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To prevent Covid-19 from entering the country, Singapore closed its doors to travelers. But in the past three months, it has gradually reopened its borders, increasing the risk of infections entering the community. To combat the virus while trying to revive the worst-hit aviation and travel industries, the Republic has put in place numerous safeguards, to keep cases low, even as numbers rise in some other countries.
AN ACT OF BALANCE
The risk of imported cases is not new and, in fact, border controls have always been a cornerstone of the Republic’s defense strategies, experts told The Straits Times.
But the challenge now is to reopen borders in a safe and controlled manner amid a pandemic that is still ravaging other parts of the world, said Associate Professor Josip Car, director of the Center for Population Health Sciences at Lee School. Kong Chian of Nanyang Technological University. of Medicine. The growing knowledge of how to stop the spread of the virus would help the country reopen its borders wisely, he noted.
But as more countries experience worsening outbreaks, including India and those in Europe, the Middle East and the Americas, it becomes more important to be prudent and cautious when organizing travel on the green lanes, to protect the fragile local situation that arises. has controlled a lot of effort afterward, said Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore (NUS).
For example, France reported more than 10,000 new cases on Sunday, while Britain reported nearly 4,000 cases that same day.
Rather, said Professor Teo, priority should be given to travel arrangements to countries with a stable local situation and that have similarly implemented strict public health measures.
The biggest benefit, when it comes to aviation and travel, will be through the resumption of mass market tourism, but it comes at a price: it represents the biggest risk to the country.
“Governments around the world will really need to decide whether recovering economic activity from tourism justifies the risk to the rest of the local economy,” said Professor Teo.
For some countries, this decision is difficult as tourism drives a significant segment of the local economy, but for many others, shutting down mass market tourism to safeguard the rest of the economy and allow the rest of the community and society work is a necessary compromise.
Singapore does not expect “any new cases”, and there would be tolerance for a small number of imported cases, said Professor Dale Fisher, senior consultant for the division of infectious diseases at the National University Hospital.
He said it is crucial that visitors entering the country continue to obey the rules on wearing masks and safe distancing, and not having gatherings of more than five in a group.
When asked about the speed at which Singapore is reopening its borders, Professor Fisher suggested that the country could afford to pick up the pace.
“I am sure there is a lot of behind-the-scenes work between governments, health insurers and those in the travel industry to make this happen. Any country that has few cases, traces contacts quickly, and has few unlinked cases should be ‘approved’ . “
If there are additional risks, more stringent restrictions can be added, such as a one-week stay-at-home notice and the use of a contact tracing device, said Professor Fisher.
FACTORS TO CONSIDER
It’s helpful to divide import risk into three components, said associate professor Alex Cook, vice dean for research at the NUS Saw Swee Hock School of Public Health.
First, assess the level of risk that an arriving passenger will be infected from that particular country, which would determine with which countries to prioritize travel arrangements.
Second, determining how much of this risk of spreading the virus to the community can be reduced through the nation’s “fences,” such as having a two-week quarantine versus a one-week quarantine, or even a test fast at the airport.
The fence is an approach highlighted by coronavirus analyst Tomas Pueyo in a New York Times article this month. Fences are necessary to control the virus and are effective if applied, he said.
Finally, the third component is that if infections infiltrate the community, how much of this spill is considered tolerable, said Professor Cook.
“(Not having) contagious infections would be perfect, but of course we could tolerate one contagious infection, or five, if this helps revitalize the economy. The combination of these three components determines which countries and how many travelers we can accommodate,” Professor Cook added.
Professor Car noted that test types and respective thresholds also need to be considered. For example, the amount of genetic material that is detected before a test is considered positive and the precision of a test will differ depending on the test used.
Ultimately, said Professor Fisher, you have to look beyond the case numbers.
“It’s about whether the country knows where its cases are.”
Most of the Malaysian cases recently come from two clusters in Sabah and Kedah, while the majority of Australian cases have recently been reported in Victoria. Having control over where the cases originated and being able to effectively contact, track and quarantine these cases would make the country an unlikely source of infected travelers, said Professor Fisher.
Professor Teo agreed, adding that a well-established and functional monitoring and management protocol, and having the political will to isolate and quarantine when necessary, will be long-lasting aspects of keeping the Covid-19 situation under control.
Another aspect worth noting is whether a country is transparently reporting the local situation, or whether there is a considerable degree of underreporting due to insufficient evidence capacity or incomplete surveillance, for example when certain segments are overlooked. from the community, such as those living in informal housing such as slums and unregistered migrant workers, Professor Teo said.
RISK MANAGEMENT
Given how complex the pandemic has been, risk must be managed with a variety of strategies, ranging from the individual (being vigilant and adhering to protocols, for example) to the government level, Professor Car said.
Government processes such as rigorous protocols for testing, guidance on pre-arrival testing and quarantine would be necessary, and these must be tailored to balance risk, inconvenience and cost to travelers, explained Professor Car.
What works in one country may also not be transferable to another due to cultural, social, scale or economic factors, he added.
“You also need to remind people that there is no perfect test and that a negative result is not a 100% guarantee that they cannot spread the virus.”
Relying on tests to shorten the quarantine period will always result in some escape and this risk increases if the traveler comes from a place with a severe outbreak, said Professor Teo.
However, a strict quarantine effectively stops many short trips, said Professor Cook, emphasizing that traveler testing remains key to reducing risk.
“The question is how and when to do the test to keep the risk tolerable. For example, if you do the tests before you arrive in Singapore, you could still get infected after the test. I am leaning towards a rapid test on arrival, followed by repeat the test a few days later to confirm negativity, “said Professor Cook.
Ultimately, Singapore’s goal has always been to live with the virus, Professor Fisher said, unlike some countries like New Zealand, China and Vietnam, which all aim for eradication.
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