Singapore's return to tighter rules raises the question: what does living with Covid-19 really mean?
After Singapore this week reimposed Covid-19 restrictions that were eased just days earlier amid raised hopes that the city state would adapt to living with the virus, the frustrations of whiplashed Singaporeans were laid bare on social media.
On Facebook and LinkedIn, some wrote long posts questioning whether the government's Covid-19 task force, partly comprising younger ministers from the People's Action Party (PAP), was too risk-averse to weather a surge in cases without hitting the panic button.
The task force co-chairs, including Health Minister Ong Ye Kung, earlier this month outlined plans to transition to a new normal - effectively treating Covid-19 like the flu once a critical mass of the population was vaccinated.
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Instead of monitoring infection numbers, they said, the focus would be on outcomes, such as the number of patients in intensive care (ICU) or needing oxygen.
This new approach was challenged when daily caseloads - linked to clusters among fishmongers and patrons of clandestine karaoke bars - rose to their highest since last year's outbreak in foreign worker dormitories. As of Thursday, the two clusters accounted for 781 infections.
Officials were particularly unnerved by the cases linked to the Jurong Fishery Port, which they feared would expand quickly in markets and adjoining cooked food centres patronised by the elderly. About half of Singapore's 5.7 million population has been fully vaccinated, while 73 per cent have received at least one vaccine dose. Among citizens 70 and older, 71 per cent are fully vaccinated
The government task force, which initially pursued a "zero-Covid" strategy similar to Hong Kong, Taiwan and Australia, said it would not risk turbocharging the new clusters.
Restrictions imposed in May and June after a previous spike in cases were thus reinstated: no dining out, most gym activities banned and social gatherings, including visitors to households, capped at two people. They will remain until August 18, and the country's National Day Parade on August 9 has been postponed to August 21.
One of Singapore's most recent clusters emerged among fishmongers near wet markets. Photo: EPA alt=One of Singapore's most recent clusters emerged among fishmongers near wet markets. Photo: EPA
Public anger over the policy flip-flop was immediately palpable after Tuesday's announcement, with people pointing to the steadily increasing vaccination rate and the relatively small number of patients in hospital compared to other cities battling the Delta variant. Of the 415 people currently hospitalised, eight are in serious condition, with one patient in ICU.
Health Minister Ong sought to mollify frustrated citizens, saying on Facebook that the country was just two weeks away from having 64 per cent of its population fully vaccinated.
"Given the gravity of the Jurong Fishery Port cluster, we felt it is not the time to risk it all now," he wrote, noting that his friends along with members of the public were asking why restrictions were reinstated "when we plan to live with Covid-19".
In comments responding to his post, many thanked him for the clarification. Some, however, asked if the government was too risk-averse and overreacting to accommodate unvaccinated residents.
"The country shouldn't suffer for a small group of stubborn individuals who refuse to get vaccinated," one commenter, Faisal Abdul Aziz, wrote in response to Ong's post. "Perhaps a more equitable policy is to ban unvaccinated people from entering the hawker centres [and] wet markets. Of course exceptions should apply to those with allergies."
Political observers said the public frustration reflected the country being "caught in transition" between its initial "zero-Covid" strategy and its plans to begin treating the virus as endemic after a critical mass of residents were vaccinated.
"This results in the apparent lurch from over-exuberance to over-cautiousness," said Eugene Tan, a commentator and an associate law professor at the Singapore Management University. "It leaves all of us unsure of what living with Covid means."
A major spike in cases last year was driven by infections in Singapore's foreign worker dormitories. Photo: Reuters alt=A major spike in cases last year was driven by infections in Singapore's foreign worker dormitories. Photo: Reuters
Analysts who spoke to This Week in Asia acknowledged that the government's fear the new clusters would overwhelm the health system was not entirely alarmist.
Health Minister Ong told Tuesday's press conference that if 10 per cent of the roughly 200,000 unvaccinated residents older than 60 were infected, about 2,000-3,000 ICU beds would be required to treat them. The country has allocated 1,000 ICU beds for Covid-19 patients.
However, Ministry of Health data currently shows that in the past two weeks, there have been 450 local cases in people aged 19-39 and 76 new cases in people older than 70.
Some Singaporeans compared their situation unfavourably to the scenes of celebration in the US, Israel and Britain, where restrictions have largely been lifted after the countries reached vaccination levels on a par with Singapore. For example, Britain, which removed most of its restrictions last week to great fanfare, has a vaccination rate of 54.4 per cent.
Dr Paul Tambyah, the president of the Asia-Pacific Society of Clinical Microbiology and Infection, suggested the government's stance reflected a kiasu streak - a Hokkien phrase co-opted into the local Singlish lingo that describes a fear of losing.
Tambyah said the Delta variant's impact on Singapore's health system was "unlikely to be significant" given Singapore's current vaccination rate. He warned that compliance would likely fall away if restrictions were prolonged.
Tan, the law professor, said the frequent reinstatement of restrictions risked eroding public trust in the PAP to effectively manage the crisis.
"What people expect is to look forward with hope rather than being mired in rollbacks and setbacks," he said.
Others sympathised with the government. National University of Singapore (NUS) sociologist Tan Ern Ser said officials were inclined to err on the side of caution and preferred to have a "comfortable buffer rather than living on the edge".
The government also faces domestic pressure as "the people have high expectations of its ability to deliver safety and security in the face of external threats, and therefore any 'slip-up' would be seen as making a big dent on its track record", Tan said.
Health Minister Ong has targeted a 90 per cent vaccination rate among senior citizens. In light of this, Dr Jeremy Lim of the NUS Saw Swee Hock School of Public Health questioned whether the government had been proactive enough in encouraging vaccination, particularly among the elderly.
"It's surprising that Singapore, which has been so clear-headed about how national service [mandatory military service for able-bodied males] and water technology are existential and taken decisive measures to ensure defence and water security, seems so soft on vaccinations," Lim said.
Authorities have so far relied on public service messaging and medical teams making house-to-house visits to persuade elderly residents to get vaccinated. Those who have mobility problems are eligible to receive their shots at home.
Lim suggested making vaccinations mandatory for dining out, entering markets and taking public transport could increase vaccination rates among the elderly.
Ashley St. John, an immunologist at the Duke-NUS Medical School, said the government could consider requiring all travellers entering Singapore to be vaccinated or relaxing the eligibility criteria for people to receive vaccines.
Allowing even those on short-term visit passes to receive vaccines would be beneficial as these visitors interact with the rest of the population on a daily basis, St. John said.
Activists have suggested that those in legal grey areas, such as sex workers plying their trade on social visit passes, need access to vaccines without fear of detention.
The first reported case in the karaoke club cluster was an unvaccinated hostess on a short-term visit pass.
One non-health matter being parsed meanwhile is how the younger PAP ministers, known as "4G" or fourth generation leaders, weather the criticism they are currently facing.
Among them, Health Minister Ong, Finance Minister Lawrence Wong and Education Minister Chan Chun Sing are considered likely candidates to succeed Prime Minister Lee Hsien Loong, 69.
Lee's government has been widely praised at home and abroad for its steady hand during the pandemic. At low points, such as in April last year when mass infections broke out in dormitories, the government rallied quickly to assuage public frustration.
Elvin Ong, an assistant professor of political science at NUS, said the ups and downs would likely help the 4G group "sharpen their political nous [by] judging when to accept public frustration and change policy course, and when to push back against public frustration and persuade the public of the correctness of a policy".
On the other hand, law professor Tan said the younger ministers had yet to prove their mettle and that pandemic policy-making has been "patchy".
Ultimately, voters may remember only the "major slip-ups", said Tan, a former nominated member of parliament, referring to the karaoke cluster, the dormitory saga and a more recent cluster at Changi Airport.
Some citizens blamed the airport cluster on the government's failure to shut its borders to India early enough after the country's surge in Delta variant cases began in March.
Tan said the government deserved credit for the overall outcomes, but there was a risk of it appearing reactive.
"All of which doesn't help the standing of the 4G leadership," he said. "This state of affairs has led to speculation that the 4G leadership is not equal to the task or that they are unable to work as well as they ought to, so this litmus test for the 4G leadership may not reap political dividends and mileage for the putative leadership."
This article originally appeared on the South China Morning Post (SCMP).
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