Friday, 2 July 2021

Living with endemic COVID-19: Ong Ye Kung

Singapore may ease more COVID-19 curbs on 12 July 2021, says Health Minister Ong Ye Kung in interview with The Straits Times

Country transitioning to new normal, with SHN-free travel possible by year end
By Yuen Sin, The Straits Times, 2 Jul 2021

Covid-19 measures could next be relaxed on July 12 as part of Singapore's graduated reopening. This could potentially see it transitioning to a new normal and resuming travel without serving a stay-home notice by the end of the year.

"Come July 12, we are looking at opening up to (allow) more people dining together, and whether there are other steps that we can consider," Health Minister Ong Ye Kung told The Straits Times' senior health correspondent Salma Khalik in an exclusive interview yesterday.

The further easing this month would depend less on vaccination rates and more on whether Covid-19 clusters are under control, he said.

The next milestone for relaxing curbs will be in the second half of this month, when half of the country's population would have been fully vaccinated, followed by National Day on Aug 9, when two-thirds of residents would have been inoculated. The step after that would see Singapore transition to the new normal of living with endemic Covid-19, Mr Ong added.

"You want the transition to be a... step-by-step one where you progressively move towards it, as opposed to a sudden change," said the minister, who co-chairs the multi-ministry task force tackling Covid-19.

Mr Ong said he shares Singaporeans' aspirations for leisure travel to resume by the end of the year. Possible destinations would be countries with high vaccination rates that are seeing their infections dip.

For instance, countries with infection rates below two or three cases per 100,000 people could be monitored to see if travel could restart there. This includes most countries in the European Union as well as the United States.

Asked if end-August or early September would be a good time to switch gears to the new normal - given that all eligible residents who want the jab would have been inoculated - Mr Ong said this was a realistic timeframe, but there will be no "big bang opening".

The multi-ministry task force announced on June 24 that Singapore will eventually transition to a new normal where Covid-19 will be managed like other endemic diseases. Testing still remains important during the transition, said Mr Ong, who added that 37 per cent of the population are now fully vaccinated. About 59 per cent are partially vaccinated.

There were also other key considerations that nudged Singapore to move towards living with endemic Covid-19, though the decision to take that route was made on the basis of science, he added.

After an extended period of restrictions, there is a certain sense of battle weariness among people. "You cannot expect people to live like that - restricting themselves, not meeting friends, not being able to travel," he said.

Other major considerations include the trajectory of the pandemic, as well as the development of the vaccines and treatments Singapore now has at its disposal that could make living with endemic Covid-19 a possibility.

While scientists estimate that a vaccination rate of at least 80 per cent is required for the population to gain herd immunity against the Delta variant, Mr Ong said that people can still live with an endemic Covid-19 if this is not achieved.

"People will still get infected, but they are fine. And so you make Covid-19 more like influenza, you can't make Covid-19 like measles, for example, where you try to eradicate (it)."

But masks are here to stay for a long time and may be among the last of measures to be reviewed, Mr Ong said. "Masks, to me, is a very important non-pharmaceutical intervention, and may well be one of the last things we want to consider removing."

Wearing of masks still key after Singapore transitions to a new normal
By Yuen Sin, The Straits Times, 2 Jul 2021

The wearing of masks will still be key after Singapore transitions to a new normal of living with endemic Covid-19, and may well be among the last of the measures that will be shed, Health Minister Ong Ye Kung said yesterday.

In an interview with The Straits Times, he said masks remain a very important non-pharmaceutical intervention for reducing the spread of Covid-19.

"(The measure) may well be one of the last things we want to consider removing... And even if we remove, this is maybe just for safe environments, like open-air areas," said Mr Ong, noting that Israel recently reintroduced a requirement to wear masks indoors amid a rise in coronavirus cases, just 10 days after it lifted the measure.

Asked if this means that workers will continue having to wear masks when they return to offices, the minister added that this is something the multi-ministry task force on Covid-19 will have to mull over.

"Masks will allow us to do a lot more things, compared to not wearing masks... In terms of risk and reward, it is one of the most sensible things to do."

The requirement to wear masks had been the last remaining restriction in Israel after all other Covid-19 measures had been progressively reduced.

The country has one of the highest vaccination rates in the world at more than 59 per cent, and reintroduced the mask requirement after it recorded more than 100 new daily cases in consecutive days after registering zero cases in June.

Most of the cases have been linked to the more infectious Delta variant.

Officials from the World Health Organisation have also urged fully vaccinated people to continue wearing masks and to keep taking other measures to prevent infection.

This is because while immunisation is highly effective in preventing severe illness and death, the degree to which vaccines guard against mild or asymptomatic infections is unknown.

Health officials in Los Angeles County on Monday also recommended that everyone wear a mask indoors in public places, regardless of vaccination status. This comes after the United States Centres for Disease Control and Prevention told fully vaccinated Americans in May that they no longer need to wear masks indoors.

Getting COVID-19 could soon mean an MC, isolation and self tests at home
Ong Ye Kung envisages how people could live with a virus that is here for the long haul
By Joyce Teo, The Straits Times, 2 Jul 2021

A person who suspects he has Covid-19 could get a medical certificate (MC) from his doctor, who will tell him to isolate and test himself at home.

Someone else could get an SMS informing him of exposure to the virus, with instructions to also isolate at home and conduct self-tests. Those who are working could let their employers know that they may have been exposed to Covid-19, and be allowed to stay home without an MC.

Health Minister Ong Ye Kung shared such likely scenarios for the coming months, as he outlined how people could live with a virus that is here for the long haul.

Currently, infected people who are at higher risk of falling ill with the disease may be admitted to hospital, while those who are at lower risk may be sent to community care facilities.

"Can we imagine a time where the default is to say, 'Here is an MC, go home, isolate yourself, rest, and here is a bunch of test kits. Test yourself every X number of days until you are fine, and then you can come out'," Mr Ong said in an exclusive interview with The Straits Times' senior health correspondent Salma Khalik yesterday.

"Or, you could let your employer know that you have been ex-posed to the virus and notified by MOH (Ministry of Health). Your employer should allow you to just stay at home and don't demand your MC... That is part of endemic Covid-19... It is a big psychological shift."

Changes are also afoot for people who have been exposed to the virus. Today, they could get an SMS telling them they will be quarantined, which in most cases means to be taken to a facility and isolated for at least two weeks.

"Can we imagine a day when your SMS doesn't say you are quarantined? It just says you are exposed (to Covid-19), go home, get a bunch of test kits, test yourself, isolate yourself, don't move around too much and just go out for essentials," said Mr Ong.

Touching on the psychological impact of reopening, Mr Ong said that there will not be a "big-bang opening" at the end of August or September, but a gradual easing.

"The key thing is (vaccine) supplies are no longer a constraint," he said. "We want a step-by-step approach because it enables us to better manage the higher-risk settings, which should not happen all at once. Second, you give people a sense of progression rather than waiting for that big day when everything opens and then you go crazy."

Mr Ong, together with Minister for Trade and Industry Gan Kim Yong and Minister for Finance Lawrence Wong - the three co-chairing the country's Covid-19 multi-ministry task force - had said in an article published in ST on June 24 that the priority in the next few months would be to prepare Singapore for life with Covid-19 as a recurring, controllable disease.

When contacted, Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said that as people have been worrying about Covid-19 for the past 18 months, it will take a while for them to accept that it is okay to go about their daily lives, even though community cases may continue to surface.

"Living with Covid-19 means we accept there will be some infections happening in the community, and occasionally, there will be larger outbreaks. But by and large, the infected people do not end up with any acute or chronic damage to their health, and the vast majority actually experience no or mild symptoms, because these people have been vaccinated already," said Prof Teo.

"If the evidence on vaccination continues to show that a vaccinated person has a very low chance of suffering from severe symptoms once infected, even with the emergence of new variants, then this means societies, not just Singapore's, can rely on vaccination to protect individuals and communities, and allow a resumption of pre-Covid-19 normalcy."

Ong Ye Kung hopes close to 90% of seniors in Singapore can be vaccinated against COVID-19
By Joyce Teo, The Straits Times, 2 Jul 2021

To keep the population safe from Covid-19, it is best for 70 per cent to 80 per cent or more of the population here, including close to 90 per cent of the elderly, to be vaccinated against the disease, Health Minister Ong Ye Kung said yesterday.

Seniors are at higher risk of falling seriously ill and dying from the disease, and the higher vaccination numbers are necessary, as children aged below 12 cannot be vaccinated for now, while new and more transmissible variants are spreading. The number of children who are aged up to 11 years is slightly below 506,000.

"Ninety per cent would be very hard to reach, but I am really hoping that for the most vulnerable groups - the seniors - we can approach a figure somewhere near there," he told The Straits Times.

"Two-thirds fully vaccinated by National Day, I deem it an interim milestone. We can and need to go further than that."

Beyond National Day, Mr Ong said, 70 per cent to 80 per cent of the population could perhaps be vaccinated, though this depends on the "willingness of our people".

"And if young children can get vaccinated, it will help bring the number higher," he said.

Mr Ong noted that experts have said that 80 per cent or more need to be vaccinated to achieve herd immunity against the Delta variant of Covid-19, which is the dominant strain in Singapore, and more transmissible than other strains.

"You may have future variants as well. So, I think herd immunity becomes a concept that is inversely proportionate to the transmissibility or the R-naught of the variant."

Reproduction number, or R0, is the average number of infections generated by each case.

Herd immunity occurs when a large portion of the community becomes immune to a disease, making the spread of disease from person to person unlikely.

So the whole community becomes protected, not just those who are immune.

"That doesn't mean the battle will be lost because you can still have an endemic Covid-19 (without) herd immunity.

"People will still get infected, but they will be fine. And so you make Covid-19 more like influenza. You can't make Covid-19 like measles, for example, where you try to eradicate it," said Mr Ong.

When contacted, Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said: "Herd immunity is actually not a binary concept, in the sense that once we surpass some estimated threshold for herd immunity, the community suddenly becomes safe from large outbreaks."

Instead, the extent and speed of reopening are linked to the risk of infecting the unvaccinated, and thus depend on how quickly Singapore is able to vaccinate the population, said Prof Teo.

"So, for example, if we hit 50 per cent with both doses, we may relax certain measures. When we hit 60 per cent or 70 per cent, there will be other kinds of relaxation, and eventually, working towards a lifting of most, if not all, the restrictions," he said. "And if the high-risk groups are adequately protected, then even if the vaccination rate for the lower-risk group is still catching up, there can also be more easing of restrictions."

Prof Teo said that in living with Covid-19, the right thing to do is to make sure everyone eligible for vaccination is able to receive it. This ensures that individuals are protected, and collectively, the entire community is protected too, he added.

Perks for those vaccinated against COVID-19 not meant to be discriminatory: Ong Ye Kung
Treating the vaccinated, unvaccinated differently is 'necessary'
By Clara Chong, The Straits Times, 2 Jul 2021

Perks for individuals vaccinated against Covid-19, such as being exempt from pre-event testing for certain events, are not meant to be discriminatory.

Rather, this differentiation between the vaccinated and unvaccinated is necessary from a public health standpoint as Singapore moves towards creating a sense of normality with endemic Covid-19 as an end goal, Health Minister Ong Ye Kung said in an exclusive interview with The Straits Times' senior health correspondent Salma Khalik yesterday.

The authorities see this differentiation in terms of risk - whether someone has a higher or lower risk of getting infected and passing on the virus, Mr Ong said.

He stressed that vaccination will protect not just the individual, but also the person's family and the whole of society.

When most people have taken their jabs and everyone who wants to take the vaccine has received it, there will then be good justification for this group of vaccinated people to have some privileges, such as things that they can do in bigger groups, in closer settings, Mr Ong explained.

While details have yet to be fully ironed out, the multi-ministry task force on Covid-19 provided some examples of such perks late last month, such as allowing overseas travel without stay-home notice, as well as larger group gatherings here.

Right now, those who are fully vaccinated are already exempt from pre-event testing for events such as live performances and wedding solemnisations. All participants and spectators for this year's National Day Parade will also have to be fully vaccinated.

However, there will be social aspects that need to be managed so that nobody feels excluded, such as for families with young children who cannot receive the vaccine yet, Mr Ong said.

"And so I think we would also need to think through these issues to see whether some dispensation is appropriate," he added.

US, Europe potential holiday destinations as Singapore reopens
Infection and vaccination rates of countries among considerations
By Clara Chong, The Straits Times, 2 Jul 2021

Singaporeans keen to travel abroad for leisure may soon get to do so to places such as the United States, Hong Kong and some parts of the European Union, where vaccination rates are rising.

This was a possibility sketched out by Health Minister Ong Ye Kung yesterday in an exclusive interview with The Straits Times' senior health correspondent Salma Khalik, where he shared the hope that travelling for leisure will be a viable option before the end of this year.

He said: "Once a place's (Covid-19) infection rate is going down, vaccinations are going up and you go below, say, two or three infections per 100,000, we should start monitoring those countries seriously."

In the US, the rate of Covid-19 infections has declined quickly for two months but levelled off since mid-June thanks to localised spikes in undervaccinated regions of the country, data on Monday showed. This comes as the highly contagious Delta variant continues to gain traction, poised to soon become the dominant strain among US cases.

The seven-day average of new daily cases in the US has hovered at around 11,500 since June 16, according to the US Centres for Disease Control and Prevention, or about 3.5 per 100,000 people. About 47.2 per cent of the population have already been fully vaccinated as at June 30.

When asked if the possibility of a Hong Kong travel arrangement was now back on the cards, Mr Ong said that both cities are now in a good position to relook it. These arrangements have been deferred twice.

"Fundamentally, both of us are more or less in a good place now, and both of us are vaccinating our people," he said.

"We are going to call it the air travel corridor from now on. The word 'bubble' is a bit of a jinx, I think," he added. Earlier in May, the Singapore-Hong Kong air travel bubble burst for the second time following rising community Covid-19 cases in the Republic.

Singaporeans ready to fly to Phuket - which opened its doors to international travellers yesterday - will still have to serve a stay-home notice when they return.

"When we differentiate between countries that are safer and countries that are risky, it is less to do with their own rules... but to do with their general infection rates, vaccination rates, their control measures, testing and all their non-pharmaceutical interventions," Mr Ong said.

Phuket welcomed its first international travellers under a quarantine-free scheme yesterday in a bid to save its vital tourism industry. However, this comes as Thailand is grappling with its worst Covid-19 wave and the detection of the Alpha and Delta variants. Thailand yesterday reported a daily record of 57 deaths from the virus.


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