Man with mpox symptoms breached quarantine, gets jail

SINGAPORE: Despite being placed under quarantine for being a close contact of a mpox case, a man breached the terms of his quarantine by having four men over separately for intimate relations within about half a day.

He developed symptoms of mpox - an infectious disease that spread from Africa to other parts of the world in an outbreak in May 2022, including Singapore.

The diseases was previously known as "monkeypox" and the term was phased out by the World Health Organization in November 2022.

After testing positive for mpox following a rash on his thigh, the man was isolated at the National Centre for Infectious Diseases (NCID) and taken to a hotel to be isolated.

However, he left the hotel and a search party was sent out for him.

Kelvin Low Zi Jian, a 27-year-old Malaysian man, was sentenced to 14 weeks' jail on Monday (Jul 22) for his actions.

He pleaded guilty to three counts under the Infectious Diseases Act for breaching his quarantine or isolation terms, with another five charges taken into consideration.

THE 2022 MPOX OUTBREAK

The court heard that mpox mainly occurred in Africa before 2022.

It is typically a self-limiting and mild illness, but vulnerable people like pregnant women, young children or immunocompromised people can suffer serious complications or even death.

Symptoms include a skin rash, fever, headache and body aches and swollen lymph nodes.

Since an outbreak in May 2022, mpox cases and clusters have been reported in various countries including Singapore.

In July 2022, the WHO declared the ongoing outbreak of mpox to be a public health emergency of international concern.

Mpox can spread between humans through bodily fluids, skin lesions or internal mucosal surfaces like the mouth or throat. The virus can also spread from animals to humans.

According to the prosecution, data suggests that the mode of transmission in the 2022 outbreak was predominantly via close physical or prolonged contact, and most cases were identified in people who reported intimate and sexual contact with infected people.

"Persons engaging in high-risk sexual behaviour, such as having multiple or casual sexual partners, are most at risk of infection in the context of the 2022 outbreak," said the prosecutor.

Because of the 2022 outbreak, mpox was listed in Singapore's Infectious Diseases Act from June 2022.

LOW'S CASE

On Aug 3, 2022, Low received a message from the Ministry of Health (MOH) identifying him as a close contact of a mpox case.

A member of MOH's Health Alert Task Group called Low to ask if he could serve his quarantine at home, and Low confirmed that he was staying alone.

The MOH representative told Low that he could be quarantined at home, but he could not leave the unit and could not have any visitors.

If the rubbish chute was outside his unit, he could throw away his trash only after midnight.

Low acknowledged the conditions. He had previously told the Health Alert Task Group that he had a rash on his left knee, and added during the call that he was unsure if the rash was a symptom of mpox.

That same night, an electronic quarantine order was issued to Low via SMS, informing him to remain isolated at the unit in an enclosed room from Aug 3, 2022 to Aug 15, 2022.

The order stated that Low must not leave his home for any reason, including buying groceries or going for a walk, and that he must not have any visitors.

It stated that non-compliance with any of the conditions was an offence.

Soon after receiving the order, Low went on a dating application and reconnected with a person named in court documents only as A1.

A1 visited Low's unit that night and they kissed and caressed for about 15 minutes.

After he left, another man, named as A2, arrived at Low's unit. Low had been dating A2 for about four months, and A2 went over on Low's request.

They chatted before being intimate. After about one-and-a-half hours, they left the unit and went to a nearby petrol kiosk.

Low did not tell A2 that he was under an electronic quarantine order, and A2 would not have visited if he had known about it, the court heard.

That same night, Low texted another man, A3. They knew each other through Telegram in mid-July 2022 when A3 messaged Low about a shirt Low was selling.

Low asked A3 if he still wanted to buy the shirt. He offered to pay for A3's private-hire ride to Low's home.

A3 agreed and arrived at Low's home at about 12.46am on Aug 4, 2022.

Low proposed having sex and A3 left the unit at about 7am, after about six-and-a-half hours there.

About three hours later, a fourth man, named as A5, visited Low. They talked, hugged and kissed and A5 left after about 1 hour and 40 minutes.

After he left, A3 returned to the unit to retrieve his belongings.

TESTED POSITIVE FOR MPOX

The next day, on Aug 5, 2022, Low noticed he had a rash on his right thigh. Suspecting he had mpox, he reported it to MOH officials and was taken to NCID for testing.

He was confirmed to have mpox that afternoon and was isolated before being taken to Village Hotel Albert Court.

He was told to isolate there, receiving a phone call about it and another electronic order. The order stated that he had to be isolated in the hotel room until MOH gave him a memo that he could cease isolation.

Low acknowledged the order and signed it. MOH caught wind of Low's breaches of quarantine, with officials from the Health Alert Task Group heading down to the hotel on Aug 8, 2022 to issue Low a warning letter.

However, Low refused to sign the warning letter and the officials left.

About 15 minutes after the officials left, Low breached his isolation order and left the hotel.

The officials and hotel employees searched for Low, and the police were activated to find him.

When contacted, Low said he would return to the hotel. A hotel employee chanced upon Low at 4.30pm and scolded him, saying there was a search party out for him.

Low had been walking outside for over an hour, with a mask on, before returning to the hotel, where the police interviewed him.

During investigations, Low admitted that he had met A2 and A3 to have sex and discuss his personal problems. A2 and A3 did not contract mpox, but A3 was placed under quarantine because he visited Low.

The prosecutor sought 26 weeks' jail for Low, saying he had engaged in physically intimate acts with his visitors, which was particularly risky given that mpox is spread through physical contact.

By engaging in those acts without telling them he had been quarantined, Low had "robbed them of the opportunity to decline and protect themselves", said the prosecutor.

She said the visitors faced a "real risk" given that Low later tested positive for mpox, but acknowledged that it was not confirmed at the time he had visitors over.

MITIGATION

Defence lawyer Ms Shehzhadee Abdul Rahman from Shehzhadee Law Corporation sought a fine or not more than three weeks' jail instead.

She said her client was in Singapore on a work permit and has been working here for the past six years.

He was orphaned at the age of 17 after his father died and relocated to Singapore temporarily to work and provide for his family in Malaysia, said Ms Shehzhadee.

She said mpox was "practically unheard of in Singapore" at the time and it was not as widely reported or understood.

The case is unprecedented in terms of quarantine order offences for mpox, said the lawyer, asking for the sentence to be "carefully calibrated" as mpox causes significantly less harm than COVID-19.

Recent cases of breaching quarantine orders have been linked to COVID-19, which is categorised as a dangerous infectious disease, while mpox is a regular infectious disease.

Citing a report by MOH and NCID, Ms Shehzhadee said there were only 21 reported mpox cases in Singapore between May 2022 and Jan 17, 2023, and no more than 76 deaths worldwide.

The lawyer added that her client had left the hotel room as he was experiencing panic attacks from being isolated for two days and the thought of criminal proceedings.

He left the room to "clear his head and regulate his breathing" and returned to it, said the lawyer.

Low will begin his jail term after completing an unrelated imprisonment term of one year for a drug offence.