Singapore is trying not to strain its hospitals, stabilise its healthcare system, and increase its capacity as Covid-19 cases continue to be high, finance minister Lawrence Wong said in an interview with Haslinda Amin from Bloomberg on Sep. 27.

Wong reiterated that Singapore's overall strategy has not changed as the country is committed to reopening the economy, but doing so by preventing avoidable deaths and without stressing the healthcare system.

However, this latest wave of Covid-19 cases in the thousands each day has applied pressure on healthcare workers and the resources available.

Labelling the current one-month restrictions as "temporary", Wong said: "The reason why we had to do these temporary restrictions now – it was a very difficult decision, but we felt that we had to do it, because our healthcare system and our healthcare workers are truly facing tremendous pressures and stresses during this latest wave of cases."

Preparing for 5,000 cases daily

And the peak, it appears, has yet to arrive.

According to Wong, the government is preparing more medical centres and personnel to take care of the sick as Singapore is preparing for 5,000 Covid-19 cases daily, given how there are 2,000 new daily cases now.

The way Intensive Care Unit admission works, Wong said, is for Singapore to first have enough hospital resources.

This will allow hospitals to treat 10 per cent of the infected persons who are considered vulnerable, as among this group are the 0.2 per cent of all cases who require ICU care.

The math, even though seemingly miniscule in percentages, can prove to be a challenge over time.

Wong said:

"Think about it this way. We know that about 0.2 per cent of cases need ICU care and that appears quite small to people. But to provide timely care for the persons who need ICU treatment, the doctors need to admit about 10 per cent of infected persons to our hospitals, because these are the ones that the doctors would triage and identify as the more vulnerable persons – they could be older, serious symptoms, comorbidities."

He added:

Now, if you have 5,000 cases a day, 10 per cent is 500, and each person stays at least a week in the hospital. That is a lot of hospital beds, and that is what we are trying to do, to augment our hospital system with medical centres, medical facilities. It is not just equipment, it is medical personnel as well.

How to get to endemic state?

Wong also explained the government's approach in getting Singapore to an endemic state with new restrictions in the face of rising number of cases, which is a seemingly contradictory approach.

He said Singapore has not gone back to a circuit breaker or to a lockdown, even though measures have been tightened now temporarily to buy some time to build up medical capabilities by slowing down the rate of transmission, so that "a higher volume of cases" will not cause our healthcare system to be "overwhelmed".

Wong also cautioned in the interview that Covid-19 cases will remain high after this period of restrictions and capability-building in hospitals.

"I am quite sure, even after we have stabilised our healthcare system and gotten the new capacity in place, cases will continue to be high; the virus will continue to circulate," he said.

"That is what living with Covid means and that is what we are on the journey towards."

Is there consensus within the leadership?

Asked to comment if there have been conflicting viewpoints or consensus within the leadership on how Singapore should handle its reopening, Wong said the "taskforce deliberates over every decision carefully" in consultation with medical experts and advisors.

Wong added: "This particular decision was a very difficult one to take. We did not make it lightly. We knew that it would cause pain, frustration and anger amongst many people who have been looking forward to continued reopening. We understand that."

But given the foreseeable outcomes, he said Singapore was not prepared to take a huge risk with the healthcare system becoming overwhelmed based on the data and the evidence gathered.

Murmurings on the ground suggesting people are tired and dissatisfied was also addressed in the interview.

Asked if there was a dwindling of trust in the leadership among the people, Wong said there was "no choice" with regards to how Singapore should respond to the latest situation.

He said:

"We are always concerned – we do not take the trust that people have in the government for granted at all. And that is why, as I have said, we considered this very carefully, but we had no choice because this was a situation where there were, indeed, a lot of strains on the healthcare system. So, we seek everyone's understanding, support, and forbearance for the measures, and we hope everyone can rise in solidarity with our healthcare workers who are facing a lot of pressures, working flat out in the recent weeks to deal with the huge surge in cases."

Top photo via Bloomberg