Living with Covid. Living with Singaporeans. Living with idiots.

There is a blogpost about how Singapore is coping or not coping with the current "transition" from containing Covid, to living with Covid. And it points out (eventually) that Singapore's policies are inconsistent:

"... there are actually more than 1000 patients admitted for Covid-19. Are our admission criteria too lax? By now we should have enough data to know what are the patient profile characteristics that will give a good prognosis and those that we know will not do well later on. This data should be carefully analysed and translated into better clinical practice so that we do not admit excessively and take up too many beds. At present, out of all patients diagnosed, 1.8% require oxygen, 0.2% are in ICU and the rest are either asymptomatic or mildly ill. Given our extensive experience in the last 20 months treating Covid-19 patients, can we extract more efficiency out of the system in terms of hospitalisations of asymptomatic and mildly ill patients?
On one hand, we say we are resolute on opening up and living with the virus. On the other hand, when we test almost everyone under the sun, we seem to be also going for a zero-case disease elimination strategy. As one public health expert put it, it is like asking each and every person caught in a downpour, “Are you wet?”
Another expert put it more starkly, “the pain of transition is made worse by being stuck in applying disease elimination measures to deal with an endemic disease. Much of what is being done in the name of disease prevention is counter-productive”."

He is right. The policy is to live with it, but the measures are for zero covid strategy. And the reason for this inconsistency: Politics. Or Political reality.

He is right that hospital admission (for Covid) is tool lax. Of the 1000+ patients admitted, 95% can be discharged to home monitoring/isolation. Why don't they do it? 

Try lah. Tell a Singaporean that he has Covid, but is asymptomatic, and he can just rest at home, isolate, and monitor and see how fast that Singaporean turn into a KAREN (and no, I don't mean the Burmese ethnic people)!

The task force is trying to thread a needle in a hurricane while riding a roller coaster, and having dropped their presbyopia glasses (Yes, I could have have said, "reading glasses", but will you respect me?).
In the meantime, there are Singaporeans. Demanding Singaporeans. Kiasu/Kiasi Singaporeans. Ever ready to turn into Karens at ANY sign of perceived incompetence of the task force, or discriminatory treatment.

The task force needs to pivot from containment to living with covid. That means the numbers will rise. But let it rise. If 90% of Singaporeans are vaccinated, for most vaccinated Singaporean, even the Delta variant will be just like the flu at worst. For most people.

This is the timeline for how Delta became the dominant variant in the US. I suspect
it's about the same for Singapore.

BUT... and this is a BIG BUT... Some will be severe. Some may even die. Just like some will die from flu.
And there will be a political cost. Already some opposition parties are smelling blood in the water and have started to circle.

Too much to read? I'm rambling on (as usual)? Here's an 8 minute video for those less inclined to read (or are just sick of my rambling):

[back to my rambling:]

And then there is the unvaccinated... because life isn't complicated enough, we need stupid people who think they are thinking and that their thinking is superior to other people's thinking. (My theory is that they watched too many X-files and have learned to "Trust No One".)

The answer is simple: Go with living with Covid. Prepare to treat those who have severe symptoms. For the vaccinated, they would be mostly protected, unless they have co-morbidities. For the unvaccinated, they are slightly more likely to have symptoms and at a higher risk of severe illness and even death.
That's life. And Death. 

In other words, treat it like the flu. If you have mild or no symptoms, isolate at home and monitor. If you need medical attention, seek medical attention then. 

And then there is politics. And that is politically unworkable. Policies are easy. Politics... the PAP suck at it.

Which reminds me of two stories.

A) The first story is how terrorists hijacked a plane and demanded the release of "prisoners". A politician (prime minister) over-rode the negotiations by the police and the army. He negotiated for the release of the hostages, in exchange for the prisoners, and the hijackers escaped. But the hostages were freed. (As far as I remember.) But the rest of the world criticised the politician for negotiating with terrorists and setting a precedent, and his actions would just incentivise more hijackings. (Subsequently, one or more of the released "prisoners" were involved in the 911 attack.)

B) The second story is about a country who decided to hold a military exercise just over the border from their neighbour on the neighbour's national celebration. Normally, as a matter of courtesy, friendly neighbours would inform each other if they were engaging in military exercises to avoid panic and misunderstandings. In this case, this country did not extend this courtesy to their nieghbour. They were testing the (new) prime minister of the neighbouring country. What would he do? On the advice of his generals, he approved their plan to mobilise their reserves and put them on standby. Just in case. He later explained, "I have no doubts they (the neighbours) are friendly. But I was advised by my generals that it would be prudent to activate our reservists. I pay my generals a lot of money. I should listen to their advice." No political fallout. Just listening to professionals providing professional advice based on their professional assessment of risks.

But here we have a Ministerial Task Force. And every decision they make impacts on their political future.

So could we have implemented the transition, BETTER?

Take our Home Recovery strategy, which has been declared as the “default care management model” for Covid-19 patients (From "Meandering Undead"):

"In itself, this strategy is absolutely correct and in-line with our stated strategy of living with the virus. But the implementation was (out of an abundance of euphemism) in a word – suboptimal. Which is rather interesting, because our transiting into endemicity was not a sudden thing. It has been discussed publicly for months. Other countries have also done it; there are both positive and negative examples of this that we can learn from. Yes when the rubber eventually did meet the road, we were found wanting.
The famous World War 2 American general, George S Patton said “Good tactics can save even the worst strategy. Bad tactics will destroy the best strategy”.
Surely, if this was intended to be a “default” model, then small-scale trials could have been run earlier to spot potential problems in communication and implementation? For example, when a new and important software system is introduced in a big company, there is always User-Acceptance Testing (UAT) performed before the system is rolled out, so that teething problems can be identified and ironed-out. Was there any trial or UAT done before our Home Recovery care management model was implemented? A past Head of Civil Service once said “Policy is implementation”. Unfortunately, some folks obviously didn’t read his memo."

Subsequently, in early October, Lawrence Wong of the Ministerial Task Force was reported to say:

“We’ve already said, because of our high vaccination rate, we are no longer focusing solely on headline numbers. Our focus is on the people who are seriously ill and to make sure that our healthcare system is able to take care of them.” 

And yet, we are still reporting infection rates because that is what the people are expecting and if they stop reporting the infection rates, watch the conspiracy theories arise.

And the comms is still wanting. Ask 100 people what is the strategy, and how many will know that the 1000+, 2000+ infection figure is not important?

And how would “small scale trials” (as proposed in the other blogpost) work? If TTSH turns away asymptomatic Covid-positive for home recovery, but SGH and NUH are still on lax admission criteria, it just means eventually the kiasu/kiasi karens will head to SGH & NUH.

That said, I do agree with the points about trialling, testing (resources), and communication. LOTS of EFFECTIVE communications. My point simply is that small-scale trials MIGHT have already been considered and after due consideration, rejected as being unworkable. But this does not invalidate the principle and validity of the suggestion - trial, test, communicate. Perhaps, covid-positives could be given the option of trialling home recovery with some incentives. These “volunteers” might be more willing to help, and are less likely to be karens. And the trials would be more successful (tho, volunteers are self-selecting and the results would be a best case result, not a real-world result.)

Anyway, that was then. The progress of this pandemic is so fast that the death count has reached 162 (Oct 10; 207 as at Oct 14). 

Singapore still has restrictions in place but now the authorities have imposed stricter restrictions on the (adult) unvaccinated. Those with valid reasons for not being vaccinated, are being allowed some freedoms, but those with eccentric or idiosyncratic reasons (i.e. no justifiable reasons) will be ostracised.

Singapore is not going to make vaccination mandatory. At least not in the next few months.

Why? Because, on the whole Singaporeans are not conspiracy theorists; not rabid anti-vaxxers. And mostly kiasi, kiasu, and kiazhenghu. But mostly kiasi and they know vaccines protect them. So over 82% of Singaporeans are vaccinated, and soon Children will be able to be vaccinated, and the percentage will go up even further. 

Those who do not want to be vaccinated for whatever reasons will have to understand that freedom of choice does not mean freedom from the consequences of those choice.