Will a China Covid-19 wave set back endemic living in Singapore?
Despite immense efforts to strengthen the healthcare system, Singapore is not immune to future waves and should be careful not to clam up each time one approaches.
Khoo Yoong Khean
A medical worker administers an IV drip treatment for a patient at the fever clinic of Beijing Chaoyang hospital on Dec 27, 2022. PHOTO: REUTERS
Dec 30, 2022
Just when the world has made progress in understanding and managing Covid-19, with the World Health Organisation (WHO) even hoping it would no longer be a global health emergency by 2023, a spanner has been thrown into these shifting gears.
China, the world’s most populous country and last one standing in holding fast to an indefinite zero-Covid strategy of suppression, announced it would
lift several pandemic restrictions two weeks ago. It has since allowed people with mild symptoms to rest at home instead of requiring quarantine at a dedicated facility, reduced public testing and removed QR codes previously needed to enter public places.
And just like every other country that relaxed its rules, these sweeping moves have expectedly led to surges in infections, with
one million daily cases estimated alone in the Zhejiang province.
With 1.4 billion people, China’s healthcare system will be tested in the coming months. China’s National Health Commission (NHC) has since
stopped publishing daily Covid-19 data, announcing that the China Centre for Disease Control and Prevention will only publish relevant information for reference and research. As we will not know the number of new daily infections going forward, it will be hard to ascertain the true burden of the disease.
But given the nature of the virus and our highly globalised world, China’s high-impact decision could affect many parts of the world.
Will Singapore change its measures?
Outside China, it has been a patchy and bumpy ride since 2020. Many nations have bought time during the 2020 lockdowns to fast-track vaccine development and procurement, shore up healthcare capacities and sensitise populations to the need for mitigating measures to be imposed from time to time.
Through a careful, phased approach, Singapore has navigated the pandemic with relatively minimal damage, emerging with one of the
lowest mortality rates in the world from Covid-19 in September 2022. Omicron and its variants swept through the population over the past year, but the number of severe cases of infections has stayed low and our healthcare capacity remains protected.
Life has gradually returned to some semblance of pre-Covid-19 normalcy, with most mask mandates lifted and vaccination-differentiated measures removed. But is Singapore truly out of the woods? Or should we sound the alarm given the potential impact of the situation in China?
And most importantly, how prepared are we to face a potential new wave of infection?
Singapore’s healthcare system shored up
Since 2020, we have taken advantage of each trough in the epidemiological waves of Covid-19 to strengthen our healthcare system, including general wards and intensive care units.
During the height of the pandemic,
Singapore further expanded healthcare capacities by repurposing sites like the
Singapore Expo and the F1 Pit Building at Marina Bay as community care facilities. Facilities like these supported up to 4,500 beds in total.
The development of Covid-19 vaccines was arguably the turning point in the pandemic. While the vaccines have been proven to be very safe and effective, constraints on global manufacturing capacity saw the rise of issues around accessibility and equity, with high-income countries accumulating a high number of doses early in the pandemic and leaving many other countries struggling to purchase them.
In the past two years, five pharmaceutical companies have committed to
setting up vaccine manufacturing plants in Singapore, capable of producing one billion doses annually. Having these facilities will enable Singapore and neighbouring countries in the region to access vaccines much faster in the future.
The key limiting factor remains healthcare human resources, for which we must press on with investments and efforts to reduce growing attrition. They are the spine of our healthcare system and have gone above the call of duty to care for us.
Notwithstanding
pay hikes of 5 per cent to 14 per cent for more than 56,000 healthcare workers, the global demand for doctors, nurses and allied health professionals has swelled since the pandemic began and competition for this scarce resource remains stiff.
Other strategies Singapore has implemented will
supplement the healthcare workforce, including redeploying underemployed manpower elsewhere to serve as healthcare assistants, recruiting volunteers from SG Healthcare Corps and collaborating with private hospitals.
But the healthcare workforce is situated within a dynamic and changing landscape. Cost of living, distance from families and mental health issues such as burnout are some factors determining whether people stay or leave. Apart from reviewing remuneration and redistributing manpower, other measures to keep the attrition rate low are to continually provide opportunities for career progression to encourage more to permanently relocate here. Outreach services such as counselling and peer support programmes could shore up morale and provide mental health support.
Managing risks at national and individual levels
Should Singapore close up or implement new restrictions in view of the worrying situation in China?
Compared with past waves, including those involving the Delta and Omicron variants, Singapore’s potential response to any future surge has also been strengthened owing to the incredible progress in the science around Covid-19.
The availability and uptake of vaccines have heightened population immunity, shielding us from severe illness and death. Extending vaccine coverage to children aged below five and, recently, rolling out the updated bivalent Covid-19 boosters have gone some way to offer stronger protections, especially against new variants with some immune evasive properties to the previous vaccines.
Constant reminders for people to keep up with booster shots have ensured that 82 per cent of the population have minimal protections and 62 per cent have up-to-date vaccinations. Post-infection immunity also plays a part in building up our collective immunity.
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However, we know immunity levels wane naturally over time and our current level of coverage may not be enough, especially if there is a sudden spike in infection numbers. A high level of virus circulation among the population could overcome our population’s immunity if our vaccination coverage is not continually updated, which is why it is important for us to go for our booster shots.
Understanding the mechanics of transmission has allowed us to develop a robust testing strategy to close down infection clusters – including the dissemination of antigen rapid test kits to households, the decentralisation of polymerase chain reaction testing at many general practitioners’ clinics and pre-emptive sewage testing.
Masking, while not mandated in most settings now, remains highly used in Singapore with individuals exercising personal responsibility and has proven to be a simple and effective method of mitigating spread. Wearing masks in crowded spaces or if we are always in contact with the vulnerable population such as the elderly, the immunocompromised and children can help to protect them.
If necessary, public health interventions such as targeted testing and mandatory masking can be easily rolled out again in response to future health risks. In short, we have a toolkit of interventions we can pick and choose from if the situation changes.
The availability and uptake of vaccines have heightened population immunity, shielding people in Singapore from severe illness and death. PHOTO: ST FILE
As more people return to offices, smart investments like improving ventilation can stem virus transmission. Simple measures such as keeping operable windows and doors open and installing exhaust fans will increase air circulation.
In air-conditioned spaces, ventilation systems and filters should be continually cleaned and maintained. Portable high-efficiency particulate air filtration systems placed in high-risk areas such as meeting rooms or office pantries can help to decrease the risk of transmission. As a standard, it would be useful for all enclosed spaces to employ particulate matter and CO2 sensors to measure air quality and ventilation.
Maintaining flexible work arrangements and allowing hybrid work, while seen primarily through employee welfare lenses, can help our workforce cope with a surge in infection.
A balancing act
Moving into the fourth year since the first Covid-19 outbreak, there is a balance we must strike between avoiding being alarmist, responding to every change in the situation and upkeeping caution, remaining ready to adapt and apply necessary measures only when needed.
This balance is never easy to strike. Decisions to impose public health interventions such as mandatory masking, crowd control and vaccination-differentiated measures will require a deep understanding of the evolving science, human behaviour and national trade-offs, as well as clear communication and transparency to preserve public trust.
This highlights the need to remain constantly vigilant and make decisions after carefully considering all the aspects of the pandemic. In the end, while many decisions are on an individual level, we must consider others in our actions to protect our community and population.
Still, the evolving situation in China once again demonstrates our interconnectedness in a globalised economy where local events can have a ripple effect globally. In Singapore, one such example of its effects is how
more people are purchasing over-the-counter medicine in view of the outbreak there.
More recently, as news that
more flights from Beijing to Singapore will be launched by Singapore Airlines, many Singaporeans are wondering what the implications are for Singapore and how Singapore could deal with a surge in cases.
The introduction of infection through cross-border travel and the potential emergence of new variants are some of the risks we face. Health Minister Ong Ye Kung cautioned in early December that the
holiday period and increased travelling will lead to a surge in infections.
Surges in infection are inevitable, given the location of Singapore as an international hub, receiving travellers either for trade or tourism. However, we can mitigate the risk by continuing to monitor developments overseas and be steadfast in the knowledge that a surge in infections isn’t anything Singapore hasn’t weathered before, and we have a toolbox of measures and strategies that can be implemented if the situation develops enough to warrant this.
Implementing targeted pre-departure and arrival Covid-19 tests for inbound travellers if the risk of a sudden influx of Covid-19 positive patients is determined to be too high is one such example.
Countries cannot live in a bubble forever and close ourselves off each time there is a huge Covid-19 outbreak elsewhere around the world. This is where continual investments in new technology and interventions such as novel diagnostics, therapeutics and vaccines will improve health security, not only in Singapore but also in the region and globally.
The situation in China will continue to evolve and depending on what transpires, we will have to adjust our response accordingly. Border closures are the first knee-jerk reaction many countries respond with to prevent the introduction of infection, but it will only delay this.
Closures also represent a nationalistic approach to a virus that does not care for nations and borders. The world is in this together as one and only by working collaboratively do we stand a chance against the relentless march of the virus.
- Dr Khoo Yoong Khean is scientific officer at the Duke-NUS Centre for Outbreak Preparedness.