SINGAPORE – As Southeast Asia struggles to contain a Covid-19 resurgence, Singapore has so far avoided the harsh fate of neighboring nations that have fallen ill to second waves of infection far deadlier than the first. But the island nation is determined not to become a victim of its virus-curbing success.
Nearly three weeks since re-imposing lockdown-like conditions to arrest its largest Covid-19 community outbreak in months, daily infections in the city-state are only a fraction of those recorded in neighboring countries, even though all four variants of concern (VOCs) have been detected locally.
To mount a stronger defense against the more contagious strains, including those first identified in the United Kingdom, South Africa, Brazil and India, the island nation has recalibrated its vaccine strategy to prioritize first dosage so that a wider segment of the population receives immune benefits more quickly.
It has also opened up its vaccination program to adolescents and teenagers before completing inoculations of adults, making it one of the first countries in the world to do so. Around one-quarter of the population has been fully vaccinated so far, more than almost anywhere else in Asia, where Covid-19 vaccination campaigns have been sluggish.
Singapore’s leadership has begun to put forward their vision for a post-pandemic “new normal” where mask-wearing and travel curbs are gradually relaxed amid expectations that Covid-19 will circulate as a mild endemic disease for years to come, offering a glimpse into how the city-state aims to avoid the so-called “Covid zero” dilemma.
For places that have nearly eliminated coronavirus spread, many say the challenge now is finding a path to reopening so that successful pandemic management doesn’t become a straitjacket eliciting ever-tighter border curbs that risk turning globalized economies into hermetic ones.
Faster, less invasive yet more widespread forms of testing are thus set to play a critical role in reopening the regional business and transport hub. Those include plans to introduce routine virus screenings at workplaces, offices, sporting and religious events, and even shopping malls and restaurants.
That doesn’t mean residents will be forced to take frequent throat or nasal swabs. Authorities say a variety of fast, low-cost testing methods designed to aid in the crucial early detection of new infections, including self-test kits that can be purchased over the counter at pharmacies, will soon be available in the city-state.
A locally developed breathalyzer test that can determine whether someone is infected with Covid-19 in under a minute with more than 90% accuracy was provisionally approved in late May.
The device is now being trialed at one of the city-state’s border points with Malaysia and is expected to be phased into wider use domestically in the coming months.
“Henceforth we will not only test to identify infections when a new case pops up. We will also routinely and regularly test people who appear well, in normal work or social or community settings, to make these places safe,” said Prime Minister Lee Hsien Loong in his May 31 speech, adding that testing will provide confidence to resume larger-scale events.
“We will not be able to prevent some infected persons from slipping through from time to time. Our aim must be to keep the community as a whole safe while accepting that some people may get infected every now and then,” said the premier. “In this new normal, we will have to learn to carry on with our lives even with the virus in our midst.”
Lee added that Singapore “should be on track” to relax the latest curbs on social gatherings and public activities such as dining by June 13, the date the measures were initially set to expire. Current restrictions, which went into effect on May 16, are the strictest since the “circuit breaker” lockdown last April-May.
Singapore finds itself “in a much better position today” compared to last year, when the country confronted its first large-scale outbreak, said the long-serving premier. But with the emergence of more infectious variants, Lee asserted that the city-state would have to “raise [its] game” to keep the pandemic under control.
Health experts say India’s highly contagious B16172 variant has been the most prevalent strain behind the resurgence of locally transmitted cases in recent weeks. Several airport staff working in a zone that received travelers from high-risk South Asian countries are believed to have contracted and spread the more transmissible variant.
“Transmissions are happening faster and more aggressively compared to what we saw previously, meaning contacts of infected cases are becoming contagious within a shorter span of time and are infecting others in their circles,” said Teo Yik Ying, dean of the National University of Singapore’s (NUS) Saw Swee Hock School of Public Health.
New weekly community infections have fallen to 74 cases from May 23-30 compared to 199 cases during May 9-16. After months of reporting nearly zero daily Covid-19 community infections, Singapore’s highest recent daily toll was 38 cases on May 16. The current seven-day [May 29 to June 4] moving average of daily cases stands at 20.
Singapore has reported 62,158 cumulative cases – more than 98% have recovered – with just 33 fatalities since the island republic reported its first case in late January 2020. There are 555 active cases but only two are hospitalized in critical condition despite increased community transmission over the last month.
Finance Minister Lawrence Wong, who chairs a multi-ministry Covid-19 task force, said that while tightened curbs have brought down cases, undetected infections in the community remain a cause for concern. He said new variants are “capable of spreading much faster than anything we’ve had to deal with before and causing large clusters to break out easily.”
Changi Airport has been the site of the city-state’s largest cluster so far this year, involving over 100 cases. Flights and passengers from higher-risk countries and regions have since been segregated from those arriving from lower-risk places, measures that many on social media criticized authorities for not enacting earlier.
May’s variant-fueled outbreak forced the cancelation of the Shangri-La Dialogue defense summit, which was scheduled to be held in-person from June 3-4, for the second year in a row. Organizers of the World Economic Forum (WEF) also nixed plans to hold the Davos-based annual gathering in the city-state in August.
Both high-profile events were intended to showcase the city-state’s virus-quelling resilience and their cancellations were a setback for the hard-hit aviation, hotels and events sectors. A much-anticipated quarantine-free travel bubble with Hong Kong that was set to open on May 26 was also derailed for a second time due to the viral uptick.
Along with increased testing, Singapore intends to increase the pace of vaccination over the next two months so that all eligible residents who want to be vaccinated receive their first dose by early August. Nearly four in 10 residents, slightly more than one-third of the population, have so far received at least one dose of a Covid-19 vaccine.
The country shifted its vaccine strategy in late May, announcing it would extend the interval between the first and second vaccine doses to between six and eight weeks, up from three to four weeks, to allow more of the population access to the first dose to be better defended against more transmissible variants.
“Extending first doses to as many people as possible has actually been shown by modelers to be a sound public health move that confers better protection to the community,” said academic Teo. “At the same time, reports have shown a better immune response was observed when the second dose was delayed beyond the recommended 3-4 weeks.”
Authorities said they opted for a first dose strategy after studying data from countries such as the United Kingdom, Germany and Israel that have adopted the approach and found that one jab conferred at least 75% protection against the virus, a rate that experts say varies slightly depending on the virality of a given strain.
After a number of recent infections involving children, Singapore approved and expedited vaccinations for 12-to-18-year-olds during the June school holiday ahead of adults aged 39 years and younger, who will be the last group to be given vaccine access despite epidemiological data pointing to increased vulnerability for the latter group.
According to the US Centers for Disease Control and Prevention (CDC), 5-to-17-year-olds were 45 times less likely to die from Covid-19 compared to 30-to-39-year-olds. Experts say that variant strains currently circulating in Singapore are no more likely to infect children, however, their clustered learning environments are more generally prone to transmission risks.
“Children are also more likely to interact in close proximity during learning, and they are in classes for prolonged periods. With variants that are more transmissible, this does mean that schools and education centers now are at risk of being the locations where super-spreading events or widespread transmissions can take place,” said Teo.
The Saw Swee Hock School of Public Health dean added that Singapore made the “conscious decision” to vaccinate school children to avoid Covid-19 further “affecting schooling and education, which any missed opportunities in this area can have a negative impact on an entire generation.”
Ling Li Min, an infectious diseases physician at the local Gleneagles Hospital, said that while a majority of children would likely have mild illnesses if infected, younger people have been found to be more at risk of “rare severe Covid infection-related complications” such as multi-system inflammatory syndrome.
After more than a year of managing the pandemic, Ling said the Covid-19 situation remains fluid, dynamic and unpredictable. “What we learn from current wave will enable us to adapt more quickly so that when the next waves happen, it will be quickly brought under control without too much pain for everyone,” she told Asia Times.