A man wearing a protective facemask walks past the Rain Vortex display at Jewel Changi Airport in Singapore. Photo: AFP via Getty Images / Roslan Rahman

SINGAPORE – With 84% of Singaporeans fully vaccinated against Covid-19, one of the highest percentages worldwide, many had expected authorities would by now be easing, not maintaining, social distancing and other contagion-curbing restrictions.

But that’s exactly what officials are doing as the island nation seeks to cope with its largest outbreaks since the start of the pandemic.

Singapore’s Ministry of Health (MoH) announced on Wednesday (October 20) that stricter curbs introduced in late September as part of a so-called “stabilization phase” implemented to minimize health care system strains would be extended for another month as daily cases have soared to all-time highs.

As other nations begin pursuing reopening strategies and treating the coronavirus as endemic, Singapore’s experience is now being looked upon as a sobering case study, particularly for countries that have until now kept cases low by relying on strict measures but are under mounting pressure to manage, rather than eradicate, Covid-19.

Singapore’s daily cases hit a record 3,994 on October 19, with the seven-day average number of new infections more than tripling in the last month. The overall death toll has more than quadrupled over the same period, rising to 280 on October 21 from just 65. Authorities, meanwhile, have attested to rising pressure on hospitals and healthcare workers.

“At the current situation, we face considerable risk of the healthcare system being overwhelmed,” said Lawrence Wong, Singapore’s finance minister and co-chair of a multi-ministry Covid-19 task force. “It’s not simply a matter of having extra beds or purchasing new equipment… our medical personnel are stretched and fatigued.”

As of Wednesday, about 89% of isolation beds and 67% of intensive care unit (ICU) beds, including those for non-Covid-19 patients, were filled in public hospitals, according to the MoH. That is despite only around 1% of cases requiring oxygen supplementation and 0.1% requiring ICU care over the last 28 days, with 98.6% of cases showing mild or no symptoms.

Around 10% of infected patients are being admitted to hospitals due to more severe symptoms or co-morbidities, with around 100 unvaccinated seniors per day. A substantial number of seniors have forgone vaccination for various reasons despite being given priority access to Covid-19 vaccines ahead of other demographic groups in February.  

Two men wait outside a clinic after being vaccinated on June 24, 2021, in Singapore. Photo: AFP via NurPhoto / Suhaimi Abdullah

A large proportion of severe outcomes and coronavirus deaths have since been linked to unvaccinated seniors, who are proving to be the Achilles’ heel of the city-state’s pandemic response. Unvaccinated patients made up 54.7% of 495 severe cases recorded in recent days, with others being vaccinated but with co-morbidities, said the MoH earlier this week.  

At a press conference on Wednesday, Health Minister Ong Ye Kung told media that queues for beds for both Covid-19 and non-Covid patients have formed at certain hospitals, and that the MoH would open up more ICU beds if necessary, although that will be “at the expense of further degradation of normal service and normal medical care.”

Since the “stabilization phase” began on September 27, the number of new infections appears to be plateauing, though there is no sign that cases are falling. Social gatherings were capped to a maximum of two while work-from-home has become the city-state’s default arrangement. Those measures will be reviewed after two weeks but will otherwise remain in place until November 21.

Businesses and retailers have lamented the latest month-long extension of Covid-19 restrictions, the latest in successive rounds of rule-tightening since May that have left affected sectors reeling. A support package for businesses and workers worth S$640 million (US$475 million) was announced in the wake of the extended restrictions.  

Food and beverage (F&B) businesses across Singapore have been among the hardest hit by start-stop measures to reduce transmission, and industry groups have appealed to the government for greater leniency. Taskforce co-chair Wong maintains that it is still “too risky” to allow five people from the same household to publicly dine in together.

At the same time, the city-state began welcoming quarantine-free entry to vaccinated travelers from the United States and some European nations this week, arguably exposing Singapore to greater risk than permitting fully vaccinated residents to patronize restaurants in higher numbers in accordance with past pledges for more freedoms for the immunized.

With policymakers previously holding up a high vaccination rate as the key prerequisite for a phased reopening, public sentiment has been divided over the stuttering pace of plans to “live with Covid.” As frustrations rise with what is seen as an overly cautious approach, some experts are have questioned the use of blanket restrictions amid rising endemicity.

Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, says the current rate of transmission in Singapore has illustrated the limits of broad non-pharmaceutical interventions. “There is no good evidence that the measures put in for the ‘stabilization phase’ have had an impact on case numbers or on ICU utilization rates,” Tambyah said.

Paul Tambyah (L) and Lawerence Wong (R) have divergent views on how to handle Covid-19. Picture: Facebook

“There is a need to target the vulnerable to concentrate resources and avoid unintended consequences of blanket restrictions,” he added.  

Tambyah has said that he does not think loosening the restrictions to the previous set of measures in place earlier this year, in which the maximum group size for public gatherings was five, would lead to a surge in infections.

Tambyah is also chairman of the opposition Singapore Democratic Party (SDP), which last month published an eight-point plan detailing how Singapore can more effectively deal with and exit the Covid-19 pandemic. The report criticized the government’s multi-ministerial task force as being “plagued with a distinct lack of coherence and direction.”

“The reactive nature of the multi-ministerial task force’s approach in dealing with outbreaks of infections has led to stop-start, on-again/off-again policies, which had impacted adversely on both employers and employees [and has] left Singaporeans confused and frustrated,” said the SDP’s healthcare panel, which authored the alternative strategy.   

Tambyah told Asia Times that the SDP’s suggestions would be submitted to the task force pending public feedback.

“Basically, we would stop testing asymptomatic individuals, have a dedicated ambulance hotline for those who need oxygen, empower the general practitioners to make clinical decisions on hospitalization and other practical suggestions.”

With the coronavirus “already endemic almost all over the world,” the disease expert said non-pharmaceutical interventions such as strict caps on gatherings of vaccinated individuals and differentiated measures for the vaccinated and unvaccinated “would not have a significant impact on the transmission at this stage in the pandemic.”

Singapore introduced so-called “vaccination-differentiated safe management measures” at restaurants in August, with only fully vaccinated people allowed to dine in. Last week, it extended those rules to prohibit unvaccinated people from dining in at open-air hawker centers or even entering shopping centers, with some exceptions.

People relax during lunch break at the Raffles Place financial business district in Singapore on September 14, 2021. Photo: AFP / Roslan Rahman

“The disease is all over Singapore right now and the priority should be reaching out to the unvaccinated seniors and protecting the vulnerable rather than taking measures which adversely affect the bulk of the population with little benefit,” Tambyah maintains, saying he hopes ongoing restrictions “will be lifted in a month or earlier.”

Health Minister Ong told reporters on Wednesday that the current wave of infections will not last “indefinitely” and will peak at some point in a “new equilibrium with the virus” as the population builds up better immunity and more people receive booster shots, which have recently been made available to people aged 30 years and older.

“Hopefully this [new equilibrium] will come in the next few months. There may not be a peak but a plateau followed by a downturn. It is very hard to tell,” said Tambyah. “The aim is to reach a low level of endemicity, like the Zika virus, which appears in Singapore every now and again with a few imported cases and a handful of local cases every year.”