Endemic Covid-19: Experts question relevance of SafeEntry, TraceTogether

SINGAPORE - Infectious diseases experts have questioned the need for continued widespread enforcement of TraceTogether and SafeEntry rules as Singapore moves towards more targeted contact tracing and living with endemic Covid-19.

They noted that while daily new cases continue to number in the thousands, the vast majority of the population – 94 per cent – is fully vaccinated and most will show mild or no symptoms if infected.

Extensive contact tracing, as was done in the early days of the pandemic, is no longer practical or necessary, they added.

“Given that contacts are now subject to much less stringent quarantine, there scarcely seems much point in doing contact tracing as thoroughly as before,” said Associate Professor Alex Cook, vice-dean of research at the National University of Singapore’s Saw Swee Hock School of Public Health.

“It's unclear how much extra benefit TraceTogether provides, beyond showing evidence of vaccine status when seeking entry to venues or events.”

Professor Paul Tambyah, a senior consultant at the National University Hospital’s Infectious Diseases division and a professor of medicine at the NUS Yong Loo Lin School of Medicine, agreed.

“The mortality rate has dropped with the advent of vaccination, so the urgency to do high-quality contact tracing has also dropped in parallel as we are dealing with a less deadly but still highly contagious disease,” he said.

“There is no good reason for enforcing TraceTogether for the general population if we are doing targeted contact tracing.”

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Their comments come after Singapore’s director of medical services Kenneth Mak said during a press conference on Nov 8 that the focus has shifted away from an aggressive “blunderbuss approach” to contact tracing and isolation of close contacts.

While contact tracing and epidemiological investigations are still being carried out, the authorities are now focusing on settings where vulnerable people may be exposed to infection, such as nursing homes, hospitals and schools, he added.

In a separate statement to The Straits Times, the Ministry of Health (MOH) said targeted contact tracing efforts continue to be supported by the use of TraceTogether and SafeEntry data.

“TraceTogether is used to identify close contacts and issue health risk warnings (HRWs), while SafeEntry is used to issue HRWs to persons who have entered locations with increased spread of Covid-19,” it added.

The use of TraceTogether is effectively mandatory for entry to most venues such as malls, eateries and workplaces, where performing a SafeEntry check-in with it and using it to prove one’s vaccination status are enforced.

The app previously notified users of possible exposures so they could take precautions to avoid infecting others, but this feature was removed in August when the MOH streamlined its health alerts and warnings.

Experts acknowledged that there is some benefit to keeping robust contact tracing mechanisms in place, even if they are scaled back or not actively being used. But they suggested that measures like mandatory check-ins could be relaxed for the general population while continuing to be enforced in specific settings.

Said Prof Cook: “Once we are in the endemic state, the balance between civil liberties and protection from disease will probably shift against regular use of contact tracing technologies.”

He noted that the National Centre for Infectious Diseases had implemented an internal contact tracing system for patients and healthcare workers even before the pandemic. That system uses radio frequency identification tags.

“I see that approach as the future for our hospitals and other high-risk settings for which routine contact tracing capabilities are needed,” he said.

Prof Cook added that the purpose of defining clusters of infection is to trigger a certain response, such as vector control measures in the case of dengue outbreaks. This means it is rare to define clusters for diseases like influenza which do not generally require intervention.

“I suspect that future Covid-19 cases may be treated more like influenza than dengue, with contact tracing of clusters retained for high-risk populations or settings but not for most cases. If we reach that point, there would be no point in mandatory check-ins.”

Dr Leong Hoe Nam, an infectious diseases specialist from the Rophi Clinic, said the main function of TraceTogether has become largely irrelevant for vaccinated individuals.

However, he said it may remain useful for unvaccinated and vulnerable people as it can aid earlier detection, which will improve outcomes if they are infected.

Requirements like mandatory check-ins could be loosened if and when daily infections fall further and the burden on the healthcare system is lightened, he said.

In the past few weeks, the percentage of intensive care unit (ICU) beds that are occupied has fallen slightly. This is partly because capacity was increased to 430 beds as of Nov 16, up from around 360 in end-October.

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The authorities have been gradually relaxing restrictions, with dining in and social gatherings to resume in groups of up to five from Monday (Nov 22).

Restrictions on business and leisure events have also been eased under a pilot scheme that started last Monday.

Up to 1,000 fully vaccinated people at a time are now allowed to attend meetings, incentives, conferences and exhibitions (Mice) events as well as sporting events and live performances. Zones are capped at 100 people each, up from 50 previously.

Prof Tambyah said contact tracing efforts can be activated when needed, similar to what is currently done when noteworthy clusters involving other endemic diseases like tuberculosis emerge.

He added: “Temperature screening was dispensed with some time ago in Singapore malls and buildings as it does not work. Hopefully, the same will be done for check-ins soon.”

Authorities in some countries with similar Bluetooth-based apps have had to adjust their approach to contact tracing in response to endemic Covid-19 and the Delta variant in recent months.

In Britain, the government lifted most social distancing rules in July but did not tweak the rules for its National Health Service (NHS) Covid-19 app.

The number of self-isolation advisories issued automatically through the non-mandatory app rose sharply in a phenomenon dubbed the “pingdemic”, leading to concerns over labour shortage as a result of too many asymptomatic workers mistakenly believing they were legally required to self-isolate.

The British government later updated the app so it would issue fewer isolation orders and explicitly exempt fully vaccinated close contacts of confirmed cases from isolation unless they test positive themselves.

In Australia, the CovidSafe app was launched in April 2020 and touted as a key plank in the country’s Covid-19 recovery plan.

However, according to The Canberra Times, a March 2021 report from a consulting company tasked by the federal government with reviewing CovidSafe revealed that the app was rarely used by contact tracers, who found it cumbersome and time-consuming to extract the data.

In September, ABC News reported that Australian state authorities did not use CovidSafe to uncover any close contacts since a new wave of infections driven by the Delta variant began around May, preferring to rely on QR code-based check-in data instead.