Having passed the 80 per cent double-vaccination mark last month, the example of Singapore suggests that achieving a milestone coveted by Australia is not a guarantee of returning to anything like pre-pandemic life.
The island state reluctantly delayed reopening measures and reimposed some restrictions last week after seeing its highest daily COVID-19 infections in more than a year.
On Sunday, the nation of 5.7 million people reported 555 new local COVID-19 cases, the most since August 2020.
A day earlier, it recorded its 58th death, a partially vaccinated 80-year-old man with a history of diabetes, hypertension and heart problems.
Singapore’s Ministry of Health last week banned social gatherings at workplaces after recent clusters in staff canteens and pantries, believed to have been caused by employees removing their masks in common areas.
With Singaporeans told to limit social gatherings to one per day, Gan Kim Yong – co-chair of the multi-ministry task force – said the “worrying” spike in infections would “probably get to 2000 new cases a day”, describing the next two to four weeks as “crucial”.
Alex Cook, an infectious diseases modelling expert at the National University of Singapore, said life had not improved “by as much as we might have hoped”, despite Singapore being one of the world’s most vaccinated countries.
The nation has relied mostly on the Pfizer and Moderna vaccines, with a handful of older residents opting for China’s Sinovac. Last month, it agreed to a 500,000 Pfizer dose swap deal with Australia.
“The community cases have actually gone up since reaching 80 per cent coverage, in part because we’re allowing more social events for those who are vaccinated and, I dare say, more fatigue at the control measures,” Mr Cook told the ABC.
“One main lesson from across South-East Asia is that it is incredibly hard to prevent Delta’s spread and, as Singapore shows, even high vaccination rates will not help that much,” he said.
“We’re finding quite a lot of breakthrough infections among vaccinated people, but these are mostly mild or asymptomatic.”
Singapore has only 35 seriously ill COVID-19 patients, with seven in ICU, according to its Ministry of Health.
With 50 per cent of Singaporeans now allowed to return to the office and most using public transport to get there, the city last week announced that more than 300 COVID-19 cases had been linked to eight bus depots across the island.
And it closed the popular Chinatown Complex, frequented by seniors over the age of 60, after a cluster of 44 infections.
Achieving 80 per cent ‘too low for Delta’
Leong Hoe Nam, an infectious diseases expert from Singapore’s Rophi Clinic, said the Delta strain had moved the goalposts, in terms of what level of community vaccination was necessary.
“They set a target of 80 per cent, which is too low … it would have worked fine for the Alpha strain but this is Delta, a variant with easily two to three times more transmissibility,” Dr Leong said.
“They now need at least 90 per cent vaccination, which is technically not possible due to hardened anti-vaxxers or refusers.”
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Dr Leong said 80 per cent was “not good enough because it can still burden the hospital system very significantly and there will be too many excess deaths”.
“The numbers are mind-boggling, given what’s possible over the next few weeks,” he said.
Prime Minister Scott Morrison set a vaccination target as part of his four-step opening plan for Australia, with phase C triggered when double vaccination reached 80 per cent.
However, Australia’s threshold is actually lower because it is based on the population aged over 16.
Singapore’s threshold is based on the total population.
Mental health issues rising
Although Singapore has not endured as many lockdowns as Sydney or Melbourne, clinical psychologist Annabelle Chow said she had seen a 20 to 30 per cent rise in people seeking counselling at her practice since the pandemic began.
And she said the most recent setback with Singapore’s increased infections was already taking a toll.
“We’re not any different in experiencing pandemic fatigue, compared to other countries, and don’t forget most of us live in tiny spaces here, without the countryside of Australia,” said Dr Chow, who runs practices at Novena and Newton near Singapore’s CBD.
“Despite achieving 80 per cent vaccination, Singapore has taken a conservative approach in terms of opening up … given our population is so concentrated, it means that any spread moves very quickly.
“So, mental health professionals are trying to help Singaporeans live in a new normal, and not thinking about returning to an old normal, while accepting rules are going to change very frequently.”
Glenn van Zutphen, an American radio host who runs Singapore’s Van Media Group, said it had been difficult to negotiate “the changing official guidance” on COVID-19.
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“We know we will get through it but, in the meantime, the uncertainty of how and when is taking an economic, physical and mental toll on people here,” he said.
Singapore opens up to Germany
Renowned as an international hub, Singapore last week opened a limited travel corridor that allows fully vaccinated people to enter the country without undergoing quarantine.
The Vaccinated Travel Lane accommodates travellers from Germany and Brunei who are required to take PCR tests before departure and on arrival at Changi Airport.
Dr Cook said the risk of the program was negligible, because “even if travellers bring another 50 cases that will have very little effect on community risk”, given the current high rate of infection.
“With 90 per cent of the eligible age groups vaccinated, society is quite resilient now to severe disease, and so a greater range of travel corridors should be considered,” he said.
With neighbouring Malaysia and Indonesia still inaccessible, Dr Chow said the ability to step on a plane again had lifted the spirits of stir-crazy Singaporeans.
“There’s some light at the end of the tunnel, given that that we have travel bubbles with Germany and Brunei and also we can now dine out in groups of five,” she said.
‘Bring mountain to Mohammed’
As for what Australia can learn from Singapore, in terms of ramping up vaccination rates towards 80 per cent and beyond, Dr Leong said the federal government needed to “bring the mountain to Mohammed”.
“There are many people who would agree to being vaccinated but find it inconvenient to get to vaccination centres,” Dr Leong said.
“But, they will take the vaccine if you go to them, which is what we did in Singapore, including individuals who are bed-bound or with other medical conditions.”
Dr Chow – who studied at Monash University and Deakin University in Victoria – warned locked-down Australians not to think of the 80 per cent vaccination mark as a cure-all panacea.
“It doesn’t mean the end of the pandemic, as we’ve seen here in Singapore,” she said.
“Eighty per cent is just a plaster onto the problem. We still don’t know what’s going to happen under plaster with the wound.”
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