At the stroke of noon on Saturday, two weeks after Singapore reintroduced social distancing measures to deal with a growing COVID-19 outbreak, the country’s Prime Minister, Lee Hsien Loong, stood in front of a sheer curtain and addressed the nation.
He wore an open-necked shirt and his tone was reassuring. Like Australia, Singapore initially pursued an elimination strategy. But last month, after it had reached 80 per cent vaccination coverage and largely reopened for business, case numbers began to rise exponentially. On September 27, it reimposed measures including limits to the number of people allowed to dine in restaurants.
But the Prime Minister’s message to his citizens was to stay the course. Do not go to hospital with mild symptoms. Get vaccinated. Expect numbers to rise.
“We must proceed with our strategy to live with COVID-19,” Mr Lee said. “We need to update our mindsets. We should respect COVID-19, but we must not be paralysed by fear.”
When NSW reopens on Monday with a 70 per cent vaccination rate, there is every reason to expect that case numbers will similarly rise. Former premier Gladys Berejiklian warned that numbers would “go through the roof” when restrictions were loosened. Her successor, Dominic Perrottet, has urged people to continue to get vaccinated and to stay within the rules.
“This journey is not over,” he told a press conference on Saturday. “There is a long way to go.”
But no politician is game to predict what happens next because what NSW is about to do has never been done before. Other countries that have reopened have a base level of immunity in their populations due to previous infections.
Allen Cheng, an infectious diseases physician at Prince Alfred Health, said even Singapore, which had similar case numbers, was an imperfect comparison because it had a different demographic profile – it was a city state and had a tropical climate.
“Australia is pretty unique in that we don’t really have any background protection,” Professor Cheng said.
“We’ve had a large outbreak in NSW, but it’s not comparable to what other countries have had. What probably encourages me the most about NSW is that the case numbers are coming down fairly quickly, so there’s probably a bit of room to move.”
Adam Kamradt-Scott, who helped to prepare Australia’s pandemic plan and is now chair of global public health at the European University Institute, said the biggest challenge for Australians will be getting used to hearing about high numbers of confirmed cases. Even in vaccinated societies, the virus continued to circulate, but people did not end up with severe illness.
“It will be up to leaders to explain this new reality to Australians, and unfortunately we’ve seen some of Australia’s premiers and chief ministers paint themselves into a corner by promising to maintain zero cases,” Dr Kamradt-Scott said.
“That was never a viable long-term strategy. And the challenge for those leaders now is helping their population understand that as their societies start to open up, we can expect to see case numbers rise.”
Singapore recorded fewer than 200 cases when it reopened its restaurants, bars and gyms in mid-August. By the end of the month, it was counting more than 1500 cases a day. Last week, it breached 3000.
But most of the new cases were among the vaccinated, who were 12 times less likely to require hospitalisation or die than the unvaccinated. Some 98 per cent of the new cases had mild or no symptoms.
Ashley St. John, who works in emerging infectious diseases at Duke-NUS medical school in Singapore, said it was important to distinguish between COVID-19 cases among the vaccinated and the unvaccinated, in terms of both managing resources and working out what restrictions were required.
“There are real questions around whether the milder vaccine breakthrough cases should be considered in these assessments or if a revised strategy is needed,” Associate Professor St. John said.
“In the public, I think there is a bit of confusion why the case numbers are increasing when the vaccine coverage is so high in Singapore. One reason for this is because of Singapore’s very aggressive surveillance and testing, which also increased in parallel to the easing of containment measures. This has allowed many more mild and asymptomatic cases to be detected, often in the vaccinated.”
NSW Health Minister Brad Hazzard said it was extremely unlikely that Sydney would face another lockdown (although regional areas with lower vaccination rates might), and other social distancing measures would not be reimposed on the basis of case numbers alone.
“As Health Minister, I’ve learnt to never say ‘never’ in a COVID environment,” Mr Hazzard said.
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