Doctor who helped identify Singapore's first case was alerted by patient's rashes

It was a routine day at work for Senior Consultant and Associate Professor Lim Poh Lian at the National Centre for Infectious Diseases (NCID) when events started unfolding which would lead to her suggesting that Singapore could be dealing with its first monkeypox case.

She was on duty on May 7 when a man was brought to the adjacent Tan Tock Seng Hospital (TTSH) with suspected Lassa fever.

Prof Lim said she received a call from the emergency department at TTSH and was told the patient was a 38-year-old man who had arrived from Nigeria on Apr 28.

"I was sitting in clinic seeing HIV patients (when I) got a call from the emergency department saying: 'I've actually got a question about Lassa fever'," she added.

​"The concern that we have has really been around viral hemorrhagic fevers. And there are actually a lot of different exotic infections that come in from all over. And so you can't really be screening for every single thing. But you have to know the travel history (of the patient)."

However, when Prof Lim was told that the patient had rashes on his face and body, she ruled out Lassa fever as the virus does not produce such symptoms. Instead, she started thinking if this could a case of monkeypox.

NCID was already on the lookout for possible cases, following a major outbreak of the disease in Nigeria in 2017. Tracking of such outbreaks is carried out by the Ministry of Health (MOH) and the NCID, which gather information about emerging infectious diseases from around the world. Details are then passed on to frontline doctors about such developments.

Once it was flagged that the man could be suffering from monkeypox, staff at NCID swung into action to confirm it.

"From that point on, the emergency department was on the alert and they admitted him to NCID... to the negative pressure room as a potential monkeypox case. And then the testing was done, which subsequently confirmed it," said Prof Lim.

"It's one of those challenges when you're seeing cases because we do get a lot of travelers and you can't cry wolf too often.

"So it's a bit of a judgement call. You have to balance it between trying to not under call it but not over call it either. And it's constantly a struggle that we as frontline doctors face," she added.

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