Covid surge a ‘rite of passage’ on return to normality, says Singapore health chief

Singapore’s national plan to stop counting daily Covid-19 cases and learn to live with the coronavirus is being put to the test as pandemic restrictions are eased and infections spike.

On Tuesday, the country hit a new daily record of 1,178 Covid-19 cases, with experts predicting the city-state could reach 2,000 cases a day by October if the current vertical trajectory of infections persists.

Fuelled by the more infectious Delta variant, the virus is spreading rapidly through the densely packed 5.7 million population, despite some 82 per cent now being fully vaccinated.

The Asian country’s situation mirrors soaring cases in Israel, which has also had one of the fastest vaccine rollouts in the world, and it highlights the challenges of Singapore’s stated goal to evolve from tackling a pandemic to treating Covid-19 as an endemic disease.

Ong Ye Kung, the health minister, said on Friday that the wave of cases should be seen as a “rite of passage” for any country trying to make the transition. “It is a journey that is uncertain and full of twists and turns,” he told reporters at a virtual press conference.

In a Sunday Facebook post, he warned that the next one to two weeks “will be critical” to ensuring hospitals are not overwhelmed, but he has also reassured the public that deaths would have been much higher without mass vaccination. Currently, Singapore has recorded 65 deaths since last year.

Public health experts believe that while Singapore may readjust and slow down the pace of its reopening, that the authorities will ultimately stay the course of a roadmap that was initially launched in June to return to quarantine-free travel, large gatherings, and to treat Covid-19 like the flu.

The broad plan to return to normality relies heavily on controlling infection rates through vaccines, shifts in testing methods, better treatments and social responsibility.

Prof Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said the main reason for rocketing cases was that the vaccines do not prevent transmission and their protection against infection wanes over time.

Singapore, like Israel, is pioneering booster shots for the over-60s, but Mr Tambyah pointed out that despite the surge, the number of severe cases in ICU has so far remained relatively low.

Currently, there are 18 critically-ill patients using the 100 available ICU beds, which can be expanded to 300 at short notice. Of vaccinated people in Singapore who caught the virus from May 1 to September 16, only 0.09 per cent of them had to go into intensive care or died. The rate for the unvaccinated was 1.7 per cent.

The large daily figures raise the question of whether vaccines are sufficient to tackle the Delta variant without additional non-pharmaceutical measures, but Singapore has long been a model for strict Covid-19 protocols, with mandatory masks, efficient contact-tracing and tight border controls.

“I think that this illustrates the limitations of non-pharmaceutical measures in controlling the Delta variant which is now the dominant strain of the virus worldwide,” said Mr Tambyah.

“Singapore has some of the strictest non-pharmaceutical interventions worldwide,” he said, citing no singing in churches, strict mask mandates with jail terms for violators, vaccine mandates for restaurant dining and rostered testing for a large number of professions.

“The main lesson is that we need newer and better vaccines. The good news is that there are many in the pipeline including newer versions of both Pfizer and Moderna vaccines which are most widely used in Singapore.”

Dr Alex Cook from Singapore’s Saw Swee Hock School of Public Health said that while the pandemic situation remained superior to the US or UK, Singapore’s outbreak was a “test of the government’s and the people’s resolve” in the face of an unprecedented rise in cases, even if the majority were mild.

“The outbreak is not a signal that we need NPIs (non-pharmaceutical interventions) forever but rather that in this post-pandemic liminal state, we must pass through a potentially large wave of mostly mild infection before we can reach endemic Covid,” he said.

He suggested that the significant number of vulnerable senior citizens who remained unvaccinated – an estimated 87,000 – could prompt a vaccine mandate to supplement compulsory mask wearing and social distancing rules.

Serious infection rates among the elderly are striking. Of infected unvaccinated people aged 80 or older, 15 per cent of them had to be treated in intensive care or died, compared to 1.79 per cent of the same age group who were vaccinated.

“If the hospitals are under pressure and people with other illnesses are being put in jeopardy because of a small minority's unwillingness to get a simple jag, there’s a strong case to be made to make vaccination compulsory, especially if the alternative is yet more lockdown for everybody,” he said.

The authorities are banking on the ability of the healthcare system to cope with the rush of cases as limits on social gatherings ease, exposing more people to infection.

Treatments are shifting from an emphasis on isolating Covid-19 patients at a healthcare facility to a default strategy of allowing most to recover at home. Self-test kits have been distributed in 100 vending machines across 56 locations.

Covid-19 cases were rising because Singapore was following “gold standards” for widespread testing and tracking, said Jeannette Ickovics, a Yale University professor of public health and psychology, currently visiting Singapore’s Yale-NUS College.

“It is really important to note that 98 per cent of infected individuals have had no symptoms or mild symptoms and have not required oxygen supplementation nor care in intensive care units,” she said.

As well as booster shots, other “promising drugs” in the pipeline included a monoclonal antibody cocktail discovered at Vanderbilt University Medical Centre in Tennessee and developed by AstraZeneca, she said.

This reduced the risk of symptoms in a study of immunocompromised and chronically ill adults later exposed to the virus by 77 per cent.

Singapore was trying to strike the balance of “health, social and economic priorities,” said Prof Ickovics, but in order to live with the virus, “prevention is better than treatment,” she added.

“We all must remain vigilant and remember the basics: wash your hands, wear a mask, convene outdoors, socially distance, if not feeling well stay home. We need to assure that social distancing does not result in social isolation, depression and anxiety,” she said.

“I recommend that we all try to do something restorative every day – make a home-cooked meal, reconnect with a friend in real-time, exercise and spend time in nature, get sufficient sleep. Get and promote vaccinations, and help support vulnerable members of your community.”

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