Coronavirus Singapore
Ease curbs further, but keep an eye on health system: Experts
Panellists say S'pore must be prepared for return of safety measures if cases surge again
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The daily Covid-19 case count peaked about three weeks ago and has been declining since, but public hospitals are still seeing a heavy patient load, said experts.
This is because there is always a lag of about two weeks for the situation in hospitals to catch up with the peak in case number reporting.
Healthcare workers are also dealing with a growing number of non-Covid-19 cases that have been building up, given the focus on coronavirus patients in the last two years.
National Centre for Infectious Diseases executive director Leo Yee Sin said the current pressure on the healthcare system comes from other illnesses as well.
"We have to look at the totality of the critical services currently wit-hin the healthcare system. How can we cater to all the needy patients regardless of Covid-19?" she said.
Professor Leo was one of three panellists speaking at the Covid-19 Restrictions: When Can They Be Eased Further? discussion hosted by The Straits Times and held at SPH Studios in Toa Payoh.
She noted that many of Singapore's earlier healthcare protocols were based on the disease patterns observed in the Delta variant. When the less severe Omicron variant emerged, these protocols led to a significant number of patients being admitted to hospitals when they might have been better off recovering at home.
But Prof Leo added that most hospitals have reorganised themselves to better care for patients infected with the newer variant.
For instance, many hospitals now care for patients in cohorted facilities, which means housing several Covid-19-positive patients together, instead of isolating them individually.
Most hospitalised patients with Covid-19 now tend to be older and have other conditions such as stroke or heart disease, she said.
She added that there will be a need to balance the needs of the healthcare system with those of other sectors as Covid-19 cases fall.
Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital, and infectious diseases expert Teo Yik Ying agreed it was important to keep an eye on the healthcare system.
Still, there can be an easing of safe management measures without serious impact on the system, they added.
What is important, though, is that Singapore needs to be prepared for a return of restrictions if the situation worsens.
Prof Fisher said the assumption is that the measures contribute to controlling case numbers in a major way. But he argued that they can, in fact, be rolled back gradually without impacting hospitals.
He added that people are unlikely to be satisfied with being allowed to have just five visitors to a household at any one time, and questioned if having 10 vaccinated people together in one place would really "destroy hospitals".
"The psyche of people, I think, will benefit a lot from not having to wear a mask when you are outside, and being allowed to have 10 people at your home for a birthday or for Christmas or Chinese New Year."
At the session moderated by ST senior health correspondent Salma Khalik, Prof Fisher said that healthcare workers also want their lives outside of work to return to normal.
"The people that are vulnerable - there is no doubt they exist. They will get Covid-19 just as people get flu and get serious illness," he said.
"We knew from the trials that vaccines were not 100 per cent effective, so we always expected this. Part of the future needs to be - how do we protect those individuals without impacting the whole of society?"
Professor Teo, who is dean of the National University of Singapore's Saw Swee Hock School of Public Health, said that the decision to relax Singapore's Covid-19 measures hinges on whether the healthcare system is ready for it, as infections will certainly go back up once the authorities do so.
But he predicted that most of the prevailing measures in place to curb Covid-19 will be eased this year.
Prof Fisher said Singapore should still be prepared for measures to be stepped up if cases surge and hospitals begin filling up again in future due to new variants of concern or waning immunity.
EXPERTS' TAKE ON...
Additional booster shots
The Singapore population currently has some degree of resistance against Covid-19, thanks to high levels of infections and the recent administration of booster vaccinations, but this will not remain the case indefinitely, infectious diseases expert Teo Yik Ying said yesterday.
Professor Teo, who is dean of the National University of Singapore's Saw Swee Hock School of Public Health, said people may need multiple boosters, perhaps taken annually, or the country may see another outbreak or recurrent waves of Covid-19 in the future.
National Centre for Infectious Diseases executive director Leo Yee Sin added that the authorities are looking closely at the local data before making a decision, noting that many countries now offer additional shots for those over the age of 80.
Flu and other diseases
Even though Covid-19 has killed more than 1,100 people in Singapore, some deaths from other causes might have been prevented due to the reduction in social interactions.
Professor Leo noted that Singapore was among a handful of countries and regions that saw a negative excess mortality rate in 2020 and last year, according to a study published in The Lancet medical journal.
This means that fewer people died overall during the pandemic compared with the years before.
Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital, said that while cases of diseases such as hand, foot and mouth and even sexually transmitted infections would have declined because of the lower level of social interaction, other negative factors such as childhood weight gain and mental health issues are on the rise.
Prof Teo said the impact of the measures themselves may prove to be just as significant as Covid-19.
Herd immunity
Prof Teo said that getting vaccinated or being exposed to the coronavirus provides immunological protection so that subsequent exposures will not be as severe.
He also noted that the currently dominant Omicron variant is less severe than the Delta variant, and questioned whether it might be the right time to allow people to be exposed to the virus naturally and build up their immunity.
In the years to come, Covid-19 may hit in "returning waves", but each wave may cause fewer and fewer severe illnesses as people's bodies get used to it, he added.
Prof Leo, however, cautioned against taking Omicron too lightly. She noted that Omicron is effective at evading the immune system, even if one has been previously infected by Delta or another strain.
The Deltacron variant
One recent development is the so-called Deltacron variant, which combines the characteristics of the Delta and Omicron variants, but little is currently known about it, said Prof Leo.
"Although the number is very small at this point in time, it may fizzle out or it may become a problem," she said.
"We just don't know."
Prof Leo added that it is possible that yet another variant could emerge, even as scientists are busy studying the Deltacron variant, which was first detected in Covid-19 samples collected from France in January.
According to Gisaid, an online open-access repository for genomic data on viruses, 35 cases have been detected in France and eight in Denmark.
Germany, Belgium and the Netherlands each have one case, while genetic sequencing company Helix has identified two cases in the United States.
Rei Kurohi
