Singapore – Only 60 people in Singapore have died from COVID-19 since the pandemic first emerged, and some 82 percent of its population is now fully vaccinated against the disease.
In June, the government announced it would move towards a “living with COVID-19” strategy, focusing on tracking and treating outbreak clusters with vaccinations and hospital admissions – but without the strict lockdowns, border closures, and work-from-home orders that have been the defining feature of much of the pandemic across the world.
That month, it began the gradual easing of its coronavirus curbs, but the weeks since have laid bare the challenges of moving from pandemic to endemic.
Relaxed restrictions have sent cases soaring. Reopening plans have been delayed and some restrictions have been re-imposed, giving lockdown-weary Singaporeans a renewed sense of deja vu.
After months of relatively low numbers of daily new cases, over the weekend Singapore reported crossed the 1,000 mark for new daily cases, the highest since April last year.
Health officials found 1,012 new cases on Sunday, up from 1,009 new cases on Saturday. There were 873 patients in the hospital on Sunday (up from 863 on Saturday), with 118 serious cases requiring oxygen support (up from 105 on Saturday), and 21 in critical condition in the intensive care unit (up from 18 on Saturday).
The government has called the increase a “rite of passage” as the island nation adapts and adjusts its hoped-for model of living with – as opposed to eradicating – the virus and its variants.
“We are on a path of transition to a new normal of living with COVID-19,” Health Minister Ong Ye Kung told a virtual press conference on Friday. “It is a journey that is uncertain and full of twists and turns.”
Public hospitals are seeing a surge in the number of patients but the vast majority – more than 98 percent – are asymptomatic or with mild symptoms, so health officials are now urging them to go to a general practitioner or clinic to free up hospitals for urgent care.
On Saturday, health officials expanded home recovery as the default care management model for fully vaccinated COVID-19 patients aged 12 to 69 without severe symptoms. Seven in 10 patients are expected to qualify for home recovery under the new scheme, which is designed to relieve the pressure from growing caseloads on hospitals, intensive care units, and the healthcare community’s capacity to cope with what feels like an endless battle.
Dr Ong Eu Jin Roy, a family physician in Singapore, says medical workers are nearing exhaustion.
“We’ve been enduring, but there has to be an endpoint where we can see the goal post,” Ong said. “When the government wants us to open up and be endemic, I think that’s great, because really we are reaching the end of our limits. You cannot be in a heightened alert state where the adrenaline is going every day that you go in. It cannot go on.”
‘Back to basics’
In addition to boosting the capacity of medical services to handle increased cases, Dr Steven Tucker credits the country with expanding services to help residents cope with mental health issues and COVID-induced stress, from anxiety over personal safety to rent relief for food and beverage outfits forced to close under lockdown orders.
“The stressors that are affecting everyone, as variable as they may be, are: ‘Am I going to get sick. Is my family member sick? Am I going to need to quarantine? Do I have access to care?” Tucker, an American-trained oncologist living and practicing in Singapore since 2006, told Al Jazeera.
“All of this amounts to a mental health stress that Singapore has responded very quickly to, acknowledged, and has made efforts to address,” Tucker added.
Dr Ong says the country of 5.7 million has not yet reached the endemic stage, where the virus becomes something people routinely live with, like the flu.
“I would say it’s endemic when half our friends have it, or have had it,” Ong told Al Jazeera. “Right now maybe one in 10 or one in 20 of our friends have had it. In my circle, it’s only my relatives who have had it. None of my friends have had it.”
But even when the virus poses severe risks only to the vulnerable and unvaccinated, living with COVID-19 will mean the many precautions that Singaporeans have taken – including wearing face masks, social distancing, working from home, eating at home, and limits on inbound travellers – are likely to stay for the foreseeable future, Ong said.
He also sees booster shots as having a place in Singapore’s ongoing coronavirus strategy as variants arise, as well as daily or weekly rapid tests at work, until the pandemic comes under control everywhere in the world and the virus gradually loses its potency.
Among the reasons for Singapore’s high vaccination rates is that the country makes it hard to do things – such as being allowed into restaurants or other public places – without being fully vaccinated.
“Singapore has done relatively well, with widespread testing, tracking, vaccinations, and broad adherence to government policies,” Jeannette Ickovics, a professor of public health and psychology at Yale-NUS College in Singapore, told Al Jazeera. “These practices and policies will continue here, because the global epidemic persists with more infectious variants and an anemic global vaccine rollout. It is a basic principle of public health that all are vulnerable if any are vulnerable; therefore, we must remain vigilant.”
She added, “How do we live with COVID-19? Go back to basics: wash your hands, wear a mask, convene outdoors, socially distance, if not feeling well stay home. Try to streamline your work, evaluate and articulate what you need to get it done, and embrace flexibility.”
Following the rules
Juliana Chan, a media entrepreneur, says she appreciates how much work has gone into the effort to keep the virus from spreading. Her daughter was placed on quarantine when a classmate came down with COVID-19 and her son had to take a leave of absence from school as well.
“We were visited regularly at our home either in person or by video call, and we received texts and calls daily,” Chan told Al Jazeera. “It is a mammoth exercise to run contact tracing at scale, and I was very impressed by the professionalism of all the staff involved.”
Eugene Tan, an associate professor of law at Singapore Management University, says decisive leadership has been aided by Singaporeans’ willingness to follow government instructions such as mask-wearing, which also was common during the 2003 outbreak of severe acute respiratory syndrome (SARS).
“Singapore’s experience has demonstrated the need for not just a whole-of-government but a whole-of-society approach to dealing with the pandemic,” Tan told Al Jazeera. “While Singapore has benefitted from a cooperative citizenry, the use of technology for contact tracing has been critical too in keeping the pandemic under control.”
Although some in the business community complain privately that it is time to allow more cross-border travel freedoms, many say Singapore’s handling of the pandemic has helped its status as a key centre for global business.
“If anything, Singapore has become even more attractive as a hub for global and regional business in the past two years,” Steven Okun of consulting firm McLarty Associates told Al Jazeera. “For example, as a result of both US-China trade tensions and the need for more resilient supply chains given the pandemic, businesses from both China and the US see Southeast Asia as a critical market.”
While Singapore’s vaccination rate is among the world’s highest, the country is still trying to convince sceptics to go for the jab.
On Friday, Prime Minister Lee Hsien Loong, already vaccinated nearly eight months ago, received a COVID-19 booster jab, and shared a photo and video with a message to fellow seniors.
“Cases are increasing rapidly. A booster jab will strengthen your protection against COVID-19,” Lee said on Facebook.