How readable is the roadmap to endemic Covid-19?

WHAT a difference a weekend makes. Last Friday, the government's multi-ministry taskforce on Covid-19 reiterated the country's commitment to living with the virus, with tighter curbs only needed as a last resort.

Then on Monday, taskforce co-chair Lawrence Wong called on the public to reduce their non-essential social activities over the next two weeks, warning that those last-resort measures remain on the table.

Perhaps to the taskforce, this did not seem like a significant change in messaging.

After all, they had already struck a cautious note last Friday, with further reopening put on hold to monitor clinical outcomes, and an emphasis on widespread testing as part of the "new normal".

On Monday, Mr Wong also noted that the new advisory to reduce social interactions was not mandatory.

Why, then, was there a widespread sense of frustration at Monday's update, and a perception that the taskforce is "flip-flopping"?

This public reaction might point to a longer-running issue: an apparent lack of clarity regarding what it means to live with endemic Covid-19, and how to react to a high number of daily cases.

For weeks, the taskforce had stressed that its focus was shifting away from daily numbers and towards cases of severe illness.

Last Friday, the taskforce reiterated this, noting that the increase in cases was not unexpected, and the number of patients who need supplementary oxygen or are in intensive care "remains stable and under control".

There were 216 new locally-transmitted cases that day, then 253 and 186 on Saturday and Sunday respectively; 20 cases requiring oxygen supplementation and five in intensive care on Friday, versus 21 and six respectively on Monday.

So when Mr Wong sounded a note of alarm on Monday, despite there being no apparent major change in the daily numbers, the public might be forgiven for being somewhat confused.

Mr Wong's worry was the virus' reproduction rate. This is now above one, with cases doubling every week. If unchecked, this could mean Singapore seeing 1,000 daily cases in just two weeks' time.

Yet it is unclear whether calculations of the reproduction rate would have changed drastically since last Friday. If this danger of an exponential increase had been flagged then - perhaps in relation to the need to monitor the situation - that might have lessened the sense of whiplash.

Trigger points

There is a more fundamental tension, too. The Delta variant is much more virulent than the original, and its spread less inhibited by vaccines.

Would keeping its reproduction rate low require continued curbs? If so, how does that square with the idea of living with the virus?

Does living with endemic Covid-19 still mean tightening measures when flare-ups occur - which is rather different from how Singapore treats influenza or dengue?

And if so, when should such moves be expected? Since early in the pandemic, there have been calls for the government to specify the trigger points - whether new case numbers then, or clinical outcomes now - at which measures must be tightened.

Granted, the lack of hard thresholds gives the taskforce room to manoeuvre. But it also contributes to a continuing sense of uncertainty.

Then there is the question of the long run. In his National Day Rally on Aug 29, Prime Minister Lee Hsien Loong said: "With endemic Covid-19, sooner or later everyone will meet the virus."

Vaccination greatly reduces the chance of severe outcomes among the infected. But its protection is not absolute; nor is the entire population fully vaccinated.

Living with endemic Covid-19 means accepting a certain degree of serious illness and death, particularly among the unvaccinated.

It might instead be a question of timing, and spreading out these losses - "flattening the curve", as that early-pandemic phrase went, to ensure the healthcare system is not overwhelmed.

What's the goal?

Even Israel - until recently seen as a success story for containing Covid-19, before the Delta variant led to a fresh wave - has had more than 7,200 deaths from Covid-19, out of a population of 9 million.

What potential death toll might Singapore be facing, in the official epidemiological models that undoubtedly exist somewhere?

What is the goal of containment measures - beyond the obvious rhetoric of preventing death as far as possible? While maintaining national morale is of course important, the population must be prepared for losses that might lie ahead.

We have been told that there is a roadmap to a Covid-resilient future. But a map without numbers - measurements, estimates, a sense of scale - is of little use for navigation.

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