Each week, TODAY’s long-running Big Read series delves into the trends and issues that matter. This week, we examine areas Singapore did well in its Covid-19 response and areas it fell short. This is a shortened version of the full feature,​ which can be found here.

SINGAPORE — Singapore has come full circle since its first Covid-19 case surfaced in January 2020, from a lockdown, shuttered borders, ever-changing permitted group sizes, mass vaccination programme, to a mask-lite existence in recent days. 

Along the way, its efforts at battling the unprecedented pandemic has also won international plaudits.

In May 2021, Singapore topped the Bloomberg Covid Resilience Ranking — which considers factors ranging from Covid-19 case numbers to freedom of movement — knocking out New Zealand which had ruled the chart for months.

Bloomberg cited Singapore's efficient vaccination programme compared to the slow rollout in New Zealand as the chief reason for the change in position.

Singapore was also one of the countries where a majority of its people feel more united than before the pandemic, according to a survey by American think tank Pew Research Center last year.

The survey also found that a majority in Singapore feel that it is very important to get the Covid-19 vaccine in order to be a good member of society, and this opinion translates to higher rates of vaccination across the population.

While Singapore’s overall handling of the pandemic is deemed successful by international standards, there were also missteps, said infectious disease experts. One of them was the Government’s response to the Covid-19 outbreak in migrant worker dormitories.

As a Government review of its Covid-19 response remains underway, TODAY speaks to infectious diseases experts and those at the front lines to take stock of a crisis that is without parallel in recent memory. The areas highlighted in this feature are those that they largely agreed on. 

WHY IT MATTERS

Singapore recently changed its Disease Outbreak Response System Condition (Dorscon) to the lowest alert level of green and largely removed mask wearing. The population has also achieved 92 per cent vaccine coverage for the primary series and the lowest mortality rate in the world.

Infectious diseases expert Leo Yee Sin, who has been at the forefront of Singapore's Covid-19 battle, told TODAY: “Barring unexpected surprises by the rapidly evolving Sars-CoV-2 virus, Singapore has reached a significant milestone of ‘normalcy’ with remarkable achievement."

Thus, it is now time to reflect on areas of deficiency and learn from the lessons to further strengthen Singapore’s capability to take on emerging infections, added the executive director of the National Centre for Infectious Diseases (NCID). 

THE BIG PICTURE 

There were undoubtedly three areas that Singapore did well in — the procurement of vaccines and test kits, using a science-based approach in tackling the pandemic and public communications. 

Infectious diseases experts largely attributed Singapore’s high vaccination rate to the rapid procurement of Covid-19 vaccines and test kits, which helped reassure the public and healthcare professionals.

Professor Alex Cook, from the National University of Singapore (NUS)'s Saw Swee Hock School of Public Health, said that the Government’s success in reaching deals to get enough supplies of vaccines enabled the mass vaccination to start quickly, so that Singapore could move out of containment as early as possible. 

Experts also said that one of the hallmarks of the Government’s approach is to put a strong emphasis on epidemiological reasoning when formulating policies.

Deputy Prime Minister Lawrence Wong, who co-chairs the multi-ministry task force (MTF) handling the pandemic, had said earlier that the Government’s decisions have always been based on data, evidence and science, and stressed that the guiding priority throughout Covid-19 has always been to keep the community safe.

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said Singapore generated key scientific data, including the first study to conclusively show pre-symptomatic transmission of the coronavirus, as well as the benefits of vaccinating children.

Experts added that a whole-of-society approach was also important in communicating the rationale behind certain Covid-19 measures.

Professor Dale Fisher, a senior consultant at National University Hospital's division of infectious diseases, said a critical aspect of Singapore’s response was community engagement — the authorities strategically communicated with residents through a variety of media and spokespeople from the prime minister to the MTF, relatable cultural leaders and television personalities. Academics also regularly gave commentary. 

“The end result was that Singapore residents were reliably informed with explanations given, describing the objectives and reasons behind interventions. This was critical in enabling the success of efforts,” said Prof Fisher.

Still, despite the high compliance among the population, experts said that communication, which was clear and reasoned for the most part, broke down at times, such as when testing protocols became overly complicated or when there were flip-flopping of measures.

THE BOTTOMLINE

In navigating the constantly changing and uncertain conditions during the pandemic, there were also several blind spots. One of them being the outbreak in the migrant worker dormitories. 

Many of the experts interviewed agreed that this was a major area in which the Government fell short, with Prof Cook saying that the dorm outbreaks are a “big black mark” on Singapore’s record.

“If you look at the fraction of the total population in the dorms and general public to be diagnosed as infected, we kept pace with the United States over the first six months of 2020 — that’s how bad it was. There wasn’t much that could be done once the outbreaks had started — what could be done to re-house 300,000 men in low density accommodation at short notice?” he said.

“But what I found most disappointing is what happened afterwards: The tight control over their day-to-day lives imposed for over a year afterwards. This came despite most dorm residents having been infected already and thus at lower risk of another infection.”

Being hit by an unprecedented pandemic also put a tremendous strain on Singapore's healthcare system, said experts, adding that this came at cost of the mental well-being of healthcare workers. 

A 24-year-old Singapore General Hospital nurse, who was deployed to the Covid-19 ward at the height of the pandemic, told TODAY: “It was a psychological battle…because for a very long time, there was no light at the end of the tunnel.”

Some nurses also recalled how they were initially shunned by the public as possible carriers of the virus. 

To be sure, Prof Fisher noted that there were also many efforts to support the stressed-out healthcare workers  — from cash bonuses to tokens of appreciation such as free food. Occupational health and specific mental health services were also provided, he added. 

"I don’t believe more could have been done to mitigate this adversity. The truth is no one else could do what was a task of healthcare workers. I don’t believe healthcare workers were let down by health leadership. Of course, there are likely to be anecdotes where support did fall short and I can’t speak for every facility,” he said.