Health Minister Ong Ye Kung issued a clear message to Singaporeans listening to his Ministerial Statement in Parliament on July 26 -- Singapore should shift its "collective psychology" on Covid-19 and get ready to treat it as an endemic disease.

This includes scrapping or modifying existing Covid-19 protocols for infected cases.

However, this would not be possible without high vaccination rates, which have helped to keep hospitalisations and deaths low, despite the recent spike in cases linked to the KTV and Jurong Fishery Port clusters.

KTV cluster origins

Ong provided a background on how the now-infamous "KTV cluster" was discovered.

The Ministry of Health (MOH) discovered on July 12 several positive Covid-19 cases among individuals who frequented KTV bars.

They included patrons and hostesses working in the bars, who were engaged in barred "high-risk" activities, although Ong did not specify what these were.

MOH moved to isolate infected people and identify contacts, and ordered a two-week suspension of pivoted nightlife establishments from July 16 to 30.

They can't resume operations without written approval demonstrating they have followed safety protocols.

Priority is getting care to individuals

In response to Member of Parliament (MP) Xie Yao Quan, who asked if individuals in the KTV cluster could be made to pay their medical expenses in full, Ong acknowledged that "we are all upset by the irresponsible behaviour".

However, the government has a "public responsibility" to ensure everyone receives their needed medical care.

Also, they don't want people to avoid getting tested and treated for fear of being penalised. "This will make it harder to contain the spread, and would cost us more in the long run," Ong added.

Ong said that based on the development of the cluster, they believed it was the right call to continue with the current safe management posture and the schedule to open up. "As of 25th July 2021, that means yesterday, end of yesterday, the KTV cluster has a total of 237 infected persons. For the past three days, the daily increase in infection for the cluster was six, five and five respectively. So it is coming under control," he said.

Unfortunately, Singapore ran into another, bigger cluster.

Jurong Fishery Port cluster

On July 16, MOH detected multiple infections at Jurong Fishery Port and Hong Lim market.

Those infected included fishmongers, stall assistants, and customers.

MOH and the National Environment Agency worked to contain the spread of infection by stopping fishmongers from setting up stalls on July 18, and later mandated PCR tests.

Of the 1,548 tested, 43 were found to be Covid-19 positive, which indicated that significant community transmission had most likely already silently occurred in the days prior to July 18, Ong shared.

He added that because older people frequented the markets, there would be a risk of them falling ill and dying, taking into account that one-quarter of senior citizens remain unvaccinated.

Hence, the MTF decided to roll back measures to Phase 2 (Heightened Alert).

"Multiple introduction points" likely

Ong said:

"The preliminary phylogenetic findings suggest that while the KTV and Jurong Fishery Port clusters were all driven by the Delta variant, it is distinct from the Delta variant that infected Tan Tock Seng Hospital and the Changi Airport cluster.

The recent clusters have a Delta strain that is more closely related to what we detected in imported cases from our immediate region. However, there are also slight genetic differences between the strains in the two clusters, suggesting that there were multiple introduction points."

Ong gave more details about the port cluster:

• As of July 25, the Jurong Fishery Port has a total of 792 cases.
• The daily infections numbers over the past three days were 79, 79 and 46 respectively.
• Overall, a high number of daily cases at over 100 were seen for the past few days. But the situation is stabilising, with daily infections falling.

Catching more infectious cases while in isolation

Ong also shared that the percentage of isolated individuals who then test positive for Covid-19 has been rising, from 27 per cent to 40 per cent.

This suggests that the authorities are stopping potentially infectious cases from going out into the community, and progressively stop the transmission.

However, Ong acknowledged that it may no longer be possible to completely stop transmissions due to the infectivity of the Delta variant.

"The only possible way to eradicate infections is to go into another hard Circuit Breaker. But we don’t want to be locked up. Even if we do, once we open up, cases will rise again," Ong said.

Singapore needs to learn how to live with Covid-19, he added.

Living with an endemic disease

"Vaccinations are key to this transition," Ong said. As of July 25, 54 per cent of the population has received two doses of a mRNA vaccine.

By National Day, this should reach almost 70 per cent, and almost 80 per cent by early September.

This would put Singapore at one of the most highly-vaccinated countries in the world, important for a transition into treating Covid-19 as an endemic disease.

Ong gave an update on the continuing efforts to vaccinate seniors, with the rate at 70 per cent fully vaccinated for those 70 and above.

MOH has launched nine home vaccination teams, with 734 seniors receiving their jabs under this programme as of July 23.

All the way to Ubin

More seniors have also been coming forward to vaccination centres.

Ong described the efforts being undertaken:

"Our mobile teams have gone all the way to Pulau Ubin to vaccinate seniors who are living there. We know of GPs who persuaded, called up their clients, persuaded them to go for vaccinations, and then opened up their clinics to let them sit in the clinic for the whole day, so that they feel assured that if they feel unwell, help is always nearby. Help from someone they trust, their GP.

Mr Deputy Speaker sir, this is a measure of the kind of society we are. We are making such an extraordinary effort with our seniors because we are not prepared to accept the high fatality rates among the elderly that other countries had or are experiencing."

As a result of these efforts, 77 per cent of seniors have received their first dose of the vaccine.

Ong highlighted that the vaccinations have been paying off, in terms of having low numbers of cases who require supplementary oxygen or are in the Intensive Care Unit.

Are we opening up or not?

Ong also addressed the issue that the roll back to Phase 2 (Heightened Alert) may seem at odds with Singapore's goal of treating Covid-19 as endemic.

While other countries have lifted restrictions en masse, Ong said Singapore does not want a "big bang" and a "blow-up" of cases, but rather a controlled opening.

While the government has a roadmap of measures to be taken, it is based on the safety afforded by high vaccination rates. The more people getting vaccinated, the more "solid" the ground, Ong said.

"So, in a way, this is the most peculiar period of our transition, where we are clear about the mission; our will is firm; we have a broad plan. But we don’t have enough antibodies in all of us to ensure that we can follow through with our plans without a hitch. But let us not underestimate the progress we have made. The roadmap is in fact being implemented as we speak."

Current Covid-19 protocols will be phased out

Ong explained the coming shift in health protocols.

"As we learn to live with Covid-19, our healthcare protocols must be remodelled. If Covid-19 is indeed endemic, having 200 or more cases a day may not be unusual at all," he said.

He rhetorically asked what would happen if the government treated those with the flu like those with Covid-19.

Everyone with the flu would be isolated, their close contacts would be isolated, hospital beds would be filled.

"So if we want to live with Covid as an endemic disease, we cannot carry on with the current healthcare protocols. They need to shift closer to how we treat influenza today, without extensive contact tracing and quarantine in dedicated facilities, and hospitalising only those who are very ill.

But that can only happen when the likelihood of developing very serious or life-threatening disease as a result of Covid-19 infection has been significantly reduced by effective vaccination of the population, especially among the vulnerable groups."

Given our current rate of vaccination, Ong shared that some measures have already been implemented. For instance, the authorities are making greater use of community care facilities instead of hospitals for Covid-19 cases.

The next step is for 80 per cent of infected cases to be admitted to such facilities, with some even allowed to recover at home.

As tests have shown, the viral load in infected persons who are fully vaccinated falls very rapidly, to a very low level after nine days. This allows MOH to discharge patients from hospital or isolation in a shorter time.

As more people are vaccinated, more than 50 per cent of cases may be able to serve quarantine at home.

Breaking the link between case numbers and deaths

Ong spoke of the need to make a psychological "shift" in how we view Covid-19 cases. While previously a high number of cases was shocking, as this led to more hospitalisations and deaths, this has changed due to vaccinations.

As of today, only 14 cases require hospitalisation, which does not threaten to overwhelm Singapore's healthcare resources.

Ong said it's a good thing that the attention on case numbers has been shifting to a focus on hospitalisation numbers instead.

Ong also highlighted that while Singapore remains in a period of transition, the rules need to differentiate between those who are vaccinated and those who are not.

This is a practical way to open up some activities, while protecting those vulnerable.

Safety of vaccines

Among the questions that Ong addressed at the end of his speech included an overview of the safety of the vaccines.

As of June 30, the Health Sciences Authority (HSA) received 12 reports of myocarditis and pericarditis occurring in persons after receiving a dose of the mRNA-based Covid vaccine.

While there is a small increased risk among those in the younger age groups relative to the baseline rate, the local incidence rate remains low. MOH gives a breakdown of such cases on its website.

Ong said:

"We implemented the Vaccine Injury Financial Assistance Programme or VIFAP to give greater peace of mind to people taking the vaccination. But remember, with or without vaccination, there is a baseline number of disease cases amongst our population.

Since the vast majority of Singaporeans have stepped forward to be vaccinated, there will naturally be numerous incidents which just happen to coincide with vaccinations.

Hence, we have to do what is practical and reasonable, which is to have the VIFAP applications reviewed by a panel of medical experts, who will consider them against known evidence about the vaccines."

Top image from MCI YouTube channel.