Phase 3 unlikely until more people use TraceTogether: Experts

Singapore's Covid-19 cases in the community have been at an all-time low, with zero local cases for two weeks last month (November).

This has raised hopes that the Republic could see off the difficult year with a transition into phase three of its reopening, which would see more easing of restrictions, including allowing for larger gatherings.

The multi-ministry task force tackling the pandemic has said however, that Phase 3 could happen before the end of the year only if three key conditions were met.

They are: a 70 per cent TraceTogether take-up rate, safe management compliance and sufficient testing capabilities.

It has been more than five months after the country moved into phase two of its progressive reopening, following an eight-week circuit breaker from April 7.

Experts say the major stumbling block to phase three is the inadequate adoption of the TraceTogether app or token, which helps to facilitate more effective contact tracing.

So far, around 2.9 million people have downloaded the app or collected the token, the Smart Nation and Digital Government Office said. With a total population of 5.7 million, the uptake of TraceTogether is 50.8 per cent, a far cry from the 70 per cent target.

Associate Professor Alex Cook, vice-dean of research at the National University of Singapore's (NUS) Saw Swee Hock School of Public Health, said: "One of the targets set has been for sufficient numbers of people to have TraceTogether as more effective contact tracing will counter the relaxation in rules. I think we're not yet at that target, and that may hold us back from advancing a phase."

His colleague, Professor Teo Yik Ying, dean of the school, agrees, noting that adoption of TraceTogether is lagging behind.

He said: "At present, it appears we will not be moving to Phase 3 by the end of the year as it appears that token distribution has not achieved a complete coverage of the entire population."

By the end of the month, the country will move away from SafeEntry, and checking in with the TraceTogether app or token will be mandatory at public venues including restaurants and shopping malls.

The tokens are being distributed one constituency at a time and are currently being given out at 37 community centres and clubs, including Aljunied CC and Bukit Batok CC.

However, in recent months, the TraceTogether programme has seen some teething issues including complaints about the app draining phone batteries, as well as a surge in demand for tokens, which meant that not everyone has been able to get hold of one.

Testing capacity

Since the start of the pandemic, rigorous testing regimes have been in place, including as part of community surveillance. These have helped to detect and isolate cases.

Eight cases have been detected since Nov 26, including a stallholder and a migrant worker during the mass testing of those working in and around Tekka Centre on Nov 26.

Whether a community case is linked or unlinked is also worth noting. Of the eight recent cases, at least five were unlinked while two belonged to the dorms.

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But there is no need to be overly worried, Prof Cook said, as the two Tekka cases seem to be isolated, suggesting that infection control measures have been effective in halting transmission chains.

When asked why Tekka Market was chosen as a testing site, Prof Cook explained: "People working in customer-facing roles are more likely to interact with a case and thus to get infected themselves."

He also highlighted the ways which testing can be done: Proactively - such as the pre-school swabbing exercise to provide reassurance that it is safe to reopen pre-schools after the circuit breaker - and reactively, such as when those working in the public bus depots and interchanges were tested in response to a cluster that broke out at the Bukit Panjang Integrated Transport Hub in July.

Professor Dale Fisher, senior consultant in the infectious diseases division at the National University Hospital, said Singapore's testing strategy is multi-faceted. It includes testing those with acute respiratory infection and close contacts, and routine testing of residents in high-risk dormitories and industries as well as front-line workers.

He said: "I believe continuing surveillance in places like hawker stalls is simply an extension of such efforts to look around for cases and at the same time reassure ourselves that there is no significant community spread going unrecognised."

With the outbreak well under control, Singapore has the opportunity to redirect that capacity to look for any unidentified problems, he added. "It's quite a luxury compared to the rest of the world."

Keeping to the rules

The public seems to have been generally complying with the rules around mask wearing, social distancing, and gatherings in groups of five, Prof Teo noted, an area that the country must score well in before the gates to phase three open.

However, some black sheep remain. For instance, on Nov 28, about 30 people across six tables in Tekka Centre were allegedly intermingling, according to a Lianhe Zaobao report.

This was one of four recent reported incidents of non-compliance.

This week, Gemma Steakhouse in National Gallery Singapore was ordered to close for 20 days starting Dec 3 for flouting safe management measures during a dinner involving 75 people in October.

On Saturday, shoe retailer Foot Locker's Orchard outlet was ordered to close for 10 days after large crowds gathered at the store on Friday.

The response to these infringements shows the Government is committed to taking action against those who don't keep to the rules, Prof Cook said.

Risks from abroad

With some countries experiencing new waves of Covid-19 infection, and the recent bursting of the Hong Kong travel bubble, questions have been raised if the regional and global situation will affect Singapore's phase three reopening.

If Singapore does not intend to further review its border control measures, then the global situation actually has very little bearing on Singapore, Prof Teo said.

"However, if we are actively making plans to ease further movements of business travellers and tourists in, then certainly we will be prudent to consider what is happening globally, especially amongst our key business and tourism partner countries."

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Prof Cook said the global situation and resurgence of cases as countries open up provide various lessons on what can go wrong in the pandemic.

"I think we will want to avoid going into phase three and then reverting back to a more stringent level of control if the cases pop back up, and the risk of a volte-face will be one of the things being considered."

Prof Teo cautioned that with additional restrictions eased in phase three, including allowing for larger gatherings, the risk of an uncontrolled and accelerated spread within the community will increase, as seen in places such as Hong Kong and South Korea.

South Korea is currently gripped by a third wave of infections, with 629 new cases on Friday - the highest in nine months.

Clusters have been sprouting rapidly in various parts of Seoul, including a call centre, gym and a university, making it difficult for the authorities to stem the spread. Only about 15 per cent of cases reported in the past two weeks could be traced to known transmission routes. "It is these kinds of accelerated spread that we want to control with our public health measures," said Prof Teo.

On a personal note, Prof Cook remains upbeat about Singapore's Covid-19 performance.

The nation has kept deaths very low - just shy of 30 - and if the United States were to be shrunk to the size of Singapore, they would have had 4,500 deaths, he pointed out.

There have been over 280,000 Covid-19 deaths in the US.

Healthcare workers have also provided great care, government policies have been sensible and evidence-based and most people have been keeping to the rules.

"Personally, I think we're ready to move into phase three," he said.

"The longer we're subject to restrictions but have low cases, the more people will struggle to stay motivated to follow the rules. Moving to phase three will be a demonstration that everyone's sacrifices have been worth it to make progress back to normalcy."

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This article was first published in The Straits Times. Permission required for reproduction.