By Salma Khalik, Senior Health Correspondent, The Straits Times, 25 Jul 2021
The large number of people here infected with Covid-19 in recent days has been alarming.
It jumped from single digits in the first third of the month to double digits in the week following that, and now for the past four days, it has been above 100.
The multi-ministry task force tackling Covid-19 reacted the day after the number of infections crossed the 100-people mark. Indeed, the number of newly diagnosed infections almost doubled from 87 last Sunday to 163 the next day.
So, people here are now faced with four weeks of tightened measures.
While Ministry of Health (MOH) statements like "the number of new cases in the community has increased from 127 cases in the week before to 883 cases in the past week" sound scary, a closer look at the numbers tells a somewhat different story.
Eight people required oxygen or intensive care on Thursday, compared with 18 on June 25. The number is likely to go up over the next few days, given that it usually takes some time for serious illness to manifest.
The task force's decision to move Singapore back to phase two (heightened alert) reflects this possibility.
But the eight people needing oxygen or intensive care are fewer than the 10 people needing such care on July 7, when the easing of measures was announced.
Earlier this year, the task force said it is not the overall infection numbers but rather the number who are seriously ill that is important, as this could have an impact on hospital care or even overwhelm hospital services.
Health Minister Ong Ye Kung explained in a Facebook post the recent decision to tighten measures. He said: "Markets are frequented by seniors, many of whom remain unvaccinated.
"This is most worrying, and we are at risk of an uncontrollable rise in cases, which could potentially result in many severe illnesses or even deaths. So we need to pre-emptively tighten up social activities."
I totally agree that measures need to be tightened. I only question if the tightening was too much of a blanket move, and whether it was really necessary to return to a semi-lockdown status.
This is especially so since the number of vulnerable seniors infected remains low. On Thursday, there were six unvaccinated or partially vaccinated seniors out of the 162 people infected.
Could a middle path have been taken instead - giving sufficient protection to those yet to be vaccinated, while leaving the majority with greater freedom to live a more normal life?
If this situation had happened at the start of the year, or even just three months back, I would have said "lock down".
But today, half of the population have been vaccinated, and while this might not be enough for Singapore to switch to an endemic mode, it does provide some measure of protection, even against the more transmissible Delta variant at work here.
Finance Minister and task force co-chairman Lawrence Wong said earlier this month: "If you have been vaccinated, you get good protection against the infection and against severe illness, and therefore you don't need to have such strict measures applied to a vaccinated person or to groups of vaccinated persons."
Why the change of mind within such a short period? The numbers might have changed, but the science has not.
A study funded by Public Health England, published in the New England Journal of Medicine last week, found that two doses of the Pfizer vaccine gave a significant 88 per cent protection against the Delta variant, just slightly lower than the 93.7 per cent against the original version of the virus.
Another 1.4 million people here have had at least one vaccine dose, again conferring some level of protection. Unfortunately, the protection is much lower with one dose - 31 per cent against the Delta variant versus 49 per cent against the original.
So it remains important to get everyone fully vaccinated as soon as possible.
Nevertheless, the protection conferred by the vaccine is borne out by the figures released by MOH.
Of the people infected in the past fortnight, the 484 who have been fully vaccinated were either asymptomatic or showed only mild symptoms.
Those who became seriously ill were either only partially vaccinated or not vaccinated at all.
Mr Ong mentioned his worry over unvaccinated seniors. That is a real worry indeed. But is the answer to lock down the entire country because of some recalcitrant seniors who refuse to get vaccinated?
The Government has gone out of its way to persuade them, even making it possible for them to just walk into any vaccination centre, without prior appointment, to get the protection.
Until and unless vaccination is made compulsory, this group will remain. Is it fair for the country to come to a standstill to cater to a stubborn minority?
It is true that if everyone else is vaccinated, it does provide some herd immunity to people not vaccinated. But the risk of getting Covid-19, serious illness and possibly death will always be there for older unvaccinated people.
It might be better if these seniors stayed home, and for their family members who might pass the disease to them to either stay away or remain home with them to reduce the risk of infection.
The whole nation cannot live in a constant state of tightened measures to protect a group of people who refuse to protect themselves.
Looking at the community cases over the past fortnight, only 76 of the 1,014 cases were people aged 70 years and older. Among these 76, 57 have been fully vaccinated and another seven partially vaccinated, while 12 are unvaccinated.
Let us look at the slightly younger cohort, those aged 61 to 70. Of the 154 infected, 131 were fully vaccinated, seven partially vaccinated and 16 unvaccinated.
So even among the infected seniors, the majority have been vaccinated.
Cross-refer to the earlier figures and we know that all those who had been vaccinated, no matter their age, did not suffer serious symptoms.
Yes, efforts must continue to persuade more seniors to get vaccinated. But, meanwhile, could Singapore have adopted more nuanced measures?
Just over a week ago, Minister for Trade and Industry and task force co-chairman Gan Kim Yong said that a "targeted approach will better protect those who are yet to be vaccinated while allowing those who have been fully vaccinated to continue with the current measures".
So by all means close and clean places where outbreaks have been identified. At present, these places are primarily the markets and some foodcourts.
And ring-fence as many contacts as possible.
But was it necessary to close the food and beverage sector so soon after allowing it to open? Could a limit of two people per table have been imposed instead? Since two people are allowed to visit households each day, the logic is that small groups of two people pose an acceptable risk.
Could sporting facilities have allowed only people who have been fully vaccinated to continue with the activities?
Such differentiation would also serve to encourage younger people to get vaccinated.
Over the past fortnight, the largest cohort of people infected were aged 19 to 39. There were 450 of them, of whom 144 - or almost one-third - had not had a single vaccine dose, even though they were invited to get vaccinated more than a month ago.
Experts say while it is true that a fully vaccinated person who is infected can transmit the virus to others, the risk is low, since the person's viral load would also be low. Yes, it is not without risk, but the risk is low and unlikely to lead to a surge in serious infections if both parties have been fully vaccinated.
If the number of people needing hospital care, or who get seriously ill, remains fairly stable over the next few days, could a more calibrated approach replace the current phase two (heightened alert)?
There are pressures to open up the economy and save jobs, giving people a sense of near normality that will certainly improve their mental well-being, and safeguarding the lives of the vulnerable.
It is a difficult tightrope to walk, but some fine-tuning of measures over the coming weeks would go a long way to show that vaccination can provide the light at the end of the tunnel.
After all, Mr Ong had said: "Once we reach 50 per cent, it'll be timely for us to have a more definitive road map to transit towards living with endemic Covid-19."
We are now at that point.
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