My fellow Singaporeans
Local COVID-19 cases have increased sharply over the past few weeks. All of you are understandably anxious. Many have found it difficult to keep up with new policies and changes to measures. I understand your concerns and frustrations. Some ask: What happened to our plans to build a COVID-resilient nation? Has the Government changed its mind? Are we on track to reopening our society? Yet, others ask: Why are there so many cases? Should we not be fully locking down now? These are all valid questions.
Hence I have decided to speak directly to you, to explain: Our current situation and what has changed, our strategy for this phase of the pandemic, and our path forward to a new normal.
I want to share my thoughts and concerns with you, because unity of purpose and hearts is crucial to get us through the next few months.
Our Original Approach – "Zero COVID"
Last year, at the start of the outbreak, we were dealing with an unknown disease. Globally, there was little scientific knowledge about COVID-19. Our own experience from SARS gave us some idea where to start. As we learnt more about the virus, we adjusted our strategy to the evolving situation.
Our original approach was to do our utmost to prevent Singaporeans from being exposed to COVID-19. We tightened Safe Management Measures (SMM) as much as necessary, to bring cases down to a very low level. We judged this the best way to minimise serious illness and deaths.
"Zero COVID" was the right strategy at that time. Our population was not yet vaccinated. People had little or no immunity against COVID-19. The consequences of catching the virus were serious. But because the virus was not so infectious then, our measures could work to break the chain of transmission. The strategy succeeded. We avoided the huge loss of lives that many countries saw. We have one of the lowest COVID-19 death rates in the world.
At the same time, we planned ahead and secured vaccine supplies. Vaccines were a game changer. A safety vest for each of us in this pandemic. Our national programme to vaccinate everybody has been very successful. Thanks to your trust and cooperation, we now have one of the highest vaccination rates in the world – almost 85%. This has greatly enhanced our protection against the virus. Our data, as well as data from around the world, clearly show that vaccination sharply reduces the risk of serious illness. The vast majority of local cases (more than 98%) have mild or no symptoms. Only 2% or less developed more serious illness. Of these, 0.2% died or needed ICU treatment – just two out of every one thousand cases. The rest have needed oxygen supplementation for a few days. In other words, with vaccination, COVID-19 is no longer a dangerous disease for most of us.
A Changed Situation
But the emergence of the Delta variant has put us in a changed situation.
The Delta variant is highly infectious, and has spread all over the world. Even with the whole population vaccinated, we still will not be able to stamp it out through lockdowns and SMMs. Almost every country has accepted this reality.
Furthermore, even if we manage to keep COVID-19 cases down through stringent SMMs, the virus will spread swiftly again as soon as we ease up. This is especially true in Singapore, precisely because of our "Zero COVID" strategy. The majority of us have never experienced an infection. Or as doctors say, we are COVID-naïve. As a result, our natural (population) immunity is low. Even if we have been vaccinated, we are still at some risk of getting infected. This is why we must be prepared to see quite many COVID-19 cases for some time to come.
Yet Singapore cannot stay locked down and closed off indefinitely. It would not work, and it would be very costly. We would be unable to resume our lives, participate in social activities, open our borders, and revive our economy. Each time we tighten up. Businesses are further disrupted. Workers lose jobs. Children are deprived of a proper childhood and school life. Families are separated for even longer. Especially families with loved ones overseas and extended families who have not been able to come together. All these cause psychological and emotional strain, and mental fatigue. For Singaporeans and for everyone else here with us, including our migrant workers.
Therefore, we concluded a few months ago that a "Zero COVID" strategy was no longer feasible. So we changed strategy, to "Living with COVID-19".
Living with COVID-19
"Living with COVID-19" has not been a smooth and easy journey. In August, after we reached 80% vaccinations, we eased up the Heightened Alert. We expected cases to go up, as more people resumed activities and interacted with one another, but the numbers went up more sharply than we had anticipated, because the Delta variant was so infectious.
Initially, our healthcare system was still able to cope. But we worried that it would come under significant strain, and it has. So have our medical personnel. As cases grow exponentially, the number of serious cases will also grow in step. And when the number of cases grows very large, even 2% of a very large number will translate to many patients needing hospital and ICU beds. Our healthcare system would rapidly be overwhelmed.
That is why last month we tightened up our restrictions. It was to slow down the growth in cases, so that we can ease the burden on our healthcare workers and stabilise our healthcare system. We are using this time to further expand healthcare capacity and strengthen our case management. So that we can better identify COVID-19 patients with mild symptoms to recover at home. And make sure we can care properly for those who fall seriously ill. As well as continue to attend to the many non-COVID-19 patients who also have urgent medical needs.
The Next Steps
We must press on with our strategy of "Living with COVID-19". What next steps must we now take?
To start with, and most fundamentally, we¬ need to update our mindsets. We should respect COVID-19, but we must not be paralysed by fear. Let us go about our daily activities as normally as possible, taking necessary precautions and complying with SMMs. With vaccinations, COVID-19 has become a treatable, mild disease for most of us. This is especially so if you are young. Or even if you are not so young but fully vaccinated. The threat of COVID-19 is now mainly to seniors: 60 and above if you are not vaccinated, or 80 and above even if you are vaccinated. So for 98% of us, if we catch COVID-19, we can recover by ourselves at home, just as we would if we had the flu.
That is why we are shifting to relying heavily on Home Recovery. It will be the norm for COVID-19 cases. You can get well in a familiar home setting, without the stress and bother of admitting yourself into a care facility. If most of us can recover at home, it will greatly ease the strain on our hospitals, doctors and nurses. It will free up badly needed beds for COVID-19 patients who are at high risk of becoming seriously ill, especially the elderly. Of course, if you have vulnerable family members at home, you can go to an isolation facility to recover. I know many people still have concerns and anxieties about Home Recovery. They are fearful of the disease itself. They fret about the risk to the rest of their household. They also worry whether they will receive adequate care and support at home, should they get worse. I understand your anxieties. Let me assure everyone on Home Recovery that you will get the care and support you need throughout your recovery journey. Earlier, our service delivery fell short. But we have worked hard to fix this, and put things right. If at any point you need to be admitted to hospital or a COVID-19 treatment facility, we will get you there.
Next, since COVID-19 has become a manageable disease, we should now drastically simplify our health protocols. No more complicated flow charts. People must be clear what to do if they test positive, or if they come into contact with someone who is infected.
We also need to know what we can do ourselves. Each one of us needs to take personal and social responsibility. Test ourselves as necessary. Self-isolate if we test positive. Consult a doctor if we have symptoms. Knowing what to do, we will no longer find COVID-19 such a scary disease. Let's all do our part to keep everyone safe, in particular the vulnerable ones among us.
The group that worries me most is the elderly, especially those who are not yet vaccinated. We have thus far managed to keep our fatalities very low. But sadly, even that has still meant 142 deaths so far. Nearly all were elderly, and with pre-existing medical conditions. They were uncles and aunties in their 60s, 70s and 80s, living in our community. A disproportionate number are unvaccinated seniors. They account for barely 1.5% of the population but they make up two-thirds of those who needed ICU care or died. The remaining one-third were vaccinated seniors. We feel every single loss keenly. My deepest sympathies and condolences to all the families.
With more COVID-19 cases, already most of us have either met someone who has gotten COVID-19, or know someone who does. Sooner or later, every one of us will meet the virus. This means all the elderly will meet the virus too And for them, the risk is very real. As I said earlier, COVID-19 is now mainly a danger to seniors: 60 and above if you are not vaccinated, or 80 and above even if you are vaccinated.
As cases grow, so will the number of elderly cases. If we reach 5,000 COVID-19 cases a day, every day we can expect around 100 to become seriously ill – not a small number.
Our doctors and nurses do their best for every patient. Unfortunately, despite their best efforts, not every seriously ill patient will make it through. Sadly, quite a few will succumb. Just like with pneumonia. Every year more than 4,000 people die of pneumonia in Singapore, mostly elderly and with other underlying illnesses. Over the next few weeks and months, we will likely see the number of COVID-19 related deaths continue to go up.
There are several things we can do, and the elderly can do themselves, to protect them and reduce the numbers falling seriously ill. For the unvaccinated elderly, we will continue trying hard to persuade and vaccinate you. If you are above 60 and not yet vaccinated, you are at very high risk – please get your jabs now! For the elderly who are already vaccinated, please get booster shots to strengthen your immunity. Vaccination has already lowered your risk substantially, but your risk is still much higher than someone younger. A booster shot will reduce your risk further. If you are a vaccinated senior, taking the booster reduces your risk of severe infection by more than 10 times. Or to put it in another way, to the virus, the booster shot makes a vaccinated 80-year old look like a much younger vaccinated 50-plus year old! This is why I am happy to see many seniors walking in for boosters as soon as you are eligible, even before receiving your SMS invitations. Seniors themselves should take extra precautions. By all means go out to exercise and get fresh air but please cut back on makan, kopi and beer sessions with your friends and kakis. This will lower your exposure to the virus. We want you to stay well! Younger people living with seniors can also help to protect them. For instance, you can cut down your own social interactions for now. And test yourself regularly to check that you are not bringing the virus home.
Another group that parents are concerned about is children under 12. Vaccines have not yet been approved for such young children. As cases grow, parents are understandably anxious about their children catching the virus. Though the data shows that children with COVID-19 seldom get seriously ill, parents are still worried. We are closely tracking the progress of vaccine trials on children in the US. We will start vaccinating children as soon as vaccines are approved for them, and our experts are satisfied that they are safe. This will likely be early next year.
Meanwhile, we will build up our healthcare facilities to be able to provide those seriously ill the medical care they need, especially oxygen support and ICU care. However, there is a limit to how much we can expand. We can build new care facilities and purchase new equipment, and we are doing so. But we cannot easily find more and more doctors and nurses to staff them. That is why we have to moderate the surge in COVID-19 cases.
At the same time, as part of living with COVID-19, we must also connect ourselves back to the world. In particular, we must continue to re-open our borders safely. Companies and investors need to carry out regional and global business from Singapore. People working for them need to travel to earn a living. Students need to go on overseas attachments and internships without having to SHN each time. Families and friends will once in a while want to spend time together, overseas.
We have started Vaccinated Travel Lanes with Germany and Brunei, and just announced another with South Korea. These pilot projects have shown it is possible for vaccinated persons to travel safely, while letting in very few COVID-19 positive cases. We are implementing more such arrangements, especially with countries whose COVID-19 situations are stable. This will keep us connected to global supply chains and help to preserve Singapore's hub status .
The Next Few Months
The next few months will be trying. I expect daily cases to continue rising for some weeks. Our healthcare system will still be under pressure. We can slow, but we cannot stop the Delta variant.
At some point, the surge will level off, and cases will start to decline. We don't know exactly when, but from the experience of other countries, hopefully within a month or so. As pressure eases off on the healthcare system, we can relax our restrictions. But we will have to do so cautiously, to avoid starting a new wave again.
We must protect our healthcare system and workers at all costs, in order to get through the pandemic safely. Let me say this to all our healthcare workers. I know the enormous stress you are under, and the heavy load that you bear. You have been fighting so hard, for so long. Now we are going through perhaps the most difficult phase of our journey. But it will not last indefinitely. After this surge peaks, things should get better. We are doing all we can to protect you and the healthcare system as we go through this wave. If we don't protect you, you can't protect us. On behalf of all Singaporeans, I thank you all. We are with you, and will give you our fullest support.
And to all Singaporeans, we need your support too. Hospitals and healthcare workers are our last line of defence. Help us to protect them. Let each of us be the first line of defence. Continue to abide by prevailing SMMs, and cut back on social activities, to slow the spread of the virus. Get vaccinated if you have not already done so – this will minimise your chances of falling seriously ill and go for your booster shot when your turn comes. Self-test regularly, to avoid infecting others, especially seniors around you. If you are infected, take up Home Recovery, unless you have serious illness, or vulnerable family members. Please don't rush to the A&E with mild symptoms. Let us reserve hospital capacity for those who need it most – serious COVID-19 cases as well as others with serious illnesses.
The Path Beyond
It has been a long campaign against COVID-19. The war continues but we are in a much better position now, than a year or even six months ago. Sometimes it may not feel like it, but we are making steady progress towards the new normal.
After this surge stabilises, we may still see future surges, especially if new variants emerge. We may have to tap on the brakes if cases again grow too fast, to protect our healthcare system and healthcare workers. But we will be better able to cope with future surges. Our capacity and processes continue to improve. As more people are exposed to the virus and recover, our immunity levels will increase. COVID-19 will spread less quickly among us. With each passing day, we are getting stronger and more resilient. And we are more ready to live with the virus in our midst.
How will we know when we have arrived at the new normal? It will be when we can ease off restrictions, have just light SMMs in place, and cases remain stable – perhaps hundreds a day, but not growing. When our hospitals can go back to business as usual. When we can resume doing the things we used to do, and see crowds again without getting worried or feeling strange. A few countries have reached this state, e.g. in Europe but they have paid for it dearly, losing many lives along the way. It will take us at least three months, and perhaps as long as six months to get to this new normal. COVID-19 has surprised us many times before, and may yet surprise us again. But get there, we will. In a careful and safe manner, with no one left behind to fend for themselves and with as few casualties as possible along the way.
With everyone's cooperation, we will put the pandemic behind us, hopefully soon. We have the resources, the determination, and the courage to get through this crisis. The pandemic has brought out the best in Singaporeans. We have stayed united and resolute despite the difficulties. Let us keep that up, and continue working together to complete the journey towards COVID-resilience.