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Singapore abandons the 'zero COVID' strategy


The COVID-19 pandemic is one of the major topics at this year's G-20 summit. Some countries in Asia have decided that their earlier strategy of zero COVID is futile and that they must learn to live with the virus. In Singapore, that shift has ushered in a surge of coronavirus infections. NPR's Julie McCarthy has this report.

JULIE MCCARTHY, BYLINE: Singapore has one of the world's highest vaccination rates at 82%, yet cases of COVID-19 are skyrocketing from just double digits in August to well over 3,000 cases a day now. Infectious disease physician Dale Fisher of the National University Hospital says Singapore is letting nature take its course.

DALE FISHER: We're allowing endemicity.

MCCARTHY: Endemicity or endemic disease refers to the constant presence or prevalence of a disease in a population, like influenza in the United States or dengue in Asia, where there's a certain amount of disease each year. Recognizing that the coronavirus is not going anywhere, Fisher says Singapore has decided to coexist with COVID-19 and not try to eliminate it. He says the 88,000 new cases in the last month are the result of that change in strategy.

FISHER: You allow the doors open, and of course, a lot of people get infections. The vast majority of those are asymptomatic or very mild.

MCCARTHY: Fisher says thanks to the vaccine, 98% of new cases are mild enough for patients to recover at home, leaving hospitals to focus on the seriously ill. Fisher says Singapore's experience teaches that the vaccine is not very good at preventing transmission...

FISHER: But it is maintaining its capacity to prevent severe disease and ICU and deaths.

MCCARTHY: Only a tiny fraction of Singapore's cases wind up in the ICU, and they are mostly the elderly. In fact, senior citizens remain the most vexing problem as transmission rapidly spreads. They are more susceptible to bad outcomes, and a considerable number remain unvaccinated. Inoculating them, says Fisher, is the priority.

FISHER: Because the reality is these are the people that, through their decisions, are putting the strain on the health system and actually slowing down the opening up.

MCCARTHY: But infectious disease specialist Dr. Paul Tambyah says door-to-door canvassers in Singapore report that many seniors isolated, sick and alone seem to be indifferent to their fate.

PAUL TAMBYAH: A friend was telling me. He said, you know, he knocked on 10 doors, and eight people told him, go away. And then he said - why? He said, look, I don't care if I get pneumonia. He said five people actually told him that.

MCCARTHY: If Singaporeans are assured that a positive test would likely mean mild symptoms for themselves, they do worry about transmitting the virus to older relatives, where outcomes can be fatal. Tambyah says if seniors were protected with vaccinations...

TAMBYAH: Then the rest of us can get along with our lives.

MCCARTHY: China is one of the last remaining countries pursuing a zero COVID strategy. Australia and New Zealand are grappling with how best to open up safely. Singapore has pushed open the border, allowing travelers from a small group of countries, including the U.S., to enter. Fisher says compared to local transmission, cases at the border are negligible.

FISHER: All these quarantine restrictions to stop 10 people a day when you're getting 3,000 a day - you can see it makes no sense. So these are being peeled back.

MCCARTHY: But when restrictions on indoor dining were peeled back, infections soared.

FISHER: And that really saw our numbers go from double digits to over a thousand in a few weeks.

MCCARTHY: Singapore's health experts say exiting the pandemic will mean a carefully calibrated lifting of lids and laying them back on again as needed. Fisher says it may take another year or two. Meanwhile, he says don't expect a Singapore version of the U.K.'s Freedom Day, where almost all COVID-19 restrictions were lifted.

FISHER: It's much easier to have Freedom Day and say, take off your masks and stop testing than it is to exit the pandemic in a controlled, safe in inverted commas way, but this is what Singapore is trying to do.

MCCARTHY: As Singapore transitions to living with the coronavirus, Fisher says we're ripping the Band-Aid off slowly.

Julie McCarthy, NPR News.

(SOUNDBITE OF DAVID BYRNE AND ST. VINCENT SONG, "WHO") Transcript provided by NPR, Copyright NPR.

Julie McCarthy has spent most of career traveling the world for NPR. She's covered wars, prime ministers, presidents and paupers. But her favorite stories "are about the common man or woman doing uncommon things," she says.