Tackling COVID-19 with targetted measures

Matthew Mohan

SINGAPORE (CNA) – It had been a tough year for Singapore.

Then, as 2020 came to its close, it looked like the country could see a flicker of light at the end of the long COVID-19 tunnel with its transition on December 28 to Phase 3 of its re-opening.

And in the months that followed, the path to a post-pandemic normality looked to be fairly smooth, with community cases generally running to no more than a few a day.

Plans for events which hadn’t been possible for months started to gather pace. This was in spite of the pandemic continuing to rage worldwide, with a number of countries forced to introduce and then reintroduce measures to curb the spread of the raging virus.

Singapore hadn’t needed to.

Then, very quickly, things changed. Clusters began to spring up, with one emerging at Tan Tock Seng Hospital – the first in a local hospital since the pandemic began. Community cases began to steadily increase.

To tackle the spike, Singapore announced some tighter, targetted measures on May 4.

Places that were considered high-risk, such as indoor gyms and fitness studios, were instructed to close unless they offered low-intensity activities, while fewer people would be allowed at attractions, public libraries, funerals and MICE events.

Limits for gatherings reverted to five people.

A man sits next the pond at Marina Bay Sands in Singapore, ahead of tightening restrictions over Covid-19 concerns. PHOTOS: AFP
People wearing face masks walk along the promenade at Marina Bay in Singapore

But as community cases showed no signs of letting up, measures were further tightened on Friday under what the Health Ministry called “Phase 2 (Heightened Alert)”.

Among other initiatives, sizes of group gatherings were further reduced from five to two people, with dining-in at F&B establishments banned. Working from home is also to be the default at workplaces.

The new measures will take effect from today through June 13.

Speaking at a multi-ministry task force press conference on Friday, Education Minister Lawrence Wong noted in particular that “risk settings” for the spread of the virus were indoor environments where people do not put a mask on.

This is why the government had focussed on tightening restrictions in such areas, he noted.

“We have already done so earlier for activities in the gyms and fitness centres where you are unable to keep your mask on,” Wong explained.

“And now the next step… is to restrict such activities in F&B establishments, and therefore no more dining in. In other settings – outdoors or when you are in a space but you are able to keep your mask on – we believe with safe distancing, with proper precautions, and safeguards, these activities can still continue.”

Health Minister Gan Kim Yong also added that such moves would be part of Singapore’s “journey to recovery”.

“This is part of a journey to recovery, because every now and then, when there’s (an) outbreak, we have to review our measures, and we need to tighten as we go along. And when infections come under control, then we’ll have (the) opportunity to roll back some of these measures, open up the economy, open up the community, so that people can begin to also socialise and interact with one another.”

BREAKING THE CHAINS OF TRANSMISSION

As the COVID-19 situation continues to evolve globally, infectious disease experts say that targetted sectoral measures, such as the ones introduced by Singapore, are set to be the way forward.

“Sectoral lockdowns in a targetted fashion (are) likely the way to go, but the thing is that the decision to do that must be quick and fast,” said Dr Ling Li Min, who is an infectious disease specialist at Rophi Clinic.

Dr Ling noted that such an approach requires that community cases are not widespread.

“When countries embark on these targetted measures, it is probably at a point in time whereby they feel that they can still control it, meaning that community cases are not widespread, it’s only small clusters here and there,” she explained.

“Early on, you can’t keep waiting for the cases to increase, and that can only happen when the community cases overall are still low. If there are a lot of community cases, then your sectoral lockdown isn’t going to work.”

For such measures to bear fruit, the rest of the community must be “clued in”, said Dr Ling.

“The testing, the tracing, (the) isolation must be superb and robust. Some of these countries don’t quite have that – they’re not as swift with that,” she noted.

Dr Paul Tambyah, infectious diseases expert and president of the Asia Pacific Society of Clinical Microbiology and Infection, noted that these sectoral measures are likely to remain in place until vaccination rates reach higher levels.

“I think that these measures are temporary until the vaccination rates reach levels that have been achieved in countries such as Israel where the measures are being lifted gradually,” he said.

“Similar opening up is occurring in other highly vaccinated places such as the UK and US and UAE. If the WTO (World Trade Organisation) waiver on vaccine patents is granted, then this is likely to happen sooner rather than later all over the world.”

As Singapore is one of the world’s most globally connected cities, it is likely to need “far higher” levels of vaccination to protect the population than other more “closed or isolated” societies such as Israel or New Zealand, added Dr Tambyah.

As of May 9, about 1.8 million people had received at least one dose of a COVID-19 vaccine, with 1.2 million of them receiving their second dose, Gan had said in Parliament on May 11.

Data compiled by the Our World in Data project at the University of Oxford, shows that close to 60 percent of Israel’s population has received at least one dose of the vaccine. The number currently stands at about 30 per cent for Singapore.

FINDING ‘MIDDLE GROUND’

One of the reasons why total lockdowns have been implemented in some countries is due to the fact that hospitals are facing the possibility of being inundated, said Dr Teo Yik Ying, who is dean of the Saw Swee Hock School of Public Health.

“A total lockdown is necessary when the health system is at risk of being overwhelmed. That is when you realise that the situation is getting rapidly out of control. And the definition of out of control here is that the infection is spreading so fast in the community, and resulting in a large number of people entering the hospitals,” said Dr Teo. A total lockdown would serve two main purposes, he noted. The first of which would be to stop interaction so as to cut chains of transmission in the community.

And when such chains are cut, this minimises the infections only to households, he added.

“What that means is that with time, you actually allow the number of patients in the hospitals to slowly go down… Your hospitals now have a chance to breathe,” he said.

“That is actually very important because once your hospital is overwhelmed, you realise that anyone seeking care at the hospital, whether it is COVID, or non COVID related, they will be compromised because nurses are overwhelmed, doctors are overwhelmed.”

And while Singapore had been forced into a circuit-breaker period – similar to a lockdown – last year, there has not been a need to re-impose that because the healthcare system is not at the risk of being overwhelmed, said Dr Teo.

For one, in addition to current bed capacity, there was also the setting up of community facilities around the island last year to bolster capacity, he pointed out.

“After our initial fear that we saw in April (and) May last year, there is now built in place some additional surge capacity. It is not massive, it is never massive, but at least hospitals now have a better way of coordinating their resources to cope with rising numbers,” he added.