#covidsg 29 Sept 2021

Do people still blink at the daily new case counts? I think the shock of new restrictions last Friday had a more material impact than just daily numbers.

The Covid pandemic has been here for so long that you’re probably in a routine – either you are in the A. covid-response side (healthcare, support, ancillary, etc), B. industry affected by covid shutdowns (tourism, aviation, f&b), or C. not directly affected by covid that much (banking, finance, or etc).

You should be in a routine, and not have to turn your life upside down with each +/- restriction, because it’s just not over yet. Sure you can be annoyed/upset by the changing of it, but it’s not just in Singapore. Even Germany and other countries reserve the right to adjust the state depending on current situation. The only difference is how often, how much, and how lax the targets.

Of course one very major impact, still, is if you get the virus, or get quarantined, and that’s a major discussion in itself on how it is managed and whether the policies are appropriate and reasonable.

One bizarre thing has been (the probably few number of ) the HCWs being unhappy with the workload, and saying policies are bringing on more work for them. This is in a way, contradictory, or something, I can’t quite put a firm finger on it.

  • healthcare is busy, much much busier with Covid, no doubt about this
  • they are busy because of preventive measures, PPE, increased and differentiated treatment protocols
  • isolation, quarantines, reduction in available staff, physical space, resources
  • knock-on effect due to having to ‘protect’ other non-covid patients, from covid-patients

I gather that many of them, being in the field, quite thoroughly understand the rationale, risks, and protocols. Of course, understanding something could also lead to even more frustration at not being able to ignore it, as compared to an old uncle at the coffeeshop not wearing his mask properly.

How should we solve this though? short of magically conjuring more personnel.

If healthcare says they have a problem coping with Covid, isn’t that MOH’s problem, and not the public’s problem? What could the public possibly do, to make Covid go away?

Since we established (nowadays) that we can’t eradicate it from SG, from Earth, it means that Covid keeps returning. (I’m just gonna call the virus+disease all Covid because it’s tiring to keep differentiating.) This means the public cannot stop getting infected, sooner or later, this means the public will end up at healthcare, be it self-care, primary-care, tertiary-care, morgue… But what basic tenets can we drop/adjust/ignore/change?

  • Covid-19 is mild and we need to prevent ourselves or family members from contracting Covid

Is this still true? Do we need to isolate household members from one another? We don’t do that for flu etc, we don’t quarantine active cancer patients etc. We don’t quarantine 90 year old grandparents. We just accept it as a fact of life? So is this a mental vestige of earlier fears?

Or is this a way of reducing the infection rate to protect healthcare staff from being overwhelmed

  • Covid-19 is generally mild, except for higher risk people, and we need to prevent these people from contracting Covid

Do we need to do extensive isolation for nursing homes? It’s causing a big workload for just a preventive measure. I feel that this is unnecessary even with the increased risk of serious illnesses.

Do we need to do extensive isolation within the hospital setting? Is this to be standard for infectious diseases? How long can this be kept up?

  • Hospitals are saying that excessive of mild Covid cases come to A&E, and wards.

Look we are barely having 2000 new covid cases a day, it will take ages for people to finish getting infected with Covid. If you can’t handle 2000 cases a day, the solution is not to tell people to stay out of medical care settings, the solution is to properly direct the masses to the appropriate level of care that you want people to go to. Possibilities:

  1. set up dedicated treatment ‘hospitals’ for serious covid (the new CTF concept, which has barely a few hundred beds)
  2. set up dedicated ‘primary-care’ for mild covid (since it’s all the same disease, it makes life easier for the healthcare workers than a normal general care gp or polyclinic setting)
  3. set up self-help conditions for v mild covid
  4. use the expo-concept for mass monitoring/treatment/triage? (is this too low class? how about use this as a primary care?)
  5. set up 24/7 walk-in that are not your A&E for goodness sake. It’s so difficult to get late night treatment for any illness, and the default medical support is the v rare gp clinic, or A&E.
  6. have more extensive use of pharmacists
  7. reduce over-diversion of resources towards eldercare support if the endgame is to reduce the total loss of productive citizens
  8. reduce support of non-vaccinated, simply because of limited resources and outcome probabilities

These are changes that the medical system needs to do on their own, not the public. The public will keep getting covid, and in greater and greater numbers as we open up. It will not get any less. They need to plan for 10X patient counts, not 1.5X. They need to do things like sending oximeters, OTC meds to mailboxes in a big blast, rather than one by one courier.

I wont be surprised if some of these are already in the works.

On one hand, we should only escalate or degrade care if the system is truly not coping, instead of pre-emptively degrading care levels, on the other hand, people feel discouraged to hear of systems being strained.

We seem to have a ridiculous amount of manpower right now on vaccination, move them to do something else. Vaccination people can queue for an hour, no big deal.

#covidsg 29 Sept 2021

#covidsg 24 Sept 2021

It arrived. The latest tranche of changes / restrictions for Covid-19. It wasn’t a surprise that changes were incoming, there were so many clues and indications that things weren’t going well. It was a simple prediction that the next possible scheduled press conference (fridays) was the day to go for, that the news was delayed due to the ongoing press conference, that so many things needed to be changed due to how massively the Covid situation has evolved in the past 1-2 weeks.

So let’s see the latest changes

Social:

  • Social gatherings reduced from 5 pax to 2 pax sizes for 1 month
  • Dining-in at F&B similarly reduced from 5 pax to 2 pax. No change to 2pax at Hawker centres and coffee shops.
  • Indoor Mask-off gym and exercise, 2 pax groups
  • Marriage solemnisations 1000 vaccinated, 50 unvax. Wedding receptions 250pax, 5 per group. Unvax and elderly discouraged
  • Workplace: WFH as default for 1 month, ART if required to be in office
  • Workship: 1000pax, 50 unvax. Elderly discouraged
  • Funerals: 30pax, 2 per group

Healthcare:

  • Home Recovery Program (HRP) is now default for Covid-19, unless you have certain high risk factors.
  • If unsuitable home environment, push to Community Care Facilities CCF (basically isolation facility)
  • If need monitoring, push to Community Treatment Facilities CTF (CCF with medical)
  • If need active treatment of serious breathing or other conditions, push to main Hospitals
  • CCF capacity expanded from 3500 to 4600
  • CTF capacity to expand to 1200
  • Hospital beds to expand to about 1600?
  • Expand capacity of HRP support/management, with more telemedicine resources, hotline resources, buddy resources, support in Telegram group, print article ads, People’s Association
  • Covid-19 testing on weekends expanded to Regional Screening Centres
  • ART rate increased

Education:

  • Primary school HBL extended slightly
  • Tuition mandatory virtual/remote

Vaccination:

  • Boosters expanded to 50yo and up.

Financial:

  • Businesses affected will get additional rental support, wage subsidies

Please refer to StraitsTimes or MOH for the latest correct versions, there are just too many announcements, including add-on announcements by MOM, ECDA etc etc on their respective industry specific adjustments, many of which are more minor, but nevertheless impactful.

Is this the right path?

Since we are at a very ‘open’ state of conditions, there are so many opinions from different parties on how we should proceed, how good/bad a situation we are in. It’s not easy to come to any consensus, or balance.

  • Infectious Disease experts who believe that high vaccination is sufficient to provide “mild” status to high majority of infected vaccinated individuals
  • Infectious Disease experts who believe that the current numbers of severe/ICU is still risky
  • Layperson who believes high vaccination is the endpoint and we have reached it
  • Layperson who believes Covid is still dangerous and refuses to get infected
  • Layperson who has kids and is extremely worried about their kid getting it
  • Layperson who has kids and is more concerned about kids not getting social interaction
  • Layperson who has elderly parents and is concerned
  • Vaccinated adults who believe Covid is dangerous for themselves
  • Infectious Disease experts who believe Quarantine system is overly strict
  • People under Quarantine who feel that MOH is doing a bad job by poor management of HRP
  • People with Covid who rush to hospital A&E
  • People with kids or elderly with Covid, who rush to A&E
  • People with Covid who are panicking at home

Wow it’s a major mess with a thousand cooks making this soup.

Some premises though:

the most sobering factlet i can offer you in terms of how singapore is handling covid, is that literally nobody in healthcare expected the numbers to go up so quickly. yes. even the most pessimistic and most cynical expected the numbers to go up fairly fast. but this fast? nope

https://twitter.com/saanenziege/status/1441406103586160645

OYK also said that the rise was faster than expected, with insufficient time to ramp up resources.

It would appear to be true, that Singapore’s daily case count curve, is very rapid, higher than a normal modelled 80%(or higher) vaccination rate. But models and stats and predictions are only as good as the source data, and we know that many countries do not have a comprehensive finger on their pulse, they might not know the exact real world statistics, they don’t have insane testing and ring fencing like we do, they might only have had resources to focus on the more serious or symptomatic cases. So it is possible that our extensive testing is throwing up so many more case counts, that we’re off their charts.

Going into 23 Sept, we knew that there was strong public interest in the daily case counts crossing 1000, there was a huge pressure on the hospitalization and A&E tranche, there was a pretty much overwhelmed HRV / QO system. Something needed to be done, something more extensive than some slight adjustments, 250 enhanced CCF beds, primary school HBL. On 22 Sept LHL himself posted about the MOH QO team being beefed up. So obviously 23 Sept is going to be a change and anyone with a brain will be waiting to hear it, don’t make big plans before the weekly friday time.

Question is, did MTF deliver correctly? And what do their plans indicate.

  • No change to the requirements that Covid positive individuals (PCR positive), need to be Isolated for 10 days. This might sound duh but it’s a huge tenet in the basis of endemic Covid management.
  • ART positive test is not sufficient for official diagnosis, PCR test is still required for confirmation.
  • No change to the requirements that close contacts of C+ individuals need to be under Quarantine.
  • No change to HRW
  • No change to upgrade of higher risk C+ individuals to CTF and CCF
  • Hospitalization criteria is much stricter due to handing over of monitoring to CTF. Essentially CTF is covid-hospitalization-lite?
  • Stricter entry barriers to hotel-or GQF based Quarantine

CCF should have been increased way way earlier, or be able to ramp up even faster. Note LW keeps harping on exponential numbers. Can you double CCFs overnight? or in 1 week for example. Covid can.

CTF should have been active earlier, instead of sending to hospitals. Full ward isn’t optimal? Expo needs to be re-activated. Dumb usage of the facility for entertainment purposes should never have been allowed.

GQF is a toss-up right now, at 80% vax it seems like we should drop this, but there are other competing factors.

The continuation of IO, QO, all means that MTF is still ringfencing and controlling Delta spread. They want to keep Rt number at 1+, not at 5 or 6 in a full blown no quarantine no testing situation. If we go up to full Delta Rt … , wow it’s gonna be over in 2021. If we drop QO, we don’t need GQF. If we drop IO for C+, we don’t need HRP, don’t need admin manpower, don’t need to distribute care packs, don’t need QO society support, we will go straight to managing full CTF-hospitalization-ICU.

Is the general population ready for this? Has anyone tried to convince them that 1. Covid is usually very mild if you’re vaccinated or young, 2. you can just walk around the house and to work if C+, 3. you can self medicate, or go to GP if needed?

Is it right to say we just want you to isolate at home so we reduce the overall speed of spreading, but then once you isolate at home we think that it’s mild and we’re not going to support you? That would feel at odds. So we can’t put that together. We can’t isolate without providing support, test kits, payment, tests.

Can and should we say that if you isolate at home, it’s ok to have your kids and elderly stay together? If we don’t let you roam around in society, why should you risk your kids and elderly? Again it seems at odds. Can we have partial rules or must it be all-or-nothing?

Because of this all-or-nothing, we need to prepare the hospitalization system to also cope with all-or-nothing. Currently it’s not nothing, as they’re already pretty dang busy with real work, but they don’t seem to have bandwidth for ‘all’.

‘All’ in this sense means retain masks, retain dining-in limits, retain event limits, retain travel limits, but without any mass routine ART testing, without mass Quarantine Orders, without sudden workplace WFH requirements. These will have a big impact on the healthcare system capacity, it will reduce the load on the administrative side, and workplace side. However it will increase the load on the treatment side, which is the poorer decision. Because treatment side – doctors, nurses, hcw, support staff, beds, resources – these are very hard to ramp up magically.

So, to protect this resource, they can only do it by reducing the Rt rate and hope the conversion to serious illness stays low. Serious only meaning requiring hospitalization. This is where the new social restrictions come in. They will allow us to see what our special brand of Singapore 80% vaccination conversion rate is going to be, find the comfortable steady state of daily new cases that convert to the serious case rate, and maintain that until the wave dies out or everyone is infected.

I feel that the high vaccination % still doesn’t equate to a safe enough level for full opening. We don’t know the % of people who need medical care. By medical care meaning anything above a 3 day MC and simple flu medication of zyrtec / piriton / paracetamol / cough medication / phlegm thinner. Heck if a high % require basic flu care, it is already overwhelming. But if a large enough % require 14day rest, higher level medication, second follow up, or more, that is bad. And this large enough % is not counted as a % of the population, what we are concerned with, is the % increase workload arriving at clinics and hospitals, and whether they can cope.

If a hospital receives 1000 new patients a day, and in the pandemic now receives 2000 a day. That’s an increase of 100%. This 1000 number, might only be 1000/6million, which is a tiny %, but it’s still bad news.

Every other restriction stems from these numbers. Nothing else matters. The current vaccination rate is not important, the type of vaccine you took is not important, the number of jabs is not important, what is important is at the end of the day, what are the actual numbers of people falling significantly ill and whether the healthcare system is coping.

So I can understand why MOH is still doubling down on the quarantine / test-trace-isolate model, which is undoubtedly painful on a good day and catastrophic when they are overwhelmed. They just really ought to have way more slack and ramp up faster on their procedures, with much more automation.

They should also seriously push out more education info on self-management of covid, manage people’s expectations, change the risk profile ever so slightly, do things that scale.

In hindsight, giving out oximeters to each household doesn’t seem like a dumb thing to still be doing in Q3 2021 now.

Surprised that Temasek hasn’t publicly stepped in to do anything in this wave. They seem to just be happy-happy do things whenever it suits their convenience – at least publicly. I hope the GLCs are doing something on the backend.

#covidsg 24 Sept 2021

#covidsg 23 Sept 2021

#covidsg

WYSIWYG – an old computer acronym meaning What You See Is What You get

If you read the Covid response in the mainstream news, it’s just one side of the story, it’s (mostly) the public mouthpiece that the Gov / MTF wants to put out. That’s not wrong, and largely it keeps the messaging concise, clear, focused, and controlled.

But of course, as with everything, it is important to have independently verifiable data, a healthy dose of skepticism, and proper critical thinking. Not to mention to understand different viewpoints, intentions, and to take care of yourself because nobody else will.

So the other sides of the stories include anything from the pure anti-vax movements, the standard conspiracists, the grassroot WhatsApp chats, the online forums, the coffeeshop chats, scientific community, healthcare community. And of course the actual C+ patients themselves.

It’s not easy to tell who is telling the truth, and how much of the truth. It’s rare for anything to be completely true, or completely false. Anything clearly false would be dismissed immediately, but half truths are more dangerous.

The Current Endemic Mess

So anyways, now we have MOH MTF going headlong into their concept of “endemic” – the dangers of which is that they branded it with this silly name, and over equate it with influenza without the same conditions.

MOH still pursues extensive quarantine and isolation. Not wrong per se. It has great intentions in slowing down spread, flattening the spike, helping hospitals. Really. Slowing down, not reducing to zero. That’s the crux of ‘endemic’, that’s all.

But MOH’s team, despite whatever sugarcoating that LHL/MTF says, cannot micromanage thousands and thousands of home quarantine/patients/phonecalls/home service of swabs+checks+carepacks.

A radical radical radical conceptual change is required. From a top-down to a bottom-up approach. We need to clearly look at the needs vs possibilities and pare it down.

We can guess what is happening at MOH team: anything super critical is attended to: require hospitalization/ICU. breathlessness, low SPO2. everything else is on a best-effort basis. Leads to dropped calls, dropped cases.

The methodology needs to change to prioritize: 1. Entry/registration of C+/QO/IO, 2. Automate entry, followup, exit. Except for escalations and special cases. 3. Digitalize: use of integrated online case status, tracking, QO status etc.

MOH needs to not just resolve 500 caseloads per day. They need to implement new solutions that continuously automate 10% of the above issues per day, at the end of the week, it will lead to scalable solutions that can handle the increasing daily case rates in a sustainable way.

Change in Mindset

It’s incredibly difficult. Firstly the healthcare side themselves do not have the confidence to 100% say that hey if you’re Covid PCR positive or ART positive (somewhat different states here), that you can do some/all the following:

  • Take MC for 2-3 days (typical flu MC duration), take normal GP medication, continue work/school after that
  • Monitor own condition (as a layperson) until severe enough to require to go to the GP, or to the Next Escalation Point (NEP), currently A&E.
  • Stay at home, with isolation, with other vaccinated household members (v v ideal and rare situation)
  • Stay at home, without isolation, with other vaccinated household members
  • Stay at home, without isolation, with other ‘vulnerable’ members like unvaccinated kids or vaccinated elderly (common)
  • Stay at home, without isolation, with other really vulnerable members like unvaccinated adults/elderly with comorbidities
  • Continue to work or go to school after the initial 2-3 day MC

There are some basic premises we need to establish

  1. Very serious Covid+ patients need to be able to be seen by a doctor at NEP. This can be A&E, or I propose setting up dedicated Covid sites if possible. It will help in triaging.
  2. People should be easily able to self-isolate, basic needs are actually an official MOH policy, an official MOH notification or verifiable certificate just like the MC system, and employer participation in this scheme (voluntary or enforced)
  3. Social support in terms of food supply, logistics, staying alive.

That’s all! It’s so simple. Everything else is ‘good to have’.

  • Requirement for people to self ART daily while on QO – good to have, but a big $ cost and logistics. Suggestion: Reduce interval
  • Requirement for entry/exit PCR tests – good to have, but a big $ cost and logistics. Suggestion: downgrade to ART, self submit.
  • Requirement for isolation room at home – good to have, rare. drop this if we don’t mind community transmission. It’s a huge effort and low use if everyone is eventually going to be infected. if it is “vulnerable” like kids and vaccinated elderly, does MOH have the guts to go ahead?

We know that

  • Sars-Cov-2 / Delta will still rip through a double-pfizer-vaccinated population. This is now a Known fact that we wished not to happen, but it does. Layman need to realize this and stop thinking vaccination can stop infection.
  • Sars-Cov-2 infection is layman-mild for most person. Meaning manageable flu symptoms that can self resolve, or with GP visit.
  • Sars-Cov-2 infection can lead to medical-mild for vaccinated persons. In a layman flu concept, it feels serious enough that we would definitely go to a doctor, or maybe a second visit, an extended MC. In a layman Covid-era concept, we would rush to the Next Escalation Point, and the only thing offered is A&E / hospitalization. I believe in the medical concept, this might still be considered mild.
  • In the medical ‘serious’ case concept, hospital admission is offered. We all agree this is serious.
  • Sars-Cov-2 in an unvaccinated person, will have a XX-times higher rate of serious illnesses. Everything tends higher. We really can’t do much for them right now.

MOH’s strategy now is still focused on one end point: juggle hospital capacity for serious cases. We all can say that it’s ‘endemic’ yada yada, but as long as the percentages above lead to a temporary unmanageable spike in hospital load, and I mean hospital load for truly serious cases, then it’s game over and back to a lockdown.

MOH wants to go to a hands-off self isolation no QO concept. But if we do that, how fast is the rise in serious cases, how high does this serious case spike go? We won’t know if the wave is going to stop doubling at 5 cycles, or further! It’s a prediction. Do we wait to 6X, 7X and see? If we don’t measure new/mild cases, we don’t have a predictive value of serious/ICU cases – we’ll be blind until people turn up at A&E.

We currently log 1500 Sars-Cov-2 positive people per day. Unmeasured let’s say 2x this number. And people who got challenged but not infected, … let’s say it all totals 10k exposures a day? 6 million popn, 10k..600 days to finish one round of exposures. If we abandon full QO, exposures a day should go up 10x, say 100k a day. Can we manage serious cases for this rate? This is the true end point question.

So what kind of theoretical public health measures will lead to a manageable serious case load?

And can MOH and society support and implement these public health measures properly?

In an analogy, MOH’s current rules and on the ground implementation is like saying you Must wear a mask outside of your home, but then 20% of people don’t have masks, 20% forget to bring it out, 20% only remember to put it on after 1 hour outside, 20% still fall sick, etc etc. Is it really then still effective?

#covidsg 23 Sept 2021

Joni Mitchell – Both Sides Now

Rows and flows of angel hair
And ice cream castles in the air
And feather canyons everywhere
Looked at clouds that way

But now they only block the sun
They rain and they snow on everyone
So many things I would have done
But clouds got in my way

I’ve looked at clouds from both sides now
From up and down and still somehow
It’s cloud illusions I recall
I really don’t know clouds at all

Moons and Junes and Ferris wheels
The dizzy dancing way that you feel
As every fairy tale comes real
I’ve looked at love that way

But now it’s just another show
And you leave ’em laughing when you go
And if you care, don’t let them know
Don’t give yourself away

I’ve looked at love from both sides now
From give and take and still somehow
It’s love’s illusions that I recall
I really don’t know love
Really don’t know love at all

Tears and fears and feeling proud
To say, “I love you” right out loud
Dreams and schemes and circus crowds
I’ve looked at life that way

Oh, but now old friends they’re acting strange
And they shake their heads and they tell me that I’ve changed
Well something’s lost, but something’s gained
In living every day

I’ve looked at life from both sides now
From win and lose and still somehow
It’s life’s illusions I recall
I really don’t know life at all

It’s life’s illusions that I recall
I really don’t know life
I really don’t know life at all

Joni Mitchell – Both Sides Now

The others

Recent covid cases have hit the port/marine industry and the airport borders pretty consistently. Low, but consistent occasional cases of transmission from their interactions with foreigners.

Kinda sucks to be them. It’s a constant risk. Maybe it’s not as high profile as the risk of healthcare workers treating and attending to covid patients, but nevertheless it’s a higher risk than other industries that’s walled off.

Because it’s not as recognized, it might not be as appreciated too. I should say hardly anybody’s job description is to deal with this viral outbreak 24/7/365 and ongoing. The general healthcare industry on a normal day attends to medical issues without such risk of transmissions, the port industry just wants to move ships and cargo, the airport industry just wants to check and move people and cargo.

I’d liken it to like a normal policeman is not equipped or supposed to be having to guard against the mafia or a war day in and out. Tough. Hope y’all have an easier time soon.

The others

Phase 2 once again

So we back into “Phase 2” covid measures, sort of. mostly.

The ‘little’ TTSH case, and cluster, seems to have blown up significantly. There are so many reactions to it, so many comments, complaints. Somehow I just feel the measures are both quite-expected, and yet also not-expected. It’s cringe-y to see public’s reactions, many which are just off-the-cuff feelings or layman.

Probably will not be able to cover everything, but:

  • The presence of a single nurse-case in TTSH – not unheard of in itself, though rare. Not a major concern if a single case.
  • The presence of a sizeable cluster within the Ward 9D
    • very alarming as it directly proves that person-to-person retransmission has occurred
    • the transmission either happened really fast, or the detection has been late
    • the presence of cases in inpatients, who are already ill, who are very elderly (high risk factor), and have significant medical history
    • the presence of positive cases in fully vaccinated individuals, which indicates high transmissibility, break-through of vaccination, and even symptomatic infections
  • On the same day they announced an ICA guy, + transmission into the entire family group that shared a meal
  • from the above evidence, in day2 of public announcements, it was already clear to me that this was strongly indicative of a large big cluster, very high transmissibility and vaccine breakthrough which is like the strong Indian variant rampaging in India.
  • It was probably a coincidence that the multiple community cases and clusters all surfaced in the same few days, but it could also show that now we are experiencing influx of the Indian variant, which behaves very differently from the previous variants/clusters/quarantine escapes. At that time they didn’t have evidence yet to say this publicly, and implement community lockdowns, but it was apparent from their actions (by friday) that the situation was intense behind the scenes:
  • they announced which (ttsh) cases went to which venues, implemented 2 day venue closures and clean-ups. they implemented testing for all inpatients, all staff (mega exercise + cost), they isolated lots of staff. much unprecedented actions compared to all previous advisories, or even any other hospital case.
  • the announcement and measures were announced so hastily that it was obvious they were rushing and reacting to the situation

I don’t think the strong public outcry is wrong, there are many good points brought up by public, online, media, although we do bear in mind the rule that hindsight is 20/20.

(The media must be having a field day with all the delicious news cycles though)

Before I go through the Phase 2 festivities, between friday and tuesday, things escalated daily, notably:

  • more ttsh staff, inpatients and visitors were added to the cluster, in sizable numbers daily
  • multiple hospital wards during lockdown
  • community-visited places spanned all over Singapore
  • multiple clusters being fought, with many of them considered as under active cluster period. while likely unrelated and individually manageable, having all of them come under the same period is alarming, stressing (to infrastructure), and potentially a problem (specifically this is a potential but real risk), all of which led to:

The mega Phase 2 announcement on 4 May 2021.

  • 8 person to 5 person restrictions.
    • this strongly strongly reduces the transmission possibility. social distancing is by far the most effective tool in reducing risk. don’t forget the main idea in infectious disease is reproduction rate. reduction of social contact, regardless of any any other factor (eg variant, severity, vaccination), will 100% cut or reduce transmission.
    • However it’s a huge impact to Hari Raya and other social events, sizable impact to F&B industry
    • It’s not as bad as stopping of dining-in, but still quite a headache to industry.
    • It’s definitely majorly proven by the ICA cluster, very rare has a variant infected the entire dining group.
  • 50% WFH.
    • theoretically this allows economy to continue at near the same levels while reducing transmission, as all companies who can reduce has already known how to do so, while at the same time excluding essential workers.
  • Reduction of attendance at in-person events like weddings, funerals, museums, libraries, tours.
    • Very broad measure, odd as we didn’t have proven transmission this way
  • Closure of gyms.
    • HK had a real bad case of this. Quite similar to why Karaoke and pub singing are banned. Low economy activity and disproportionate risk, and also affect small target population segment only.
  • TT-only check-in
    • about time to just go ahead and stop dilly dallying on this. Very helpful right now due to large number of cases. Digital tools really help avoid alot of manual labour. Disregard the whiners.
  • advising all public who have been to venues where ttsh infected cases have been to
    • big move. something like what Australia does. very tedious and high amount of work for some minor returns. really shows they are worrying and trying hard and throwing everything they have at it
    • the long queues and ‘lack of planning’. fairly disappointing after so long, poor management, also shows how last minute this decision was
  • Banning ttsh-exposed visitors from visiting other hospitals
    • wowzer. understandable as there was one case. Poorly managed as it wasn’t announced clearly to the public. again shows the rush.
  • Postponement of non-urgent admissions and procedures at all hospitals.
    • fairly impactful, points more to the temporary loss of ttsh functions, the wide ranging Leave of Absence and Quarantine orders applied
    • also alludes to their planning and prediction of:
      • how a cluster (ttsh) develops over time as new infections typically do not test positive for days/weeks
      • time taken to even complete Round 1 testing of current inpatients and staff (still ongoing after days!)
      • time taken to complete testing of public
      • time taken for newly infected to also test and treat
      • time taken for quarantine periods to end
    • while the above is taking place, for even round 1 to be secured down, it will take weeks to clear. And then after that there’s still round 2 of confirmatory testing to clean up stragglers.
    • near complete shutdown of one of our biggest and busiest public hospital, AND the important NCID capacity is highly and disproportionately impactful of their planned covid capacity.
    • together with their mathematical modelling, prediction of undetected cases, it probably triggered a red line in their warning systems.
  • 14 to 21 day SHN for imports
    • it seems to be quite painful for incoming persons, both in cost and time. 3 full weeks is a long time to be ‘jailed up’
    • based on previous % numbers, number of community leaks seemed to be a balanced risk. they know there are leaks, they aren’t stupid, they just want to balance the economic cost and financial cost to employers
    • Is it possible to even stop leaks? Taiwan and Australia both experience SHN / hotel leaks too. It is important also to not stop 100% of leaks until you can’t detect any leaks and all your internal infrastructure shut down. It’s similar to body immune systems, prime it with vaccines and small infections, build up the capability and strength, remain on heightened alert, shutting down will take time to ramp up, who is paying for the $$ to maintain at high alert level!
  • banning of India incoming non-citizens and PRs.
    • overdue. however politically testy, and sends quite a signal. we were among the first countries to ban, but we are also having one of the highest number of incoming from India, and the cleanest internal state (maybe compared to Australia)
    • still, could be some weeks earlier once India hogged the news with astronomical cases and deaths
    • never ever wait for WHO to announce anything
  • Suspension of in-person Meet MP sessions, school activities, nursing home visits, etc etc
  • delay from Friday to Tuesday
    • well things always move slower over weekends and public holidays, but this should not be a valid excuse for this. I’m sure they were already working hard to come to a consensus to approve the above painful Phase 2 package
    • some unnecessary events like May Day Rally should have been cancelled. prevailing advisories don’t count.
  • Vaccination push
    • Just keep going. There are many logistics and contractual and production limitations. Public should push the govt, but we also know that it probably would not have prevented this cluster really.
    • Don’t fall into the India trap that vaccination solves everything. Social distance first, everything else later.
    • hoo-ha that vaccination “didn’t work” – the caveat was always there, people just didn’t realize or read between the lines. We knew. But from a public health perspective, they still had to market vaccinations as Very Helpful etc. You can’t explain the fine print to everyone, not everyone is capable of fully rational and critical thinking. However the evidence is stark and still eyebrow raising. Comes back to the point about vaccine breakthrough and strength of this mutant. Also again it ties into infectious disease modelling.
  • HK travel bubble
    • It’s cursed, what else can we say. Glad we’re not the ones with pressing travel plans. Granted some people have strong family reasons etc. In this pandemic, sometimes strong reasons aren’t good enough if confronted with long term disability and death on the other end of the scale.
  • Shangri-la dialogue event
    • facepalm, just cancel it. still trying to save face and keep it dicey right now. go away and do video calls like everyone else. political suicide to keep it, prob still trying to spin a story.

Many, many people are just so misled with statistics. Maybe online is just not great for serious discussions, maybe they just don’t know any better.

I’ve been trying to get a feel of the false-negative rates of incoming imports. It’s a little scary. I know/hope someone is keeping an eye on this. Factors include, prevalence of virus in incoming cohort, absolute number of incoming cohort, false negative rates. We know that prevalence is not insignificant, and pretty high or getting higher. This is going to happen regardless of testing skill. A very long SHN should help, but still not guaranteed.

People keep quoting the 93% effectiveness of vaccines. Well there are multiple factors inside there. 1. antibody production of the individual and whether it even worked on your body in the first place. If it didn’t work, you’re screwed 100%. Also this is not black/white, it’s a range of how well your body worked. 2. if you have a shield that works pretty well, but if you using this shield against 100 bashes (covid positive transmission attempts), you’re probably still going to lose 5% of the time. Meaning if you get hit 100 times, you’re still ded. Again, prevalence. 3. if you do all that and your body is having a bad day, meaning weakened immune system, you’re still ded. Also see https://www.youtube.com/watch?v=yhZGAt_SDtc

Phase 2 once again

Jan 2021 – WhatsApp is at a weak point

A significantly sized hoo-ha over WhatsApp privacy is sweeping many countries. WhatsApp has an app / platform has been growing larger and larger over the years, and it’s at a rare weak point.

There are many reasons for WhatsApp, and against WhatsApp, same as for many other messaging apps and platforms. I’ll list them below.

Security is complicated

But while these tools and their characteristics are important, one must remember they are not the end-all of your personal digital security, privacy, or safety. That relies on a holistic care and maintenance of your digital life and habits. Changing from WhatsApp to Signal does not make you a spy. But that’s a story for another time, meanwhile all we can say it 2fa helps.

So which app is better

This isn’t a comprehensive and detailed table as I don’t have the time for that, nor is it a serious IT security analysis, this is just my personal opinion and impression of the apps.

ProsCons
WhatsApphuge network effect, probably near ubiquitous in your circles, free to use, fast app, lots of useful features like audio calls, video calls, location sharing, file sharing, picture sharing, video sharing, tagging, forwarding, web app, chat encryptionsfacebook owned, new monetization push, new privacy policy change, sharing of data to facebook servers for certain info, bad history of facebook company integrity and culture, probably future encroachment
Telegramfree to use, lots of fancy features, gaining in popularity, one of the more common apps amongst the rest, stickers, large group chats, file sharing, photo and video sharing, web app, not by facebook/apple/google/microsoft/amazonugly, bloated app, still mobile number based, russian-linked, new monetization push, not wholly encrypted
Signalfree, encryption, audio calls, pretty app, fastnewer and small in network, still mobile number based, few people using, USA influenced, non-profit org
FB messengerfree, chat w fb contacts, instagramfacebook, need fb acct
WeChatchina network, lots of china featureschina gov control, no privacy, irrelevant features
Google Hangouts / Chatfree, google contactsslow app, poor features, unable to integrate with mobile contacts
SMSubiquitousnot free, no features
RCSfree, independentlow availability, low reliability between sms/data switching, low features
Lineirrelevant
iMessagesecure within Apple, integration with Apple productsonly for Apple, irrelevant to everyone else
Viberif you’re in Philippinesdidn’t win the global competition

Why stick to one app

If you are a digital native, you would be super used to commenting/replying/interacting on all platforms, you would have lots of different groups, and that could be interest groups, family, extended family, significant other, friends, close friends, work, colleagues, work contacts. Not just across different apps, different platforms, but also across different phones.

You should keep them separate, don’t use your one facebook account to comment on everything, don’t use your one email account to sign up for everything.

In this (digital) age, where the online world continues to grow, where data sharing is inevitable, data leak is also inevitable, you can only minimize your exposure by hedging your bets.

  1. multiple accounts so that if you lose one, you don’t lose everything. as many as you can keep up with.
  2. have different tiers of security. higher security accounts for important things.
  3. don’t blindly use your real full name on everything online. you might not be untraceable, but at least make it less easy or obvious at first glance.
  4. look for companies with a better commitment / culture / alignment of incentives
  5. some security is better than no security

Tradeoffs

One big issue here is that WhatsApp new privacy change was very poorly communicated, as characteristic of Facebook, with no proper release, explanation, guarantees.

It did not present a benefit to the consumer. Many other services with privacy tradeoffs like smarthome assistants provide a huge benefit for an intrusion of privacy and heightened risk.

Given how WhatsApp and Facebook behaved, plus the bad history of the split of the WhatsApp founders, most tech savvy individuals knew it was going on a downhill path, down to the Facebook level, which is easily assumed, and nothing else could be believed because of poor behaviour by Facebook towards their other properties.

Will something better appear

My hope is that something else better and more stable appears. It took the world many many years to get to where it was with WhatsApp, and many years with Facebook to ruin it.

But something better can still come along. It’s impossible to say which app or from where. After all Zoom seems so popular, for now.

I really hope that apps can stop being tied to mobile numbers and the contact list. While it’s a quick way to gain users, it’s less flexible, less anonymous, and unable to support multiple identities and privacy.

So what exactly am I using

So many things. I still use alot of WhatsApp, because of the network there, because of work, but I also am almost equally active on Hangouts/Chat (on at least 3 google accounts), I use Telegram for certain groups/stuff, I install wechat only when I need it, I’ll see if anyone really wants to use Signal, but I avoid other platforms.

Jan 2021 – WhatsApp is at a weak point

no longer a baby

It kinda feels like she’s no longer a baby, and more of a child. Wasn’t it so many months ago that she was just crawling, and pulling herself up by holding on to a box, that she was cruising along the dining chairs, that she was standing under the dining table, that we had to pull her up by the hands to get her to take some steps.

She’s even past just walking by herself, now getting stronger, more stable, walking further. Still stumbling often for sure.

But now she’s communicating what she wants, doesn’t want, being sticky to people, and just thinking so much more.

15 months and no longer a baby.

So tiring

no longer a baby

2020 movies and shows

stay at home, also means lots of shows watched:

  • The Meyerowitz Stories (2017)
  • Knives Out (2019)
  • The Farewell (2019)
  • Frances ha (2013)
  • Then Came You (2019)
  • While We’re Young (2015)
  • Where’d You Go, Bernadette (2019)
  • The Peanut Butter Falcon (2019)
  • Official Secrets (2019)
  • The Art of Self-Defense (2019)
  • Knock Knock (2015)
  • After The Wedding (2019)
  • Wild Rose (2019)
  • Shazam (2019)
  • Dunkirk (2017)
  • Ford v Ferrari (2019)
  • A Beautiful day in the Neighbourhood (2019)
  • Jojo Rabbit (2019)
  • 1917 (2019)
  • Little Women (2019)
  • Good Boys (2019)
  • The Old Man & The Gun (2018)
  • The Night Clerk (2020)
  • Suburbicon (2017)
  • Ocean’s Eleven (2001)
  • Ocean’s Twelve (2004)
  • Ocean’s Thirteen (2007)
  • Anna (2019)
  • The Devil Wears Prada (2006)
  • Love & Other Drugs (2010)
  • Uncut Gems (2019)
  • The Colony (2013)
  • The Gentlemen (2020)
  • The Half Of It (2020)
  • Mistress America (2015)
  • Equilibrium (2002)
  • Lost Bullet (2020)
  • Edge of Tomorrow (2014)
  • Eurovision Song Contest: The Story of Fire Saga (2020)
  • The Old Guard (2020)
  • Greyhound (2020)
  • Twelve Monkeys (1995)
  • Tron: Legacy (2010)
  • Nobody Knows I’m here (2020)
  • An Education (2009)
  • Hamilton (2020)
  • When Harry Met Sally (1989)
  • Don Jon (2013)
  • The Princess Bridge (1987)
  • T-34 (2018)
  • Project Power (2020)
  • Blade Runner 2049 (2017)
  • Kiss Kiss Bang Bang (2005)
  • Midsommar (2019)
  • Fast Times at Ridgemont High (1982)
  • Easy A (2010)
  • Stardust (2007)
  • I’m Thinking of Ending Things (2020)
  • Enola Holmes (2020)
  • The Cold Blue (2018)
  • Enemy at the gates (2001)
  • Triple Frontier (2019)
  • The Witches (2020)
  • Secondhand Lions (2003)
  • Drive (2011)
  • The Hangover Part II (2001)
  • National Theatre Live: Skylight (2014)
  • Fatman (2020)
  • Wet Season (2019)
  • Moana (2016)
  • The Greatest (2009)
  • Tenet (2020)
  • Our Times (2015)
  • The Notebook (2004)
  • Sometimes Always Never (2019)
  • Wonder Woman 1984 (2020)
  • The Midnight Sky (2020)
  • Page Eight (2011)

TV shows

  • The Mandalorian Season 2
  • Young Sheldon Season 3 & 4
  • Star Trek Picard Season 1
  • Altered Carbon Season 2
  • Westworld Season 3
  • After Life Season 1
  • Collateral Season 1
  • Band of Brothers
  • Modern Love Season 1
  • The Umbrella Academy Season 1 & 2
  • Raised by Wolves Season 1
  • The Great British Bake Off Season 11

2020 movies and shows