Explainer: Some countries are testing travellers from China for Covid-19 but others are not. What approach should Singapore take?

SINGAPORE — After China announced that it would be ditching Covid-19 quarantine for all overseas arrivals and resuming outbound travel, citizens reacted with joy and rushed to book flights overseas. However, this enthusiasm has not been reciprocated in some countries they will be visiting.

The relatively sudden easing of some of the world's toughest and longest-running Covid-19 restrictions has been met with caution in countries such as Japan and the United States, which are imposing mandatory Covid-19 tests on travellers arriving from China. 

The authorities in those countries were concerned that a recent surge in Covid-19 cases in China could result in new variants of the coronavirus, as well as a spike in cases imported into their own countries. 

Others destinations such as the United Kingdom are welcoming travellers from China with open arms, while countries such as Australia and Singapore are taking a middle path. They have not mandated Covid-19 testing but are monitoring the situation closely. 

So why have different countries taken these different approaches and should Singapore be wary about accepting travellers from China? TODAY spoke to several experts to get some answers. 

REASONS FOR THE DIFFERENCE IN APPROACHES 

Currently, countries that have implemented mandatory Covid-19 tests include the US, India, Japan, Italy and South Korea. 

Malaysia also announced on Friday (Dec 30) that all visitors entering the country will have to undergo temperature checks for fever, due to concerns over the rise of Covid-19 cases in China. 

On the other hand, countries such as Australia, the Philippines and Singapore have not imposed any measures for travellers from China, but are monitoring the situation. 

Infectious diseases specialist Loh Jiashen from Farrer Park Hospital said that the different approaches are a result of each country’s specific domestic situation. 

For instance, only two-thirds of the US population are fully vaccinated and a third have received their Covid-19 boosters. Similarly, Japan has seen rising Covid-19 numbers over the last month. 

“They may not be able to sustain a continuous influx of imported cases from China, hence the (Covid-19) testing,” Dr Loh said. 

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that public health measures are often based on “inexact science”, with each country having to weigh up the relative risks and benefits of each approach. 

In Singapore’s case, there are “hundreds of thousands of people” here from mainland China who have not seen their family or friends in three years. 

“The thought of spending another Chinese New Year without meeting elderly relatives or others who might be put off by the cost and hassle of testing would be very depressing,” he said. 

Other areas of consideration include the impact of Chinese tourists on the economy here, Singapore's high vaccination rates, as well as a high rate of “hybrid immunity” from natural infection.

Hybrid immunity is acquired from both prior infection and vaccination.

“So the risk to our healthcare system is very low but this may not be true in many countries,” Dr Tambyah said. 

He added that countries with temperate climates in particular are concerned about winter spikes of Covid-19, influenza and other respiratory viruses, which is not the case here. Winter recently began in the northern hemisphere.

HOW IS THE SITUATION IN CHINA NOW? 

Although there has been an uptick in Covid-19 cases, the absence of credible information from China's government has left experts grappling to determine the size and severity of the recent surge. 

Britain's broadcaster BBC reported that the Covid-19 wave hitting China now is not due to a “radical new variant” but strains known as BF.7 and BQ.1, which are both sub-lineages of the Omicron BA.5 subvariant. 

The authorities in China have stated that since Dec 1, the country has recorded just 12 deaths from the virus, because it only counts those who die from respiratory failure directly linked to an infection, The New York Times reported. 

This leaves out vast numbers who died because Covid-19 aggravated underlying diseases or caused heart or liver failure, the paper said.

Some estimates of the Covid-19 surge underway as the country reopens paint a bleak picture.

The worst-case scenarios outlined by some scientists suggested that Covid-19 could kill as many people in China in the next four months as the more than one million who died from the coronavirus in the US during the three-year pandemic so far, The New York Times reported. 

WHY HAS CHINA OPENED UP DESPITE THE INFECTION WAVE? 

Known for its extremely strict “zero Covid policy”, China has implemented numerous lockdowns, quarantine measures and mass testing to curb the spread of the virus over the past three years. 

Now, it has made a switch away from the approach, choosing to loosen Covid-19 restrictions in December. 

Several experts, when asked what could have possibly caused China to relax its border measures when an infection wave is just beginning there, said that they did not understand why the country is doing so. 

Dr Leong Hoe Nam, an infectious disease expert at Mount Elizabeth Novena Hospital, said that it would be better for China to open up only when the country’s healthcare system can cope better. 

On the other hand, Dr Tambyah said that the infection wave may have started before the relaxing of measures, and it could have driven the shift that is happening now.

Official reports showed there was a major spike in cases in China during late November and early December. 

“It is likely that the Chinese officials realised they were facing a virus, which the rest of the world realised a long time ago, could not be stopped,” Dr Tambyah said. 

And seeing how past measures were not sustainable, along with the popular consensus against continuing with these measures in the face of rising numbers of cases, these may have played a large part in persuading China to move towards a “living with Covid” approach like the rest of the world, he added.

SHOULD SINGAPORE BE WARY? 

Associate Professor Hsu Li Yang, vice-dean of global health at the Saw Swee Hock School of Public Health, said that Singapore is already being affected by the surge in China as shown by the recent supply shortages of fever medications in pharmacies here. 

“There might also be an acceleration in terms of development of new transmissible Covid variants and subvariants,” he added. 

However, other experts adopted a more optimistic stance. 

Dr Tambyah said that the findings from a recent report by German-based non-profit organisation Gisaid are reassuring, because they showed that the main reason for the spread in China was not due to a new variant.

Instead, it is most likely because few people there have hybrid immunity.

Dr Loh from Farrer Park Hospital said that Singapore has withstood three Omicron variant outbreaks and the intensive care unit utilisation rates here are not reaching critical levels. 

The country also has ample drugs to treat the patients in the Omicron spikes this year. 

“Not imposing any restrictions on Chinese travellers coming to us is exactly the gesture of resilience that we have all worked so hard to achieve,” Dr Loh said. ADDITIONAL REPORTING BY JANARTHANAN KRISHNASAMY