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For those of us living in Singapore, the past 20 months of living through the Covid-19 pandemic have been full of regulations: mandatory mask-wearing, required use of TraceTogether in most public places, limitations on group sizes, mandatory Stay-Home Notices and more.
At the same time, the 20 months have also been full of resources provided by the government: free masks, free vaccinations, free oximeters, government-subsidised Stay-Home Notices (until Jan. 1, 2021).
All-in-all, the Singapore government has been very hands-on in how it's dealt with the Covid-19 pandemic.
And overall, that's worked pretty well for us. For the majority of the pandemic, Singapore has been heralded for its pandemic response (with the important caveat of the situation in migrant worker dormitories).
But in the past two months, the tide has turned, amidst rising numbers of cases and not-always-clear instructions.
People are feeling confused; on one hand, we've been told that we are moving toward an endemic state, while on the other, restrictions have again been tightened at the end of September.
It's also scary to simultaneously see record-high numbers of reported cases and deaths, while also hearing stories of people, such as these reported by CNA, being unable to reach the Ministry of Health (MOH) or not being supported so that they can follow the correct quarantine practices.
While we've all gotten used to the government having such a hands-on method of dealing with Covid-19, it's likely not sustainable as we look toward the future.
As we move toward a Covid-endemic stage, we will all need to make decisions more independently while at the same time considering social responsibility, instead of relying on government guidance on what we're allowed or suggested to do.
This shift toward independent decision-making will need to be accompanied with a set of mindset shifts, in terms of how we think about living with Covid-19. Here are some we'll need to consider:
Decisions to prevent contracting Covid-19
Restrictions on group size and numbers of meetings
As of Sep. 27, we've gone back to needing to limit our social gatherings to groups of two, and no more than one meeting per day, until Oct 24.
But it's unlikely that it will be feasible for government-imposed limits to continue into the distant future.
We will need to decide for ourselves what group size we are comfortable with when meeting people, given our circumstances, by assessing the level of risk that we are comfortable to take on.
Perhaps if you want to go to a high-risk event, like the concert of your favourite singer, then you would need to plan to not meet up with any vulnerable loved ones for at least 10 days afterward, so that you wouldn't risk getting infected at the concert and pass the virus to them.
Or if you have an important event coming up, such as a major exam or a flight, you may opt to keep your social interactions to a minimum for 10 days beforehand, so that you lower the risk of getting Covid-19 at an inconvenient time and ruining your plans.
Self-testing
There are currently many groups of people who are mandated to test themselves regularly because they have been identified by MOH as close contacts of confirmed Covid-19 cases; people under quarantine order (QO) and health risk warning (HRW) are required to take PCR tests and ART tests throughout their 10 days of quarantine or self-isolation.
If contact tracing efforts slow down, as they likely will, less people will be issued official QOs and HRWs. This means that testing will likely become more of a self-initiated thing. We will need to decide how often we want to test ourselves, in order to feel safe and comfortable.
For example, we may opt to self-isolate for a few days and conduct an ART self-test before visiting vulnerable loved ones.
Or, as paiseh as it may feel, perhaps it'll become a more common practice to ask our friends to all do a self-test before meeting up for a big gathering.
Decisions after testing positive
If you find out that you've tested positive for Covid-19 — which, as we've been told, most people can expect to at some point or another — what should you do?
Currently, MOH has a whole host of different instructions for people, depending on their situation:
Those who test positive on an ART self-test kit and are asymptomatic have very little restrictions placed on them, and are simply instructed to self-isolate at home and take another ART test after 72 hours. If the test comes back negative, they are considered to be recovered.
There is no need to report their case to MOH, no official contact tracing is done, they do not need to get a PCR test, and there are no legal ramifications for not self-isolating.
Taking a look at the lack of restrictions — and therefore, flexibility — given to ART-positive Covid-19 cases offers us a lens through which we can consider how we may need to make personal decisions about social responsibility in the future, if we become infected with Covid-19.
Seeking medical attention
Many people recently have taken to rushing to hospitals' emergency departments, raising concerns about overburdening Singapore's hospitals and prompting a number of public hospitals to remind people that priority will be given to critically-ill patients.
The fear of people rushing to hospitals is understandable, to a degree — people are alarmed that they have tested positive for Covid-19 and want to make sure to be treated as soon as possible.
And for the majority of the pandemic, people who tested positive for Covid-19 were not just encouraged, but strictly mandated, to seek medical attention and get formally diagnosed, while those who showed any acute respiratory infection (ARI) symptoms at all were instructed to see a doctor.
But now, with 82 per cent of the population in Singapore fully-vaccinated, we've shifted away from this policy of every potential, or even confirmed, case going to a doctor.
As we've been told, for the majority of fully-vaccinated individuals, contracting Covid-19 should result in few, if any, symptoms, and is unlikely to lead to severe illness or death.
Thus, rushing to the hospital or to the doctor is not necessary, nor responsible, if you are not a member of a high-risk group.
If we think about pre-Covid times: for most of us, if we got a cold and had a slight sore throat, we wouldn't rush to the A&E. In fact, we probably wouldn't even go see a doctor unless it refused to go away for a prolonged period of time or escalated into a fever and cough.
Similarly, recovering at home will likely be the path forward for most of us, in order to not strain the healthcare system.
Contact tracing
And what about all of the people you interacted with before you realised you had Covid-19?
In the future, if contact tracing efforts are scaled back — as it's likely not sustainable to keep them at the current level they're at — most "contact tracing" would need to be self-initiated.
This would mean going through your schedule to list out who you met in close proximity in the days prior to your positive test result, and inform them that you contracted Covid-19. The close contacts would then want to monitor their own health and test themselves for several days.
For people who don't already use a calendar to keep track of social interactions, perhaps the possibility of needing to do personal "contact tracing" in this way would spur them to start doing so.
Self-reported "contact tracing" will also be important in environments such as workplaces and schools, so that the institution can inform other colleagues or classmates to conduct self-testing.
Self-isolation
For ART-positive individuals who are asymptomatic, they are instructed to self-isolate at home for 72 hours. And while they are recommended to avoid contact with other members of the household and to use a separate bathroom if possible, these are not requirements.
In fact, unlike those placed under QO and HRW, it appears that people who are asked to self-isolate aren't legally required to stay home.
In a Facebook post on Sep. 17, former Temasek Holdings CEO Ho Ching suggested that Covid-positive individuals who wish to go out to "jalan jalan" (take a walk) should wear a "good quality medical grade surgical mask" when leaving the house.
This may indicate that, as we look toward the future, fewer people may be mandated by law not to go into public if they have Covid-19. Instead, it will be up to someone's sense of personal responsibility to decide to properly self-isolate.
Ways to make the independent decision-making accessible to everyone
When it comes to exercising responsible personal decisions, we will need to pay closer attention to whether it's feasible for some segments of our population to do so.
For example, some are unable to self-isolate at home due to certain limitations, such as sharing a one-room flat with many other household members, or living with a highly-vulnerable and immunocompromised family member. In these cases, it would be ideal if isolation facilities continue to be available.
In addition, while regular self-testing will likely be an important part of living with endemic Covid, actually getting access to enough ART kits to test oneself on a regular basis is not cheap; currently, one test kit costs roughly S$10.
In August and September, MOH distributed six ART self-test kits to each residential household in Singapore.
The Ministry of Education (MOE) and Early Childhood Development Agency (ECDA) also announced that they would distribute three ART kits to all students and staff in ECDA-licensed preschools, MOE Kindergartens, Early Intervention centres, primary schools and Special Education schools (primary/junior sections) from mid-September.
If possible, the continued provision — or at least, subsidisation — of ART kits to people in Singapore would lower the barrier to entry to testing and encourage people to continue to engage in responsible behaviour, even when not mandated to do so by law.
It is also important to recognise that not everyone in Singapore may be given the same degree of agency to exercise individual decision-making; the majority of migrant workers living in dormitories have been unable to leave their dormitories and enter the wider community for the past 17 months.
Although a pilot programme allowing 500 workers per week to visit Little India was launched in September, there has been no clear indication of when all migrant workers living in dormitories may be allowed to move freely.
Moving toward endemic Covid and a need for more independent decision-making, it will make less sense to continue to place asymmetrical restrictions on certain groups, such as migrant workers, as expressed by public health expert Jeremy Lim previously.
The time will come to leave the nest
Much has been written about the perceived paternalism of the Singapore government — both in general and, more specifically, in the handling of Covid-19.
The parent-child relationship that paternalism gestures toward is perhaps a fitting way to think about the relationship between the individual and the government throughout this Covid-19 pandemic in Singapore.
For most of the past two years, we were children of strict but caring parents who provided for us. On one hand, we were given strict rules to follow — you must wear masks when you leave the house, you cannot meet in groups of more than X. But at the same time, we were provided with important things to help us stay safe: free masks, hand sanitiser, vaccinations, quarantine facilities.
As a result, we "grew up" through the Covid-19 pandemic with relatively less bumps than people in many other countries with less involved, or less prepared, "parents".
But now, as we shift from treating Covid-19 as a pandemic to an endemic, we're similarly growing out of our childhood and into our late-teenage and early-adult years.
Now, we realise that sometimes, our parents aren't as well-prepared as we thought they were (take the recent complaints of MOH's lack of communication with some Covid-19 patients, for example). And they may make decisions that we feel don't make sense (the perceived inconsistency of tightening measures while also talking about an endemic state).
So, like the process of growing up, we learn to rely on our parents less.
That doesn't mean that we completely ignore our parents' suggestions — we can still look to them for guidance, such as through tools like this website which lays out steps to take in different situations. But we also learn to make our own decisions, when our parents can't or don't tell us what exactly to do.
And our parents, who know that they can't keep us under their wing forever, will eventually send us off into adulthood with important reminders to be responsible, care about others, and make good decisions.
Hopefully, we do.
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Top photo via Facebook / Ong Ye Kung.
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