A few weeks ago I started drawing attention to Singapore's Covid-19 response as one NZ can learn from. S'pore has pop 5.7 million, 73 Covid-19 deaths, 83K cases. After reopening commenced on 19 Aug, cases rose exponentially. What should we be learning? /1
https://t.co/KgLKRLVBVd https://t.co/GSkRKEqPQr

Vaccination currently stands at 84% of the *population* has received 1 dose, 82% population has been fully vaccinated. Now, 5 weeks after reopening commenced, the Singapore government announced the need for increased restrictions. It *did not* lie down and scream "Freeeedom" /2

No, the Singapore government has (rightly) taken steps to protect it's population from Covid-19. The large majority of new cases (98%) have been mild or asymptomatic. This is thought due to the high vaccination rates. /3

Of 254 cases of severe illness in the past 2 weeks, 48% were unvaccinated. The S'pore MOH calculates vaccine efficacy against severe illness to continue to be high - 80-90%. The susceptible vaccinated are elderly and those with co-morbidities. /4

So, 10 days ago, they started to roll out a booster programme for people aged 60y and above, and residents of aged care facilities. According to S'pore MOH, within 1 week, 91,500 seniors had received booster doses. Boosters are also recommended to extend to those 50-59y. /5

To care for the large numbers of people with mild illness who were presenting to hospital, the government is establishing community treatment centres, which help monitor the progress of infected people with comorbidities. These centres will liaise with hospitals /6

School learning continues from home, social gatherings are slashed to 2 people max, masks are in place, and work from home is the default. BUT for those who are unable to work from home, self-test rapid antigen testing is recommended *weekly*. /7

Sporting, religious, and entertainment events can go ahead to a limit of 1000 fully vaccinated people, but if unvaccinated people are admitted, that maximum number falls to 50. The government is increasing financial supports to hard hit sectors. /8

About 1 month ago, *all* households in Singapore were mailed a pack of Covid-19 rapid test kits for free. People are now encouraged to use these before heading out or visiting. These I understand are also widely available for purchase. /9 https://t.co/p3M1AwbuzJ

From the 1st October, the S'pore MOH website will host a live time map of areas where there have been large numbers of confirmed Covid-19 cases. Citizens are asked to watch these hotspots, and self-test for 10 days after exposure. /10

It's important to recognise that S'pore has huge hospital capacity compared to NZ. Hospital care is used much more frequently for Covid-19. There are currently 1092 cases in hospital, of which 162 require O2, and 23 are critical /11 https://t.co/ofYku81XkQ

So we need to watch the hospitalisation numbers *for those requiring O2/ventilation/severe illness* over the coming weeks, as this gives us a good indication of how well their strategy is tracking, not cases alone, majority of which are now v mild. /12

Importantly, S'pore has excellent healthcare for a nation of it's size, with >2 x the ICU/critical care beds per 100,000 compared to NZ (11.4 S'pore vs 4.6 NZ) https://t.co/Lk1psGD4oo /13 https://t.co/sOGGxI7SYJ

Singapore's ICU capacity is more like that of Switzerland or England, while NZ's ICU capacity is at the bottom of the OECD. https://t.co/8QbhUvGivT Improving NZ's capacity cannot be fixed overnight, or even in months, it requires sustained $ investment over successive govs /14 https://t.co/5sTPFX8vNi

In summary, S'pore continues to be a rich source of novel Covid-19 mitigation strategies which NZ can learn from. As they navigate their re-opening with high vax rates, we can learn from their response, because their government HASN'T GIVEN UP PROTECTING THE PEOPLE'S HEALTH /15

Some are uncomfortable to learn and imitate S'pore. It is too 'authoritarian" they say. This was certainly the case under Lee Kuan Yew. But high public compliance isn't the only factor in play. /16

S'pore is wealthy, draws highly educated workers, has excellent science & technology. The government response has been proactive, transparent, intelligent, and coherent. An educated citizenry is more likely to comply when they see the value of public health measures. /17

NZ has shown itself to be able to mount a hugely effective collective response when provided good information and leadership. So we may be able to achieve the same levels of collective action, if we understand why it's important /18

Finally, before anyone asks, I am not advocating for us to blindly follow S'pore out of elimination, but rather to learn from their response. We need to find a strategy that fits our unique demographic profile, existing inequities, healthcare capacity /19

But continuing to learn from a government with an excellent track record against SARS and now COVID-19, that HAS NOT GIVEN UP and is still moving to protect it's people from Covid-19 using novel strategies is definitely one to watch. /20

The reference for much of the thread above on S'pore Covid-19 responsiveness is: https://t.co/gvkhc88cOS /end

Addendum: I think it hardly needs to be said but NZ should be looking to achieve VERY HIGH >>90% vaccinated proportion before it attempts to move out of elimination in this way. If broadly ~10% of S’pore popn is not eligible (<12y), that means they have ~93% eligible vaccinated.