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

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