Singapore has opted for phasing in the easing of circuit breaker measures over several weeks, perhaps even months, despite the fact that the number of new community cases a day has been low.
Some are asking if Singapore is moving too slowly, as the economy is suffering and people are feeling the strain of the social restrictions.
But a graduated opening is the wisest course, say experts.
Based on experience with past pandemics, opening up the country too quickly could lead to a second wave of infections that is even worse than the first, said Professor Teo Yik Ying, dean of the National University of Singapore’s Saw Swee Hock School of Public Health.
During a panel discussion on The Big Story on Friday, he said: “There will be countries that will definitely experience a second wave of infection. And we saw from experience with the Spanish flu that the second wave can be much more deadly than the first wave.”
The Spanish flu, which started in 1918 and lasted two years, killed more than 20 million people – some estimates say as many as 50 million – with the majority falling victim during the second wave caused by a mutated and more virulent virus.
Professor David Heymann, infectious disease epidemiologist at the London School of Hygiene & Tropical Medicine, agreed that “a phased-in unlocking is very important”. Each country has to do its own risk assessment of different sectors and “see where transmission has occurred in the past and where it might be safe to open up first”, he said.
Singapore’s slower approach in easing measures will be better in the long run, Prof Teo said, as “even if we do have a second wave, a very small resurgence, that our current measures – very aggressive testing, very comprehensive contact tracing – will be able to keep a lid on”.
But countries that do not contact trace and quickly isolate people infected with Covid-19 “are almost guaranteed to experience a second wave”, he said.
Sensible governments “are putting in place this very slow easing, and this stress testing of different sectors, allowing particular sectors to resume in a slow manner, because that is the only way that you can figure out which sector in your particular country is likely to experience a resurgence of infection”.
But he cautioned that what works in one country may not necessarily work in another because of cultural, political and fiscal differences.
Singapore was caught off guard by the surge of cases in foreign worker dormitories in March. That outbreak, in spite of measures the Government has since deployed to test and separate groups of workers, is still raging.
For every step that we take, we learn from it and we adjust along the way till one day we know more about this virus and we know a better coping mechanism.
PROFESSOR LEO YEE SIN, executive director of the National Centre for Infectious Diseases.
It’s safe to say that nobody can guarantee that when we ease some of these restrictive measures that there will not be a resurgence.
PROFESSOR TEO YIK YING, dean of the National University of Singapore’s Saw Swee Hock School of Public Health.
It makes much more sense epidemiologically than just locking down a whole society without any exit plans, which is what happened in many European countries.
PROFESSOR DAVID HEYMANN, infectious disease epidemiologist at the London School of Hygiene & Tropical Medicine, on Singapore’s exit strategy, which aims to keep community spread low.
Though the number of new cases among these workers has fallen from the high of more than 1,000 people infected a day seen last month, the outbreak there is still not under control, with hundreds of people infected every day.
Professor Leo Yee Sin, executive director of the National Centre for Infectious Diseases, also does not believe in rushing to return to normalcy.
She said: “It is important for us to take a ‘stepwise’ measure. For every step that we take, we learn from it and we adjust along the way till one day we know more about this virus and we know a better coping mechanism.”
Some people have pointed out that activities and businesses not allowed when phase one of the easing of measures starts on Tuesday pose no higher risk than those allowed to resume. The Government’s criteria were to allow more critical sectors to resume working on-site first.
Prof Teo explained that it is not so much the risk of any particular activity, but rather how people taking part behave.
“When people return to work on-site, children go to school, the public taking public transportation, all of these activities can be very low risk if everyone is taking the necessary precautions – or they could be very high risk if people are behaving irresponsibly and not taking personal responsibility.”
Prof Heymann agreed that underpinning the easing of restrictions “must be an understanding by the population of how to protect themselves and how to protect others”.
Prof Teo added: “It’s safe to say that nobody can guarantee that when we ease some of these restrictive measures that there will not be a resurgence.”
How bad any resurgence would be also would depend on the resources available to quickly isolate cases and trace people who may have been infected. If large numbers of people are infected daily, this becomes more difficult.
But Prof Teo said the risk of Covid-19 is actually lower now than before the circuit breaker measures kicked in. This is partly because more is known, such as “the coronavirus spreads the best when people are interacting in fairly close proximity, perhaps over an extended time, be it talking or eating together”.
This is why many “sensible governments worldwide” are telling people to practise social distancing, to wash hands frequently, minimise physical interactions, and wear a mask, he said.
Countries also need to know the activities that are most likely to result in an increase in transmission, and opening up slower allows for this.
‘A GOOD STRESS TEST’
This is why, although as a parent Prof Teo would like to see his two children (in Primary 4 and 6) back in school full time, Singapore’s decision to allow children to physically return to school only on alternate weeks is a good move.
He said: “It is actually a very good way to stress test the system.”
While it is believed that children are less likely to get infected, and if infected, to have a milder illness, they could bring the disease home to their families.
Prof Heymann praised the way Singapore had initiated the circuit breaker measures, starting with fewer measures but adding more when there was a need.
As a result, the transmission of the coronavirus in the community has been kept low. Singapore has also planned its exit strategy with the aim of keeping community spread low.
Said Prof Heymann: “It makes much more sense epidemiologically than just locking down a whole society without any exit plans, which is what happened in many European countries.”
As to whether it is safe for restaurants to reopen for dine in, since people cannot wear masks when eating, Prof Heymann said: “Many restaurants in Europe have opened up but only outside, while others are opening up inside with physical distancing between tables. We will see what that brings. And I think they will always be ready to lock down again if necessary.”
Prof Leo spoke of having to balance hospital capacity to treat and allowing economic activity to return. Opening up slowly and keeping the number of Covid-19 patients low will allow the healthcare system to take care of patients suffering from other health issues.
The Ministry of Health had told public hospitals in February to hold back on non-urgent treatments, fearing a surge in Covid-19 cases that would require large numbers of hospital beds.
Said Prof Leo: “Many of the healthcare services have been ongoing, but there are certain clinical services that we put on hold and we cannot be putting them on hold forever. We have to bring them back into the care system.”
This will be possible only if Singapore does not face a surge in cases once the circuit breaker measures are relaxed.