Strain on Singapore's healthcare system among key indicators of if and when it's safe to lift remaining Covid-19 rules: Experts

SINGAPORE — The amount of strain on Singapore’s healthcare sector should be one of the main indicators of whether or not it is safe for the Republic to lift its remaining Covid-19 restrictions, even as China experiences a surge in coronavirus infections, said three infectious disease experts.

However, they added that there is little for Singaporeans to be worried about due to both the high rate of vaccination and the natural immunity that has been conferred from infections.

These were the views they shared with TODAY on Sunday (Jan 1), a day after Prime Minister Lee Hsien Loong delivered his New Year message.

In his speech, Mr Lee said Singapore could lift the remaining Covid-19 social restrictions if “things remain stable”, despite risks from year-end travel and the surge in cases in China.

While Singapore has lifted most Covid-19 restrictions, a few remain, such as the wearing of masks in healthcare settings and on public transport.

There are also pre-departure requirements for inbound travellers who are not fully vaccinated.

INDICATORS TO WATCH OUT FOR

The infectious disease experts largely agreed that Singapore needs to consider the strain on its healthcare system before it lifts the remaining Covid-19 restrictions.

Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, described the current burden on the healthcare system as “quite manageable”, though he added that it would be good to further reduce the number of people admitted.

As of noon on Saturday, data from the Ministry of Health (MOH) showed that there were 89 patients who have been hospitalised for Covid-related infections.

Eleven required oxygen supplementation, while three were in the intensive care unit.

The ministry’s seven-day moving average of local cases also showed that infection numbers have been trending downwards.

Further, it said that 99.6 per cent of the nearly 25,000 cases reported in the last month in Singapore had no or mild symptoms.

Associate Professor Alex Cook from the National University of Singapore's Saw Swee Hock School of Public Health pointed out that at this stage of the pandemic, most Singaporean residents have been infected by Covid-19.

This gives them additional protection beyond what has been conferred by the vaccines, he said.

As a result, Assoc Prof Cook said the number of infections which are diagnosed and notified to the MOH is not a great measure of impact.

Instead, he said Singapore should be looking at the number of patients hospitalised solely because of Covid.

Giving an example, he said patients with a broken leg and also a mild case of Covid may be added to MOH’s daily infection numbers.

Right now, he said the number of patients who are in the hospital solely because of Covid-19 is low, and that Singapore is in a “pretty stable epidemiological situation” as long as it stays that way.

Another indicator to look out for, he said, is the emergence of new variants that might lead to larger waves and potentially more hospitalisations when they reach Singapore.

“We can't really predict these but since Omicron emerged about a year ago, none of the new variants has really changed the risk level,” he said.

CHINA’S COVID-19 INFECTIONS

Gisaid, a global data science initiative, confirmed on Dec 28 that no new variants have yet emerged from the current outbreak in China.

The AFP news agency reported that the World Health Organization met Chinese officials for talks on Dec 31 about the surge in Covid-19 cases, urging them to share real-time data so that other countries can respond effectively.

The rise in infections in China, said AFP, has triggered concern around the globe and questions about its data reporting, with low official figures on cases and deaths despite some hospitals and morgues being overwhelmed.

Nevertheless, infectious disease experts agreed that the risk to Singapore is low.

Said Assoc Prof Cook: “China has to go through a large wave of Covid (infections) before the pandemic would be globally over, and now is the time its leaders have chosen to do that.”

He added that while the number of infections in China is high, which increases the risk of mutations, he pointed out that the rest of the world “has been creating mutations all this while and we managed those”.

Dr Leong Hoe Nam from Rophi Clinic at Mount Elizabeth Novena Specialist Centre said that with each infection of the Omicron strain of Covid-19, the infections get milder and milder.

“One day it could be an overnight sore throat with rapid recovery the next day,” he said.

‘SAFE TO LIFT RESTRICTIONS' 

That said, Dr Tambyah believes the authorities are likely to want to wait till after the Chinese New Year festivities are over in China, due to the surge in Covid-19 cases there — though he added it would be “theoretically” possible for the authorities to lift the remaining restrictions in the next couple of weeks. Chinese New Year falls on Jan 22. 

This was a sentiment agreed upon by Assoc Prof Cook and Dr Leong.

Dr Leong added that if the New Year’s celebration over the weekend does not result in an increase in Covid-19 infections, then there is “no concern to lift it even before the Chinese New Year”.

In any case, Dr Tambyah said one of the things Singapore learned from the last two years of the pandemic is that tightening restrictions through 2021 and 2022 did not lead to a drop in cases.

Conversely, he said loosening them in August last year did not lead to a spike in cases.

Said Dr Tambyah: “I think it will be safe (to lift the remaining restrictions). Singapore has a high rate of both vaccination and natural immunity from infection.”

On the dropping of mask mandates on public transport and in hospitals, Assoc Prof Cook said they are not likely to have a major impact on transmission.

“The justification for needing masks when you have no reason to believe you have Covid while on public transport is a bit weak, in my view,” he said.