To weather the Omicron wave, we must remember the past

In his bestselling book The Order of Time, Italian physicist Carlo Rovelli wrote that memory is a key ingredient in the foundation of our identity: Humans use memories of the past to predict the future. For instance, we will move our hand instinctively to catch a ball thrown at us: the brain uses past impressions to rapidly calculate the future position of the ball.

There is a lesson to be learnt here: To prepare for the future, we must remember events of the past.  The way we approached, weathered and overcame the Delta wave last year is instructive to how we should confront and defeat Omicron.

One key indicator is the weekly infection growth rate, which refers to the ratio of community cases for the past week over the week before. A rate of less than 1 signifies the slowing down of transmission.

On Aug 26 last year, the weekly infection growth rate was at 1.4. Just a few days later on Aug 30, the growth rate doubled to 3.01, which remains the peak infection rate in Singapore. It only fell to below 1 on Oct 16.

Fast forward today, as of Jan 26, 2022, the weekly infection growth rate is 2.5, coupled with the fact that some 90 per cent of the daily cases are now of the Omicron variant, signifies that we are now in the Omicron wave. 

Due to its higher transmission rate as compared to Delta’s, one could assume that the peak infection rate will be higher than 3.01 and a wave that could be several times larger than Delta. With past experience, this means that it will take another two to three months before things stabilise. 

If Delta infections peaked at 3,000 cases a day, Omicron may probably reach 15,000 to 20,000 cases a day, or more.  Cases are likely to double every two to three days. 

But the Battle of Omicron will be markedly different.

Enhancing our healthcare capacity

On Jan 10, Health Minister Ong Ye Kung spoke in Parliament and gave an update on how Singapore has been preparing for the battle ahead.

First, we have made tremendous progress in enhancing our healthcare capacity.

Today, we stand ready to provide up to 350 ICU beds, 2,000 isolation beds and 4,000 Covid-19 treatment facilities (CTF) beds for Covid-19 cases with a couple of weeks’ notice. Coupled with the Home Recovery Programme, we are in a good position. As of Jan 26, 2022, there are 11 Covid-related ICU cases.

To further ease the load on our hospitals, we have expanded the age bracket suitable for Protocol 2 to include children aged 5 to 11 years old, regardless of their vaccination status.

Manpower is always a limiting factor, but ICU staff has increased by 12 per cent over the past year to 1,800 now, and we have trained or are training about 500 more staff to assist with ICU operations. 

To better protect our patients and healthcare workers, we only recently announced that in-person visits to all hospital wards and residential care homes will be suspended for a period of four weeks, from Jan 24 to Feb 20, 2022.

There has been consistent international evidence showing that Omicron infections are less severe than Delta. The incidence of hospitalisation and severe illness is lower, and there are also indications that hospital stays are generally shorter.  Indeed, the clinical outcomes, particularly the number of people who become severely ill or die, are much more important than the topline infection numbers.  

However, we should be careful in interpreting these observations as it is early days.  Further, Omicron transmits much faster and infects more people.  So even if a small percentage of infected individuals falls very sick, the far larger number of infections can still lead to many people needing ICU care, or die.  

However, we must guard against the thinking that coping with a transmission wave is a matter of expanding our healthcare system.  Hence, we implemented Safe Management Measures and continue to exercise self-restraint in our social interactions.  

Boosting our vaccination rate

In countries where Omicron has spread, the unvaccinated and under-vaccinated are still the most prone to falling seriously ill when infected.

Around 132,000 individuals aged 18 years and above remain unvaccinated, while around 300 persons are medically ineligible. We will continue to try to convince those who are medically eligible to get vaccinated.  But as the number gets smaller, it is also harder to convince them.  For those who are homebound, our Mobile Vaccination Teams can visit their homes to vaccinate them.

Over the past months, we have managed to vaccinate well over 90 per cent of every eligible age group.  For the even younger ones aged 5 to 11, we have just started vaccinating them. The response has been good and operations smooth.   

At the same time, our vaccine booster program is accelerating. More than 51 per cent of our population has received their boosters.  We have also set a validity period for full vaccination status of 270 days, as a strong signal to our population to get their boosters promptly.  

We also announced on Jan 22 that we will expand the national booster programme to cover those aged 12 to 17.

As to whether there is a need for further booster shots, it is too early to tell.  Today, Israel is the only country that has authorised a fourth dose for non-immunocompromised individuals. 

Continuing with Safe Management Measures

In recent months, instead of imposing across-the-board social restrictions, we introduced more Vaccination-Differentiated Safe Management Measures (VDS). 

This is because unvaccinated individuals are at far higher risk of falling severely ill.  This group has consistently taken up two-thirds of our ICU beds, throughout the pandemic.  By restricting their social interactions, we protect them against infections and serious illnesses and taking up hospital resources. The rest of society who have been vaccinated can then live life more normally.

When the Delta wave subsided late last year, we refrained from being too jubilant and over relaxing restrictions.  We kept our mask requirements, did not allow back night entertainment, and kept group sizes at five.

It is the Multi-Ministry Taskforce’s hope that we can ride through the Omicron wave with the current Safe Management Measures.  If we have to tighten the restrictions, it will be as a last resort when our healthcare system is under severe pressure. 

We did it before, we will do it again.

Vaccinations, expansion of healthcare capacity, and Safe Management Measures must work in tandem, and we must strike a balance between the three factors.  

We cannot over-liberalise, remove all social restrictions, let infections rise uncontrollably and leave the healthcare system to bear the consequences.  Neither will we protect the healthcare system at all cost, go for a zero-Covid strategy, and lock down our borders and society which will cause tremendous suffering to our people. 

We have withstood the Delta wave with unity and resolve.  We will be able to do so again with the Omicron wave.  While Omicron is a different enemy, we are much better prepared and much more resilient than before. 

And after the Omicron wave passes, which it will, we would have taken another huge step towards living with Covid-19.  Singapore will be one of the best and safest places to live in the world.

Cover image credit: Tan Chuan-Jin Facebook page