Coronavirus: Singapore should expect gradual reopening, experts say

As Singapore approaches the end of a month-long period of tightened social distancing measures, the big questions on many minds are whether restrictions will be loosened after June 13 and whether a long-awaited travel bubble with Hong Kong can finally begin.

But health care experts, while pointing to positive signs such as a tapering of new cases and more proactive surveillance of high-risk groups, believe measures will be loosened only gradually.

Dr Dale Fisher, professor at the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine, said the current restrictions would have to be maintained “to some degree” as a handful of recent unlinked cases meant Singapore was still “vulnerable”. On Wednesday (June 9), for example, Singapore reported two new cases, one of them unlinked.

Dr Hsu Li Yang, an infectious diseases expert at the NUS Saw Swee Hock School of Public Health, said it was unlikely that Singapore would after Sunday return to the previous situation, in which people were allowed to gather in groups of eight and restaurants, bars and cinemas were allowed to open.

Instead, Hsu expected a gradual relaxation, suggesting that social groups of between two and five would be allowed and that people might be able to eat inside restaurants, albeit with distancing requirements. Hsu also thought that residents would still have to wear masks in gyms.

This would be similar to the restrictions imposed from June to December last year, during which eating inside restaurants was allowed and social gatherings were limited to five people.

The current harsher restrictions that began on May 16 banned dine-ins and moved classes online. Working from home became the default and social gatherings were limited to just two people. These restrictions came on the back of rising infections, with 533 domestic cases clocked in May, compared to 55 in April.

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Fisher, who chairs the World Health Organisation’s Global Outbreak Alert and Response Network, felt reopening restaurants to dine-in customers would be “most contentious” as it would involve people removing their masks.

Meanwhile, for those eagerly waiting for the quarantine-free travel bubble with Hong Kong, Singapore’s recent case numbers may be encouraging.

The country’s seven-day moving average of unlinked cases stood at 0.86 as of Wednesday, while Hong Kong’s was 0.14.

Previously, both sides had said that for the bubble to resume, the moving average on the last day of suspension should be under five, among other indicators.

Hong Kong authorities had previously said that an announcement on when to resume the launch of the travel bubble would be made on or before June 13.

The experts’ views come as the health ministry released figures this week showing that the B. 1.617 delta variant, which was first reported in India and is thought to be more contagious, is the dominant strain in Singapore.

A ministry spokesperson told This Week In Asia that 428 local cases were confirmed to have the B. 1.617.2 sub-variant as of May 31. There were seven cases found with the B.1.1.7 alpha variant that was first reported in Britain, nine with South Africa’s B. 1.351 beta variant, and five with the P1 gamma variant first reported in Brazil.

“Based on the cases we have seen, the current understanding is that some of the [variants of concern] such as B. 1.671.2 are more transmissible,” the spokesperson said.

“However, we have adapted our measures accordingly and the number of locally transmitted cases has decreased over the last two weeks.”

The delta variant is also taking a toll on other countries. In Britain , the mutant strain has forced the country to reconsider its plans to fully reopen this month and in India , it has been linked to unusual symptoms such as hearing loss and blood clots leading to gangrene , which suggests that its impact may be more severe than other strains.

Hsu, the infectious diseases expert, said there had been sporadic reports of hearing loss previously but these had increased with the delta variant.

Blood clots were “rare” but had been documented in earlier severe cases, he said, adding that more data was needed to tell whether these occurrences were more frequent.

Fisher, the NUS medicine professor, said: “Covid-19 is a nasty disease for many; these and other complications together with the threat of long-term complications are all reasons we have wanted to keep numbers as low as possible.”

Dr Jeremy Lim, an associate professor at the NUS Saw Swee Hock School of Public Health, said the public should not be concerned about variants going undetected because Singapore had a “very robust monitoring framework”.

He added that vaccination rates must go up to 75 to 80 per cent for Singapore to step far away from the “knife’s edge” – a description that Singapore officials have used previously to describe the virus situation.

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Hsu thought authorities would want to vaccinate at least half the population before further easing measures, while Fisher said measures should be controlled “until everyone has had the opportunity to be vaccinated and the vast majority have taken it”.

As of June 7, 33.1 per cent of Singapore’s 5.7 million population had been fully vaccinated while a further 10.8 per cent had received one dose. Authorities last month announced the city state would start vaccinating students, and would stretch the interval between the first and second doses to six-to-eight weeks to get more people inoculated.

The country currently uses the two-dose Pfizer-BioNTech and Moderna vaccines , and inoculations are available for students and those aged 40 and above. The last group of residents – young adults aged below 40 – will get their jabs starting mid-June. Two-thirds of residents are expected to have received at least one dose by early July.

Singapore has also recently allowed residents to opt for alternative vaccines via the private route. This would apply to vaccines approved under the World Health Organization’s emergency use listing, including Sinopharm, Oxford-AstraZeneca, Johnson & Johnson and Sinovac.

Singapore received a shipment of 200,000 Sinovac jabs in February but its drug regulator has yet to approve them for local use. Yet, there has been an ongoing debate surrounding the efficacy of the Chinese vaccine , which uses a more traditional technology involving an inactivated virus compared to the Pfizer-BioNTech and Moderna ones that use a newer mRNA technology.

A group of 12 doctors had earlier penned an open letter calling for children to be given non-mRNA vaccines, citing fears of “unknown and unstudied” long-term side effects. Online, others urged the government to include Sinovac in the national vaccine programme, and messages alleging that mRNA vaccines are ineffective against variants of concern have circulated.

But a government-appointed expert committee on Monday refuted those claims, saying there was “no evidence” that inactivated virus vaccines were more effective against the variants. Eleven of the 12 doctors later retracted their statements.

Authorities had earlier said that some 20 private clinics would soon be selected to administer the Chinese jabs, and that they would be free.

This article was first published in South China Morning Post.