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Explainer: Pandemic not over, so why is Singapore relaxing Covid-19 rules?

SINGAPORE — Infectious disease experts told TODAY that as the country’s Covid-19 situation stabilises, restrictions should be lifted because the costs of having them in place outweighs their benefits.

 

Pedestrians at a traffic crossing in the Central Business District on April 26, 2022.

Pedestrians at a traffic crossing in the Central Business District on April 26, 2022.

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  • More infection controls to protect the public from Covid-19 were dropped from April 26
  • Experts agreed that the restrictions should be lifted with Covid-19 cases and vaccination rates stabilising
  • This would help improve the economy and boost mental health and children's development, among other benefits
  • They also cautioned unvaccinated individuals to be extra careful and said people may still take precautions as they see fit 

SINGAPORE — Infectious disease experts told TODAY that as the country’s Covid-19 situation stabilises, restrictions should be lifted because the costs of having them in place outweighs their benefits.

For example, the economy may improve and people’s mental health and children's development may be boosted, which are some of the benefits expected.

Infection controls for Covid-19 were further reduced on Tuesday (April 26) as office workers returned to their workplaces and SafeEntry digital check-in systems at venues such as malls were weeded away. 

Aside from removing capacity limits on workplaces and stepping down the use of SafeEntry and contact-tracing system TraceTogether, the Ministry of Health (MOH) also lifted limits on group size for social activities.

Vaccination-status checks are done only for selected settings such as at eateries, nightclubs or venues with more than 500 people.

Singapore is now managing the pandemic at a level where Covid-19 is spreading but it is typically mild or contained and it poses minimal disruption to daily life.

WHY SINGAPORE IS OPENING UP MORE NOW

Aside from the number of Covid-19 patients hospitalised or under intensive care falling, MOH said last Friday that the number of vaccinations administered has been "reducing steadily over the past weeks".

More than 92 per cent of Singapore's population have completed their primary vaccination series, with 73 per cent having received their booster shot.

These numbers are one reason why Associate Professor Alex Cook believes that Singapore can relax restrictions.

The vice-dean of research at Saw Swee Hock School of Public Health said: "Earlier in the pandemic, there were reasons to wait, (such as) to convince the last few adults to get vaccinated, to approve and deploy paediatric vaccines, and to keep the healthcare system from being utterly overwhelmed during the first big community waves.

"Keeping restrictions for longer implies we are waiting for the situation to get better somehow... but there's nothing to wait for (now)."

However, he did not rule out that there may be a resurgence of cases in future.

Children have to go to school and be allowed to have birthday parties. The elderly need to mix with their families or have visitors. So we have to work out how to enable this normality.
Professor Dale Fisher, senior consultant at National University Hospital's division of infectious diseases

Associate Professor Hsu Li Yang, vice-dean of global health from Saw Swee Hock School of Public Health, said: "This will be as good a time (to reopen more), because we are not likely to improve our situation significantly with regards to vaccination rates and there are no new major coronavirus variants of concern on the horizon."

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, noted that the last few months have shown that non-pharmaceutical interventions have little impact on case numbers.

This means that case numbers have more to do with how transmissible and severe the disease is and the immunity of the human population, rather than to restrictions on group sizes or other measures.

"As with everything in medicine, this is a risk-versus-benefit calculation and the equation shifted very much towards opening up once the Omicron variant of Sars-CoV-2 emerged," he added, referring to some scientists' analysis that the milder but more infectious Omicron strain had worked to build up people's immunity.

DO BENEFITS OF OPENING UP OUTWEIGH COVID-19’S IMPACT?

Professor Dale Fisher, senior consultant at National University Hospital's division of infectious diseases, said that it is important to strike a balance between the "health, social and economic impacts of the disease and the interventions".

"Now that the health impact is considerably lower than in the pre-vaccination period and when the Delta virus variant first hit, we don’t need to suffer the social and economic costs," he said.

"Children have to go to school and be allowed to have birthday parties. The elderly need to mix with their families or have visitors. So we have to work out how to enable this normality."

While repeat infections are possible, they are not as frequent as infections in an immune-naive host, so the next wave ought to be smaller than the one just past.
Associate Professor Alex Cook, vice-dean of research at Saw Swee Hock School of Public Health

Restrictions on social activities may affect people's health in other regards such as reduced physical activity, increased substance abuse and greater suffering when mental health deteriorates, Assoc Prof Cook said.

Considering the impact that Covid-19 has had on livelihoods, Dr Leong Hoe Nam, an infectious disease consultant from Rophi Clinic, said that the Government has given enough time for people to get vaccinated against Covid-19 and ought to reopen the country to save livelihoods.

"Hospitals have enough resources to cope with vulnerable persons, such as having more antiviral agents to protect them," he added, noting that such medicines were not available a year ago.

The Health Sciences Authority here granted interim authorisation on April 19 to molnupiravir, the second of such oral Covid-19 drugs.

WILL THERE BE ANOTHER SPIKE IN COVID-19 CASES?

Experts had mixed opinions about a potential spike in Covid-19 cases after restrictions are lifted, but all said that should cases rise, they are unlikely to be severe or require hospitalisation.

Assoc Prof Hsu believes that "over the next year or so", Covid-19 may be viewed as being similar to flu. However, he warned that the infectious disease still has the potential now to cause high spikes of cases with new variants and sub-variants.

Prof Dale doubts, though, that a significant spike would happen among vaccinated people unless a new coronavirus strain surfaces that escapes the present immunity people have, or there is a new virus.

High vaccination rates and an increased likelihood that unvaccinated persons have developed natural immunity from catching Covid-19 may prevent hospitals from becoming strained again as cases are less severe.

Echoing this view, Assoc Prof Cook said: "(Vaccinations and previous infections) curtail the risk of severe disease if we get infected substantially.

"And while repeat infections are possible, they are not as frequent as infections in an immune-naive host, so the next wave ought to be smaller than the one just past."

Referring to a Financial Times report on Covid-19 cases and fatality rates in England, Dr Tambyah noted that Covid-19's lethality has reduced to that of the flu.

He added that pandemics have historically become more transmissible and less virulent, such as the 2009 H1N1 flu, which is milder than the H3N2 flu.

HOW SHOULD WE LIVE WITH COVID-19?

Dr Leong cautioned that unvaccinated people should not treat Covid-19 like influenza because the virus' impact on them can be severe, even though the Omicron strain is milder.

As we reopen, and enjoy a return to near-normalcy, we should not so quickly forget those who have died (due to the pandemic) and the efforts made to contain it over the past two years.
Associate Professor Hsu Li Yang, vice-dean of global health from Saw Swee Hock School of Public Health

Noting that Singapore is moving towards granting individuals greater responsibility to decide how much effort they wish to take to protect themselves from Covid-19, Assoc Prof Cook said: "Individuals can, of course, if they wish, continue to limit their social gatherings to groups of 10, to wear a mask outdoors, to do frequent antigen rapid tests, and any other restrictions they feel are merited.

"I would hope that some behaviours stick, such as staying home if you’re unwell, or at least wearing a mask, and practising good hand hygiene."

On this note, Assoc Prof Hsu said: "As we reopen, and enjoy a return to near-normalcy, we should not so quickly forget those who have died (due to the pandemic) and the efforts made to contain it over the past two years."

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