Singapore's Covid Response Overlooked a Major Factor: Fear

(Bloomberg Opinion) -- Singapore is very proud of its reputation for technocratic excellence. In recent months, government officials have tried to tackle the country’s most pressing question — how to live with Covid-19 — by scrutinizing, modeling and projecting data, as if staring hard enough at those little gray-rimmed boxes on Excel would produce the answer.

The trouble with this strategy is that living with Covid is messy, and the data will never look good. Countries that have been praised for the most meticulous of approaches to the outbreak have stumbled time and again. Ultimately, treating the coronavirus as endemic will require Singapore to do something it may find unnatural: think beyond the numbers.

In recent days, the government reintroduced a host of restrictions to curb a quickly rising case count, which has remained above 1,000 for more than a week. Low by global standards, these figures are staggering for a country that had all but eliminated the coronavirus for several months before the delta variant emerged in the spring. In an interview with Bloomberg TV on Monday, Lawrence Wong, the finance minister who co-chairs the Covid task force, said Singapore should prepare to cope with 5,000 daily cases or more.

By most measures, Singapore’s Covid situation remains under control. With 82% of the population fully vaccinated, 98% of cases have mild or no symptoms. There are 209 cases requiring oxygen supplementation and 30 people in the intensive care unit. Officials’ major concern is an exponential increase in cases that would overwhelm ICU capacity. Wong said that while just 0.2% of cases end up in the ICU, doctors need to admit 10% into hospitals to provide “timely care” — these include seniors, those with serious symptoms, and patients with comorbidities. Intensive care cases stay in the hospital for at least a week, according to Wong. At 5,000 cases a day, 10% can add up quickly, even if those cases don’t all end up in ICU beds.

Singapore’s pathway to what it has called a “whole new normal” broadly relies on a three-pronged strategy (captured in this catchy jingle): test, trace, vaccinate. The government has delivered self-testing kits to every household throughout the month. As of Sept. 20, it had tested 19.1 million swabs in a population of 5.7 million.

The result? Lots and lots of positive mild or asymptomatic cases. Because the government made little attempt to de-stigmatize Covid — catching it is still broadly seen as some sort of moral failure or impurity — many Singaporeans justifiably got scared and flooded into emergency rooms. “A lot of people are actually very anxious,” Kenneth Mak, the director for medical services told the Straits Times last week. It’s likely that people who are well are going to the hospital because they are worried and unsure of what to do, he said. 

Now the government is hustling to shore up medical staffing and facilities. The latest plans account for 1,600 Covid-19 hospital beds, up from 1,000. Singapore is opening community treatment centers for non-serious cases, providing booster shots for the vulnerable, and has introduced a number of services to get people comfortable with the idea of staying home, from telemedicine and hotlines to assigning “recovery buddies.” It’s even deploying the Singapore Armed Forces to help roll out this effort.

This military-grade exercise is Singapore at its finest, but it’s only half the battle. Anyone who looks at data for a living will tell you that numbers are a Rorschach test: You see the story you want to see. Right now, Singapore wants an aggressive Covid tracking strategy, but cannot absorb the information that it produces. That leaves two choices: 1) Stop testing asymptomatic cases because the numbers are scary and, given the high rates of vaccination, lack informative value; or 2) change the public narrative. That means, instead of playing on fear, urging people to look past the numbers. Success will come down to trusting the smart plans the country is already putting in place. As Covid becomes endemic, managing emotions will be just as critical as managing the virus.

The psychological toll of Singapore’s data-first strategy is high: 73% of respondents in a recent survey fear catching the virus, up from 37% in August 2020, before vaccinations began. More than three-quarters reported feeling sad or depressed, and many parents are again juggling working from home with home-schooling. It’s this type of pressure that pushes people to the brink over arbitrary restrictions. (A live event can have 1,000 vaccinated attendees, but toddlers “need to stay in one place with their assigned play partner,” according to the latest communication from our pre-school.)

Singapore acknowledges the frustrations of its citizens and businesses, yet far too often this is seen as a necessary sacrifice toward a larger goal. “Living with Covid,” by definition, means those priorities need to be reversed: Day-to-day life must come first.

Singaporeans are resilient. But waiting for the numbers to paint a pretty picture is a fool’s errand. Far more important is mentally preparing the population for a whole new normal. You simply cannot program your way out of Covid Zero.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Rachel Rosenthal is an editor with Bloomberg Opinion. Previously, she was a markets reporter and editor at the Wall Street Journal in Hong Kong.

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