By Rosie Collins*
Opening up won’t be as easy as we think – just look at Singapore.
Like New Zealand, Singapore has not let the virus run rampant and kept a low tolerance for deaths. As the island nation of about 5.5 million people begins to open, there have been breathless suggestions that Aotearoa should follow suit, and in haste.
But let’s pause and look at the numbers. Singapore’s partial opening led to over 26,000 cases and 38 deaths in September. Fearing health system chaos, they slapped on domestic restrictions – similar to a New Zealand level 2.5. High vaccination rates have kept most cases mild. Widespread rapid antigen testing, community-based care, and health capacity-based restrictions show us how we may follow.
Living with the virus will mean living with more restrictions – there is no going back to 2019; there is no going back to level one. These are myths.
What’s happening in Singapore
Singapore eased restrictions from early-August; after more than 70% of the population was partially vaccinated.
But it was not like our level one between lockdowns – more like 2.5. Gyms, restaurants, and bars reopened, and public gatherings were limited to groups of no more than five. Borders eased to let vaccinated travellers from low-risk countries skip quarantine or isolate at their choice of location.
Despite restrictions delta spread much faster than officials expected. Cases climbed from 70 a day in early August to over 2,000 a day in late September.
High vaccination meant 98% of cases were mild or without symptoms. But the sheer case volumes pressured hospitals. At the end of September, 238 people were on ventilators, using nearly a quarter of the country’s 1000-bed surge capacity.
To curb the exponential rise, Singapore tightened restrictions again last week. Group sizes for most public activities have now dropped further, to two people, household guests are limited to two a day, work from home is the default, and there are capacity limits on public spaces like malls and libraries.
If Auckland were Singapore
If Singapore’s experience was replicated in Auckland, over six weeks the city would face 7,400 new cases and 12 deaths. At the end of six weeks there would be 70 on ventilators, using a third (36%) of Auckland’s ventilator capacity. This doesn’t even account for very uneven vaccine rollout across Auckland (and New Zealand).
Singapore reimposed restrictions when health capacity was pressured. Germany also has a rules-based approach – using up 10% of ICU capacity in a day triggers strict domestic and border restrictions. We would reach this point sooner because we have less health capacity. Singapore has 50% more ICU beds than Auckland per person, and Germany has more than double.
The unvaccinated are most likely to need hospitalisation. But when health capacity is exhausted, the vaccinated majority will not get timely care. Emergency care will be restricted, and elective care will be rationed. The cost is societal.
Living in the in-between
Singapore did not throw caution to the wind and remove all restrictions. It reduced restrictions cautiously, and their health system came under pressure despite a highly vaccinated population.
There are some important lessons for us in New Zealand. First, vaccination helps. The majority of Covid cases are mild or asymptomatic.
Second, scared people will flock to the hospital. Singapore now has guidance for home-based care and telehealth access. We will need to create a similar approach.
Third, widespread rapid antigen testing is giving officials timely intelligence. Each household in Singapore received six home-test kits this month, and there are test-kit vending machines to support regular self-testing. We need to urgently introduce rapid antigen testing and make it widely available. This is complementary to, rather than instead of, existing PCR testing.
Fourth, restrictions are a policy choice, but there’s no credible scenario yet of zero restrictions. We can choose which restrictions and when.
We can relax the border, but the cost is other domestic restrictions, such as regular testing, vaccine-only access to many events and locations, and group size limits in public places.
Even with 80% of New Zealand’s eligible population vaccinated, 1.6 million people – including children under 12 – will eventually get the virus. Imposing restrictions will slow the spread and protect health system capacity. This is the only sensible way to manage an endemic virus.
Singapore’s reopening shows our hospitals could be overwhelmed in a matter of weeks, even with high vaccination. Individually, our best bet is to get vaccinated. Collectively, we need to prepare to live with more restrictions than level one. Getting ready for restrictions to be flexible and responsive to hospital space may be the primary policy takeaway from the Singapore experience.
*Rosie Collins is an economist at Sense Partners. This article first appeared on The Spinoff and is used here with permission.
27 Comments
"If Singapore’s experience was replicated in Auckland, over six weeks the city would face 7,400 new cases and 12 deaths. "
That doesn't sound particularly scary.
600-700 New Zealanders per week die in normal circumstances of all causes. The number above is a rounding error in that context.
Singapore currently has exponentially increasing cases. There is no reason to believe they will repeat the same case and death count this month.
https://www.worldometers.info/coronavirus/country/singapore
Not criticising the plan. May as well have first wave while the vax is still effective but those numbers are minimising the downside.
Singapore's cases are rapidly increasing, but you can't say for sure if it's exponential. If you look at the cases numbers of the log plot here over the last month of so, the trajectory isn't a straight line with cases looking to increase a bit slower than exponentially.
NZ is now divided by who take vaccine and who do not. This divide is pretty much a reflection of the same divide between certain ethnicity groups.
Unfortunately, building an harmonious, socio-economic equal, and ethnic-non-discriminated society was never a real focus of any NZ politicians.
However, money does not discriminate.
I'd say pay $399 per person who has done two jabs, and $299 for ongoing booster shots.
Asian Kiwis lead the way in Covid-19 vaccine uptake, high rates 'a triumph'
( https://www.stuff.co.nz/national/health/coronavirus/300408761/asian-kiw… )
They are a clear example to all of us, and also a proof that so called "cultural barriers" or "language barriers" are just an excuse for ignorance and laziness. I have seen elder Chinese, who could barely speak a word in English, getting vaccinated.
Good on them.
Since the government likes to break everything down by ethnicity, how about just keep L3 lockdown for Maori and Pasifika, but L2 for everyone else?
That would get their rate up pretty quickly, and there's precedent in place since she gave a shelter in place order to unvaccinated over 65s in L3. So no human rights violations that she's not doing already.
Singapore is a similar population to NZ but is an island about the size of Auckland. Almost everyone lives in apartment buildings and are in much closer proximity to each other than in a large NZ city, let alone a small one or rural area. We also learned first hand through MIQ here that ventilation systems can spread the disease.
While it is useful learning from what has happened overseas, we should take into account these significant differences that are likely to lead to a much slower spread.
Here here morepork. These endless articles by journos and scientists who should know better, who think that just because a country has a similar population to NZ they are comparable, are doing my head in. Today it's Singapore, yesterday it was the Republic of Ireland in the Herald. Of course countries (and the cities within them), with very much greater densities of population, with land borders and more than one government as the decision maker, have had more cases and deaths.
"Singapore has 50% more ICU beds than Auckland per person, and Germany has more than double".
What has this Government done in the last year and a half, regarding the expansion of ICU beds ? Stuff all.
Any government can manage Covid with lockdowns, but not all Governments have a multi-pronged approach that is based on expanding healthcare capability, aggressively pursuing vaccination targets with a mixture of enforcement and incentives, talking with the affected businesses and industry with regards to fine tuning a measured and targeted approach to lockdowns, be ready to accept reality that a moderate level of deaths is unavoidable, let willingly un-vaccinated people live with the consequences of their choices, look at the total cost to the economy and healthcare etc
And this Government has done little, apart from jumping into lockdowns - which may have been a great strategy last year, but which looks positively dystopian at this time.
I don't have much faith that a National Government would have done much better either.
Did you see the article from the icu doctor saying why it would take years to increase icu capacity and would mean other parts of the health system missing out because it's so expensive? Icu nurses and doctors don't just pop out of nowhere.
No they squandered $50 mill and still counting, on a pie in the sky bridge over Auckland Harbour as a priority instead of any health service preparation. Booted families out of their homes whilst at it. For a PM who spouts incessantly about being kind and huggy for all “her” people, that don’t add up that well does it
Great reckon there Foxglove, except there was health service preparation - in the last year more ICU capable ventilators, more nurses trained to provide ICU support, increased surge capacity for contact tracers, added more negative pressure rooms in hospitals, for example.
Bollocks Foxglove.
The neoliberal idiocy - and I'll take anyone on on that description - which attempted to commodify social 'goods' like health and education, ;ed to the corporate just-in-time make-them-queue-it's-more-efficient-for-us bull--it. Those in the profession of a less than altruistic bent, went the private hospital way (but the one near me takes their patients to Public if it turns pear-shaped; they're still freeloading on the Commons.
And the idiot ethos though there should be no public service, no Government. Except the idiocy couldn't survive without it. So they ran down the communally-owned edifice. Force everyone to pay or die, was apparently the goal. Thus we don't have the capacity; the resilience.
Don't you DARE deflect the blame from that stupidity.
Rosie , check the data re oxygen supplementation and ventilators , one is not the other.
You have written "At the end of September, 238 people were on ventilators, using nearly a quarter of the country’s 1000-bed surge capacity."
This from Singapore MOH
"Over the last 28 days, the percentage of local cases who were asymptomatic or had mild symptoms is 98.1%. 443 cases required oxygen supplementation and 52 had been in the ICU."
' As of 30 September 2021, 12pm, 1,360 COVID-19 cases are currently warded in hospital. Most are well and under observation. There are currently 204 cases of serious illness requiring oxygen supplementation, and 34 in critical condition in the ICU. Of those who have fallen very ill, 197 are seniors above 60 years."
https://www.straitstimes.com/singapore/health/askst-what-does-oxygen-su…
Singapore has great vax rates. Vax rates will be 85, 90 plus here. So now we are living with covid, how do we find out what it's like to have, when vaxxed. Seems its flu like to day 8 (less for vax), then almost allergenic & oxygen deprived there on. In places with not the money for pharma, there are 6 to 9 medications given over the infection, with timing and interaction of administration & dose critical.
Treatment solutions, Vejon.
Singapore City adding capacity, reviewing protocols and getting mentally prepared.
Psssssst....forget Singapore and take a look at this!
Uttar Pradesh, (India): Population 240 million (4.9% fully vaccinated)
5th August
Covid daily cases 26
Covid daily deaths 3
Similar success rates in all other provences.
How: An agressive house-to-house campaign with medical kits given out to every household.
But we are not allowed to talk about it. Blackout. Because there are alternatives that are more effective but they interfere with expensive contracts with big pharma.
Don't get distracted with Singapore, Israel, Vermont (state of USA), or other places NZ could well mimic. If there are indisputably more efficient and cheaper solutions (those medical kits only cost $2.60 a piece), that's what we need to focus on. A policy that divides society, destroys the economy, destroys job and lives, ultimately has been a bad sell!
Yes and I believe there is a media blackout on ivermectin as a private equity firm has shares in Pfizer, NZME (Herald/IZB) and TV3 ie Vanguard. The media are shills for the vaccine. Cheap therapeutics, such as ivermectin, would reduce the IFR for Covid below the peer reviewed research level of 0.1% (J Ioannidis). As this is lower than the flu ICU's will not be swamped.
The blackout is over it's in enough MSM to talk about.
https://indianexpress.com/article/cities/lucknow/uttar-pradesh-governme…
I have been to Singapore dozens of times. Like most Asian countries, it is very rare to spot any obese people. When I travel to the USA, I am shocked at the level of gluttony and obesity. The USA was hit hard by Covid because they have a huge population of obese and gravely ill people. In New Zealand we have large sections of our society that are more like the people in the USA than Asia.
If you are obese or old and gravely ill, the vaccine will not create a strong immune response in you. The fit and healthy are the ones who get the best immune response. They are also very unlikely to get severely ill from Covid. Ultimately the fully vaccinated vulnerable will still be at risk as the virus continues to spread as the vaccine does not eliminate transmission.
We are vaccinating and quarantining (locking down) the fit and healthy. We should have vaccinated and isolated the vulnerable. We should only be testing and isolating people that are physically sick. I support opening up, but realise vulnerable people will die. That is a sad fact, but what we have done so far is breaking people mentally.
New Zealand will be far worse than Singapore. That population lives in a small area with quick access to high quality hospitals. Consider remote places like the East Cape of the North Island and how quickly medical care can be accessed. Most regional hospitals in NZ are third world with staffing shortages.
We welcome your comments below. If you are not already registered, please register to comment.
Remember we welcome robust, respectful and insightful debate. We don't welcome abusive or defamatory comments and will de-register those repeatedly making such comments. Our current comment policy is here.