Experts cautiously optimistic as Covid-19 infection growth rate dips below 1

Finance Minister Lawrence Wong had said that if the rate fell below one, people from the same household might be allowed to dine in groups of up to five. ST PHOTO: KUA CHEE SIONG

SINGAPORE - As the weekly Covid-19 infection growth rate falls below one for the second day in a row on Thursday (Nov 4), infectious diseases experts are cautiously optimistic about the easing of safe management curbs should the trend continue.

However, they do not expect the relaxation of restrictions to come soon.

On Oct 20, the Ministry of Health said Singapore would extend Covid-19 restrictions - which include capping group sizes for social gatherings and dining at two - for another month to Nov 21 as more time was needed to stabilise the situation.

Health Minister Ong Ye Kung said the measures would be reviewed at the two-week mark and adjusted based on the community situation.

Finance Minister Lawrence Wong said last month that if the weekly infection growth rate falls below one, people from the same household may be allowed to dine in groups of up to five. More team sports and school activities may also be allowed to resume.

Another condition is that the hospital situation remains stable, especially in intensive care units (ICUs).

The infection rate refers to the ratio of community cases in the past week over the week before. A rate that is more than one shows that the number of new weekly Covid-19 cases is still increasing.

On Thursday, the rate dipped to 0.93, down from 0.96 on Wednesday. It was at 1.09 on Tuesday, a slight increase from 1.05 on Monday.

Dr Leong Hoe Nam, an infectious diseases specialist from the Rophi Clinic at Mount Elizabeth Novena, told The Straits Times that the rate should remain below one for at least two to three weeks before the authorities ease restrictions.

He added that for the Covid-19 situation here to be considered stable and not straining the healthcare system, daily cases should plateau at around 2,000, and the ICU occupancy rate should be around 50 per cent to 60 per cent.

"Although the weekly infection growth rate has come down, there is still the issue of ICU bed shortage. I'm not confident we can open up now or soon, as the ICU occupancy rate is still quite high," he said.

The ICU occupancy rate was 70.2 per cent on Thursday. The rate has fluctuated over the past week from last Thursday (Oct 28) - with the highest at 74 per cent and the lowest being 67.1 per cent.

Professor Dale Fisher, senior consultant at the National University Hospital's Division of Infectious Diseases, said it takes a week or more after Covid-19 patients are infected to show an effect on the demand for ICU beds.

He noted that the demographic of the infected is more important than daily case numbers in evaluating the ICU situation.

"For instance, unvaccinated people who get infected are much more likely to need ICU care especially if they are older. If all recent infections are young vaccinated people with no comorbidities, then none of them will need the ICU," he said.

Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said if there is an increasing number of unvaccinated people becoming infected, it will still result in considerable stress to the healthcare system, even if the weekly infection growth rate is below one.

This rate should not determine whether the Covid-19 situation is stabilising, he added.

Prof Teo said the rate is still subject to daily fluctuations, noting that the "abnormally high" report of 5,324 cases on Oct 27 could have resulted in the recent dip.

"Given that there are now people who may test positive with the ARTs (antigen rapid tests) but do not come forward for any confirmatory PCR (polymerase chain reaction) testing, the daily case count is not a good representation of the Covid-19 situation," he added.

Any further easing of restrictions would affect the unvaccinated as they are more likely to be infected and require hospital care, which would result in a high ICU occupancy rate, he said.

The experts agreed that hospital capacities should be the main factor in deciding whether to relax restrictions.

Prof Fisher said: "Of course, we are not through this yet, but there does seem to be a good balance with the current measures controlling the surge…

"Easing of restrictions will happen and the timing is the balance that the authorities have to determine. (They should) open up as quickly as possible while ensuring it is done as safely as possible."

Singapore has extended Covid-19 restrictions - which include capping group sizes for social gatherings and dining at two - for another month to Nov 21, 2021. ST PHOTO: CHONG JUN LIANG

Booster shots are also important to reduce the need for hospitalisation for Covid-19 patients, Dr Leong said. He noted that millions of people have taken the booster shot in Israel, which helped to suppress the number of infections.

"More people taking their booster shots would greatly reduce the need for hospitalisation," he added.

As at Thursday, 84 per cent of the population have been fully vaccinated, 85 per cent have received at least one dose and 17 per cent have taken their booster shots.

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