Covid-19 crisis Why are the new infections spiking in Singapore?
My friend asked me - why are the new infections spiking in Singapore? We already have a high vaccination rate, above 80%, which is among the highest in the world. Why is SG faring so badly?

The answer is quite simple. 
We are counting new cases differently from other countries. 

Here are the figures for the cases and deaths during the past 7 days, as shown in the Worldometer website.

All countries - 3,207,000 cases, 52,000 deaths, rate 1.6%
Singapore - 11,876 cases, 20 deaths, 0.16%

Our death rate, calculated on deaths over cases, is 0.16%. This is one tenth of the global average of 1.6%.

This means that Singapore is reporting 10 times the number of infections, compared to the practice in other countries. In this instance, I am taking the total for all countries. The practice may differ from one country to another. 

In most other countries, a case is recorded when a person is unwell and sees the doctor. If he is diagnosed to be infected with covid, a case is recorded. 

There are many people in other countries that are infected with covid, but they are not sick. After a few days, the covid disappears. These cases are not recorded. 

Singapore adopts a different practice. We test all front line workers once a week. This will catch many cases which are mild. They are recorded as an infection and placed under isolation. 

Another source of cases is the contact tracing through safe entry recording and trace together recording. These are two separate sets of contact tracing data. Many people do not realize the difference between these two data sets.

These two sets of data are used to identify people who might be exposed to infected people and to send out health alerts and health warnings to the potentially exposed persons.

I do not know how many health alerts or health warnings are sent out each day. My guess is that it could amount to several thousands or a few tens of thousands.

The alerted people are required to be tested for the virus using the self test kits or the tests administered at the testing centers. 

When several tens of thousand tests are carried out daily, it is likely to capture a large number of infected people. Most of these cases are mild.

We now have 2,000 cases a day. This number used to be less than 100 a day but has spiked many times in recent days.

The Ministry of Health said that 98% are mild and only 2% are serious, i.e .need oxygen supplement or ICU care. 

My guess is that 90% of these cases are captured through front line testing and contact tracing and only 10% (i.e. 200 cases) are people who are unwell, and are tested covid positive by the doctor.

If our new cases are reduced by 90%, we will get the same death to cases ratio as the global average. 

Why did we face this issue now, rather than during the previous 18 months? We seem to be doing very well, compared to other countries prior to the recent spike which occurred in August 2021.

The answer is probably - the delta variant. 

The earlier variants were more lethal and less transmissible. The strategy of contact tracing using safe entry data was probably useful to a limited extent. 

When the delta variant became quite widespread, and more people are infected in a mild form, the contact tracing throws out many times more cases to be tracked.  I do not know the exact number, as it is not disclosed by the Ministry.

As the delta variant is more transmissible and more widespread, it makes sense for us to stop the contact tracing using the safe entry data, as it is quite useless now. 

Conclusion.

It is time to stop the regular testing of front line workers and the contact tracing. 

We should focus only on people who are unwell and have symptoms. We will reduce the cases by 90% as most of these cases are mild.

It is possible that some of the mild cases may be spread to the vulnerable people and increase the deaths. However, I expect that this increase will be small, and that better treatment protocols can help to keep the deaths in check.

Tan Kin Lian

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