Covid-19: Should Singapore lift mask-wearing rule on public transport, healthcare venues? Experts think so

SINGAPORE — As the Covid-19 situation in Singapore and around the world has stabilised, infectious disease experts here are saying that now is a good time to do away with the public health safety rules of wearing a mask on public transport and in healthcare settings.

Singapore has kept the spread of Covid-19 under control to the point that the disease kills fewer people than influenza, experts who spoke to TODAY said.

They added that with people mingling freely in public, the remaining rules on mask-wearing have become “redundant”.

In his new year message recently, Prime Minister Lee Hsien Loong said that the Government was watching the Covid-19 situation very closely and may lift the remaining restrictions if the situation remained stable.

Last Friday (Jan 27), Minister for Health Ong Ye Kung said that cases typically spike over long weekends, but the number of Covid-19 cases over the Chinese New Year holidays was low, indicating that the situation has stabilised.

The same can be said for other countries around the world.

The White House in the United States said on Monday that the country's Covid-19 emergency declarations will end officially on May 11.

Earlier this month, Dr Liang Wannian, China’s head of Covid-19 response panel under the country’s National Health Commission, said that the Covid-19 surge there has declined, and that the country has “weathered the worst” of the wave. 

China announced last month that it would ease border and travel restrictions and this was followed by a huge Covid-19 wave.

On Monday, it said that the Covid-19 situation in the country was at a "low level", and that visits to fever clinics due to the coronavirus during Chinese New Year dropped about 40 per cent from before the week-long holiday there.

Mr Wang Quanyi, deputy director of Beijing's Centre for Disease Control and Prevention, told media there on Tuesday that the city of 22 million had "established temporary herd immunity protection".

WHAT EXPERTS SAY OF SINGAPORE’S COVID-19 SITUATION

Associate Professor Alex Cook, vice-dean of research from the National University of Singapore’s Saw Swee Hock School of Public Health, said that in Singapore, the risk of death for Covid-19 has lowered.

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, noting that the Covid-19 situation has been under control here, said that the remaining restrictions can be lifted.

Agreeing, Dr Leong Hoe Nam from Rophi Clinic and Mount Elizabeth Novena Specialist Centre, said that this is due to good vaccination take-up rates in Singapore, reasonable herd immunity because of hybrid immunity, and the widespread availability of anti-virus medications. 

The World Health Organization (WHO) states that hybrid immunity refers to the immune protection in individuals who have had one or more doses of a Covid-19 vaccine and experienced at least one infection by the Sars-Cov-2 coronavirus before or after the vaccination.

Sars-CoV-2 is the virus that causes Covid-19. 

Herd immunity happens when a population is immune either through vaccination or has developed immunity through past infections.

HOW SINGAPORE SHOULD MANAGE COVID-19

All three experts said that it is now safe to remove the Covid-19 restrictions of mask-wearing on public transport and in healthcare settings.

Mask-wearing was no longer be mandated in indoor settings apart from the above places from Aug 29 last year.

This was because they are places where essential services are carried out in enclosed and crowded areas, and are frequently used by vulnerable persons.

Dr Leong said that transport restrictions have become “moot and redundant” since people are free to mingle around without safe-distancing restrictions.

He added that people who are severely ill with Covid-19 and have to be hospitalised are only those whose immunity systems are compromised, and they will continue to be exposed to the risks of contracting Covid-19 and other illnesses regardless of whether restrictions are in place or not.

People who are immunocompromised would include patients with active cancer getting treatment or patients who have undergone transplants within the past three months.

“I don't think waiting for another three to six months (to lift Covid-19 regulations) will create a better situation where cases are reduced. The disproportionate restrictions on the rest of the population will not significantly reduce the numbers of those immunocompromised,” Dr Leong added.

Dr Tambyah said that removing the regulations now is reasonable since the healthcare system can accommodate the number of cases.

“The lifting of restrictions is not dependent on the number of cases but rather on the impact on the healthcare system.

“For example, we still have millions of cases of H1N1 2009 influenza A and thousands of deaths worldwide even though WHO declared that the influenza A pandemic was over more than 12 years ago,” he added.

Assoc Prof Cook said that Singapore’s position is sufficiently stable enough for it to lower its Disease Outbreak Response System Condition (Dorscon) to the green level.

Dorscon has four levels: Green, yellow, orange and red.

Green is the first stage where disease is mild or does not spread easily, and red is the fourth stage where disease is severe and spreading easily.

Singapore has been at the yellow stage since April last year, which means that the disease is typically mild and only slightly more severe than seasonal influenza, though it could be severe among the vulnerable.

When the Covid-19 outbreak began in early 2020, the country was in the orange stage, which means that the disease is severe and easily spread, with moderate disruption to daily life such as quarantine and temperature screening in force.

Assoc Prof Cook said: “At this stage, rather than requiring that we carry masks to put on when boarding a bus, even if we have no symptoms or reason to suspect we have an infection, it would be better for people to simply take responsibility to wear a mask when they are unwell, regardless of the setting.”

He added: “With China's wave seemingly abating, it may be the time now to revert to Dorscon green.”

WHAT PRECAUTIONS SHOULD STAY FOR COVID-19

However, the experts said that the coronavirus causing Covid-19 is still not just another flu virus for people with weaker immune systems, and Singaporeans still need to take necessary precautions to reduce the spread of infectious diseases.

“We need to remain vigilant by rolling out comprehensive surveillance, appropriate vaccination of high-risk groups and active investigation of respiratory disease outbreaks especially in the vulnerable such as nursing home residents,” Dr Tambyah said.

Dr Leong added: “We can use the term ‘flu-like virus’ for Covid-19, but we need to be mindful that there exists many elderly or immunocompromised who will find the Covid-19 virus and any other influenza infections deadly.

"Those who are immunocompromised or at risk and their family members should continue wearing masks and getting their vaccines updated regularly.”