Friday, 25 June 2021

Living normally, with COVID-19: Task force ministers on how Singapore is drawing road map for new normal

Singapore preparing road map for living with endemic COVID-19
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.
By Gan Kim Yong, Lawrence Wong and Ong Ye Kung, Published The Straits Times, 24 Jun 2021

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.

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.

Singapore nearly doubles vaccination roll-out to 80,000 doses a day
Vaccine deliveries brought forward to fully vaccinate two-thirds of residents by Aug 9
By Yuen Sin, The Straits Times, 25 Jun 2021

Singapore will accelerate its vaccination programme from tomorrow, 26 June, and nearly double the number of doses administered daily, paving the way for more restrictions to be eased down the road.

Up to 80,000 vaccine doses will be administered daily, Health Minister Ong Ye Kung said yesterday, up from 47,000 now and 40,000 last month.

The ramp-up, which stems from vaccine deliveries being brought forward, allows the Republic to set a new target of having two-thirds of the population fully vaccinated by around National Day on Aug 9, said Mr Ong, co-chair of the multi-ministry task force on Covid-19, at a virtual press conference.

This comes a day after the task force spelt out plans in a Straits Times article for Singapore to transition to a new normal, where Covid-19 will be managed like other endemic diseases.

With vaccination on track, public health guidelines can be revised.

These settings could include religious services, concerts and sporting events.

Also on the cards are new guidelines that will enable Singapore residents travelling abroad to serve a shorter stay-home notice or have it waived entirely and replaced with Covid-19 tests, depending on the country visited.

Singapore is also on track for the next stage of its reopening around the middle of next month, when dining in at food and beverage (F&B) outlets will be allowed for groups of up to five, up from the current two.

"With vaccination on track, with the regular testing of workers in these higher-risk settings proceeding, we should be able to get there," said Mr Wong.

Vaccination will also help sectors hit by the pandemic, Trade and Industry Minister Gan Kim Yong said.

It will mean that more foreign domestic workers can come into Singapore, as well as other migrant workers to help the construction sector and export-oriented industries. Having more people vaccinated could also kick-start the hospitality and tourism sectors.

Even as Singapore sets its sights on having two-thirds of the population fully vaccinated by around National Day, Mr Ong stressed that this is an interim milestone, and the Republic will have to get more people vaccinated beyond this target, particularly seniors, who are more vulnerable.

As at Wednesday, more than three million people - or about 53 per cent of the population - have received at least one dose of a Covid-19 vaccine.

If supplies continue to arrive as planned, most residents willing to take the vaccine will have received their first dose by the second half of next month, giving them some protection against Covid-19.

Following that, the Ministry of Health will review the current interval between doses of six to eight weeks, which should be reduced to four weeks, and some appointments for second doses should be brought forward.

Still, the task force is mindful that Covid-19 is a "shape-shifting enemy" that will continue to throw up curveballs along the way, Mr Ong said.

"We must be prepared to adapt... but we are determined to see through this endgame," he said.

"Then we'll be able to put circuit breakers behind us, F&B and gym closures behind us, be able to have bigger events, be able to have bigger wedding receptions, and then overseas travel without stay-home notices and quarantine."

Prime Minister Lee Hsien Loong said on Facebook yesterday that vaccination is a crucial strategy for Singapore to live with endemic Covid-19. "Let's all play our part, so that come Aug 9, we can hit that target and celebrate our nation's birthday with pride and joy."

500,000 new vaccine slots to be added over next few days till mid-July 2021
If supplies arrive as planned, most will get first dose by second half of July: Ong Ye Kung
By Yuen Sin, The Straits Times, 25 Jun 2021

With more vaccine supplies on the way, the Ministry of Health (MOH) expects another 500,000 new slots to be added in the next few days for people to make their first-dose appointments for between now and mid-July.

Those who have already booked a slot for their first dose to be administered in the second half of next month are also encouraged to bring forward their appointments, MOH said yesterday.

If supplies continue to arrive as planned, most of the population who want to get vaccinated will have received their first dose by the second half of July, said Health Minister Ong Ye Kung, who co-chairs the multi-ministry task force tackling Covid-19, at a virtual press conference yesterday.

Once this target has been met, MOH will then review the current interval between doses of six to eight weeks, which should be reduced to four weeks, depending on supplies.

The authorities had lengthened the interval between doses to prioritise giving out the first dose to as many people as possible so that they would have some measure of protection.

"Once we achieve that, it will not make sense to have people continue to wait for six to eight weeks until August or beyond for the second doses," said Mr Ong.

He said this shortening of the interval means those who have received their first dose will, at some point, be invited to rebook and select an earlier date for a second dose.

More details of the review of the interval between doses will be announced when ready.

To allow more time for Singapore citizens aged 12 to 39 to make their vaccination appointments, the current two-week priority window for this group will be extended by one week, till July 1.

They will get to book slots for the vaccine ahead of other groups in the population, such as permanent residents, within this period.

Those who are eligible and have registered for vaccination, but have not yet received a booking link, should get an SMS with a personalised booking link within the next week.

From July 2, the vaccination programme will be extended to the rest of the population, including all permanent residents and long-term pass holders in Singapore aged 12 to 39.

They can register their interest in getting vaccinated and will be progressively invited via SMS to book their appointments from July 2.

On Wednesday, MOH said Singapore is set to receive a batch of Covid-19 vaccines called Comirnaty, as the Republic ramps up its vaccine supplies.

The vaccines are the same as the Pfizer-BioNTech vaccines that are now used in the national vaccination programme, with the only difference being the label.

This is because they are named according to different regulatory guidelines, though both are manufactured in Europe following the same processes and procedures.

Mr Ong also said Singapore has signed advance purchase agreements with American biotechnology company Novavax to secure its protein-based Covid-19 vaccine, with supplies possibly arriving before the end of the year.

As at Wednesday, about 36 per cent of the population have been fully vaccinated with two doses, Mr Ong revealed yesterday.

About 75 per cent of eligible seniors aged 60 and above have received at least one dose or have booked an appointment, said Mr Ong, as he urged more seniors to get their jabs.

For other age groups, 77 per cent of those aged 45 to 59 have received at least one dose of the vaccine or booked appointments.

The figure is 70 per cent for those aged 40 to 44, and 39 per cent for those aged 12 to 39.

Unvaccinated seniors urged to get jabs - they are most vulnerable
As safe distancing measures are eased, seniors who are not vaccinated face greater risk of being infected
By Rei Kurohi, The Straits Times, 25 Jun 2021

Unvaccinated seniors remain the most vulnerable to new Covid-19 infections as Singapore continues to ease restrictions in its reopening, said ministers chairing a task force tackling the pandemic.

They urged people aged over 60 to get their jabs as soon as possible.

Speaking at a virtual press conference yesterday, Health Minister Ong Ye Kung said that about 75 per cent of seniors aged 60 and above have received at least one dose, but this is "not enough".

Giving a more detailed breakdown, Finance Minister Lawrence Wong said that nearly 80 per cent of those in their 60s have been at least partially vaccinated, but the rate for those aged 70 and above is still less than 70 per cent.

"We still need to get the vaccination rates for our elderly higher than where they are today. In fact, in some places, they have already achieved more than 90 per cent vaccination coverage for the elderly population, so we still have some way to go," said Mr Wong.

More than three million people in Singapore, or about 53 per cent of the population, have received at least one dose of a vaccine.

Mr Wong noted that many of the cases in recent clusters in Bukit Merah View involved elderly people and that such outbreaks can easily happen in other parts of Singapore.

"It could happen in an area where there's a high concentration or a high proportion of elderly persons and if many of them are not vaccinated, then we will end up with more severe consequences because they will have severe illness," he said.

"Hospitalisation and intensive care unit rates will go up and unfortunately, under such a scenario, fatalities may rise too. So we must do everything we can to avoid such an outcome."

Mr Wong asked younger Singaporeans to encourage elderly family members to protect themselves through vaccination.

"If you have an elderly parent who is not vaccinated yet, please engage them. Persuade them to get vaccinated, bring them to the centre to get them jabbed. You will be doing a lot to keep them safe.

"Don't take the view that it's okay, my elderly parent only stays at home, I'm not going out so much, so it's all right. You may have people visiting your elderly parent and any visitor may well bring the virus into the home."

In response to a question on whether Singapore will consider offering incentives for getting vaccinated, such as the lotteries being implemented in some countries, Mr Wong said no option was being ruled out.

Revised guidelines that could see vaccinated people facing fewer restrictions and greater conveniences such as being able to travel overseas without quarantine on their return may also spur more people to get vaccinated, he added. But Mr Wong also noted that despite such incentives and greater availability of vaccines, there will still be certain groups who do not want to get a vaccine for various reasons.

"It may not be simply a matter of monetary incentives. There could be other barriers that may be impeding them or causing them not to want to take up the vaccination. We need to understand better what their concerns are."

Trade and Industry Minister Gan Kim Yong said seniors will face greater risks as safe distancing measures are eased.

"Today, they are protected because of the safe distancing measures that were put in place. We have kept transmission generally low because of these measures, but once we have achieved a high level of vaccination, some of these measures will then be eased.

"We have to be aware that once we allow more activities to resume, the risks will go up. Those who are vaccinated will continue to be protected but those who are not vaccinated, especially the seniors, will face a higher risk of infection and higher risk of severe disease," he said.

Larger gatherings, COVID-19 testing in lieu of SHN being considered for those vaccinated
By Hariz Baharudin, The Straits Times, 25 Jun 2021

People who have received their Covid-19 vaccinations "will be given some concession when travelling or returning to Singapore", Trade and Industry Minister Gan Kim Yong said yesterday.

Such concessions could include waiving the need for travellers to serve stay-home notice when they return to Singapore, and instead have them undergo more frequent testing to ensure they are coronavirus free, added Mr Gan, who co-chairs the multi-ministry task force tackling Covid-19.

At the same time, Singapore is holding discussions with other countries to mutually recognise digital vaccine certificates in the hopes of opening up air travel.

The announcements come as the Republic ramps up its vaccination drive, setting an ambitious target of having two-thirds of its population fully vaccinated by around National Day on Aug 9. The task force said that with higher vaccination numbers, Singapore will be looking to live with Covid-19 as an endemic disease.

Mr Gan said: "With higher rates of vaccination, we will also be able to resume travelling. Those who have been vaccinated will be given some concession when travelling or returning to Singapore.

"For example, vaccinated travellers, including Singaporeans who travel overseas and (are) returning to Singapore, may undergo more frequent testing in lieu of serving stay-home notices (SHN)."

Travel disruptions arising from the pandemic have put immense pressure on companies, especially those which depend on migrant workers, as well as families that depend on foreign domestic workers.

To help with this, Mr Gan said that more workers, in particular migrant workers and foreign domestic workers, will be allowed to enter Singapore.

"This will ease the immense pressures our companies have been under since the start of the pandemic, and allow stalled projects to restart, family members to reunite and their migrant domestic workers to join them."

He added that as the number of vaccinated people rises in the countries these workers come from, and if they are able to control and manage infections, the number of workers allowed from these places will also increase.

At the same time, the Republic is in talks with other countries about further opening up air travel too.

Health Minister Ong Ye Kung, also a co-chair of the task force, likened opening up an air travel corridor to an exam, which Singapore and other countries are doing the necessary homework for now.

"Discussing (and) recognising each other's digital certificates, that is just like doing homework - just getting the homework done while envisioning that some day you may open up some form of air travel arrangement," said Mr Ong.

"So, I think all this homework should be done now with as many partners as possible - just getting the paperwork and the mutual recognition sorted out."

Asked if there were discussions with Malaysia to use its contact-tracing app MySejahtera for cross-border travel, Finance Minister Lawrence Wong - a task force co-chair - said Singapore is in talks with many countries.

"Each time there is some news of one particular country, I can understand and appreciate the interest," he said. "These conversations continue, and as and when we have any updates, we will let people know."

Mr Wong said the Government will also be revising the public health guidelines for vaccinated people within Singapore, including permitting larger gatherings.

"We could allow gatherings involving just vaccinated persons to have larger group sizes, and also relax the social distancing rules in such settings, because only vaccinated persons are involved," he said, adding that this could apply to a range of different settings, including religious services, sporting events and weddings.

More migrant workers, including domestic helpers, to be allowed into Singapore amid COVID-19
This will ease the pressure on firms, families; precautionary steps being strengthened
By Charmaine Ng, The Straits Times, 25 Jun 2021

More migrant workers and foreign domestic helpers will soon be allowed to enter Singapore to work, said Trade and Industry Minister Gan Kim Yong yesterday.

"This will ease the immense pressures our companies have been under since the start of the pandemic," he said, adding that this will also allow family members to reunite and their migrant domestic helpers to join them.

When asked how the Government will ensure migrant workers are brought into Singapore in a safe manner, Mr Gan said the Ministry of Manpower (MOM), Ministry of Trade and Industry, and other ministries are working together to strengthen precautionary measures.

These include measures at the entry point as they enter Singapore, the process of the stay-home notice, and safety precautions in their dormitories and workplaces.

Allowing more migrant workers to enter Singapore will also be dependent on the source country's vaccination rates and Covid-19 situation, said Mr Gan, who is a co-chair of the multi-ministry task force tackling the pandemic.

"So we are also working with the source country to introduce measures at the source country level, to prevent the importation of Covid-19 cases," he said during a press conference yesterday.

"We need to take a multi-pronged approach to ensure that we are able to open the borders for more migrant workers to arrive safely."

Allowing migrant workers to enter Singapore to work is crucial to the Republic's reopening and the recovery of its economy. This is even as the Government is focusing on ensuring the health and safety of the population, said Mr Gan.

The key to helping the economy recover is to have more than two-thirds of the population vaccinated, he added.

The minister was responding to a question on whether any economic factors or pressures are being considered in Singapore's reopening timeline.

Enhanced border restrictions in recent months, including barring those with recent travel history to Bangladesh, Nepal, Pakistan, Sri Lanka and India, have placed significant stressors on sectors dependent on migrant workers.

Last month, the MOM also stopped accepting new entry applications for work pass holders from higher-risk countries or regions, except for workers needed in key strategic projects and infrastructural works.

Work pass holders from these countries who were approved to enter Singapore before July 5 were no longer allowed to do so, with some exceptions.

Yesterday, Mr Gan noted that these measures have left sectors such as construction restricted "in many ways for a long time".

"Many of them (workers) come from overseas sources, and we need to find a way to allow them to return to Singapore so that projects can proceed."

This is also the case for foreign domestic helpers, said Mr Gan.

Export-oriented industries are also under stress, as they have orders to fulfil but limited access to manpower.

"This is an area that we will need to look at, how we can help them to resume their activities," he added.

The food and beverage sector as well as hospitality and tourism-related industries have also not been able to resume fully.

"Some of these sectors will not be able to open until we are able to reach a high level of vaccination," said Mr Gan.

He noted that while Singapore is on track to allow dining in for up to five people by the middle of next month, he understands that some F&B operators are hoping for the restrictions to ease to allow eight to 10 people per group, or remove limits altogether.

"So I think we have to move in that direction. But it all depends on the pace at which we can achieve a high level of vaccination. So vaccination is still the key to our opening of our economy," said Mr Gan.

Vaccination could remedy some effects of 'long COVID-19'
Singapore health authorities still studying this syndrome, which causes residual symptoms
By Clara Chong, The Straits Times, 25 Jun 2021

Long Covid-19 syndrome - which sees patients suffer residual symptoms such as fatigue and chest pains weeks and months after infection - has been described in several countries, but Singapore's health authorities have yet to get a firm grip on what it entails.

This includes what causes "long Covid-19" syndrome, how it manifests and how it can be addressed, Singapore's director of medical services Kenneth Mak said during a virtual media conference held yesterday by the multi-ministry task force tackling Covid-19.

Associate Professor Mak noted that there are anecdotal reports which suggest vaccination provides some remedy for long Covid-19 syndrome.

"Some longstanding sufferers of long Covid-19 syndrome have reported improvements in the symptoms after vaccination. And this may potentially be another reason to encourage even recovered cases to seek vaccination," he said.

Long Covid-19 is a condition where some people continue to experience Covid-19 symptoms for longer than usual, even after recovering from the disease.

Fatigue, shortness of breath, chest pain, joint aches and "brain fog" - where one's thinking is sluggish - are some commonly described problems that emerge or linger for four weeks or more after an infection.

"The National Centre for Infectious Diseases (NCID) has been looking at this and has been following up on all recovered cases in Singapore's public hospitals, and has also been trying to study this particular issue," said Prof Mak.

NCID may be ready soon to provide further information on what the prevalence of long Covid-19 syndrome is in Singapore.

Prof Mak said the syndrome reinforces the concern that Covid-19 infection is not something like the common seasonal flu.

"There are some patients who have severe outcomes, permanent disabilities to some extent, and these... are not something to underplay."


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