Commentary

S'pore should make Covid-19 jabs mandatory so measures can be eased for all

Eventually, large swathes of the population, whether vaccinated or not, will likely encounter the coronavirus, says the writer.PHOTO: ST FILE

SINGAPORE - There is no way to stop Covid-19 infections from spreading. The only thing that prolonging, or even enhancing, safety measures can do is to slow that spread - which is Singapore's current game plan.

But eventually, large swathes of the population, whether vaccinated or not, will likely encounter the coronavirus.

Last Monday (Sept 6), the Government said quick action was needed to dampen the increasing likelihood of an "exponential rise" in cases, even as Singapore hits 81 per cent in its full vaccination rate.

Finance Minister Lawrence Wong announced more frequent rostered routine testing for people in higher-risk settings, and mandatory testing and self-isolation for those who get health risk warnings. He also urged Singaporeans to limit non-essential social interactions.

Some quarters expressed disappointment, pointing out how the Government had earlier said measures would be eased once 80 per cent of the population had been fully vaccinated.

But dining at restaurants remains capped at five people if all are vaccinated, and two at hawker centres regardless of vaccination status. Working from home is still encouraged, with only half the employees allowed back at the office, and workplace socialising in the office is prohibited.

Explaining the decision further last Friday, Trade and Industry Minister Gan Kim Yong, a co-chairman of the multi-ministry task force tackling Covid-19, said: "We want to be cautious and give ourselves more time to be certain that the high number of daily cases will not result in a high number of serious cases or deaths."

Further relaxation of measures would be postponed for two to three more weeks, the task force said.

Its main fear is hospital services being overwhelmed with the rise in infections.

As a precaution, the Ministry of Health has told public hospitals to postpone non-urgent cases to free up room for the surge in Covid-19 patients. Non-urgent or elective cases include treatment of serious ailments, such as surgery for cancer.

Looking at the current Covid-19 numbers, the Government's recent moves seem, to me, way too precautionary.

There are now more than 700 Covid-19 patients in hospital but many of them could actually be recovering at home.

Health Minister Ong Ye Kung pointed out that "the large majority of infected patients are in hospital more for observation, and most are discharged uneventfully".

Hence the decision, announced last Friday, to allow more Covid-19 patients to recover at home, instead of occupying a hospital bed.

A further 2,000 infected adults below the age of 60 who are well or only mildly ill, are housed at community care facilities.

Of the current hospitalised patients, 35 need oxygen and seven are in intensive care.

These might seem like small numbers, but director of medical services Kenneth Mak noted that the Delta variant spreading here now doubles the risk of serious illness compared with earlier variants.

The task force ministers also stressed that it is not the current numbers, but those that may be coming, that are worrying.

There is a roughly two-week time lag between infection and serious illness where a patient needs oxygen or intensive care. So a rule of thumb tells us that the 42 seriously ill people on Sunday are based on the 120 newly infected people identified a fortnight ago.

Last Friday, there were 568 new locally transmitted Covid-19 cases. On Saturday, there were 550 such cases.

In a fortnight's time, how many will be seriously ill? Meanwhile, the number of new infections continues to rise.

Said Mr Wong: "Very soon, we will reach 1,000 new cases a day, and in a few weeks' time, we will probably get to 2,000 new cases a day."

Whether the number of seriously ill people will increase in tandem is the biggest question, but this will hopefully not materialise as more people get vaccinated.

Vaccination has a huge impact on how many people get seriously ill or die as a result of infection. So far, the rates of increase in infections and serious illness differ, with the rate of infections rising faster.

If this disconnect continues, then Singapore can safely ease measures as it shows that vaccines are doing a good job.

But if the rise in infection sees a tandem rise in serious illness, then even stricter measures might have to be imposed. This is to give seriously ill patients the best possible care and stop the healthcare system from being overwhelmed.


So far, the rates of increase in infections and serious illness differ, with the rate of infections rising faster. ST PHOTO: GIN TAY

Reflecting its concern, the task force mentioned the term "intensive care unit", or ICU, 49 times during Friday's 90-minute press conference.

Similarly, there were several references to what is happening in Israel, which has a population 50 per cent larger than Singapore's.

Israel eased measures when more than 60 per cent of the population was fully vaccinated. There was a surge in cases as thousands were infected, and it is now seeing about 25 deaths a day.

While the vaccination rate here is higher, the worry remains that Singapore's trajectory might follow Israel's.

But the latest Morbidity and Mortality Weekly report by the Centres for Disease Control and Prevention in the United States issued last Friday said that in spite of Delta being more infectious and causing more illness, the risk of infection for vaccinated people there is only around a fifth than for those not vaccinated.

Vaccines offer 10 times more protection against the need for hospital care or death, the report said.

In Singapore, 99.3 per cent of fully vaccinated people who get infected have been mildly sick or asymptomatic. In other words, only seven out of 1,000 people infected risk severe illness or death. In contrast, among the unvaccinated, 45 out of 1,000 people infected became seriously ill.

Over the past four weeks, 3,516 vaccinated people were infected, with 25 getting seriously ill. While only 616 who were not vaccinated were infected, they accounted for 28 seriously ill patients.

Of the 58 people who have died as a result of Covid-19 here, only one was fully vaccinated.

The problem clearly lies with people who have not been vaccinated.

To date, 84 per cent of the population have received at least one jab of a vaccine. About half of those not vaccinated are children under the age of 12, for whom there is currently no approved vaccine. There are also some people for whom vaccines are not a medically viable option.

It is the estimated 500,000 people who are eligible but have chosen not to get vaccinated who are threatening the healthcare system.

They are more likely to need hospital care, if infected. If this leads to more postponement of treatment for people with other health problems, then their choice also impacts the health of others.

Associate Professor Mak also pointed out that among symptomatic patients, those who have been vaccinated are no longer infectious after nine days, while those who have not been vaccinated could take up to 16 days to clear the viral load to the point of not being infectious.

So it is the unvaccinated people who hold the key to how fast Singapore can open up.

As Mr Ong said: "To go through this experience differently from other countries, (with) as few deaths as possible without a prolonged hard lockdown, the key is vaccination."

Perhaps it is time the Government mandated vaccination for all who are medically eligible for it.

The argument against doing so is that none of the vaccines have received normal approval. They have been approved only under pandemic conditions.

However, millions of people here, and hundreds of millions globally, have been vaccinated, with very low rates of adverse reactions.

Previously, there were people who feared the novel messenger ribonucleic acid (mRNA) Covid-19 vaccines used in the national programme. But there are now other options, such as Sinovac, which uses more traditional vaccine methods. It is timely to rethink this issue.

Mandatory vaccination is not a new concept. That was largely how the world eradicated smallpox.

In Singapore, it is legally required for children to be vaccinated against diphtheria and measles.

If the Government takes over control of this key that Mr Ong mentioned, then the lock on the economy and people's lives can be opened sooner.