The second phase of the Great Singapore Reopening started last Friday, with Singapore joining a raft of countries worldwide that are easing their Covid-19 lockdown measures.
Students are returning to school, and the retail, sports, and food and beverage sectors are reopening. Many European countries have begun opening their borders in an unrestricted manner to allow mass market tourism to resume for the upcoming summer season.
At the same time, worrying trends continue to emerge from countries that reopened earlier. In South Korea, schools were once again closed following outbreaks in Itaewon nightclubs and a distribution centre in Bucheon.
China escalated its Covid-19 emergency response level to the second highest level after an outbreak in a Beijing wholesale market, and reimposed a series of lockdowns on schools, restaurants and public venues.
The question at the heart of this is, how do we benchmark how well a country is doing in containing the Covid-19 crisis?
After all, Singapore went from being heralded internationally as the “gold standard” to a more sombre “cautionary tale” within a mere span of two months, when case numbers spiked owing to infections spreading within the foreign worker dormitories.
BEYOND INFECTIONS TO LIVELIHOODS
Globally, the singular fixation on daily case numbers as an indicator of performance has fuelled volatility in stock markets and media frenzy, especially as they are viewed as harbingers of second waves of infections and thus, lockdowns.
Indeed, pundits and detractors have been quick to interpret Singapore’s rising case counts as a sign of failure, focusing on the oft-cited figure of how Singapore is one of the worst performing countries when measured on the number of infections per capita.
However, the measure of a country’s ability to manage the Covid-19 outbreak goes beyond a simplistic focus on daily case numbers – an indicator which dangerously ignores the impact of the outbreak on the economy and livelihoods when considered in isolation. After all, a country can maintain a very low case count with an indefinite and complete lockdown, but that naively neglects the ancillary harms caused by failing businesses and rising unemployment.
Worldwide, numerous countries are buckling under the economic strain of extended lockdowns and have opted to relax their restrictions despite worsening Covid-19 situations locally. The necessity of preserving livelihoods means countries need to move beyond their preoccupation with infection numbers and towards a more holistic systems-level consideration of what truly matters in an epidemic such as Covid-19.
What are some of these considerations?
SEVEN INDICATORS BALANCING HEALTH, ECONOMY AND SOCIETY
• First, the Sars-CoV-2 coronavirus responsible for Covid-19 is extremely infectious. What this means is when a country relaxes its restrictions on people’s movement both internally and across borders, it is inevitable that said country will begin to detect more infections.
As such, what matters more is how quickly the country can pick up new cases and break transmission chains in the community. This is a direct function of how aggressively testing is performed, how comprehensively contact tracing is executed, and how rapidly exposed contacts are identified and quarantined.
• Second, the science suggests that the coronavirus affects people differently, and severe health complications can arise in certain groups of people, sometimes leading to death. However, the majority of infections result in mild symptoms with no long-term health consequences.
Thus, it is important to recognise the ability of a country to minimise deaths and severe complications as a result of Covid-19 infection, be it through appropriate use of science to decant mild patients out of acute hospitals to preserve vital healthcare resources for those who require them, or through adequate preparations of healthcare infrastructure, workers and protocols to ensure flawless clinical execution during a crisis.
• Third, every country must be appraised by its ability to keep the members of its healthcare workforce protected and safe as they go about their work saving lives, regardless of the extent of Covid-19 spread in the community. Minimising nosocomial infections (infections caught in a hospital) must be a leading priority for any health system during an outbreak.
• Fourth, a country should be appraised by its ability to provide the necessary financial safety nets to those infected with Covid-19 to ensure they do not fall into catastrophic poverty as a direct consequence of seeking treatment and care. This guarantee of universal health coverage is even more urgent in the context of Covid-19, where it is essential to eliminate barriers to people coming forward to seek treatment.
• Fifth, measures introduced by governments to minimise community spread directly translate to economic hardship for both individuals and businesses. Whether this is caused by reduced patronage due to safe distancing requirements or a drop in consumption because of a lack of consumer confidence, economies around the world have reported sharp declines.
As such, the fiscal support for individuals and businesses cannot be overlooked as one evaluates the response of a country, especially since this directly impacts livelihoods and unemployment rates.
• Sixth, one oft-overlooked consequence of Covid-19 is its impact on the global food and medicine supply chains. To many, this appears to be a macroeconomic issue and not directly relevant in measuring the preparedness of a country during the crisis.
However, the ability to protect lives and livelihoods through ensuring a resilient and uninterrupted food and medical supply chain is an existential issue to a country, and is thus an integral aspect when benchmarking a country’s overall response.
• Seventh, countries need to transparently gauge their efforts to protect and provide for the most vulnerable and neglected populations in the community throughout the Covid-19 episode.
Population segments such as migrant workers, the low-income earners, elderly individuals without meaningful family support, prisoners and commercial sex workers are often overlooked when governments consider their national response measures. The reality with Covid-19 is that all of society is vulnerable when the most vulnerable in society are inadequately cared for.
STOCKTAKING FOR THE NEXT OUTBREAK
Singapore, like many other countries, will continue to further ease national restrictions. This is necessary to allow lives and livelihoods to regain a much-needed sense of normalcy. As Covid-19 is likely to stay with us for the foreseeable future, this is perhaps an opportune time for every country to take stock of its response and identify crucial gaps.
Thus far, we have been fortunate. Previous investments in public health and clinical healthcare laid the foundations for Singapore’s strong Covid-19 response that was focused on rapid tracing and containment of community outbreaks. This, coupled with a strong clinical management approach, has resulted in Singapore’s Covid-19 fatality rate being among the lowest in the world.
Stringent safety protocols have protected our healthcare workers: Although we have recorded some cases of healthcare workers contracting the disease, unlike many other countries, very few were infected in the line of duty.
Since the beginning of the outbreak, Singapore has provided full financial coverage of all Covid-19-related medical bills. We also announced four separate fiscal packages amounting to almost $100 billion to minimise the pandemic’s impact on livelihoods.
Extensions and expansions of multilateral agreements have further strengthened Singapore’s position to weather global shocks to food and medicine supply chains.
The outbreak in the migrant worker dormitories has painfully highlighted the fact that we overlooked vulnerable segments of the population during this pandemic. We would do well to adopt a comprehensive approach in identifying these segments and ensuring that our public health and fiscal safety nets are properly inclusive.
While it appears that Singapore has fared reasonably well up to this point, we must recognise that the road ahead is long. We must remain vigilant and cautious because every victory that we have gained in this pandemic has been hard-earned, and moving forward, how long we can celebrate or enjoy each victory hinges on our collective civic-mindedness, conscientiousness and care for our community.
We should all remember this as we ease into phase two.
• Professor Teo Yik Ying is dean of the Saw Swee Hock School of Public Health at the National University of Singapore.