Understanding the surge in Covid-19 cases in Singapore

Hello everyone! In this post I'm going to do a little bit of statistics for you regarding the current Covid surge in Singapore to help you understand what is going on here. For the record, I was one of the only people in my university to score 100% on the compulsory statistics module that we all had to do in first year and since I don't use my maths/statistics skills at all at work, please allow me to apply what I have learnt at university! Thus let's look at the recent figures to begin.

Singapore 27 October 2021

% Population fully vaccinated: 84% 

Population: 5.9 million

New cases: 5,324

New deaths: 10

UK 27 October 2021

% Population fully vaccinated: 79.4% 

Population: 68.3 million

New cases: 43,922

New deaths: 207

Why are the daily numbers in Singapore proportionately higher than the UK?

Firstly, Singapore's population is only 8.638% that of the UK, so if the situation in Singapore was on par with that of the UK, then we ought to expect to see 3,794 cases a day and 17 - 18 deaths a day. However, Singapore's daily numbers are so much higher at 5,324 despite the fact that there are such extremely strict restrictions still in place in Singapore whilst all restrictions have been effectively lifted in the UK. Just how strict are things in Singapore at the moment? This story was shared by so many people on social media: parents cannot sit at the same table with an infant when visiting a restaurant. I know, it is fucking ridiculous - they live in the same house for crying out aloud and that's the stupidity of the PAP but hey, you stupid Singaporeans get the government you voted for so you can only blame yourselves when you find yourself in this situation. The story goes, the staff at the restaurant told the mother and the child to sit at one table, whilst the father had to sit on his own at another table. When the father tried to speak to the mother to check if she needed any help feeding the young child, the staff at the restaurant pounced on them at once and warned them, "no talking" as if they were children in a primary school classroom. Contrast that to the UK where there are no rules or restrictions, hardly anyone wears a mask anywhere or observes social distancing: nightclubs, bars and pubs are all open with people mingling and spreading the virus - yet somehow, despite practically doing everything to hasten the spread of Covid in the UK, our daily case numbers are lower than that of Singapore's where the rules are so strict. Putting politics aside, this is what we call a statistical anomaly when the statistics are the complete opposite of what we ought to expect. 

Is this simply a result of much a better testing programme in Singapore? 

Yes this is one of the very plausible reasons why more cases are detected in Singapore compared to the UK. After all the local tracing system TraceTogether app that is stunningly effective, mostly because the locals in Singapore are dutifully using the app. Whereas in the UK, we do have a similar system called the NHS Track & Trace, but it is a fucking joke. Nobody uses it. It has been up and running since May 2020 but nobody uses it. I don't even have it on my phone and I've gotten with it so far since no one has ever asked me to use it - so you're supposed to scan a QR code with the app when you enter a building like a mall, a supermarket, a train station, cafe or a gym but since nobody checks if you actually do it or not. They are spending a total of £37 billion on it and it has been a colossal waste of money given how nobody uses it. This is when the British government can only look at the situation in Singapore and wonder, "how on earth do you guys get your citizens to follow the rules during a pandemic? Never mind wearing a mask or social distancing, we can't even get the idiots in this country to download an app!" The TraceTogether system is highly effective in identifying individuals need to be tested by identifying those who have come into contact with someone who is infected and thus are at risk of infection. But in the UK even if I do get infected and become an asymptomatic carrier, I wouldn't take a test unless I begin to feel quite ill. In the CNN article, it stated that 98.7% of cases in Singapore in the past month had "no symptoms or only mild ones." Thus it is likely that the true number of cases in the UK could be higher given that most British people only bother to get tested when they develop symptoms of Covid but as for how much higher now that's really anyone's guess! 

The UK is heading towards herd immunity.

When my friend Stuart told me last week that he had to self-isolate because he had developed Covid, I was like, "woah seriously? You've never had it before? You're one of the very few adults who has not had it yet in this country." After all, he has three children and I would have expected one of his kids to get infected at school, bring the virus home and infect the rest of the family - that was exactly what happened actually given that it was his teenage son that first tested positive. Thankfully for my friend Stuart, he is already fully vaccinated and thus he is experiencing very mild symptoms - thus for him, getting Covid is simply an inconvenience rather than a major illness. Finding someone in the UK who has not yet had Covid is like finding someone who hasn't heard of Squid Game yet. Officially or unofficially, the UK's government has always been counting on herd immunity being the way we get through this pandemic, hence that's why we had all restrictions lifted despite a sharp rise in cases. After all, there will be some people who will refused to get immunized so the best way to ensure that those who are not vaccinated get some form of immunity is for them to actually get Covid. This is another good reason why our case numbers are proportionately lower than Singapore: take myself for example. I've had Covid, I'm fully vaccinated and I'm due my booster very soon - thus I am more protected than my counterpart in Singapore who is fully vaccinated but hasn't been infected with Covid yet. Letting the virus spread like this through the country comes at a rather high price: our death toll of over 160,000, but the eventual result is herd immunity. 

We're literally running out of people to infect in the UK. 

We have one of the world's highest death toll from Covid, that's not something to be proud of. That does mean two things though: the most vulnerable in our society - namely the elderly and those with underlying medical conditions have either been killed off by the virus already or they are so terrified of it that they are taking every precaution to make sure that they don't get infected. Recently, I saw this older lady in the supermarket the other day wearing what looked like a full hazmat suit, she had two masks on, a face shield and she was wearing gloves. Okay, I get it, she is terrified of Covid and fair enough, she is exactly the kind of person who is most vulnerable - she is elderly and probably has underlying health conditions but clearly, she has been able to protect herself thus far by being extra careful. I feel bad for her of course because no one in that supermarket was wearing a mask - wearing a mask is now a personal choice, it is being treated like a very trivial matter such as whether you wear a raincoat or use an umbrella when it rains. This is why all restrictions have been removed and the borders have been opened, it's almost as if the government wants to make sure that every last person in the UK gets infected with Covid so we'll soon run out of people to infect - that's one way to make the case numbers fall! In sharp contrast, the situation in Singapore couldn't be more different: most people have not had Covid - compare that to the UK where most people have already been infected at some point over the last 18 months. The situation in the two countries couldn't be more different because Covid has already killed off a lot of those at risk already! 

But can you get Covid twice? 

That's a calculated risk the British government is taking: the answer is yes, but it is highly unlikely. According to a BBC report, in a study of 6,614 healthcare workers who had been infected with Covid, only 44 were infected a second time. So whilst we can see that it is possible to be reinfected, the numbers are so low - only about 0.66% of the cohort in that study were reinfected. There might be a variant in the future that may mutate so much that it can infect fully vaccinated people with antibodies from previous infections, but the British government is gambling on the fact that this may never ever happen. Thus the number of people who are reinfected with Covid after a previous infection are not significant enough be a major factor in Singapore's current situation - rather, it is far more likely to be people who have never ever been infected before getting it for the first time, often despite being fully vaccinated. Mind you, I've had two bouts of flu this year after I had recovered from Covid in January and each time I get the flu, I would think, "Holy shit, I've got Covid again." But I made sure I got tested both times and both times, it came back negative. So yeah, the moral of the story is that not every flu is Covid - we've been getting all kinds of flu type illnesses long before Covid-19 came along and such illnesses are still spreading around. In the UK, we are bracing ourselves for a severe winter flu season because there was a lockdown for much of last winter that stopped the spread of the winter flu then, but that meant a lack of immunity amongst the British public against the flu and thus that means it could potentially claim more lives than Covid this winter. 

But is the UK's death rate really higher than Singapore's?

So if the infection rates are higher in Singapore than in the UK, then we need to look at the death rate. There were only 10 deaths in Singapore on the 27 October but that figure would have been more like 17 or 18 if it followed the same trend as the UK. However, the daily death rate in Singapore does vary and it did hit 18 deaths on 20th October and 16 deaths on both 21st and 29th October. The death rate has consistently been increasing in the second half of October. There is a time lag between getting infected and death - typically, a patient who dies of Covid might take anything for a few days to a few weeks to develop complications that would lead to death. According to the CNN report, of those who tested positive in Singapore in the last month, only about 0.2% died. So to get an accurate account of the death rate in Singapore, we really need to examine what was happening about a month ago, around the last week of September because the people who died on the 27th October would have been infected around a month ago, in the period between the end of September and the beginning of October. In Singapore, the current surge began in mid-September with daily cases topping a thousand for the first time on the 18th September and then by the 28th September, that number had reached 2,236 and by 9th October that had reached 3,703; that was still much lower than the number recorded on the 28th October which was 5,324. Whereas in the UK, back on the 27th September, we had 37,485 cases and adjusted proportionately for Singapore's population, that would be 3,224 cases, this is comparable to the kind of figures that Singapore experienced between late September and early October when the numbers were increasing; so we can see that the two countries are experiencing a very similar trend, despite the situation regarding restrictions being so different. 

How bad will the situation get in Singapore? 

I hate to use statistics to predict because it is never going to be 100% accurate but let's try to work out what has happened between the 27th September and 27th October in Singapore. Cases went up from 1,647 to 5,324, that is more than a tripling of cases. So if we take into account the time lag of about four weeks or so for a patient to get infected and then subsequently succumb to Covid, then we can expect the number of daily deaths on the 27th November in Singapore to be around 32 - now how do we react to this number?As a person who is so used to seeing a steady daily death toll exceeding 100 this year, I roll my eyes and think, yeah that's 32 - if we were to adjust that to the UK's population, that would be 371. Now that would be considered bad compared to our current daily death rate (which hovers between 150 to 300) but still nothing compared to the very worst days during the second wave when we had between 1,500 to 2,000 daily deaths. But we also have to consider if the 27th October was a statistical anomaly for Singapore and we thus have to look at the average cases over a week to see if the 27th October is representative or not - as of the 29th October, the rolling 7-day average in Singapore was 3,777 cases a day, which isn't as bad as the figure of 5,324 on the 27th October and notably, the numbers for the 29th October in Singapore went down slightly to 4,248 - nonetheless, to put things in perspective, as recently as the 29th August, Singapore recorded no new cases on the 29th August. That's right, it went from the situation being totally under control to a sharp rise in cases in a relatively short space of time. Contrast that to the situation in the UK where we have been seeing a steady decline in cases in the last week of October.

Why are cases increasing so rapidly in Singapore then? 

That's a good question and one that's not easy to answer! After all, Singapore has been the poster child when it comes to dealing with the Covid-19 pandemic: death rates are amongst the lowest in the world, you have had an extremely efficient vaccination campaign and unlike the West, the borders have remained closed (even with your neighbour Malaysia) Singaporeans have been extremely compliant when it comes to following the rules on wearing masks and social distancing. But here's my theory: the new Delta variant is extremely infectious and the moment it takes hold in your country, it is virtually impossible to eradicate no matter what you do. I was infected during a lockdown back in January this year, so really it was not like I was having an active social life back then! I was working from home and only left my house to go get food from the supermarket. I went out to exercise on my own in the park a few times a week but didn't try to meet anyone. Yet somehow, despite being so careful, I still got infected - probably on a visit to my local supermarket, that was when we were dealing with the Alpha variant. Allow me to use an analogy: I make my own sambal belachan chilli sauce and it has a strong, pungent smell whenever I cook it because of two of the ingredients I use: dried prawns and the belachan (fermented shrimp paste). So I can close the kitchen door, I can open all the windows but somehow, my whole house will end up smelling of belachan no matter what I do - it's a battle I try to fight and lose every single time as that strong smell will find its way into everything in the house. I swear even my neighbours can smell that belachan when I make that chilli sauce. Thus I just accept that everything in my house is going to smell like a Malaysian restaurant.

What does this tell us about the government's efforts to control the virus in Singapore?

Well my conclusion that the Singaporean government's efforts have been futile. Statistically, the situation in the UK and Singapore are quite similar, so if I may use an analogy that my Singaporean readers can relate to: imagine we have two students Andy and Benny who are classmates and have to take the same exam. Andy is from a rich family and his parents have paid for the best tuition teacher in Singapore to tutor him in preparations for the exam. Benny's parents in contrast couldn't be less interested and didn't make any effort to try to help him with his studies, so Benny did study a little on his own but he was woefully unprepared for the exam. So when the two students go to take the exam, they realized that it was actually a really difficult exam and whilst Benny just rolled his eyes knowing that failing the exam was inevitable, Andy was both shocked and disappointed when he too failed that exam because everyone from Benny to his parents to his tuition teacher had totally underestimated just how difficult the exam was going to be. Thus in the end, both students ended up with the same F grade for the exam despite Andy having tried far harder than Benny to prepare for this exam. After all, Andy's F grade wasn't a reflection on his efforts (we all know how hard he tried) when even the very brightest students in the school would have struggled to pass this exam. Thus in this case, the exam that was impossible to pass is the Delta variant - the UK government has just given up and allowed cases to surge with no restrictions whilst the Singaporean government behaved like Andy: that's how we ended up where we are today with both countries having a very similar infection and death rate. We must recognize that this is not about what you do, but what you're up against! 

What, so you think we should give up and just do nothing when facing this Delta variant?!

Let's put it this way: given that both Andy and Benny failed the exam, Benny is actually better off than Andy. After all, his parents didn't spend thousands of dollars paying for private tuition. Whilst Andy was staying up late revising, Benny was either relaxing watching movies on Netflix or getting some much needed sleep. Did Andy prove to his parents that he was a good boy who studies very hard for his exams? Sure he did, but did it get him the results he needed in the end? Hell no, it didn't. Singaporeans are pretty much in an 'Andy' situation - they've paid an extremely high price only to end up in the same situation as Benny who hasn't bothered at all. By the same token, Singaporeans have experienced so many restrictions in their daily lives for much of the last 18 months and only for them to end up in the same situation as the British, who have pretty much returned to normality whilst casually turning a blind high to the very high death toll. Andy's parents should be shouting at the tuition teacher, "we paid you so much money for all those lessons and yet he got an F for this exam? How are you going to explain this to us? You charged us such a high price, we are entitled to a refund!" Thus by the same token, I think Singaporeans should definitely have the right to behave like Andy's parents in this case and say, "we demand an explanation, we paid such a high price, we trusted you, we did as we were told, we obeyed all your rules - now look what has happened!" Let's park our emotions at the door for this matter: you pay the high price if you think you have a good chance of getting the results you want but you don't pay that high price if you are not entirely sure you could get a desirable outcome - don't be too arrogant when facing a formidable challenge like the Delta variant. 

Will the situation get worse in Singapore in November then? 

Yes and no, it is so hard to predict what will happen but let's examine the factors that would determine what would happen in November. The trend in Singapore seems to be a very sharp increase that started from the beginning of September. There was a bit of hope when the numbers did go down for about a week in mid-October before shooting right back up again but the overall trend is going in the wrong direction in spite of all the restrictions the Singaporean government has put in place. What is clear is that we're dealing with an extremely infectious virus here that even the current strict measures cannot contain at all - it is hard to imagine a lockdown that is stricter than what is already in place in Singapore but it has been done before in the early days of the pandemic in Wuhan, the epicenter of the pandemic which endured a lockdown that lasted from January to April in 2020 with crazy strict rules such as only one person per household being allowed to leave the house once every two days to buy food and medicines. Wuhan was completely cut off from the rest of the world during that period with all transport links cut and strict roadblocks stopping anyone from entering or leaving the area. It can be done and it has been done before in places like Wuhan but will the Singaporean government enforce a lockdown as strict? The answer is no for a simple reason: that will just be kicking the can down the road as the Delta variant isn't going anywhere! The moment you relax those strict restrictions, infection rates will soar again and you're back to square one. That's why so many countries have accepted that we must learn to live with Covid. 

What is the biggest factor in facilitating the spread of the virus in Singapore?

One key factor that will make infection rates in Singapore increase is the population density and housing patterns. Let's go back to my friend English Stuart who recently caught Covid from his teenage son, Stuart's parents don't live with them and obviously, Stuart will not be visiting his parents until he has made a full recovery and is no longer infectious. In the meantime, Stuart told me that he is working from home whilst taking advantage of the fine autumn weather to enjoy his massive garden. In sharp contrast, the population density in Singapore is 29.7 times that of the UK - that means that each infected person in Singapore is far more likely to infect others because of the housing arrangements. Poorer, working class families living in HDB flats will find it very hard to protect themselves from the virus once it takes hold in a family as they are living in such crowded conditions. The more densely you pack people into an area, the faster the virus will spread. Imagine if a Singaporean student (we'll call her Jamila) tests positive for Covid, what measures can be taken to prevent Jamila from spreading the virus to the rest of her family (including her grandparents) whom she lives with in a HDB flat? There is no provision for her to self-isolate in a facility away from her family or for her grandparents to move elsewhere away from Jamila whilst she is infectious; the onus is on her family to protect her grandparents but without any extra help from the government there is very little they can do to prevent poor Jamila from infecting the rest of her family. 

Who do we blame, who is responsible for the spread of the virus? 

But wait, there's hope - we're coming to the end of the academic year in Singapore, the last term of the year ends on the 19th November and after the final exams are completed in November, there's little reason for the students to return to the classroom where all they will do is spread the virus. It would be relatively easy for the government to simply bring forward the end of term and that wouldn't cause much disruption When dealing with a pandemic, you always pick the lowest hanging fruit that will yield results quickly. But would it be fair to blame students for spreading the virus? It would be too easy to use them as the scapegoat of course, whether you're in London or Singapore, the narrative seems to be that these kids really don't care because they know they won't get too sick even if they get infected, so they let down their guard when they socialize with their classmates but bring the virus home to infect their parents and grandparents. But children who do get infected with Covid rarely exhibit severe symptoms and that means that they're not very infectious at all, so should we be blaming the children for this spike in infections? Another possible factor could be complacency amongst fully vaccinated adults: according to a recent BBC report, fully vaccinated adults can still spread the virus, particularly to those they live with. Being vaccinated doesn't make you completely immune to Covid, rather it means that when you do get infected (or in my case, reinfected), you will only experience very mild symptoms instead of becoming seriously ill. Are adults in Singapore letting down their guard, now that such a high percentage of the population are fully vaccinated? Or is the situation now much more complex, that it would be impossible to pin the blame on a single group? 

What should the Singapore government do about the situation then? 

Oh they are caught between a rock and a hard place - once this highly infectious Delta variant has taken hold in the community, it will spread rapidly. The Singaporean government has two choices: it can use the Chinese method or the British method. The Chinese approach would be to impose an extremely strict lockdown and the British method would be to lift all restrictions to allow everyone to get infected as soon as possible. Neither of these options are attractive: as discussed earlier, the Chinese method only kicks the can down the road and infections will rise again once you lift restrictions. It is not a sustainable way to deal with the pandemic in the long run as you will suffocate the economy, sure you may have less Covid deaths but you will pay a heavy price for that in terms of the damage you do to your economy. The alternative approach is the British method, where you simply shrug your shoulders and say, fuck it, the people who die are old and sick anyway, if they don't die of Covid now, they'll die of something else soon - their death is inevitable so let's just get used to the corpses piling up by the thousands and pretend that everything is normal again. The price we have paid for this approach in the UK is a death toll so far of over 160,000 - adjusted proportionately for Singapore's size, that means that you would be looking at a death toll of about 13,800 compared to your current death toll of just 380. Would most Singaporeans be happy to accept a much higher death toll like that if that meant allowing daily life to return to some degree of normality? I am afraid neither options are palatable, as there is no simple solution to just make Covid go away and disappear overnight - both the Chinese and the British methods would come at a very high price to society. 

So which option would the Singaporean go for then? 

China is clearly sticking to their guns when it comes to their zero-tolerance approach when it comes to Covid, despite the fact that Beijing is due to host the 2022 winter Olympics in February, that's just three months away. A significant portion of Chinese-Singaporeans will look to Beijing and expect the Singaporean government to do what Beijing does despite the fact that the conditions in China are vastly different. Take the tourism sector for example: China has enjoyed a boom in domestic tourism as Chinese citizens cannot travel abroad - so instead of welcoming foreign tourists, hotels in subtropical Hainan island are welcoming tourists from the north of China looking for some winter sunshine. But Singaporean hotels have suffered so much, even if a Singaporean does make a day trip to Sentosa, they're unlikely to want to stay overnight at an expensive hotel since they can get home in under an hour! Taking the British approach is the easiest option for the government but how bad would the political implications be once the dead bodies start piling up? Would Singaporeans be angry enough to vote the PAP out at the next election if they used the British approach? Actually, I doubt it - this is when we need to put politics aside and simply look at statistics from past elections in Singapore. Essentially, it doesn't matter at all whether or not the PAP runs a convincing campaign or if the economy is doing well or not - they have rigged the system to the point where they will win no matter what happens. Thus it's not a question of squandering political capital that they may have gained in the early days of the pandemic, rather it is the knowledge that they simply cannot and will not lose the next election no matter how bad things get so with that in mind, why not just adopt this British approach as it is much easier, given that the PAP are now in a consequence-free political environment. 

Are you worried about your parents in Singapore? 

Actually no, I'm not. In the UK, if you're vulnerable because you're elderly and/or you have underlying medical conditions, then you're expected to do whatever it takes to protect yourself. That means getting vaccinated, minimizing leaving the house and reducing any social contact with anyone, including your own family. Guess what? My parents are great at doing that - so they are fully vaccinated, they barely leave the house anyway and they have very few friends. So even if the Singaporean government takes the British approach, they are going to be safe enough as they only live with my eldest sister - she is their only connection to the outside world. But if the Singaporean government takes the Chinese approach with an extremely strict lockdown, then it is the economy that will suffer the most. My parents are retired, they are not affected by what the economy is doing - as retired teachers, they have their pension and CPF to sustain them. So either way, there is actually very little effect on their lives no matter what happens next. Sigh, when they finally retired, I thought they could use that free time to go enjoy themselves and have a good time - but no, my father essentially sat down in front of the TV and spent his waking hours watching TV. He could have gone on fancy holidays, he could have joined a class to learn something new and have an active social life but no, let's not forget that he is severely autistic with no social skills. Thus any kind of situation where he has to be with other people is stressful, hence he retreated to his living room to watch TV for the last 20 years and so this pandemic really didn't change his lifestyle at all. By that token, my parents are coping well with the pandemic, because unlike other normal people, they are happy just to stay at home.

That's it from me on this topic, can I point out that it took me several days to write and edit this piece - I started on this on the 28th October when the surge in Singapore was reported. I published this piece on the 2nd November. I am aware that cases have come down in Singapore in the last 4 days but let's keep watching this space to see if this downward trend will continue into November. My prediction is that given little has actually changed in Singapore, we're going to see a flattening of cases: so they will fall but not to the kind of low numbers as seen earlier this year, but it will settle into steady pattern of between 2,000 to 3,000 cases a day. Don't forget, the vaccine doesn't make you totally immune to the Corona virus, it just means that when you do get infected, you're not going to become very ill and you'll probably only experience very mild or no symptoms. Of course, this doesn't apply to the elderly and vulnerable because their immune systems are so weak that they cannot fight the virus even after being fully vaccinated, so Singaporeans will just have to get used to a small number of hospitalizations and daily deaths for now. Now would they panic about this or just shrug their shoulders? A lot of that depends on whether they want Singapore to follow Beijing's stance or London's stance on the matter. So are you in Singapore now and how do you feel about this concept of learning to live with Covid instead of a zero-tolerance approach? Are you personally worried or concerned? I'm sure you all will have your own opinions on this issue, please leave a comment below and let me know what you think about this situation. Many thanks for reading.