9 July 2020 - World Health Organization
This document is an update to the scientific brief published on 29 March 2020 entitled “Modes of transmission of virus causing COVID-19: implications for infection prevention and control (IPC) precaution recommendations” and includes new scientific evidence available on transmission of SARS-CoV-2, the virus that causes COVID-19.
This scientific brief provides an overview of the modes of transmission of SARS-CoV-2, what is known about when infected people transmit the virus, and the implications for infection prevention and control precautions within and outside health facilities. This scientific brief is not a systematic review. Rather, it reflects the consolidation of rapid reviews of publications in peer-reviewed journals and of non-peer-reviewed manuscripts on pre-print servers, undertaken by WHO and partners. Preprint findings should be interpreted with caution in the absence of peer review. This brief is also informed by several discussions via teleconferences with the WHO Health Emergencies Programme ad hoc Experts Advisory Panel for IPC Preparedness, Readiness and Response to COVID-19, the WHO ad hoc COVID-19 IPC Guidance Development Group (COVID-19 IPC GDG), and by review of external experts with relevant technical backgrounds.
The overarching aim of the global Strategic Preparedness and Response Plan for COVID-19(1) is to control COVID-19 by suppressing transmission of the virus and preventing associated illness and death. Current evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is predominantly spread from person-to-person. Understanding how, when and in what types of settings SARS-CoV-2 spreads is critical to develop effective public health and infection prevention and control measures to break chains of transmission.
Modes of transmission
This section briefly describes possible modes of transmission for SARS-CoV-2, including contact, droplet, airborne, fomite, fecal-oral, bloodborne, mother-to-child, and animal-to-human transmission. Infection with SARS-CoV-2 primarily causes respiratory illness ranging from mild disease to severe disease and death, and some people infected with the virus never develop symptoms.
Contact and droplet transmission
Transmission of SARS-CoV-2 can occur through direct, indirect, or close contact with infected people through infected secretions such as saliva and respiratory secretions or their respiratory droplets, which are expelled when an infected person coughs, sneezes, talks or sings.(2-10) Respiratory droplets are >5-10 μm in diameter whereas droplets <5μm in diameter are referred to as droplet nuclei or aerosols.(11) Respiratory droplet transmission can occur when a person is in close contact (within 1 metre) with an infected person who has respiratory symptoms (e.g. coughing or sneezing) or who is talking or singing; in these circumstances, respiratory droplets that include virus can reach the mouth, nose or eyes of a susceptible person and can result in infection. Indirect contact transmission involving contact of a susceptible host with a contaminated object or surface (fomite transmission) may also be possible (see below).
Airborne transmission is defined as the spread of an infectious agent caused by the dissemination of droplet nuclei (aerosols) that remain infectious when suspended in air over long distances and time.(11) Airborne transmission of SARS-CoV-2 can occur during medical procedures that generate aerosols (“aerosol generating procedures”).(12) WHO, together with the scientific community, has been actively discussing and evaluating whether SARS-CoV-2 may also spread through aerosols in the absence of aerosol generating procedures, particularly in indoor settings with poor ventilation.
The physics of exhaled air and flow physics have generated hypotheses about possible mechanisms of SARS-CoV-2 transmission through aerosols.(13-16) These theories suggest that 1) a number of respiratory droplets generate microscopic aerosols (<5 μm) by evaporating, and 2) normal breathing and talking results in exhaled aerosols. Thus, a susceptible person could inhale aerosols, and could become infected if the aerosols contain the virus in sufficient quantity to cause infection within the recipient. However, the proportion of exhaled droplet nuclei or of respiratory droplets that evaporate to generate aerosols, and the infectious dose of viable SARS-CoV-2 required to cause infection in another person are not known, but it has been studied for other respiratory viruses.(17)
One experimental study quantified the amount of droplets of various sizes that remain airborne during normal speech. However, the authors acknowledge that this relies on the independent action hypothesis, which has not been validated for humans and SARS-CoV-2.(18) Another recent experimental model found that healthy individuals can produce aerosols through coughing and talking (19), and another model suggested high variability between individuals in terms of particle emission rates during speech, with increased rates correlated with increased amplitude of vocalization.(20) To date, transmission of SARS-CoV-2 by this type of aerosol route has not been demonstrated; much more research is needed given the possible implications of such route of transmission.
Experimental studies have generated aerosols of infectious samples using high-powered jet nebulizers under controlled laboratory conditions. These studies found SARS-CoV-2 virus RNA in air samples within aerosols for up to 3 hours in one study (21) and 16 hours in another, which also found viable replication-competent virus.(22) These findings were from experimentally induced aerosols that do not reflect normal human cough conditions. Some studies conducted in health care settings where symptomatic COVID-19 patients were cared for, but where aerosol generating procedures were not performed, reported the presence of SARS-CoV-2 RNA in air samples (23-28), while other similar investigations in both health care and non-health care settings found no presence of SARS-CoV-2 RNA; no studies have found viable virus in air samples.(29-36) Within samples where SARS-CoV-2 RNA was found, the quantity of RNA detected was in extremely low numbers in large volumes of air and one study that found SARS-CoV-2 RNA in air samples reported inability to identify viable virus. (25) The detection of RNA using reverse transcription polymerase chain reaction (RT-PCR)-based assays is not necessarily indicative of replication- and infection-competent (viable)
virus that could be transmissible and capable of causing infection.(37)
Recent clinical reports of health workers exposed to COVID-19 index cases, not in the presence of aerosol-generating procedures, found no nosocomial transmission when contact and droplet precautions were appropriately used, including the wearing of medical masks as a component of the personal protective equipment (PPE). (38, 39) These observations suggest that aerosol transmission did not occur in this context. Further studies are needed to determine whether it is possible to detect viable SARS-CoV-2 in air samples from settings where no procedures that generate aerosols are performed and what role aerosols might play in transmission.
Outside of medical facilities, some outbreak reports related to indoor crowded spaces (40) have suggested the possibility of aerosol transmission, combined with droplet transmission, for example, during choir practice (7), in restaurants (41) or in fitness classes.(42) In these events, short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out. However, the detailed investigations of these clusters suggest that droplet
and fomite transmission could also explain human-to-human transmission within these clusters. Further, the close contact environments of these clusters may have facilitated transmission from a small number of cases to many other people (e.g., superspreading event), especially if hand hygiene was not performed and masks were not used when physical distancing was not maintained.(43)
Respiratory secretions or droplets expelled by infected individuals can contaminate surfaces and objects, creating fomites (contaminated surfaces). Viable SARS-CoV-2 virus and/or RNA detected by RT-PCR can be found on those surfaces for periods ranging from hours to days, depending on the ambient environment (including temperature and humidity) and the type of surface, in particular at high concentration in health care facilities where COVID-19 patients were being treated.(21, 23, 24, 26, 28, 31-33, 36, 44, 45) Therefore, the transmission may also occur indirectly through touching surfaces in the immediate environment or objects contaminated with virus from an infected person (e.g.
stethoscope or thermometer), followed by touching the mouth, nose, or eyes.
Despite consistent evidence as to SARS-CoV-2 contamination of surfaces and the survival of the virus on certain surfaces, there are no specific reports which have directly demonstrated fomite transmission. People who come into contact with potentially infectious surfaces often also have close contact with the infectious person, making the distinction between respiratory droplet and fomite transmission difficult to discern. However, fomite transmission is considered a likely mode of transmission for SARS-CoV-2, given consistent findings about environmental contamination in the vicinity of infected cases and the fact that other coronaviruses and respiratory viruses can transmit this way.
Other modes of transmission
SARS-CoV-2 RNA has also been detected in other biological samples, including the urine and feces of some patients.(46-50)One study found viable SARS-CoV-2 in the urine of one patient.(51)Three studies have cultured SARS-CoV-2 from stool specimens. (48, 52, 53) To date, however, there have been no published reports of transmission of SARS-CoV-2 through feces or urine.
Some studies have reported detection of SARS-CoV-2 RNA, in either plasma or serum, and the virus can replicate in blood cells. However, the role of bloodborne transmission remains uncertain; and low viral titers in plasma and serum suggest that the risk of transmission through this route may be low.(48, 54) Currently, there is no evidence for intrauterine transmission of SARS-CoV-2 from infected pregnant women to their fetuses, although data remain limited. WHO has recently published a scientific brief on breastfeeding and COVID-19.(55) This brief
explains that viral RNA fragments have been found by RT-PCR testing in a few breast milk samples of mothers infected with SARS-CoV-2, but studies investigating whether the virus could be isolated, have found no viable virus. Transmission of SARS-CoV-2 from mother to child would necessitate replicative and infectious virus in breast milk being able to reach target sites in the infant and also to overcome infant defense systems. WHO recommends that mothers with suspected or confirmed COVID-19 should be encouraged to initiate or continue to breastfeed.(55)
Evidence to date shows that SARS-CoV-2 is most closely related to known betacoronaviruses in bats; the role of an intermediate host in facilitating transmission in the earliest known human cases remains unclear.(56, 57) In addition to investigations on the possible intermediate host(s) of SARS-CoV-2, there are also a number of studies underway to better understand susceptibility of SARS-CoV-2 in different animal species. Current evidence suggests that humans infected with SARS-CoV-2 can infect other mammals, including dogs(58), cats(59), and farmed mink.(60) However, it remains unclear if these infected mammals pose a significant risk for transmission to humans.
When do people infected with SARS-CoV-2 infect others?
Knowing when an infected person can spread SARS-CoV-2 is just as important as how the virus spreads (described above). WHO has recently published a scientific brief outlining what is known about when a person may be able to spread, based on the severity of their illness. (61)
In brief, evidence suggests that SARS-CoV-2 RNA can be detected in people 1-3 days before their symptom onset, with the highest viral loads, as measured by RT-PCR, observed around the day of symptom onset, followed by a gradual decline over time.(47, 62-65) The duration of RT-PCR positivity generally appears to be 1-2 weeks for asymptomatic persons, and up to 3 weeks or more for patients with mild to moderate disease.(62, 65-68) In patients with severe COVID-19 disease, it can be much longer.(47)
Detection of viral RNA does not necessarily mean that a person is infectious and able to transmit the virus to another person. Studies using viral culture of patient samples to assess the presence of infectious SARS-CoV-2 are currently limited. (61) Briefly, viable virus has been isolated from an asymptomatic case,(69) from patients with mild to moderate disease up to 8-9 days after symptom onset, and for longer from severely ill patients.(61) Full details about the duration of viral shedding can be found in the WHO guidance document on “Criteria for releasing COVID-19 patients from isolation”. (61) Additional studies are needed to determine the duration of viable virus shedding among infected patients.
SARS-CoV-2 infected persons who have symptoms can infect others primarily through droplets and close contact
SARS-CoV-2 transmission appears to mainly be spread via droplets and close contact with infected symptomatic cases. In an analysis of 75,465 COVID-19 cases in China, 78-85% of clusters occurred within household settings, suggesting that transmission occurs during close and prolonged contact.(6) A study of the first patients in the Republic of Korea showed that 9 of 13 secondary cases occurred among household contacts.(70) Outside of the household setting, those who had close physical contact, shared meals, or were in enclosed spaces for approximately one hour or more with symptomatic cases, such as in places of worship, gyms, or the workplace, were also at increased risk of infection.(7, 42, 71, 72) Other reports have supported this with similar findings of secondary transmission within families in other countries.(73, 74)
SARS-CoV-2 infected persons without symptoms can also infect others
Early data from China suggested that people without symptoms could infect others.(6) To better understand the role of transmission from infected people without symptoms, it is important to distinguish between transmission from people who are infected who never develop symptoms(75) (asymptomatic transmission) and transmission from people who are infected but have not developed symptoms yet (presymptomatic transmission). This distinction is important when developing public health strategies to control transmission.
The extent of truly asymptomatic infection in the community remains unknown. The proportion of people whose infection is asymptomatic likely varies with age due to the increasing prevalence of underlying conditions in older age groups (and thus increasing risk of developing severe disease with increasing age), and studies that show that children are less likely to show clinical symptoms compared to adults.(76) Early studies from the United States (77) and China (78) reported that many cases were asymptomatic, based on the lack of symptoms at the time of testing; however, 75-100% of these people later developed symptoms. A recent systematic review estimated that the proportion of truly asymptomatic cases ranges from 6% to 41%, with a pooled estimate of 16% (12%–20%).(79) However, all studies included in this systematic review have important limitations.(79) For example, some studies did not clearly describe how they followed up with persons who were asymptomatic at the time of testing to ascertain if they ever developed symptoms, and others defined “asymptomatic” very narrowly as persons who never developed fever or respiratory symptoms, rather than as those who did not develop any symptoms at all.(76, 80) A recent study from China that clearly and appropriately defined asymptomatic infections suggests that the proportion of infected people who never developed symptoms was 23%.(81)
Multiple studies have shown that people infect others before they themselves became ill, (10, 42, 69, 82, 83) which is supported by available viral shedding data (see above). One study of transmission in Singapore reported that 6.4% of secondary cases resulted from presymptomatic transmission.(73) One modelling study, that inferred the date of transmission based on the estimated serial interval and incubation period, estimated that up to 44% (25-69%) of transmission may have occurred just before symptoms appeared.(62) It remains unclear why the magnitude of estimates from modelling studies differs from available empirical data.
Transmission from infected people without symptoms is difficult to study. However, information can be gathered from detailed contact tracing efforts, as well as epidemiologic investigations among cases and contacts. Information from contact tracing efforts reported to WHO by Member States, available transmission studies and a recent pre-print systematic reviews suggests that individuals without symptoms are less likely to transmit the virus than those who develop symptoms.(10, 81, 84, 85) Four individual studies from Brunei, Guangzhou China, Taiwan China and the Republic of Korea found that between 0% and 2.2% of people with asymptomatic infection infected anyone else, compared to 0.8%-15.4% of people with symptoms.(10, 72, 86, 87)
Remaining questions related to transmission
Many unanswered questions about transmission of SARS-CoV-2 remain, and research seeking to answer those questions is ongoing and is encouraged. Current evidence suggests that SARS-CoV-2 is primarily transmitted between people via respiratory droplets and contact routes – although aerosolization in medical settings where aerosol generating procedures are used is also another possible mode of transmission - and that transmission of COVID-19 is occurring from people who are pre-symptomatic or symptomatic to others in close contact (direct physical or face-to-face contact with a probable or confirmed case within one meter and for prolonged periods of time), when not wearing appropriate PPE. Transmission can also occur from people who are infected and remain asymptomatic, but the extent to which this occurs is not fully understood and requires further research as an urgent priority. The role and extent of airborne transmission outside of health care facilities, and in particular in close settings with poor ventilation, also requires further study.
As research continues, we expect to gain a better understanding about the relative importance of different transmission routes, including through droplets, physical contact and fomites; the role of airborne transmission in the absence of aerosol generating procedures; the dose of virus required for transmission to occur, the characteristics of people and situations that facilitate superspreading events such as those observed in various closed settings, the proportion of infected people who remain asymptomatic throughout the course of their infection; the proportion of truly asymptomatic persons who transmit the virus to others; the specific factors that drive asymptomatic and pre-symptomatic transmission; and the proportion of all infections that are transmitted from asymptomatic and pre-symptomatic individuals.
Implications for preventing transmission
Understanding how, when and in which settings infected people transmit the virus is important for developing and implementing control measures to break chains of transmission. While there is a great deal of scientific studies becoming available, all studies that investigate transmission should be interpreted bearing in mind the context and settings in which they took place, including the infection prevention interventions in place, the rigor of the methods used in the investigation and the limitations and biases of the study designs.
It is clear from available evidence and experience, that limiting close contact between infected people and others is central to breaking chains of transmission of the virus causing COVID-19. The prevention of transmission is best achieved by identifying suspect cases as quickly as possible, testing, and isolating infectious cases. (88, 89) In addition, it is critical to identify all close contacts of infected people (88) so that they can be quarantined (90) to limit onward spread and break chains of transmission. By quarantining close contacts, potential secondary cases will already be separated from others before they develop symptoms or they start shedding virus if they are infected, thus preventing the opportunity for further onward spread. The incubation period of COVID-19, which is the time between exposure to the virus and symptom onset, is on average 5-6 days, but can be as long as 14 days. (82, 91) Thus, quarantine should be in place for 14 days from the last exposure to a confirmed case. If it is not possible for a contact to quarantine in a separate living space, self-quarantine for 14 days at home is required; those in self-quarantine may require support during the use of physical distancing measures to prevent the spread of the virus.
Given that infected people without symptoms can transmit the virus, it is also prudent to encourage the use of fabric face masks in public places where there is community transmission and where other prevention measures, such as physical distancing, are not possible.(12) Fabric masks, if made and worn properly, can serve as a barrier to droplets expelled from the wearer into the air and environment.(12) However, masks must be used as part of a comprehensive package of preventive measures, which includes frequent hand hygiene, physical distancing when possible, respiratory etiquette, environmental cleaning and disinfection. Recommended precautions also include avoiding indoor crowded gatherings as much as possible, in particular when physical distancing is not feasible, and ensuring good environmental ventilation in any closed setting. (92, 93)
Within health care facilities, including long term care facilities, based on the evidence and the advice by the COVID-19 IPC GDG, WHO continues to recommend droplet and contact precautions when caring for COVID-19 patients and airborne precautions when and where aerosol generating procedures are performed. WHO also recommends standard or transmission-based precautions for other patients using an approach guided by risk assessment.(94) These recommendations are consistent with other national and international guidelines, including those developed by the European Society of Intensive Care Medicine and Society of Critical Care Medicine (95) and by the Infectious Diseases Society of America. (96)
Furthermore, in areas with COVID-19 community transmission, WHO advises that health workers and caregivers working in clinical areas should continuously wear a medical mask during all routine activities throughout the entire shift.(12) In settings where aerosol-generating procedures are performed, they should wear an N95, FFP2 or FFP3 respirator. Other countries and organizations, including the United States Centers for Diseases Control and Prevention (97) and the European Centre for Disease Prevention and Control (98) recommend airborne precautions for any situation involving the care of COVID-19 patients. However, they also consider the use of medical masks as an acceptable option in case of shortages of respirators.
WHO guidance also emphasizes the importance of administrative and engineering controls in health care settings, as well as rational and appropriate use of all PPE (99) and training for staff on these recommendations (IPC for Novel Coronavirus [COVID-19] Course. Geneva; World Health Organization 2020, available at (https://openwho.org/courses/COVID-19-IPC-EN). WHO has also provided guidance on safe workplaces. (92)
Key points of the brief
Understanding how, when and in what types of settings SARS-CoV-2 spreads between people is critical to develop effective public health and infection prevention measures to break chains of transmission.
Current evidence suggests that transmission of SARS-CoV-2 occurs primarily between people through direct, indirect, or close contact with infected people through infected secretions such as saliva and respiratory secretions, or through their respiratory droplets, which are expelled when an infected person coughs, sneezes, talks or sings.
Airborne transmission of the virus can occur in health care settings where specific medical procedures, called aerosol generating procedures, generate very small droplets called aerosols. Some outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission, combined with droplet transmission, for example, during choir practice, in restaurants or in fitness classes.
Respiratory droplets from infected individuals can also land on objects, creating fomites (contaminated surfaces). As environmental contamination has been documented by many reports, it is likely that people can also be infected by touching these surfaces and touching their eyes, nose or mouth before cleaning their hands.
Based on what we currently know, transmission of COVID-19 is primarily occurring from people when they have symptoms, and can also occur just before they develop symptoms, when they are in close proximity to others for prolonged periods of time. While someone who never develops symptoms can also pass the virus to others, it is still not clear to what extent this occurs and more research is needed in this area.
Urgent high-quality research is needed to elucidate the relative importance of different transmission routes; the role of airborne transmission in the absence of aerosol generating procedures; the dose of virus required for transmission to occur; the settings and risk factors for superspreading events; and the extent of asymptomatic and pre-symptomatic transmission.
How to prevent transmission
The overarching aim of the Strategic Preparedness and Response Plan for COVID-19(1) is to control COVID-19 by suppressing transmission of the virus and preventing associated illness and death. To the best of our understanding, the virus is primarily spread through contact and respiratory droplets. Under some circumstances airborne transmission may occur (such as when aerosol generating procedures are conducted in health care settings or potentially, in indoor crowded poorly ventilated settings elsewhere). More studies are urgently needed to investigate such instances and assess their actual significance for transmission of COVID-19.
To prevent transmission, WHO recommends a comprehensive set of measures including:
Identify suspect cases as quickly as possible, test, and isolate all cases (infected people) in appropriate facilities;
Identify and quarantine all close contacts of infected people and test those who develop symptoms so that they can be isolated if they are infected and require care;
Use fabric masks in specific situations, for example, in public places where there is community transmission and where other prevention measures, such as physical distancing, are not possible;
Use of contact and droplet precautions by health workers caring for suspected and confirmed COVID-19 patients, and use of airborne precautions when aerosol generating procedures are performed;
Continuous use of a medical mask by health workers and caregivers working in all clinical areas, during all routine activities throughout the entire shift;
At all times, practice frequent hand hygiene, physical distancing from others when possible, and respiratory etiquette; avoid crowded places, close-contact settings and confined and enclosed spaces with poor ventilation; wear fabric masks when in closed, overcrowded spaces to protect others; and ensure good environmental ventilation in all closed settings and appropriate environmental cleaning and disinfection.


A dedicated line
of TCAR® products
Innovative tools delivering protection from stroke, and so much more
At the heart of this procedure is the ENROUTE Transcarotid Neuroprotection system. Its innovative design allows for the reversal of blood flow away from the brain to help ensure complete neuroprotection during carotid intervention.
ENROUTE Enflate® Transcarotid RX Balloon Dilatation Catheter
Silk Road Medical introduces its latest addition to the TCAR® system, the ENROUTE Enflate® Transcarotid RX Balloon Dilatation Catheter. Enflate is the only balloon designed for transcarotid access and is the optimal balloon to use with TCAR.
ENHANCE® Transcarotid Peripheral Access Kit
With the goal of making the TCAR procedure easier, safer and more efficient, Silk Road Medical has developed the ENHANCE® Transcarotid Peripheral Access Kit to allow for easy access during the TCAR procedure.
ENROUTE® 0.014” Guidewire
The ENROUTE® 0.014″ Guidewire has been developed to provide precise lesion navigation in tortuous short vessel segments while performing TCAR.


Whether it's a high fever that's kept you up all night or a bone that you think might be broken, you've likely asked yourself: do I need to go to the emergency room? In some cases, Hospital Accident and Emergency (A&E) is the appropriate place to go for treatment, but in many other instances, it is actually better to seek out timely and quality care at a 24-hour general practitioner (GP) clinic. Read ahead to learn the differences between a hospital A&E and 24-hour clinic, from costs to care.
Table of Contents
- 24-Hour Clinics in Singapore
- 24-Hour Clinic Fees and Other Costs
- When To Go To A 24-Hour GP Clinic
24-Hour Clinics in Singapore
There are more than1,800 GP clinicsin Singapore that provide a range of medical services from outpatient medical treatment to health screening and education. Of these, a few are clinics that are open 24 hours of the day, much like a hospital A&E would be. But unlike a hospital A&E, 24-hour clinics are equipped to holistically address your and your family's health in addition to treating minor emergencies.
|Examples of 24-Hour Clinic Healthcare Services|
|Outpatient Medical Treatment||Coughs, colds, headaches, minor burns, strains|
|Minor Surgical Procedures||Wound dressing, drainage of abscess|
|Diagnosis & Prevention of Chronic Diseases||Hypertension, diabetes, stroke, asthma, anxiety|
|Women, Men and Child's Health||Pap smear, STD/HIV screening, maternity care, male pattern baldness|
|Vaccinations||H1N1, tetanus, childhood vaccination|
|Health Screening and Education||Blood count, clinical measurements, lipid profiles, urinalysis|
Above all, your GP clinic is designed to assist you with the management of chronic health issues and prevention of illness and disease. Instead of waiting for a health concern to arise (that would require the attention of a hospital A&E), you can save money and your health by being proactive and seeking care from a clinic.
24-Hour Clinic Fees and Other Costs
When you visit a 24-hour clinic, you will have to pay a consultation fee to see a doctor for your medical issue. As a rule of thumb, consultation fees do not include tests, treatment, referrals or medicine. Below, we've compared the consultation fee of a lower budget 24-hour clinic to a higher budget 24 hr clinic.
|Time||Raffles 24 Hour Clinic||Mount Alverna 24 Hour Clinic|
|Weekdays||Monday to Friday||Monday to Saturday|
|8 am to 6 pm||S$27.82||S$66.34|
|6 pm to 12 am||S$40.66||S$80.25|
|12 am to 8 am||S$ 69.55||S$96.30|
|Weekends||Saturday & Sunday||Only Sunday|
|8 am to 6 pm||S$40.66||S$80.25|
|6 pm to 12 am||S$40.66||S$80.25|
|12 am to 8 am||S$ 69.55||S$96.30|
|8 am to 6 pm||S$40.66||S$90.95|
|6 pm to 12 am||S$40.66||S$90.95|
|12 am to 8 am||S$69.55||S$108.07|
Figures represent a minimum charge to the patient for standard consultations. Please refer to clinic websites for further costs, like extended consultations and practice costs.
As shown by the two examples above, a clinic consultation fee varies from S$20 to more than S$120. This fee greatly depends on the certification of your general practitioner, duration of the consultation, and the time of day and week that you seek out medical services. For example, Mount Alverna's standard consultation fee increased by almost 92% for an extended consultation after midnight on a public holiday, while 24-Hours Raffles Medical Clinic saw a 150% increase for the same.
While Singaporeans are covered by Medishield Life, this basic health insurance scheme is designed to cover large hospital bills and costly outpatient treatments in public hospitals, not medical expenses from private GP 24-hour clinics. However, some private health insurers have a panel of GP clinics which can help to offset a pricey consultation fee.
Similarly, you may qualify for government subsidies that assist you with the upfront costs of some private practice health services, like chronic disease management or dental care. For instance, under the Chronic Disease Management Programme (CDMP), you can use your MediSave account to cover15% of the copaymentfor the treatment of a chronic illness at a 24-hour clinic.
When To Go To A 24-Hour GP Clinic
Before you decide to go to the emergency room for your injury or illness, you should first consider the urgency of your condition. It's best to go to a 24-hour clinic if you can determine that your health issue isnot life-threatening.
For example, maybe you've slammed a door on your finger and are dealing with the onset of swelling and pain. While uncomfortable, this injury would likely not be considered a medical emergency. However, if you want a professional opinion or treatment, your best option is a 24-hour clinic where your general practitioner can treat your wound in-house and direct you to a specialist for further care, if needed.
For more informationon where to find your nearest local 24-hour clinic, please visitthe Ministry of Health website.
Hospital A&E in Singapore
A&E hospital visits should be reservedfor accidents and emergencies only. For instance, during the COVID-19 pandemic, it's recommended that you do not visit the hospital for non-urgent conditions, so as to conserve resources for those who are facinglife-threatening medical issues. In fact, if the hospital A&E determines that your sickness or injury does not require immediate care, then they will likely ask you to wait or redirect you to a clinic for treatment.
A&E Charges and Other Fees
In case of an emergency, you'll be directed to yournearest public hospital, in which high medical expenses will be covered by MediShield Life (not including the ambulance) or your private health insurance. Further, you can expect an A&E fee that covers your doctor's consultation, nursing care and treatment, basic tests, and standard medication up to one week's supply.
|Hospital Name||A&E Fee|
|KK Women's & Childrens Hospital||S$120|
|Tan Tock Seng Hospital||S$128|
|Singapore General Hospital||S$128|
|Changi General Hospital||S$126|
|Of Teng Fong General Hospital||S$127|
|National University Hospital||S$128|
|Khoo Teck Puat Hospital||S$128|
For some cases without a clear cut A&E fee, you may be charged a specialist consultation fee that depends on the credentials of your doctor, much like a 24-hour clinic. Additionally, you will find varying rates that depend on your citizenship status and whether you are eligible for government subsidies. In general, Singaporean citizens will be charged the lowest consultation fees.
For a first-time consultation, senior consultants (average cost of S$143.64) charge almost 40% more than associate consultants (average cost of S$104.87), and 15% more than a regular consultant (average cost of S$124.90). Similarly, first consultations are less costly than a second or third consultation, which is considered a repeat or follow up meeting with your medical consultant. For example, a first consultation with an associate medical provider is about 32% more costly than the following consultations with the same provider.
Private Hospital Doctors' Inpatient Attendance Fee Per Visit
|General Ward||S$200 to S$300||S$300 to S$400|
|High Dependency Unit||S$250 to S$350||S$350 to S$500|
|Low Intensive Care Unit (ICU)||S$300 to S$450||S$450 to S$600|
Sourced from the Ministry of Health. Attendance fee applies to doctors after hour rates, as well.
For inpatient treatment at a private hospital, a visit from your private hospital doctor will cost you at least S$200 per visit. If you are set up in a general ward, then you can expect to pay between S$200 to $400 for a doctor's visit. On the other hand, you will see a 50% increase in doctor's inpatient attendance fees if your condition requires you to stay in the ICU.
Lastly, if you are going to the hospital for a high priority condition, it is likely that you would stay overnight and receive inpatient treatment. The cost per day to stay in a public or private ward can also add up. For instance, a C ward in a public hospital may only cost between S$33 to S$45 per day, but if you were to upgrade to an A ward, you'd see daily costsbetween S$303 and S$534. Private hospital wards charge much higher rates between S$240 and as much as S$10,000 for a single night.
While an emergency trip to a hospital A&E can be costly, your total out-of-pocket expenses are greatly influenced by your health insurance plan. By upgrading your health insurance with anIntegrated Shield Plan, you can gain access to unsubsidised, private hospitals and ward types like B1 and A in restructured hospitals, as well as a wider range of coverage for pre- and post-hospitalisation costs.
When To Go To A&E
While hospitals can provide you with similar services as a clinic, like blood tests and minor surgeries, an Accident and Emergency centre will only see you if you are considered ahigh priority case. Medical priority is organized into four levels, with P1 considered the utmost important and P4 considered non-urgent.
A&E Priority Levels
|Classification||Example Medical Conditions|
|Priority 1 (P1)||Resuscitation & Critically-Ill Patients||Heart attack, severe injuries and bleeding, shock, severe asthma attack|
|Priority 2 (P2)||Major Emergencies (Cannot Walk)||Major limb fracture or dislocation, moderate injuries, severe abdominal pain|
|Priority 3 (P1)||Minor Emergencies (Can Walk)||Sprains, minor injuries, minor abdominal pain, vomiting, fever, rashes, and mile headaches|
|Priority 4 (P4)||Non-Emergency||Chronic joint pains or skin rash, long-term nasal discharge, old scars, cataracts, removal of tattoos and sore throats|
Priority levels and example conditions were sourced from Singapore General Hospital website.
Non-emergencies like an old, chronic injury will be considered the lowest priority (P4), while conditions like a heart attack or stroke are considered the highest priority (P1). If your medical status falls into a P3 or P4 classification, it's recommended that you seek treatment at a 24-hour GP clinic, rather than a A&E hospital centre.
Should You Go To A 24-Hour Clinic Or A&E Hospital?
Even though 24-hour clinics and hospital A and E centres have some overlap, they prioritize very different health concerns and services. The choice between a 24-hour clinic and hospital A&E service comes down to the severity of your medical condition. If you are facing a life-threatening medical condition that would fall into priority level P1 or P2, then you should go to an emergency room. But, if you can determine that your condition is not critical and would likely fall into level P3 or P4, then you should visit your local 24-hour clinic for a diagnosis and treatment.
If costs are a significant factor in determining your course of health services, you can consider different methods to save money. Some medical services from a 24-hour GP clinic are covered bypersonal accident plansand MediSave. On the other hand, MediShield Life and Integrated Shield Plans can help you offset the high costs of hospital bills and treatment from an A&E. Singaporeans who have financial difficulties even after utilising MediShield Life or MediSave can apply for assistance fromMedifundafter speaking to a social worker at the hospital.
- Best Health Insurance in Singapore
- How to Find the Best Health Insurance
- Average Cost and Benefits of Health Insurance
- Guide to Finding the Best Hospital in Singapore
|General Practitioner (GP)||Specialists|
|In-office consultation fees|
|Short Consultation (up to 10 mins)||$20 - $30||$60 - $100|
|Long Consultation (11 to 20 mins)||$30 - $55||$90 - $150|
|Extended Consultation (per 10 mins)||$20 - $25||$50 - $80|
Seek emergency treatment at hospitals only if your condition becomes serious or life-threatening. We are seeing a high number of patients at our Emergency Department (A&E). Priority will be given to those who are critically ill.How much is a doctor visit without insurance in Singapore? ›
While Singapore citizens and permanent residents can expect to pay between $39 to $59 for an initial visit to a specialist outpatient doctor, for example, private patients (or expats) can pay up to $150.Can foreigners go to public hospital in Singapore? ›
Locals and foreigners are free to choose any medical facility either public or private for treatment or consultation. Accident and Emergency Departments that are open 24/7 at the governmental hospitals are responsible in emergency cases.Is medical care in Singapore expensive? ›
Put simply, healthcare in Singapore is expensive for the region, but not as much as you would be expected to pay in the US. It's also no surprise, given how the demographics in Singapore have changed over the years and hospitals invest heavily in medical technology to draw in medical tourists from abroad.How much is medical fees for foreigners in Singapore? ›
The average cost of a health insurance plan for foreigners varies with age, lifestyle factors, and medical history. For a 45-year-old non-smoker, the average cost of an Integrated Shield Plan in Singapore is S$132. However, for 75-year olds, the average cost in premiums ranges from S$69 to S$1,063.How much is the emergency fee in Singapore? ›
Good news: dialing 995 for an ambulance is free – in the case of a true emergency. However, if the patient's status is later assessed as non-emergency by the doctor at the Emergency Department, $274 will be charged for each non-emergency case that the SCDF ferries to the hospital.How long do you stay in A&E? ›
The NHS has a '4 Hour A&E Target' – for emergency care. This is known as '4 Hours'. It states 95% of emergency patients should be seen, treated if necessary, and either discharged or admitted, within four hours from arrival at A&E.How long is the average stay in hospital in Singapore? ›
The mean length of hospital stay was 4.64 ± 8.31 days. On average, patients had a mean LACE score of 5.59 ± 2.77.Do foreigners get free healthcare in Singapore? ›
In short: They can't. In Singapore, only citizens and permanent residents – known as PRs – are covered by public healthcare. The term “permanent resident” means something different in Singapore than it does in Europe, where permanent residency is relatively easy to apply for.
Should you face difficulties in paying your medical bills after utilising other means of payments such as MediShield Life, MediSave and Private Medical Insurance, you may apply for financial assistance. Financial assistance for payment of subsidised medical bills is available for Singapore Citizens only.What is the disadvantage of Singapore healthcare system? ›
There isn't much to complain about Singapore's healthcare system apart from the fact that healthcare isn't free and expats and digital nomads can't access public subsidy schemes. Other disadvantages include a reliance on institutions, expensive long-term care costs, and long hospital wait times.How can I see a doctor in Singapore as a tourist? ›
If you're a tourist in Singapore ad would like to speak to a medical professional connected to an international network of doctors, you can make an appointment on the Air Doctor app right now and have an in-person or virtual consultation within minutes.Do I need health insurance to enter Singapore? ›
It is mandatory for non-fully vaccinated short-term visitors entering Singapore to purchase travel insurance with Covid-19 coverage.Why is healthcare so expensive in Singapore? ›
As you might have understood so far, health care is costly for expatriates in Singapore. This is partially due to the fact that medical facilities are outfitted with top-notch equipment and some of the most advanced technologies available in medicine.
|Home Care Services||Price Starting From|
|Home Therapy||Starting from $36.20/per visit Effective 1 July 2022|
|Interim Caregiver Service||Starting from $355.20/per 6-days shift Effective 1 July 2022|
|Home Personal Care||Starting from $7.40/per hour Effective 1 October 2022|
The Economist Intelligence Unit placed Singapore 2nd out of 166 countries for health-care outcomes. Bloomberg Global Health Index of 163 countries ranked Singapore the 4th healthiest country in the world. This superb level of healthcare means that Singaporeans enjoy an extremely high standard of living.How much does healthcare cost in Singapore compared to the US? ›
The U.S. health expenses are nearly three times higher than in Singapore.Can foreigners buy medicine in Singapore? ›
Foreign prescriptions are not valid in Singapore. You will need to visit a doctor in Singapore to receive a new prescription.How much is a hospital stay in Singapore? ›
|Ward Class||Private Patients|
|Resident Foreigner/ Non-Resident||$528||$315|
|||Estimated Average Daily Hospital Bill Size (with Government Subsidy)||Deposit Amount (with or without Medisave)|
|Rehabilitation||S$198 – S$466|| Waived |
|Sub-Acute Care||S$201 – S$553|
|IHPCS - Cat 1||S$233 – S$576|
|IHPCS - Cat 2a/b||S$207 – S$688|
Both public and private healthcare in Singapore are subject to government regulations. Singaporeans enjoy universal healthcare – meaning the public health system and mandatory health insurance is funded by the government. Patients can access care in public facilities with ease – but public healthcare is not free.Do you have to pay for ambulance Singapore? ›
Is ambulance free in Singapore? If you are facing an emergency, the SCDF emergency ambulance that conveys you to a hospital will be free. However, for non-emergency cases, SCDF charges $274.What is considered medical emergency Singapore? ›
Call 995 For Emergencies Only
In a life-threatening emergency, every second counts. You can make a difference between life and death by knowing what is an emergency. For life-threatening cases such as cardiac arrest, active seizures, breathlessness, major traumas and stroke, call 995.
The filming took place over 28 days using 70 fixed cameras and is the largest documentary series Channel 4 has ever made. The series enables viewers to see the challenges that A&E staff face as they treat the patients that come through the doors every day.What is a Type 3 A&E? ›
03. Other type of A&E/minor injury ACTIVITY with designated accommodation for the reception of emergency care PATIENTS. The department may be doctor led, GENERAL PRACTITIONER led or NURSE led and treats at least minor injuries and illnesses and can be routinely accessed without APPOINTMENT.Can someone stay with you in A&E? ›
Outpatient appointments and the emergency department
If you have an appointment at one of our hospitals or community sites, or need to go to the emergency department (A&E), you can bring someone with you for support. Read more about what to expect if you have an outpatient appointment.
A heart bypass surgery is a costly treatment for treating coronary artery disease and due to its complexity, it is one of the most expensive hospital procedures in Singapore. In fact, the median cost of a coronary bypass surgery at a private hospital is S$75,398.Is surgery expensive in Singapore? ›
In short: The average bill for surgical specialities in private hospitals can be $8,109 to $18,993. Without insurance, these are the sort of the hospitalisation costs you'll need to bear.How much does ICU cost per day Singapore? ›
|Type of Accommodations||Class of Ward Accommodation (S$)|
|Day Surgery Centre / Endoscopy Centre / Invasive Cardiac Lab Daily Room Charge|
|Private (S$)||Subsidised (S$)|
Singapore heavily regulates the number of physicians, and it has some control over salaries as well. The country uses bulk purchasing power to spend less on drugs. The most frustrating part about Singapore is that, as an example, it's easily misused by those who want to see their own health care systems change.What is the difference between inpatient and outpatient in Singapore? ›
What is the difference between outpatient and inpatient insurance in Singapore? Outpatient care includes doctor-related fees and tests. On the other hand, inpatient care includes other hospital fees, such as surgeries, a serious illness that requires admission at the hospital overnight, etc.How do I pay my hospital bill in Singapore? ›
Payment can be made via NETS and Visa/Mastercard credit cards through the OneNUHS mobile application (download via Google Play or App Store). This opens in a new window. If you are unable to use the OneNUHS app, you may also pay your bills online at https://eservices.healthhub.sg/payments.Can you refuse medical treatment in Singapore? ›
The presumption in law and medical practice is that all adults have capacity to consent or refuse treatment, unless proven otherwise. The clinician must not consider the person to be lacking capacity until all relevant medical information regarding the patient's illness and treatment has been given to the latter.What happens if you don't pay hospital bill in India? ›
State and Others case in 2016, the High Court of Delhi, with a bench consisting of Justices Vipin Sanghi and Deepa Sharma, passed an order clearly stating, “If bills are not paid, then release the patient. You cannot keep patients hostage.What are the weaknesses of Singapore? ›
Weaknesses: Falling exports in an export-focused country
Singapore's economy relies heavily on the exportation of goods to various countries, but especially to the United States. This breeds trouble. If the economy in these countries were to suffer, by proxy, so would Singapore's.
Singapore ranks 10th in the 2022 World Index of Health Care Innovation, up from 12th in 2021 and down from 7th in 2020. Singapore's overall performance was driven by high scores for Choice (12th) as well as strong research universities and top-notch digital health care.How much is health insurance in Singapore? ›
How much does health insurance cost in Singapore? On average, an individual and family in Singapore will need to fork out US$6,265 and US$17,803 for premiums, respectively, according to Pacific Prime's latest Cost of Health Insurance Report 2021-22 (COHI).What is the average wait time to see a doctor in Singapore? ›
Figures for March showed that on a national level, the median wait to see a doctor was 18 minutes. This is close to 30 per cent longer than median waiting times of 14 minutes for the whole of last year, as well as 2015. Median waiting times had otherwise been trending downwards from 18 minutes in 2014.How can I get medicine in Singapore? ›
- Book a teleconsult with a doctor. ...
- Attend your teleconsultation from the comfort of your home and request the doctor for an online prescription after that.
- The doctor will provide you with an electronic prescription.
Singapore has world-class hospitals and clinics that offer a wide range of medical procedures and treatments. There are several reasons why people choose to come to Singapore for medical care, including the high quality of care, the relatively low cost of care, and the convenient location.Is insurance required for Singapore tourist visa? ›
Is travel insurance mandatory for travelling to Singapore? Travel insurance is not mandatory when you are travelling to Singapore when you are fully vaccinated. However, travel insurance with a health cover of $30,000 is mandatory if you are not fully vaccinated.What insurance is compulsory in Singapore? ›
MediShield Life is a basic health insurance plan that protects all Singapore Citizens and Permanent Residents against large hospital bills for life, regardless of age or health condition.Do I need insurance to drive in Singapore? ›
All vehicles must have motor insurance coverage to be used in Singapore. It is a requirement for your vehicle to be insured for the entire road tax renewal period before its road tax can be renewed. The insurance must at least cover third-party liability for deaths and bodily injury.Is medical treatment expensive in Singapore? ›
Put simply, healthcare in Singapore is expensive for the region, but not as much as you would be expected to pay in the US. It's also no surprise, given how the demographics in Singapore have changed over the years and hospitals invest heavily in medical technology to draw in medical tourists from abroad.What is the most expensive country in the world for healthcare? ›
As our chart illustrates, U.S. per-capita healthcare spending (including public and private as well as compulsory and voluntary spending) is higher than anywhere else in the world, with second-placed Germany trailing quite far behind. On average, healthcare costs in the U.S. amounted up to $12,318 per person in 2021.Who has the best quality healthcare in the world? ›
- United Kingdom.
Both public and private healthcare in Singapore are subject to government regulations. Singaporeans enjoy universal healthcare – meaning the public health system and mandatory health insurance is funded by the government. Patients can access care in public facilities with ease – but public healthcare is not free.How much does hospital cost in Singapore? ›
|Ward Class||Private Patients|
|Resident Foreigner/ Non-Resident||$528||$315|
|Features||National University of Singapore||Nanyang University of Technology|
|Program Duration||5 years Singaporeans, 6 Years Singapore PRs and International Students||5 years|
|Annual Program Fees (in SGD)||$61,850||$70,500|
|QS World University Subject Ranking 2022||21||93|
Singapore's healthcare system consists of a public sector that provides heavily subsidized or free primary care to natives, and a private one. While locals and Permanent Residents (PR) are protected by mandatory health insurance, most expats not under a company plan must pay out-of-pocket.What are the disadvantages of healthcare in Singapore? ›
There isn't much to complain about Singapore's healthcare system apart from the fact that healthcare isn't free and expats and digital nomads can't access public subsidy schemes. Other disadvantages include a reliance on institutions, expensive long-term care costs, and long hospital wait times.How do I get admitted to a hospital in Singapore? ›
For scheduled procedures or non-emergency services, hospital admission is by appointment with a reference letter from a local registered physician. All hospitals need a guarantee of payment and your identification (passport) before you will be admitted. Bring a deposit or insurance form.How good is medicine in Singapore? ›
MBBS in Singapore is a 5 year degree offered by only two universities. The program is offered by National University of Singapore and Nanyang Technological University with both ranked among the top 5 universities in Asia by Qs Rankings 2023. For medicine, NUS is placed in the #21st position while NTU ranks #93 by QS.


Cajal and Neural Circuits
By Javier De Felipe
A hypothesis on the organisation of the nervous system
In the times of Cajal, the prevalent hypothesis on the organisation of the nervous system was the reticular theory, which argued that the elements of the nervous system formed a web-like continuum by means of their propagations (dendrites and axons). This theory, later proven wrong, was conceived originally by Joseph von Gerlach (1820-1896). The success of this theory was due partly to the thought that if the nervous system was a continuous, uninterrupted web of propagations, it would be easy to explain how the flow of nervous information passed from one part of the brain to another. That is, the flow of information from one nervous cell to another could happen thanks to the continuity between their propagations. And then, in 1873, Golgi created the method of the reazione nera (black reaction.) For the first time, a histological preparation allowed the observation of all the parts of a nervous cell (the soma, dendrites and axon.) So it was observed that neurons have a very complex arborisation at the axons and dendrites, to the extent that if a region of the brain was chosen and every neuron in it, with its dendrites and axons, were to be stained, the result would be such an extraordinarily dense tangle of somata, axons and dendrites that it would be impossible to analyse it. Another advantage of the Golgi method is that several cells could be stained in a single preparation—albeit only a small number of them—so that individual nervous cells could be studied as well as the possible connections between them. Yet, despite the excellent results of the Golgi staining method, Golgi himself remained the most salient supporter of the reticular theory, proposing that dendrites had open ends but that axon collaterals anastomosized and formed an extensive network, thus suggesting that the nervous system consisted of a rete nervosa diffusa(diffuse nervous web), supporting in part the reticular theory of Gerlach. Golgi always held on to this conviction, which he defended even in the lecture he gave when he was awarded the Nobel Prize along with con Cajal.
In the first article he published after using the Golgi method, Cajal confirmed Golgi’s observation that dendrites had free ends, but also added another, crucial to the neuron doctrine, that this was also the case of axon collaterals, which would then form a “free” arborisation (without anastomosis.) He asserted that “each [nervous cell] is a fully autonomous physiological canton” (Cajal, 1888). Thus, from the beginning Cajal conceived of nervous cells as functional and anatomical units that communicated with each other by means of contact or contiguity, not by continuity. Cajal continued to furnish numerous observations that supported the neural doctrine in various parts of the nervous system in different animal species. Between 1888 and 1892 he published over 30 articles, which were summarised in his first review of the structure of the nervous system (Cajal, 1892), clearly formulating the neuron doctrine. The results of these early studies were so decisive that they constituted the core of the classical and influential literature review article in support of the neuron doctrine published by Wilhelm von Waldeyer-Hartz (1836-1921) in 1891. In it, this scientist used the term neuron to refer to the nervous cell (Waldeyer, 1891). Cajal summarised his own contributions to the neuron doctrine in several articles and books, particularly in the essay ¿Neuronismo o reticularismo? (Neuronism or reticularism? Cajal, 1933). Thanks to the introduction of the electronic microscope in the 1950s, along with the development of new methods to prepare nervous tissue for ultrastructural analysis, it was possible to examine the ultrastructure of the synapsis to confirm one of the main tenets of the neural doctrine: the presynaptic and postsynaptic elements are separated physically by a space about 10 to 20 nanometres wide, which is known as the synaptic cleft (see DeFelipe, 2007).
The law of dynamic polarisation
The neuron doctrine involved a radical shift in the conception of how information could flow within an “infinitely fragmented” brain, as opposed to a continuous neural reticulum. That is, it remained to be known how the nerve impulse travelled from one nerve cell to another across a physical gap. One of the significant offshoots of Cajal’s neuron doctrine was the theory of the law of dynamic polarization of nerve cells, which he proposed to explain the transit of nerve impulses through neural circuits. At the time it was believed that the function of dendrites was mainly one of nourishment, and that axons transmitted nerve impulses out of the cell (a generalisation based particularly in the logical conduction pattern shown by motor neurons from the spinal cord to skeletal muscles.) In 1889, Cajal proposed that at least in some cases dendrites functioned as current receptors (Cajal 1889), and two years later (Cajal 1891) he attempted to generalise this idea with the law of dynamic polarization, which was based on the direction followed by impulses in different regions of the nervous system where the anatomical path that had to be followed by nerve impulses was evident, such as the retina and the olfactory bulb (from the outer world to the inner world of the nervous system.) Thus, he proposed that neurons could be divided in three different functional regions: a receptor apparatus (consisting of the dendrites and the axon), an emitting apparatus (the axon), and a distribution apparatus (the axonal terminal arborisations.) Later on, Cajal realised that the soma does not always intervene directly in the conduction of the impulses, and that sometimes the nervous current goes directly from the dendrites to the axon (Cajal, 1897). Consequently, the law of dynamic polarisation gave way to the theory of axipetal polarisation. These studies had a great influence on the scientists of his age, and the observations and theories of Cajal were proven in their essence.


Complications of testosterone deficiency in men include a wide variety of symptoms: loss of libido, erectile dysfunction, oligospermia or azoospermia, absence or regression of secondary sexual characteristics, progressive decrease in muscle mass, fatigue, depressed mood, and an increased risk of osteoporosis.
Clomid for men works by blocking estrogen in the pituitary and hypothalamus. Thus, estrogen does not signal the brain to stop producing the Luteinizing hormone (LH). LH continues to be produced; as a result, testosterone production in the testes rises.
Testosterone secretion is the result of a series of hormonal processes. Gonadoliberin (gonadotropin-releasing factor, GRF), which is secreted by the hypothalamus, controls the pulsed secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are secreted by the adenohypophysis. In turn, LH regulates the production and secretion of testosterone by Leydig cells in the male testicles, while FSH helps in the induction of spermatogenesis.
Clomiphene increases testosterone levels and accordingly has a positive effect on the side effects of testosterone deficiency.
Clomid is not a non-anabolic steroid. But, due to its properties, clomiphene is used as a mild alternative to steroids. Bodybuilders and athletes use Clomid as a muscle restorative antiestrogen drug after a course of anabolic steroids (post-cycle therapy – PCT).
Testosterone is necessary to develop and maintain specific reproductive tissues (testicles, prostate, epididymis, seminal vesicle, and penis) and secondary male sexual characteristics. It plays a key role in libido and erectile function and is necessary to initiate and maintain spermatogenesis.
Testosterone deficiency can result from the underlying disease or genetic disorders and is often an age-related complication.
Testosterone also has important functions that are not related to reproductive tissues. For example, it positively affects body composition by increasing nitrogen retention, supporting lean body mass, muscle size, and strength. It also acts on bones, stimulating bone formation.
Clomiphene increases testosterone levels and has a positive effect on the side effects of testosterone deficiency, while the testes retain the ability to respond to gonadotropin stimulation.
In the United States, there are currently several forms of testosterone therapy: cream, gel, tablets, patches, or injections.
Recently, transdermal patches have become popular. But for example, the scrotal testosterone patch gives 5α-dihydrotestosterone (DHT) levels higher than physiological levels due to the high concentration of 5α-reductase in the scrotum skin. It is not known whether these elevated levels of DHT have any lasting health effects.
Non-scrotal systems are considered more convenient, and most patients achieve the right serum testosterone concentrations and still have normal DHT levels.
Oral testosterone therapy is not recommended because the doses required for replacement therapy increase the risk of hepatotoxicity.
And although these types of testosterone replacement therapy are effective, each of them has side effects.
Compared to testosterone replacement therapy, Clomid for men with hypogonadism can be considered the best alternative because Clomiphene stimulates the body’s testosterone production and is available in tablets, and is convenient for taking.
Hormone replacement therapy is effective initially, but because Testicles do not need to produce endogenous testosterone with excess exogenous, this leads to partial or complete sterility with testicular atrophy.
Clomiphene is an antiestrogen related to tamoxifen, which blocks normal estrogen feedback at the hypothalamic level and subsequent negative feedback at the pituitary level. This leads to an increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In men, these increased levels of gonadotropins stimulate testicular Leydig cells and lead to elevated levels of intrinsic testosterone.
Clomid does not directly affect the amount of estrogen. Its action mechanism is to block estrogen access to the pituitary gland and increase follicle-stimulating and luteinizing hormones. This leads to increased secretion of testosterone by Leydig cells in the testes.
Important! In small doses (25-50 mg per day), the drug blocks estrogen receptors, but it stimulates them in large doses. Therefore, in large doses, clomiphene does not exhibit the antiestrogenic but estrogenic effect. In this regard, clomiphene is not used in large doses, even in combination with anabolic steroids.
In mature men, testosterone levels decrease every 5 years by 10-15%. Testosterone is the main male androgen and performs an important function in men’s health. Therefore, when we talk about reduced testosterone, we are talking about reduced potency and the greater risks of cardiovascular disease, diabetes, and osteoporosis.
Due to its ability to bind to estrogen receptors in the hypothalamus, Clomiphene Citrate significantly increases follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thereby leading to greater testosterone production in men with testicles. Due to these properties, Clomifene, to some extent, can be attributed to the group of anti-aging drugs.


Raising my hand for inherited retinal disease (IRD) research
March 4, 2020
Susan Purr’s vista changed after her father stumbled across a National Geographic article spotlighting advancements in inherited retinal disease (IRD) research.
Susan Purr and her husband, Stuart, celebrate their 1999 engagement.
During my first year of life, my parents noticed that I was having problems with my eyes—I wasn’t seeing the way my siblings had, and my eyes moved around a lot. After many tests and visits to eye doctors and specialists, they determined that I had a rare retinal condition called Leber congenital amaurosis (LCA). At the time, there was not a great deal of available information about LCA. Doctors told my family that I would have limited sight, and light sensitivity, and that I could eventually lose all vision entirely. They added that there was no treatment and no cure.
Aside from a few minor accommodations, I grew up pretty normally. My eyesight was stable all the way up through college and grad school, and even into my first “real” job. I couldn’t drive, but I could read regular-sized print and travel independently. I started noticing a decline in my sight at around age 27 but it stabilized again, and so I went on living my life. It became clear that retinal specialists knew of LCA academically, but that there was a lack of available information about current research into the condition. Although it is the most common cause of blindness in children, LCA still only occurs in two to three out of every 100,000 births.
But by age 40, I noticed a great deal of decline in my sight. I have gone through two cataract surgeries, which improved clarity, but the LCA has now progressed so that now I cannot read print without extreme modifications. I have a hard time recognizing faces, and I cannot travel independently without a cane. Perhaps it will come as no surprise that all of this has plagued my spirit. Forgive the pun, but I have had many dark days.
Last year, my dad found an article in National Geographic about a huge scientific push in the fight against blindness. Of course, I was excited about what I read and started digging through countless online resources, looking for more information. I found the researchers involved in some of the most promising studies, which led to emails, blood draws, genetic tests, phone calls, and finally, a year and a half later, I went up to Pennsylvania to meet with researchers.
Susan and her father, Dave. It was her dad who encouraged Susan to look into the latest gene therapy research efforts for LCA.
Clarity of my diagnosis
Often, one of the benefits of volunteering for clinical research for inherited retinal diseases is finding out more about your condition through genetic testing. That was the case for me. To be honest, getting the results from my genetic test was overwhelming. To know that the information helped someone understand my disease to the point where they knew where to locate my mutation, was like looking at a map and saying, “It’s right there!” I remember calling my dad laughing and crying and saying, “They know what it is!” He and my mom were ecstatic. My husband was thrilled. And me? I can’t even put into words what it meant to identify the cause of my disease, understand more about my condition, and then discover that someone was working on my specific mutation.
I now know more about my specific form of LCA than I ever knew in my life. It is caused by two mutations in the CEP290 gene. I have only 30 percent of the cones as a normal eye. The rods and cones that I do have are healthy, except for one problem: the cilia on my cones are not working well right now. To understand the function of the cilia on our retinal cells, think of a TV antenna. If the antenna is damaged, the signals won’t work right. The antenna of my cone cells are broken and that prevents my eyes from seeing correctly. It just so happens, however, that a research team in Pennsylvania is working on that problem!
I can’t even put into words what it meant to identify the cause of my disease, understand more about my condition, and then discover that someone was working on my specific mutation.”
Joining a clinical study
Once I identified the research being done, I didn’t have a second thought about joining it. Growing up, people said to me, “They’re going to come up with something.” They said it my whole life, but nothing happened. I had finally resigned myself to my fate, but when I saw the National Geographic article, I didn’t hesitate. I was like “Sign me up. I will do whatever I need to do to keep the research going!”
I’m excited to be part of the research effort to fight my form of inherited retinal disease. The scientists I’m working with seem very confident in their efforts. I need this confidence badly. Leber congenital amaurosis is extremely rare and I’m ready for science to go after it. It probably goes without saying that I am hopeful the study is a success. I certainly have never known “perfect” vision and, to be honest, that’s not what I need or expect. It would be enough to simply regain some of what I have already lost.
No one knows what the future will bring, but I’m ready for the ride. Buckle up, everyone. Here we go!
Susan Purr, recipient of the 2019 Irene Adler Prize, is working toward her M.F.A. in creative writing. She lives with her husband and 14-year-old daughter near Charlotte, North Carolina.


To put it quite simply, Alli is the most amazing weight loss pill on the market at the moment and if you are looking for a way to lose weight more efficiently and more safely than ever before, it is the only pill that you should have in mind.
Losing weight has become the burning issue in the last decade or two. The simple fact is that the modern way of life is perfect for developing obesity and we are seeing more and more obese and overweight people wherever we look. Even when we look in the mirror. And when you consider that being overweight or obese is the most common preventable reason for premature deaths in the world today, it becomes obvious why it is important to have such an ally like Alli.
Being overweight puts a toll on the individual both psychologically and physically. Extra weight can make us lose all confidence that we have in ourselves, our appearance and our self-worth. For some people, being overweight is such a burden that they tend to avoid interacting with people, while some even develop social anxiety or depression. And however debilitating these psychological implications of obesity may be, the physiological are even more serious.
When you are obese or overweight, you are instantly more likely to develop such serious health conditions such as high blood pressure and high cholesterol, both of which can then later cause a number of complications and life-threatening cardiovascular episodes such as heart attacks or aneurysms. Even if it does not lead to this, obesity significantly lowers the quality of life and life expectancy. This is why losing weight is not just a question of appearance, but of health as well.
And if you need some help with losing weight, then Alli is the pill for you. Alli is the over-the-counter version of a weight loss medication that has been used for decades, Orlistat, better known as Xenical. Alli is a formulation of Orlistat that has been established as safe to use without a prescription. What separates Alli from all other weight loss products is that it has been tested in over a hundred independent studies and researches and that it has been tested on more than 30,000 people. This means that you can always be sure where you are at with this weight loss pill.
The way in which Alli works is envisioned in such a way that it does not interrupt or alter any of the natural processes that go on inside your body. Appetite suppressants and stimulants are known to affect the central nervous system and thus cause different side effects. Alli, on the other hand, works only in your digestive system, binding the fats you intake in food and making sure that you do not absorb them. These fats are then naturally
expelled from your body. It is possible that you will experience certain gastrointestinal side effects in the first week of using Alli, but these side effects can easily be avoided, limited and ignored.
One of the most important things to keep in mind when taking Alli is that you will still need to adhere to a more comprehensive weight loss regimen that will include exercising regularly and eating foods that are low on fats and calories. No one is trying to fool you into thinking that Alli is a wonder drug. Wonder drugs do not exist and anyone who tells you that you can take a pill and do nothing is lying. With Alli, you will need to exercise and eat healthy, but the use of this pill will ensure that you lose much more weight than you would without it. Alli is a weight loss solution that has been tested for decades and that has shown exceptional combination of safety and efficiency, both of which are backed by copious amounts of scientific data.


Living with Pompe brings physical and emotional challenges.
Patients should know that they are not alone. Although Pompe disease is rare, there are active patient groups and caring health professionals throughout the world who can help patients manage the challenges of living with this disease.
While each experience will always be unique, reaching out to others can bring patients and caregivers both support and new perspectives on their situation.
Links to websites with more information on how to live with Pompe disease.
Taking care of your family members who have Pompe disease isn't always easy. Here are some resources with more information for patients and care givers.


Is really a Vape Kit Really the Response to Stopping Smoking?
An electronic cigarette is basically an electronic device which behaves like classic tobacco cigarettes. It usually consists of a battery power, an atomizer, and a container like a tank or cartridge. Instead of tobacco, the vaper inhales nicotine vapor instead. Therefore, utilizing an electronic cigarette is generally described as “vaping” rather than smoking.
But what exactly is the danger of these e Cigs? Many experts think that there may be a connection between the Cigs and cancer. The fact that the vapor is non-toxic will not alleviate concerns about long term health effects. Additionally, many of smokers are unaware of the point that non-smokers can also be suffering from their actions. Studies have shown that passive e smokers can be just as hazardous to health as effective smokers.
There are other health risks linked to the usage of Cigs. Nicotine has been within many trace chemicals, both man made and naturally occurring. These chemicals can include poison, pesticides, antidepressants, antispasmodics, chemotherapy medicines, hormones, insulin, lung toxicants, manufactured drugs, alcohol, hormones, along with other compounds. Nicotine along with other chemicals are also discovered in water sources that are being used to water the crops in California.
One major problem with the electronic cigarettes vapes is that the liquid smoking is highly addictive. Actually, many users who begin just using this product to temporarily relieve a certain craving turn quickly to deploying it to relieve lots of cravings. They may end up having to continually utilize them to break a habit. This issue is even more pronounced with regards to young children.
Just about all Vape products in the marketplace usually do not contain nicotine. Instead, they are typically comprised of herbal extracts like green tea extract or guarana. These juices usually do not contain any calories, but they do contain quite a lot of flavoring. Some juices, such as for example raspberry or carrot, are also noted for helping to get rid of fat. However, some juices, such as for example chocolate mint or orange, may cause serious dental complications.
The most serious health effects connected with Vaping will be the potential toxins released in to the air when you vapors pass through your lips. Those who do not know how exactly to properly breathe when inhaling shouldn’t be using a vaporizer. Even if you are using these devices properly, there’s still a risk of nicotine or other toxins being inhaled into your lungs. This can result in serious lung damage over time.
It is important that those who are working in the electronic cigarette industry educate users on proper methods in order to breathe safely while Vaping. Countless vapers aren’t breathing correctly while vapinger.com they’re Vaporizing, leading to increased risk for lung harm. Many experts state that the best way to avoid the possibility of harm is to become comfortable enough to use the device while completely aware of breathing patterns and the amount of vapor being inhaled. If you have questions concerning appropriate breathing when Vaporizing, it really is highly recommended that you seek assistance from your local medical expert.
One of the biggest benefits of Vaping may be the freedom you are afforded when you stop smoking. Without the hassles of likely to the store or the hassle of carrying around paperwork or money for medication, it is possible to stop your dependence on nicotine almost immediately. Should you be considering quitting cigarettes for just about any reason, it is crucial that you take the actions necessary to ensure that you are as healthy as you possibly can before you attempt to cut out cigarettes. Whether you are utilizing a vaporizer or not, ensure you are performing everything in your power to avoid any issues related to possible nicotine addiction.


02 Apr Rachel
~ In Memorium June 25 1991 – October 7 2021 ~
We talk a lot about cancer survivors, and have many beautiful ways to celebrate them. We talk much less about the people who have the incredible task of living with a terminal diagnosis.
It’s romantic to talk about “living like each day is your last,” but there’s nothing romantic about being given a 5 year expiry date on the life you love. Knowing that you’ll still have all the mundane tasks of living, going to work to pay the bills, all the same struggles everyone else has- and that you’ll be adding a litany of medical procedures, experimental treatments, and pain that doesn’t ever go away for long.
I met Rachel when she came in for a boudoir shoot. Young and vibrant with an ascerbic wit and sassy smile, I assumed that when she said “cancer” she meant “curable.” At the time I didn’t know what Stage 4 cancer was.
I don’t know how anyone can be so full of life when they’re dying.
Rachel wasn’t a complainer, so it was only later that I came to know more of her story. She was diagnosed with cancer for the first time when she was ten, then again at 12 with a kind caused by the chemo that cured her first cancer. That 12yo girl underwent everything from high dose chemo to radiation to a bone marrow transplant, and at 13 was told she’d never be able to have biological children; but she was cancer free for several beautiful years. She finished high school, started an undergrad degree, fell in love, and travelled when she could. She got engaged and planned a future.
In 2016, as she planned her wedding, she was diagnosed with cancer again. This time there was no cure. Despite being told only 22% of those diagnosed with this kind of cancer survived 5 years, she didn’t give up; she got married, kept studying, and got her geology degree. She also had a boggling number of invasive, painful, life-altering treatments, therapies and procedures.
Rachel’s tenacity, humour, caring and sheer grit were awe-inspiring. As her clock ran down and she wrote the final pages of her story, she stayed optimistic and sassy and kind. She was an inspiration, and I am so grateful to have had her in my life.
Love you, Rachel. You have touched the world in ways it will never forget. I’ll miss you.


No matter what age a person is, it is constantly an excellent concept to live a way of living that assists strengthen their heart. Since this is fairly actually the power supply of the body, any concerns with it will cause major and potentially even fatal consequences.
A huge component of assisting to maintain the heart healthy is ensuring to consume the appropriate type of food. This becomes particularly important when somebody reaches the age where they relocate to assisted living in Brooklyn Center. That is why this short article is right here to give a detailed list of the most effective foods that a person can eat in order to help maintain them heart-healthy.
Among the reasons salads are such a healthy meal is because of the high focus of leafy environment-friendlies that they consist of. Items like kale, spinach, collard greens, arugula, as well as romaine lettuce are some of the instances that fall into this leafy eco-friendlies category. By including this is most meals, it will assist a private in a selection of methods.
Among the wonderful things about leafy greens is the reality that they are mainly composed of just water, which is necessary to keep every part of the body healthy and balanced, not simply the heart. Some benefits that are extra particularly aimed at the heart include the reality that they have a really high quantity of vitamin K. This is a vitamin that has the ability to assist shield the arteries and improve the blood's ability to correctly clot.
These leafed environment-friendlies are also able to affect the blood in other ways. The quantity of nutritional nitrates that are found within them is able to aid reduced a person's blood pressure. If somebody consumes a great deal of leafy eco-friendlies, then they should begin to experience a softening of their arterial, which will certainly aid their heart function much more efficiently. The cells that line the capillary ought to also see an improvement.
With every one of these advantages, it is not a surprise that consuming a greater focus of leafy eco-friendlies is something that has actually been connected to a reduced chance of experiencing heart problem. Plus, they additionally have a wide variety of various other vitamins, minerals, as well as anti-oxidants, which might not directly affect the heart as much but help to make the rest of the body healthier, which puts much less of a pressure on the heart. The more leafy greens that someone in memory care in Brooklyn Facility can include right into their dishes, the much healthier their heart will be.
Anytime that a person swaps out whole grain products for white grains, this is going to be the heart-healthy option to make. This is since whole grain products will contain all three of the nutrient-rich sections of the grain, which consist of the endosperm, germ, as well as bran.
Unlike the polished grains that someone can take in, these whole grains are really high in fiber. This not only assists a person keep normal bowel movements yet is additionally really beneficial in reducing what is known as negative cholesterol. This is very important when it comes to being heart-healthy since the lower that an individual's bad cholesterol is, the smaller their possibility will certainly be of experiencing cardiovascular disease.
By simply eating three portions of whole grains each day, somebody can reinforce their heart enough to make themselves concerning 22 percent much less likely to suffer from heart disease. Therefore, somebody in assisted living in St. Cloud must challenge attempting to take in more whole grain items such as whole wheat, brown rice, rye, oats, buckwheat, barley, as well as quinoa.
A lot of individuals love consuming fruit often, particularly during the springtime and summertime. If their goal is to be a lot more heart-healthy, after that the type of fruit that they take in is going to be really essential. As opposed to consuming things like apples or oranges, they ought to attempt and also gravitate more towards berry fruits like blueberries, strawberries, raspberries, and also blackberries.
Among the most significant reasons berries are so helpful in being a lot more heart-healthy is due to the fact that they contain a high amount of anthocyanins as well as other anti-oxidants. These have the ability to lower the quantity of swelling that takes place throughout the body and lowers the amount of oxidative stress that it experiences, which are both things that help to lower the chance of heart disease occurring.
Strawberries, in particular, have actually been revealed to have a favorable effect on a person's bad cholesterol degrees. While blueberries have actually been shown to assist with blood vessel lining cell performance, just like the way that leafy eco-friendlies do. And to cover all of it off, berries are likewise fairly reduced in calories and also give the body with tons of much-needed vitamins and nutrients that will certainly assist someone handle their body weight and alleviate the quantity of anxiety that is put on their heart every day.
Although these are likewise practically thought about berries, it is fair to state that no person puts them in the very same classification as berries. One important difference that they do share with the berries discussed earlier is the truth that they are an extremely heart-healthy kind of food.
This is greatly since avocados are really high in monounsaturated fats. Despite the fact that individuals often tend to shy away from eating foods that are high in fat, these monounsaturated fats are really the excellent kind of fat that has been shown to help lower a person's cholesterol degrees and their chance of suffering from cardiovascular disease.
Avocados also have a lot of potassium, which has been shown to have a really positive influence on heart health and wellness. By eating an entire avocado on a daily basis, it will instantaneously give someone about a third of their suggested daily dosage of potassium. This will result in lower high blood pressure, which considerably minimizes the opportunities of a person in memory care in St. Cloud this website suffering a stroke. Therefore, anyone who happens to be remaining in economical elderly living in St. Cloud ought to make an energetic effort to integrate even more avocados into their everyday dishes.
Learn more about this affordable senior living in St Paul today.