Is Singapore ready for Omicron, and to live with Covid-19?

Singapore is emerging from its worst outbreak since the start of the Covid-19 pandemic. PHOTO: ST FILE

SINGAPORE - Singapore is emerging from its worst outbreak since the start of the Covid-19 pandemic - a Delta variant-fuelled spell that saw four-digit daily cases since September and a record 5,324 on Oct 27.

Though numbers have fallen to the hundreds, and fewer patients are in hospital, the nation is maintaining existing safe management measures and bolstering vaccination and healthcare efforts, while refining border controls.

It is gearing up for its next big challenge: the mutated and highly infectious Omicron variant, now spreading around the globe at an unprecedented rate.

As at Thursday, Singapore had confirmed 24 cases, with one more announced as preliminarily positive. The Government has warned that it is a matter of a time before there is a surge of Omicron infections in the community - one potentially larger than Delta's.

Observers say Singapore is well-poised to handle the new strain, with the experience gleaned from various outbreaks and road bumps over the past two years.

The result is an Omicron strategy reflecting an abundance of caution - in walking a line between restrictions and keeping the economy open, while fine-tuning the balance along the way.

It is an approach also consistent with the measured shift to living with Covid-19, experts say.

"Singapore is most certainly on track to Covid-19 resilience," says Dr Woo Jun Jie, a senior research fellow at the Institute of Policy Studies think-tank, adding that the path will "require a calibrated, and sometimes start-stop, approach that builds up Covid-19 immunity in a safe and controlled manner".

'In a good position'

The Omicron variant, first detected in Botswana on Nov 11 and South Africa on Nov 14, has been reported by nearly 80 countries and counting. The World Health Organisation (WHO) has warned against dismissing it as a mild disease, noting that a sheer number of cases could still overwhelm unprepared healthcare systems.

Singapore on Tuesday announced a slew of measures to avoid such a scenario, with a strong focus on vaccination as a key plank.

Among other moves, it is considering tweaking the definition of fully-vaccinated from two jabs to include a third booster shot; and will extend vaccination-differentiated measures to more places and events from February. Hospital and testing capacities are also being boosted, including by increasing the number of intensive care unit beds from 280 to 500.

Earlier, border and testing protocols were tightened for countries affected by Omicron and travellers arriving by quarantine-free vaccinated travel lanes (VTLs).

Together, these measures aim to slow the entry of Omicron to Singapore, delay its eventual community circulation, increase the ability to detect its presence as well as protect people while ensuring capacity to care for those who are infected, says Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at National University of Singapore (NUS).

And all in advance of Omicron establishing a permanent foothold in Singapore, he notes. "This to me is a comprehensive response."

Meanwhile, Singapore's reopening plans are continuing in tandem. It now has 24 VTLs, and an arrangement with Malaysia will be expanded from Monday to allow vaccinated Singaporeans and Malaysians to cross the Causeway. Come Jan 1, up to 50 per cent of workers who are currently able to work from home will also be allowed to return to the office.

"The viability of our economy as well as citizen employment are just as important in safeguarding lives and livelihoods," says Dr Woo.

Early in the pandemic, Singapore kept cases in the community to a handful with the help of a two-month circuit breaker, although nearly half of about 320,000 migrant workers contracted the virus while sequestered in cramped dormitories for most of last year.

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This year, the Delta variant was the main menace, sparking several clusters of infections - including at Tan Tock Seng Hospital, Bukit Merah Food Centre, Changi Airport, KTV outlets and Jurong Fishery Port - from April to August.

In September, a protocol switch to mostly home-based isolation led to frustration and confusion over logistical issues - and rapid Covid-19 spread in the community. "This change was not handled well," says Associate Professor Alex Cook, vice-dean of research at the Saw Swee Hock School of Public Health.

"Now that our protocols are more commensurate with what is a mostly mild illness in vaccinated people, we shouldn't experience the same systemic problems."

As daily cases climbed into the thousands from late September and the number of deaths hit a record 18 in a single day in October, public dissatisfaction mounted over a perception of stop-start measures and mixed messaging over the Government's intentions to actually live with the coronavirus.

On Nov 20, nearly two months of strict curbs came to an end, with infection numbers and the hospital situation largely stabilised.

"Throughout the pandemic, Singapore has been a lot more cautious, and also agile, in our responses, particularly in implementing and lifting any public health measures. This has led to the regrettable impression that there are sometimes policy flip-flops," says Prof Teo of NUS.

He points out that the alternative would have been a "blunt sledgehammer approach" of imposing a widespread lockdown, as many other cities have done.

Though the total count now stands at nearly 275,000 cases, most were asymptomatic or mild. And out of more than 800 deaths, most were elderly people with underlying medical conditions, of which a large proportion were also unvaccinated.

Running in parallel to the Delta wave was a vaccination effort that took Singapore's total population from being 8 per cent fully inoculated in April to 87 per cent today. About 30 per cent have also received booster shots, a figure projected to rise to 54 per cent by the end of January.

Singapore's continued focus on vaccination is clear - since Dec 8, the Government has also stopped paying Covid-19 medical bills for those "unvaccinated by choice".

Observers see the high level of vaccination, accelerated roll-out of boosters, increased vigilance in the healthcare sector and at ports and borders, as well as the lack of significant clusters in recent weeks, as indications of Singapore having learnt its lessons of the past 24 months.

This has helped inform the city-state's approach to dealing with Omicron - and put it in a good position to do so, says Prof Cook.

"Almost all adults are vaccinated, a third of us are boosted, and some of us - perhaps 10 per cent to 15 per cent - have been infected already, so the level of protection in the population is quite high," he notes. "If booster uptake is high enough then we might not need to tighten measures."

Defining resilience

During a Tuesday press conference on preparations for Omicron, Health Minister Ong Ye Kung said going back to stricter restrictions must be a last resort.

The Economist Intelligence Unit's country analyst for Asia Yu Liuqing says that unless evidence emerges of Omicron being more lethal and able to escape immunity mechanisms, a tightening in social restrictions would go against Singapore's endemic goal.

Adjunct Professor Lutfey Siddiqi of NUS' Risk Management Institute describes the shift from pandemic to endemic as such: "A transition and evolution of habits, expectations and behaviours even as a race between the build-up of healthcare capacity and mutations of the virus plays out in the background."

Mr Ong this week also said that living with Covid-19 as an endemic disease means that with each wave, Singapore should find itself growing more resilient.

This vision of a coronavirus-resilient Singapore - first raised in the middle of this year - has undergirded the nation's fight against the virus.

According to Prof Siddiqi, Covid-19 resilience is exemplified by not only high levels of vaccination and healthcare capacity, but equally importantly, the state of mind of the people.

"Countries with a policy of clear, consistent and repeated communication about the direction of travel and drivers of decision-making have built social resilience," he explains.

As to whether Singapore ticks this box, the jury is still out, with the Government having to deal with its share of public communication stumbles over the past two years. The result today is a tension between two distinct public schools of thought on its Covid-19 strategy, says Associate Professor Walter Theseira from the Singapore University of Social Sciences.

One is that Singapore should have pursued zero-Covid-19, and that reopening has not been worth the trade-off in infections and deaths. The other is that Singapore has been too cagey in embracing living with Covid-19, with the lessened public health impact not worth the trade-off in economic damage.

"Many people of course take positions somewhere in the middle," says Prof Theseira.

"I think the story of this debate is not finalised yet, as Omicron - or other variants - may cause us to return to this question again."

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