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COVID - 19 in Singapore: Finding Our Own Path

Power of Ideas
COVID-19 in Singapore: Finding Our Own Path

Singapore is poised to achieve at least 80 – 85 percent vaccine coverage against SARS - CoV - 2 by the end of September 2021. Excluding children aged 12 and below, this would mean that at least 90 – 95 percent of the eligible population are vaccinated. However, is it enough to allow the island state to open its border and resume global economic connection?

When SARS - CoV - 2 arrived in Singapore in January 2020, i t was among the few countries in Asia to confront the first wave of imported cases . Local transmission ensued . At the epidemic’s peak, Singapore reported approximately 1,000 cases a day, leading to a whole - of - government approach to contain the virus through coordinated policy setting and implementation of strict prevention measures . These included the partial lockdown of the city - state, contact tracing, quarantine, and ramping up of testing and isolation facilities. In this COVID - 19 pandemic, Singapore has placed great emphasis and reliance on vaccination . Investment in vaccine research and procurement paid off as Singapore became the first Southeast Asian country to roll out the vaccination in December 2020 .

There are several key learning points . First, t he state of preparedness stems from past experiences of novel pathogens , which led to hefty investment in constructing the National Centre for Infectious Disease s . This state - of - the - art isolation - treatment facility integrates clinical care with public health testing, epidemiology, research , and community engagement , as well as the ability to mob ili z e the entire health - care system , including the public - private sect or , from primary care to critical care.

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Second, the government of Singapore was commit ted to contain ing the disease , which achieved the objective of saving both lives and livelihood s . The provision of more than 30,000 beds in community isolation facilities in barely five weeks was the result of a national effort. S GD 93 billion was also set aside in stages for relief measures to buffer the negative impact on the economy . Last but not least, trust in the government and the community’s resilience were instrumental in maintaining social stability and cohesiveness.

The low number of COVID - 19 cases was unfortunately punctuated by the Delta variant in April 2021 . Within a week or two, it became the dominant variant. Its biological characteristics were surprisingly different from its origin. W e were astonished to find high quantities of viral materials in respiratory secretion s through PCR tests, amounting to approximately 1, 000 - fold greater than with the original strain. We found shorter serial intervals , where the addition of both factors suggested higher transmission capacity in a shorter time frame. We perceived that we were heading into a different phase of the battle against SARS - CoV - 2. The clinical characteristics of the Delta variant also changed , where more patients across age groups develop ed pneumonia , requiring supplementary oxygen. Blood samples from various cohort s of vaccine recipients and community seroprevalence studies showed reduced neutralization of antibodies against the Delta variant and progressive waning of antibodies. Clinical cases of post - vaccination infection started appearing , mostly affecting older age groups. A household contact study showed that vaccine effective ness is approximately 60 percent in preventing all forms of SARS - CoV - 2 infection .

Generally, the vaccine retains its effectiveness in patients with serious illness. However, with the estimated R0 ( i.e., the number of new infections estimated to stem from a single case) of 5 . 8 according to the US Centers for Disease Control and Prevention , herd immunity solely by vaccination has become unattainable . The number of cases is expected to rise. However, it remains to be determined whether herd protection against serious infections is achievable . Equally, the question arises of whether the volatile regional and global COVID - 19 situation could impede transition from a pandemic to an endemic stage .

It remains to be see n whether Singapore can find its own path toward an endemic stage without crippling its health - care system and shattering the confidence of its society . Would Singaporeans welcome a progressive easing of mobility restrictions, moving from hospital - centric to home/community - centric care? Israel , which has similar vaccination strategies , could perhaps be a reliable case study for Singapore . Would a booster dose or annual vaccination , as for influenza , be the way forward?

Moving into an uncharted area , Singapore needs to rely on several key factors : preparing the community in every step of implementation with frequent engagement ; giving clear, consistent messages ; promoting research and continuing to let science inform policy ; being vigilant and adaptable ; shifting the responsibility for COVID - 19 containment from the government to the individual and community . This last step would require universal masking, self - regulated mobility restrictions, social distancing, environmental and hand hygiene , and awareness of personal health - seeking behaviors . Compared with the seasonal influenza, knowledge of SARS - CoV - 2 is currently incomplete. The longer - term harm of SARS - CoV - 2 to health is undetermined, and this is no time to be complacent . Regardless of transition stage , it is the responsibility of ev ery Singaporean to avoid SARS - CoV - 2 infection.