Covid-19: Most experts say Singapore on track to exit current phase of measures but unlinked cases still a concern

• Three infectious disease experts interviewed believe that the Phase Two (heightened alert) restrictions will not be extended beyond Aug 18
• They said this is because Singapore is on track to meet its national vaccination target, which will help reduce the severity of infections
• However, Dr Leong Hoe Nam believes it may extend up to six weeks, as there is a need to free up hospital beds
• He also warned against nonchalance as it might lead to the development of a virus variant

SINGAPORE — Infectious disease experts who spoke to TODAY on Wednesday (Aug 4) were generally optimistic that Singapore will be able to exit the current Phase Two (heightened alert) as scheduled on Aug 18, despite the recent spike in cases linked to the Jurong Fishery Port and karaoke lounges.

However, among the five interviewed, only one, Dr Leong Hoe Nam from Rophi Clinic, expressed the view that the current restrictions may be extended by another four to six weeks.

Associate Professor Hsu Li Yang, the vice-dean (global health) at the National University of Singapore’s Saw Swee Hock School of Public Health, said that Singapore will likely have 80 per cent of its population fully vaccinated by September.

As it is, 63 per cent of the population have already completed their vaccination regime as of Monday, and the country looks set to meet its target of having two-thirds of the population — or about 66 per cent — fully vaccinated by National Day on Aug 9.

And the statistics from the Ministry of Health (MOH) about the local cases in the last 28 days by vaccination status and severity of their condition have shown the efficacy of the vaccines.

The data, which was last updated on Tuesday, showed that 5.2 per cent of non-vaccinated patients required oxygen support, while 1.1 per cent needed to be warded in an intensive care unit (ICU).

In contrast, the percentage for fully vaccinated patients was 0.4 and 0.2 per cent respectively.

Dr Dale Fisher, who agreed with Assoc Prof Hsu, said that needing oxygen support is a sign that an infection is severe. “Low oxygen levels are critical especially for heart and brain function. Oxygen supplementation works and by then, we hope that the treatment or the body’s natural capacities kick in to allow recovery.”

Associate Professor Lim Poh Lian, the director of the high level isolation unit at the National Centre for Infectious Diseases, said that Singapore has one of the highest rates of Covid-19 vaccination in the world.

“If we had not pushed vaccination so hard over the past seven months, Singapore would be in a far worse situation, as the caseloads in neighbouring countries clearly demonstrate,” Assoc Prof Lim said. She did not comment on whether the infection controls measures would be extended by the Government.

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that with good vaccination rates, he believes that Singapore is on track to “relax the restrictions, rather than extend them”.

While Dr Leong from Rophi Clinic agreed with the need for vaccinations, which he said helps to “tame the bite of the infection”, his concern is about having adequate capacity within the hospitals.

As of Tuesday, there were 592 patients in hospitals, though MOH said that most of the patients were well and under observation. There are now 37 people with serious illness requiring oxygen support, and seven in critical condition in intensive care units (ICUs).

“Think of the country as a battleship, bombarded consistently with enemy fire,” Dr Leong said.

“As long as the engine room is not damaged (by having enough ICU beds), the sailors are protected (by being vaccinated), and the ship moves (economy running), we will move on.”

Being vaccinated, he said, will help to ensure that there are enough hospital beds for those who need it.

That said, he believes that the number of Covid-19 cases will fall to acceptable levels — such as having fewer than 20 cases a day — in four weeks, and will require another two weeks for the authorities to sufficiently clear the hospitals of Covid-19 patients.

However, Dr Fisher said that even when the population is fully vaccinated, people should still expect to see high case numbers, especially when the restriction measures are eased.

When Singapore finally treats Covid-19 as an endemic disease, he said that the focus should be on monitoring severe cases instead.

“The severe (form of the) disease will be limited to the unvaccinated and, rarely, someone vaccinated,” he said.

Assoc Prof Hsu, who is also his school’s programme leader for infectious diseases, said that mild cases of Covid-19 can then be treated at home, which will similarly free up crucial space in the hospitals.

However, even after Singapore reaches the stage of treating Covid-19 as an endemic disease, Assoc Prof Lim warned that people will still die of the coronavirus, “just as people die of influenza complications every year”.

NONCHALANCE WILL LEAD TO MUTANT VARIANT

The surge in Covid-19 cases from the fishery port and the karaoke lounges led to the second round of tighter restrictions from July 22. Assoc Prof Hsu noted that the number of new cases is gradually coming down since then.

The number of locally transmitted infections has fallen from 162 to 92 on Wednesday.

“Generally it has taken at least a week, based on previous stricter restrictions, for the numbers to come down,” he said.

Still, there is some cause for concern because many in the population are not yet fully vaccinated, Dr Fisher said.

Dr Tambyah said that many people feel that their risk of infection is low so they are not willing to try a novel treatment that has only existed anywhere in the world for nine months, such as messenger ribonucleic acid (mRNA) vaccines.

“The rising number of cases, especially the unlinked ones, makes this less tenable an argument,” he added.

Since July 22, the number of cases with no known sources of infection has largely trended in the shape of an inverted-U, with numbers rising from 21 and peaking at 51 on July 27. It has since gradually fallen to 31 on Tuesday.

Dr Leong said that this is worrying because it reflects Singapore’s inability to track infected people, despite the use of technology such as the digital contact-tracing TraceTogether application.

Such technology, he added, is only as good as how well it is used.

“Singapore is relatively safe and we have become a victim of our own success,” he said. “In other parts of the world where there are plenty of cases, the need for vaccination goes up because the fear is very tangible (due to the number of deaths).”

This relative calmness in Singapore over the virus leads to nonchalance, he said.

“Unfortunately, nonchalance… will drive the development of a (Covid-19) mutant. The rest of the world, and Singapore, will be faced with yet another survival threat with yet another variant.”