Wednesday, 13 May 2020

Singapore eyes cautious easing of circuit breaker measures if new COVID-19 cases stay low

Services essential to keeping the economy going will be among the first to resume
By Linette Lai, Political Correspondent, The Straits Times, 13 May 2020

Singapore's strict safe distancing measures have helped to reduce the number of coronavirus cases in the local community, and could be further eased if all goes well until June 1, said Health Minister Gan Kim Yong yesterday.

But the measures must be rolled back in a "very calibrated, very careful way" to prevent cases from surging, he added, pointing to a second wave of infections experienced by many countries that relaxed too early. The circuit breaker measures, scheduled to last till June 1, have put a lid on many activities. Services essential to keeping the economy going will be among the first to resume, Mr Gan indicated, and more details will be made available next week.

"We do not expect that by June 1, we will open everything and everything will go back to normal, and we (can) begin to celebrate and have parties," he said.

If COVID-19 cases do not increase after circuit breaker measures are rolled back, Singapore is likely to be able to take the next step in restarting its economy "in a bolder way, at a faster pace".

But if the country sees a surge after taking its first step, it will have to rethink its approach.

"It may become necessary for us to reintroduce some of the circuit breaker measures to ensure that we continue to keep the numbers low," Mr Gan said. "Therefore, one very important factor in this opening up post-June 1 is to continue with our efforts in safe distancing."

Many safe distancing measures will remain in place even after the circuit breaker period, he added.

They have been effective in controlling the spread. In the middle of last month, there were, on average, more than 30 new cases a day in the wider community. This dropped to seven cases a day in the past week.

In migrant worker dormitories, the numbers have dipped from an average of more than 1,000 to 700 in the same timeframe.

The Government is drawing up a road map and will take a step-by-step approach to tackling the situation once the circuit breaker ends, said National Development Minister Lawrence Wong.

One of the issues under consideration is whether or not to allow immediate family members living in different households to visit one another. "We recognise that many people would like to visit their family members... I think many want to be physically connected again and we understand the desire to do so," he said.

But Mr Wong stressed that Singapore will be cautious about this, especially since it involves the elderly who are more vulnerable to the virus. "If they were to catch the virus, the disease is potentially lethal for them," he said.

Even as Singapore works towards easing safe distancing measures, it is preparing for new cases to emerge after the circuit breaker period, said the Health Ministry.

"The key is to be able to detect these cases quickly and prevent large clusters from forming," it said. "That is why we are building up our capacity for faster contact tracing and more comprehensive testing."

Mr Wong said that by the end of the month, about 20,000 migrant workers will be discharged from care facilities. Many more are expected to recover and be ready to resume work by June.

Before they return to their dormitories, the workers may be put through serology tests to ensure that they are free of COVID-19. This type of test, which can detect if an individual has had the virus in the past, will be applied to dormitories with high infection rates.

"All that, I think, is coming together, just as we ease on the restrictions of the circuit breaker and reopen the economy," Mr Wong said.

"So we are now in a good position to plan forward and ease some of the restrictions, open more, allow more workers to resume work beyond June 1, and then gradually take steps to reopen the economy."

Reopening of the economy will be gradual and phased
Ministers to unveil blueprint on how to do so, but say they will do it step by step
By Toh Wen Li, The Straits Times, 13 May 2020

The reopening of Singapore's economy will happen in phases after the end of the circuit breaker period on June 1, with the Government monitoring the number of new COVID-19 cases each time to decide how soon even more restrictions can be lifted.

The co-chairmen of the inter-ministry task force, Health Minister Gan Kim Yong and National Development Minister Lawrence Wong, said that this would mean opening up one part of the economy and then making sure it did not lead to a spike in cases before allowing more parts to open up.

"If we do the first step, we continue to monitor and the numbers do not spike, the virus situation remains under control, and we have some confidence in all the measures we have put in place, then we can do the next step, and then so on and so forth. So that will be the way we operate, once the circuit breaker ends," said Mr Wong.

Mr Gan said that this could even mean reintroducing some circuit breaker measures if the situation flares up again. He added that what happens in the period after the authorities take the first steps to reopen the economy next month will be critical.

"We can't do it (reopen) in one step. And the progress, in terms of timing and in terms of the extent of the opening, will also depend on the number of cases after the first step," he said.

"If we have a big surge of cases right after the first step of opening, of course, then the progress will have to be slowed down. And it may become necessary for us to reintroduce some of the circuit breaker measures to ensure that we continue to keep the numbers low."

Mr Gan also said the first businesses to reopen next month will likely be "more essential services that are quite critical to keep the economy going and keep life as normal as possible".

The task force has yet to announce what businesses will be allowed to reopen next month, but Mr Gan said more details will likely be announced next week.

The Government has repeatedly said that life will not return to normal straightaway after June 1, when circuit breaker measures to choke off the spread of the coronavirus are eased. Safe distancing measures should still be observed.

"We do not expect that (after) June 1, we will open everything and everything will go back to normal, (or that we should) begin to celebrate and have parties," said Mr Gan during a virtual press conference yesterday.

"We need to do so in a very calibrated, very careful way, because we have seen experiences in other countries when it is open, everybody goes back to celebrate, and new cases and clusters emerge," added Mr Gan.

The Health Ministry yesterday, 12 May, confirmed 884 new coronavirus cases in Singapore, taking the country's tally of infections past 24,000. Three of the new patients are Singaporeans or permanent residents.

The country's stricter social distancing measures, which the Government calls a circuit breaker, came into force on April 7 and were to last till May 4. They were later extended to June 1.

To help with contact tracing, two technology tools have also been introduced: SafeEntry, a digital check-in system for people visiting workplaces, supermarkets and other premises; and TraceTogether, an app that identifies users who have been in close contact with other users. Last week, the Government suggested that wearable dongles might also be introduced to help with contact tracing.

Allowing people to visit relatives after June 1 under cautious study
By Toh Wen Li, The Straits Times, 13 May 2020

It is with great caution that the Government is studying whether to allow people to visit their relatives after June 1, when the circuit breaker measures are lifted.

"We recognise that many people would like to visit their family members," said National Development Minister Lawrence Wong, who co-chairs the multi-ministry task force tackling the coronavirus outbreak.

"Many parents and grandparents miss their children and grandchildren," he added, acknowledging that video calls or phone calls are not the same as being physically present. The authorities understand this desire to be physically connected again, he said.

"While we would like to allow them to see one another... we have to be quite cautious in moving on such a measure.

"Particularly when it comes to the elderly, because we all know that they are vulnerable, and if they were to catch the virus, the disease is potentially lethal for them."

Mr Wong was speaking at a virtual press conference yesterday.

Meanwhile, the Health Ministry announced 884 new cases in Singapore, taking its tally past 24,000. Three of the new cases are Singaporeans or permanent residents.

Singapore's circuit breaker measures came into force on April 7 and were to last till May 4.

They were later extended by a month to June 1.

As part of moves to curb the COVID-19 spread, all social gatherings with friends and family members who do not live in the same household have had to stop.

People, however, can still visit their elderly relatives if these seniors need help with daily needs.

However, they have to take precautions, such as observing personal hygiene, minimising physical contact and not visiting if one is unwell.

'Too big a price to pay' to achieve herd immunity in Singapore through natural infection
Why Singapore has not adopted herd immunity strategy to fight virus
By Toh Wen Li, The Straits Times, 13 May 2020

Achieving herd immunity to COVID-19 through natural infection in the population will lead to a higher number of deaths and infections and overwhelm Singapore's healthcare system, said the Health Ministry's (MOH) director of medical services Kenneth Mak.

Speaking during a virtual briefing yesterday, Associate Professor Mak made clear that there was "too big a price for us to pay" to reach herd immunity in this way and thus it has not been part of Singapore's strategy to fight the coronavirus pandemic.

"If we assume that we're going to let COVID-19 spread freely in our population, we will then have to accept the costs associated with more seniors getting ill, more seniors getting complications, and a significant number of seniors even dying from infection.

"We will then see also high numbers of patients with COVID-19 infection potentially in our hospitals, in our ICUs, and this is a situation which is a very dangerous one."

He added that if the virus is contained well in Singapore, the country will never reach a situation where herd immunity is achieved, unless vaccination takes place.

Experts estimate that about 60 per cent to 80 per cent of the population needs to be infected and immune to the virus before herd immunity can be achieved, although such figures are often "best guesses", said Associate Professor Vernon Lee, director of communicable diseases at MOH.

Prof Lee, who also spoke yesterday, noted that countries which had high numbers of infections and conducted serological testing - which detects antibodies to determine whether a person has been infected - found that the percentage of positives was "way below" the threshold needed for herd immunity.

"So to get to that kind of percentage to achieve herd immunity will require a large number of people to get infected... So far, I don't think there's any country in the world that has tried to use overall herd immunity as a strategy to combat COVID-19," he said.

Yesterday, MOH confirmed 884 new coronavirus cases in Singapore, taking the country's total number of infections past 24,000.

The concept of herd immunity, where the virus spreads in the population, eventually building up resistance in the population, was initially key to the British government's decision-making when battling COVID-19, reported British newspaper The Guardian. However, the government abandoned this idea when it realised this would cause the healthcare system to be overwhelmed and potentially lead to the deaths of hundreds of thousands of people.

Sweden, which has been criticised for its soft lockdown measures, has reported more than 3,200 deaths from the disease - several times higher than the number of deaths in neighbouring Scandinavian countries. The Swedish authorities have denied that their strategy was based on the overall goal of herd immunity.

Advisories to be issued to all labs doing COVID-19 testing to ensure results are accurate
Move to ensure tests done correctly with accurate results, after 33 false positives found
By Linette Lai, Political Correspondent, The Straits Times, 13 May 2020

All laboratories conducting coronavirus tests will be issued advisories detailing the processes they should follow, said the Health Ministry's director of medical services Kenneth Mak yesterday.

This is to ensure that tests are performed correctly and results are accurate, he added.

The move follows the ministry's announcement on Sunday that 33 false positives had been detected as a result of an "apparatus calibration issue".

Another two tests with ambiguous results had also turned out negative following retesting.

It meant that three of the four COVID-19 cases found among healthcare workers at the Singapore Expo community care facility had actually been clear of the virus.

It also led to a factory-converted dormitory at 45 Kaki Bukit Place being wrongly identified as a cluster with 10 cases.

Its owner TKT Capital was told on Monday that nine workers do not have the virus, which means the dormitory is not a cluster.

The lab involved subsequently stopped testing and the number of COVID-19 tests that could be carried out each day decreased as a result.

At present, the lab is recalibrating its test kits and revalidating them to make sure that results are accurate.

This should take a few days, following which Singapore will be able to return to its full testing capacity, Associate Professor Mak said.

Over the last week, Singapore has conducted around 7,500 tests a day.

"To safeguard this particular process of quality assurance, and to make sure we avoid having incorrect results coming out in the future, we have put together some advisories... for all the laboratories involved in testing," he added.

Explaining how the error occurred, Prof Mak said that a test kit used on one of the lab's machines had not been optimally calibrated. This meant that test results were not interpreted correctly.

"There were also some steps that were not completely followed through," he added. "If those steps had been completely followed through, we might have perhaps picked up some of these results a little bit earlier as well."

The lab is working with the vendors that provided the test kits and testing machines to resolve the issue, Prof Mak said, adding he has "full confidence" in the facility being able to correct the issue quickly.

But even with measures in place to make sure testing is done properly, there may be a need for confirmatory tests in some cases, he said.

In such cases, labs will be required to perform confirmatory tests before the test results are released.

"(This is) so that we have greater confidence in the test results being accurate," Prof Mak said.

New daily high of 626 COVID-19 patients discharged on 12 May 2020
884 new cases reported; so far, 3,842 have fully recovered since first case on 23 Jan
By Clement Yong, The Straits Times, 13 May 2020

The number of COVID-19 patients discharged from hospitals or community isolation facilities hit a new daily high of 626 yesterday, 12 May.

The previous high was 504 on Monday. This is in contrast to the double-digit discharge figures that Singapore saw before this month.

Some 3,842 coronavirus patients have fully recovered since the first case was reported here on Jan 23.

The Ministry of Health (MOH) confirmed 884 new COVID-19 cases in Singapore yesterday, with migrant workers living in dormitories once more forming the majority - 877 - of the new cases.

The remaining cases comprised three Singaporeans, three work permit holders living outside dormitories and one work pass holder. There were no imported cases.

There were seven new COVID-19 clusters: at 45 Kian Teck Drive, 3 Loyang Way 6, 36 Senoko Road, 7 Senoko South Road, 3 Sungei Kadut Avenue, 46 Tech Park Crescent and 5 Woodlands Industrial Park E1.

MOH said the daily number of new cases continues to increase as it is carrying out more widespread testing. It noted that the number of new cases from testing workers who show acute respiratory symptoms and their contacts has remained stable.

"(We) are also testing the workers who are well and asymptomatic, as part of our process to verify and test the status of every worker," said MOH.

The ministry also announced two deaths that it classified as non-COVID-19-related, bringing the number of people who have died from other causes while testing positive for the virus to nine.

The first is a 50-year-old Thai man who was diagnosed with the coronavirus on Monday after he suffered respiratory arrest and was taken to Ng Teng Fong General Hospital the day before. He died of cerebral haemorrhage yesterday.

A 31-year-old Indian man died on Sunday after he collapsed at his dormitory after complaining of chest pain, said MOH. He tested positive for COVID-19 on Monday after his death, which was caused by a heart attack.

The number of people who have died due to complications from COVID-19 remains at 21.

MOH has said it adds patients to the COVID-19 death count only when the attending doctor or pathologist attributes the primary or underlying cause of death to a COVID-19 infection, in line with international practice for classifying deaths.

With about three weeks to June 1, when Singapore's circuit breaker measures are expected to be eased, MOH data shows that the daily average of new cases among Singaporeans, permanent residents and work pass holders has come down further, from eight cases two weeks ago to seven in the past week.

The number of such cases that are unlinked also dipped from a daily average of four to three over the same period.

Among the new local cases are two Singaporean healthcare workers. One is a 63-year-old nurse clinician at Singapore General Hospital who had not gone to work since the onset of symptoms, while the other is a 55-year-old patient service associate at Changi General Hospital who had worked a few hours prior to admission in the same hospital.

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