pandemic in Singapore

text: The MCO resulted in suspension of all bus services between Johor Bahru and Singapore. While the KTMB Shuttle Tebrau train service continues to operate between the two checkpoints, only citizens returning to their respective countries are allowed to board. The lockdown also sparked fears of food shortages, triggering a second wave of panic buying and hoarding of essential items. On 26 April, Malaysia announced that Malaysians wanting to return to Malaysia will need to obtain permits from the Malaysian High Commission in Singapore. However, only 400 of such permits will be issued daily.


title: COVID-19 pandemic in Singapore

text: Singapore began to restrict travellers from entering from 29 January in a progressive manner as a response to localised outbreaks. Travelers were banned gradually in phases between January and 23 March; only people who are in essential services are allowed entry, the last phase requires all travellers to undergo SHN at hotels. Port calls for all cruise vessels were stopped from 13 March as well.


title: COVID-19 pandemic in Singapore

text: Due to the reduced number of flights, Singapore Changi Airport suspended operations at Terminals 2 and 4 in April and May 2020 respectively. Terminal 4 became a Dino-themed funland and vaccination centre. Malaysia would also shorten the operating hours of Sultan Iskandar Building at the Johor Causeway to 12 hours daily from 24 April, effectively limiting the Causeway's operating hours. The Second Link crossing would remain open round the clock.


title: COVID-19 pandemic in Singapore

text: On 28 June 2020, Prime Minister Lee Hsien Loong and his Malaysian counterpart Muhyiddin Yassin agreed that their governments will work together to establish a Periodic Commuting Arrangement (PCA) allowing residents from both nations who hold long-term immigration passes for business and work purposes in the other country to periodically return to their home countries for short-term home leave. The Reciprocal Green Lane (RGL) and the Periodic Commuting Arrangement (PCA) were launched in August 2020. The RGL scheme will allow essential business and official travel between the two countries while the PCA scheme will allow Singaporean and Malaysian residents who hold long-term immigration business and work passes to enter for work purposes. Travel bubble arrangements with Malaysia, Germany and South Korea were suspended due to emergence of COVID-19 variant of concern, whereas in future, Singapore and Malaysia had plans to recognise each other's COVID-19 vaccine certificates with the goal of restoring cross-border travel.


title: COVID-19 pandemic in Singapore

text: Cruises were restarted in November but did not have any other port of call other than Singapore. In early December, an 83-year-old man tested positive on board and the ship had to return to Singapore a day early. Subsequent retests of the sample and additional samples proved the original test to be a false positive.