Vaccination kept Singapore’s Covid-19 death rate low; outbreak in dorms could have been disastrous

The first dormitory case in the country was detected on Feb 8, 2020, not long after the first Covid-19 case surfaced in Singapore on Jan 23.

Joyce Teo

Joyce Teo

The Straits Times


Migrant workers at S11 Dormitory @ Punggol on April 21, 2020. PHOTO: ST FILE

March 9, 2023

SINGAPORE – With one of the highest Covid-19 vaccination rates in the world, Singapore had its ticket out of a terrifying crisis that has claimed more than 6.6 million lives globally. The overall Covid-19 case fatality rate in the nation is one of the lowest in the world, at less than 0.1 per cent, compared with the average of about 1 per cent worldwide.

While it did well in protecting lives and livelihoods, the nation’s journey towards living with the virus was fraught with challenges. The 2020 outbreak in migrant workers’ dormitories, for one thing, nearly did Singapore in, according to a just-released White Paper on Singapore’s response to the pandemic.

“It’s very hard to distil such a complex crisis into one or two things. But if we look overall at the experience, vaccinations were clearly such an important way out of this pandemic, for the world and for Singapore,” said Deputy Prime Minister Lawrence Wong in an interview on Tuesday.

“And, overall, our whole vaccine strategy, from procurement to the rolling out of the vaccines, to the communication to actually delivering jabs to people, I think we have generally done well, and that has enabled us to get through this pandemic.”

Singapore recognised early on that vaccines were its most promising exit strategy, but it could not wait till vaccines were approved to buy them, because it would not stand a chance of getting them early due to the low volume of orders.

Instead, it had to place bets, at substantial cost, on potential game changers, said the White Paper.

“The only way a small country like Singapore could gain timely access to the vaccines was to sign advance purchase agreements and make early down payments on the most promising candidates,” it said.

Vaccination centres were also set up in a matter of weeks, among other moves aimed at facilitating the vaccination roll-out to the entire population.

Said Mr Wong: “We had one of the lowest Covid-19 death rates in the world. We have safeguarded livelihoods and kept supply chains open… and importantly, we have emerged from this crisis more united as a nation than before.”

The outbreak in the dormitories was one of the biggest challenges, he said.

“It could have possibly been a major disaster for us. But fortunately, with the help of the SAF (Singapore Armed Forces), everyone working very hard, we were able to manage the situation and keep our dorm workers safe,” added Mr Wong, who was co-chair of the multi-ministry task force set up to tackle the pandemic.

The first dormitory case in the country was detected on Feb 8, 2020, not long after the first Covid-19 case surfaced in Singapore on Jan 23.

The Government’s initial response was to follow the procedures instituted during the Sars (severe acute respiratory syndrome) crisis in 2003, believing them to be adequate as the prevailing view then was that asymptomatic transmission was not possible.

The White Paper also noted that the Government lacked a consolidated picture of migrant workers who may have sought treatment for acute respiratory infection symptoms from different service providers, including non-governmental organisations.

But the virus spread like wildfire in the migrant worker community, forming clusters that threatened to spiral out of control. There were also concurrent clusters in various places, including nursing homes.

To prevent the country’s healthcare system from being overwhelmed by the surge in cases, the Government announced a Singapore-style lockdown – known as a circuit breaker – in early April 2020.

By the end of that year, nearly half of the roughly 300,000 migrant workers residing in dormitories had caught Covid-19. However, many never showed any symptoms and were found to have had past infections only through serology testing to detect antibodies formed after infection. There were only two fatalities.

Had the infection spilled over into the wider community, Singapore could have experienced a devastating surge of infections which would have overwhelmed the healthcare system, leading to catastrophic mortality rates, the paper noted.

And the economy would have suffered even more, with a significant portion of workers out of action.

But it was only from June 2022 that migrant workers no longer needed an exit pass to visit most areas, and the long period of confinement took a toll on their mental well-being.

Deciding when and how to relax movement restrictions for the workers was a difficult judgment call, the Government said in the White Paper. It could have eased some of the restrictions earlier, especially after most of the workers had been vaccinated and boosted, but there was fear of a high reinfection risk, given the communal living arrangements in the dormitories.

“We should have probed deeper and conducted better and earlier ground surveillance, such as by doing dip-stick testing on sample populations to make the most of limited testing resources,” it said.

The Ministry of Manpower has since set up a new primary healthcare system for migrant workers, with clinical teams equipped with multilingual translation capabilities, at least.

With the benefit of hindsight, Singapore could have had fewer disruptions and deaths, Mr Wong added.

“But that’s like asking for the impossible because no one would have been able to have that perfect information, even at the very start of the pandemic, nor would we have the solutions at hand. It was not possible to have vaccinations ready from day one.”

Mr Wong said: “The purpose of this review is not so much to pass judgment on, but to learn. To learn and to ask ourselves, from all these experiences, how can we be better prepared when the next pandemic comes?”

There were times when the public was confused by frequently changing and sometimes inconsistent instructions, the White Paper noted, and the Government will learn from these episodes, especially in the way it designs policies and how these are then communicated.

Throughout the pandemic however, clear and transparent public communication kept people informed and reassured, and psychologically prepared for what lay ahead, said the Prime Minister’s Office in a statement.

“We will build on this foundation, and consider how else public communications could be leveraged to shape the national psyche in support of important shifts during a crisis,” it said.

It added: “In this crisis of a generation, we mounted a strong whole-of-nation response. The public, private and people sectors banded together to deliver the best outcomes for our people and country.

“From healthcare workers and other essential personnel working on the front lines, to private companies and community organisations who contributed their time and resources, as well as the many ground-up groups and volunteers who stepped forward to provide support to those in need – all went beyond the call of duty.

“The Government would like to put on record our appreciation for the dedication and sacrifices of all who were part of our multi-year fight against Covid-19. We also thank all Singaporeans for displaying considerable fortitude in abiding by the measures imposed at different phases of the pandemic.”

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