(Singapore Govt opinion post from the STRAITS TIMES on June 24, 2021.)
With vaccination, testing, treatment and social
responsibility, in the near future, when someone gets Covid-19, our response
can be very different from now. We are drawing up a road map to transit to this
new normal.
We are continuing with our efforts to control the worrisome Delta variant of Covid-19. Given its high transmissibility, it will be hard to bring infections down to zero. Instead, we are adopting an aggressive ring-fencing strategy - casting a wide net to isolate contacts of infected persons, and testing tens of thousands every day. The aim is to minimise the risk of large clusters forming.
But it has been
18 months since the pandemic started, and our people are battle-weary. All are
asking: When and how will the pandemic end?
Endemic Covid-19
The bad news is
that Covid-19 may never go away. The good news is that it is possible to live
normally with it in our midst. This means Covid-19 will very likely become
endemic. But what does that mean?
It means that the virus will continue to mutate, and
thereby survive in our community. One example of such an endemic disease is
influenza. Every year, many people catch the flu. The overwhelming majority
recover without needing to be hospitalised, and with little or no medication.
But a minority, especially the elderly and those with co-morbidities, can get
very ill, and some succumb.
In a large country,
the number hospitalised from influenza can be huge. For example, in the United
States, hundreds of thousands are hospitalised every year because of the flu,
and tens of thousands die.
But because the
chances of falling very ill from influenza are so low, people live with it.
They carry on with their daily activities even during the flu season, taking
simple precautions or getting an annual flu jab.
We can work
towards a similar outcome for Covid-19. We can't eradicate it, but we can turn
the pandemic into something much less threatening, like influenza, hand, foot
and mouth disease, or chickenpox, and get on with our lives. Doing so will be
our priority in the coming months. We already have a broad plan.
Vaccination is key
First,
vaccination. During his broadcast on May 31, the Prime Minister said we aimed
to have two-thirds of our population take at least their first dose by early
July. We are on track to achieve that target. Our next milestone will be to
have at least two-thirds of our population fully vaccinated with two doses
around National Day, supply permitting.
We are working to bring forward the delivery of
vaccines and to speed up the process. The evidence is clear: Vaccines are
highly effective in reducing the risk of infection as well as transmission.
Even if you are infected, vaccines will help prevent severe Covid-19 symptoms.
Israel's experience shows that the infection rate
among vaccinated persons is 30 times less than that of the unvaccinated. The
hospitalisation rate for the vaccinated is also lower - by 10 times.
In Singapore, of
the 120 plus fully vaccinated individuals who were nevertheless infected with
Covid-19, including some aged above 65 - and were not resident at hospitals or
nursing homes - all had either no or mild symptoms. In contrast, about 8 per
cent of the unvaccinated developed serious symptoms.
To sustain a
high level of protection, and to defend against new mutant strains resistant to
current vaccines, booster shots may be needed in the future. We may have to
sustain a comprehensive, multi-year vaccination programme.
Early evidence
suggests that with vaccination, we can tame Covid-19. Again, the experience of
Israel - which has vaccinated 60 per cent of its population, the highest
vaccination rate in the world currently - is pertinent.
Across all age
groups, the hospitalisation rate due to Covid-19 in Israel among those fully
vaccinated is 0.3 per 100,000 persons daily, and the mortality rate is 0.1 per
100,000 persons. In comparison, in 2018/19, the hospitalisation and mortality
rates for influenza in the US were 0.4 and 0.03 per 100,000 persons daily,
respectively. In a severe flu season, like in 2017/18, the rates were 0.67 and
0.05, respectively.
Essentially with
a high rate of vaccination, Israel has brought the clinical outcomes of
Covid-19 close to that of seasonal influenza in the US. These are very
promising outcomes.
Testing will be easier
Second, testing
and surveillance will still be needed, but the focus will be different. We
would still need rigorous testing at our borders to identify any person
carrying the virus, especially variants of concern.
Domestically,
testing will be less of a tool for ring-fencing and quarantining people exposed
to infected persons. Instead, it would be to ensure that events, social
activities and overseas trips can take place safely; as well as to reduce
transmission risks, especially to those who are vulnerable to infections.
We cannot rely
only on the polymerase chain reaction (PCR) test, which can be uncomfortable
and takes many hours to produce results. We need to make Covid-19 testing fast
and easy. We have rolled out antigen rapid tests, including self-tests, to
polyclinics, private clinics, employers, premises owners and pharmacies.
There are even faster test kits in the pipeline, such as breathalysers, that take about one to two minutes to produce the results and do not involve swabbing. In time, the airport, seaport, office buildings, malls, hospitals and educational institutions can use these kits to screen staff and visitors. There is also wastewater testing, which is useful to find out if there are hidden infections in dormitories, hostels or housing estates.
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| Spot the robodog is a high-tech Social-Distancing monitor. |
Treatments will improve
Third,
scientists around the world are working on treatments for Covid-19. Today, we
already have a range of effective treatments, which is one reason why Singapore's
Covid-19 mortality rate is among the lowest in the world.
Eighteen months
after the pandemic started, we now have many therapeutic agents that are
effective in treating the critically ill, quickening recovery, and reducing
disease progression, severity and mortality. The Ministry of Health tracks
these developments closely, ensuring that we have adequate supplies of these
drugs. Our medical researchers actively participate in the development of new
treatments.
Social responsibility remains critical
Finally, whether we can live with Covid-19 depends also on Singaporeans' acceptance that Covid-19 will be endemic and our collective behaviour.
If all of us practise good personal hygiene, we are less likely to be infected. If all of us
are considerate to one another, staying away from crowds when we feel unwell,
we will reduce transmission. If all of us shoulder the burden together -
workers keeping their colleagues safe by staying at home when ill, and
employers not faulting them - our society will be so much safer.
Towards a new normal
With
vaccination, testing, treatment and social responsibility, it may mean that in
the near future, when someone gets Covid-19, our response can be very different
from now.
The new norm can
perhaps look like this:
First, an infected person can recover at home, because with vaccination the symptoms will be mostly mild. With others around the infected person also vaccinated, the risk of transmission will be low. We will worry less about the healthcare system being overwhelmed.
Second, there may not be a need to conduct massive contact tracing and quarantining of people each time we discover an infection. People can get themselves tested regularly using a variety of fast and easy tests. If positive, they can confirm with a PCR test and then isolate themselves.
Third, instead of monitoring Covid-19 infection numbers every day, we will focus on the outcomes: how many fall very sick, how many in the intensive care unit, how many need to be intubated for oxygen, and so on. This is like how we now monitor influenza.
Fourth, we can progressively ease our safe management rules and resume large gatherings as well at major events, like the National Day Parade or New Year Countdown. Businesses will have certainty that their operations will not be disrupted.
Fifth, we will be able to travel again, at least to countries that have also controlled the virus and turned it into an endemic norm. We will recognise each other's vaccination certificates. Travellers, especially those vaccinated, can get themselves tested before departure and be exempted from quarantine with a negative test upon arrival.
We are drawing up a road map to transit to this new normal, in tandem with the achievement of our vaccination milestones, though we know the battle against Covid-19 will continue to be fraught with uncertainty. In the meantime, we still need to take the necessary precautions and safeguards, to keep infections and hospitalisations at bay.
History has
shown that every pandemic will run its course. We must harness all our energy,
resources and creativity to transit as quickly as we can to the desired
end-state. Science and human ingenuity will eventually prevail over Covid-19.
Cohesion and social consciousness will get us there faster. We must all do our
part.
(Trade and Industry Minister Gan Kim Yong, Finance
Minister Lawrence Wong and Health Minister Ong Ye Kung are co-chairs of the Covid-19
multi-ministry task force.)
