FEEDBACK TO MOH
3 IMPORTANT QUESTIONS
(A) Is COVID-19 a severe illness?
(B) Where is the real worry?
(C) What new steps can we take?
(A) This seems like an imprudent question to ask given the apparent widespread and worldwide casualties and deaths since early 2020. But, to answer this question honestly and objectively, we need to put things in perspective. How do we measure severity? Is it by the number of persons infected? By the number of people hospitalised or needing oxygen therapy? Or by the numbers who died?
Here, in Singapore, after 21 months of the Pandemic, we are currently seeing the highest number of “cases” (defined as anyone with a positive PCR Test) and highest number of daily deaths. But official Government statistics consistently as of 30 Sep 2021, 12pm, over the 28 days immediately prior to reporting, of the infected individuals, 98.1% have mild or no symptoms, 1.6% requires oxygen supplementation, 0.2% requires ICU care, and 0.1% has died. So, yes, the “cases” are rising, but the proportion needing special hospital care or end up dying is really minuscule at 1.9% of cases. So, perhaps thanks to our high vaccination rate, the vast proportion of the infected can actually be safely treated as outpatients like any common respiratory illness and therefore there is no need to close down large parts of business, educational or social activities to cope with the outbreak.
Of course, every death is one death too many and we should try our very best to prevent it. But, it is a fact of life that people DO die from respiratory illnesses. If pro-rated, so far, Covid-19 has killed 54-55 residents per 12 months. This is actually very low compared with the 588 – 844 annual fatalities associated with Influenza. If we desire to lower these numbers, our efforts should be targeted at those elderly with significant chronic illness either by enforced social distancing and vaccination, prophylactic and early treatments like subcutaneous monoclonal antibodies, early hospitalisation and close monitoring, not just for Covid-19, but for any respiratory illness in the future that may cause significant mortality.
Furthermore, as of 29 Sep, 82% of our population have completed their full regimen/received 2 doses of vaccines. Nothing much more can be done for the non-elderly, low-risk sector of the population to further lower their risk.
So, I think It is reasonable to say that Covid-19 is not a particularly severe respiratory illness to warrant a pessimistic outlook for the near future.
=====================================
(B) Even so, if 82% of the population are now fully vaccinated and, as CDC studies show, are 5 times less likely to be infected, 10 times less likely to be hospitalised and 11 times less likely to die, why did cases rise in mid-July and exploded from late August 2021 till there are now 2,909 new cases on 1 October, and why did nearly two-thirds of our total pandemic deaths (66 out of 103) occur in the last 2 months of the 21-month-old outbreak?
So regrettably, there is still cause for worry. But then, where are the problem areas that we need to address? No, our safe management measures like border control, mask mandates, good hand hygiene, controlled unmasked dining-in, pre-event testing, on-line learning, work from home, contact-tracing, quarantine orders and home recovery schemes are all working well. Even without the 3rd booster dose, our vaccines are still able to prevent serious illness, hospitalisation and death. No. What is driving the spikes in cases and death is the nature of the Delta variant whose high transmissibility allows it to find its way to infect more people especially the unvaccinated and its higher virulence will kill more people especially the elderly and the vulnerable. Therefore, there is a need for targeted action.
=====================================
(C) Given the almost paradoxical realisation that Covid-19 is not a major society-wide problem, but is a significant problem for a selected sector of the population, let me propose our next steps as follows:
(1) Acknowledge the above facts, the present situation and the futility and aimlessness of routine prospective active detection of asymptomatic infections in low-risk populations.
(2) Declare and clearly define the aim(s) of all future anti-Covid-19 actions.
(3) Empower all low-risk people whether as individuals or as mutually-supportive members of a family to take charge and assume personal responsibility for their own safety measures and if they were to succumb to mild ARI, seek appropriate medical treatment at primary care and jointly decide with the doctor on a practical plan of home isolation till recovery.
(4) The Pandemic Task Force should focus on the high risk group, by defining it, by using technology to conduct routine surveillance, by monitoring, testing, isolating, providing prophylaxis and early treatment and managing their hospitalisation.
(5) With safeguards and the systems (4) in place, Singapore can return to business and return to normal life.
(6) To ensure that the aim(s) in (2) are achieved.
(7) Establish a new template for the public management of large-scale respiratory infections, including seasonal influenza under clearly-defined mortality ceilings or trigger points. This will set the SOP (standard operating procedure) for preventing further disruptions to Singapore’s economy and society by future viral outbreaks.
With this road-map and its tangible steps published for the public, I think it will give everyone more clarity of the path ahead, more certainty and a more positive sense of hope for returning to our normal life soon.
