真能與新冠并存？新加坡如何應對史上最高日增病例
GRADY MCGREGOR
2021-10-08
新冠肺炎疫苗接種率很高的新加坡正計劃重新向世界開放，卻迎來了一波史無前例的感染潮。但新加坡80%的疫苗接種率使重癥病例和死亡人數(shù)均保持在較低水平，或許可以證明，與試圖清除病毒相比，與病毒共存是結束疫情的最可靠方式。
新加坡新冠肺炎確診病例近來連創(chuàng)新高，但死亡人數(shù)仍然很低。上周，這個570萬人口的國家平均每天死亡人數(shù)為3。
新加坡的優(yōu)勢是它的疫苗接種率。
新加坡目前已經有80%的人完全接種了疫苗，是世界上疫苗接種率最高的國家之一。據(jù)彭博社報道，中國的接種率為73%，而歐盟和美國分別為65%和55%。
某種程度上，新加坡的高感染人數(shù)和其“與病毒共存”的計劃密切相關。過去18個月，新政府試圖找到每一起病例的源頭，但現(xiàn)在，新加坡的部長們說，打算在幾周內取消隔離措施、重新向世界開放，盡管短期內仍會施行一些保持社交距離的措施。
專家表示，在新加坡不斷攀升的病例中，超過一半是已經接種過疫苗的人，這可能意味著，新冠肺炎正在成為這個國家的一種地方病，也就是說，新冠肺炎病毒像它的四種冠狀病毒表親一樣，在人群中傳播，但由于群體的大范圍免疫力，不會顛覆人們的生活。只要死亡率保持在低水平，新加坡就可以為其他國家、特別是對新冠肺炎病例保持零容忍的國家，樹立如何走出疫情的榜樣。
與病毒共存
今年5月，新加坡總理李顯龍推出了“與病毒共存”的計劃，打算從“零病例”模式做出轉變。
“我們的目標是在保證社區(qū)整體安全的前提下，允許個別人的感染個案存在。”李在今年5月宣布，新加坡將逐步放開內部限制，之后再向外國旅客開放。
新加坡在很大程度上遵循了李顯龍?zhí)岢龅闹匦麻_放計劃。6-7月，新加坡開始放寬對餐飲、工作和娛樂場所的限制。到了8月，許多企業(yè)可以接近或完全滿員運轉。
但新加坡不斷增加且快速攀升的病例數(shù)還是引起了人們的警惕。
7月和8月，新加坡的病例上升至每天100多例，而此前由于新政府的零容忍政策，近一年來幾乎沒有感染病例。上述政策包括居家令、密集檢測和病例追蹤溯源，以及禁止外國旅客入境。本月，病例呈指數(shù)級增長，從9月1日的180例增至9月中旬的500例，9月最后一周更是增至近1500例。
9月27日，新加坡表示將重新執(zhí)行一些保持社交距離的政策，包括將聚餐人數(shù)從5人減少到2人，以及允許員工居家辦公。新加坡政府表示，這些措施將實施至少一個月，以防止醫(yī)療系統(tǒng)被病例壓垮，使新加坡能夠擴大幫助感染患者在家康復的醫(yī)療服務規(guī)模。目前，新加坡因新冠肺炎需要重癥監(jiān)護室床位的人數(shù)為30人，本月初為5人。
杜克-新加坡國立大學醫(yī)學院衛(wèi)生服務助理教授約翰·安薩博士說：“疫情這一波爆發(fā)將減緩新加坡重新開放的速度，還可能會延長這個過程。”
9月初，新加坡開通了“已接種疫苗旅客通道”，來自中國香港和德國等低風險地區(qū)、接種過疫苗的旅客進入新加坡后無需隔離。新加坡曾希望在今年晚些時候擴大范圍，努力實現(xiàn)邊境的全面開放。新政府表示，盡管疫情復發(fā)，但上述計劃仍在按計劃推進。
“我們的整體戰(zhàn)略沒有變。” 新加坡副總理兼經濟政策統(tǒng)籌部長王瑞杰周一接受彭博社采訪時說，“我們計劃逐步重新開放經濟和社會，但目標始終是在不給我們的醫(yī)療系統(tǒng)帶來太大壓力的情況下做到這一點。”
地方疫情的尾聲
這波疫情部分程度上歸因于德爾塔變種和突破性感染的增加。新方數(shù)據(jù)顯示，上個月有52%的感染者接種了疫苗，而48%的感染者未接種疫苗。
新加坡在全國疫苗接種行動中用的是美國制藥商輝瑞(Pfizer)和莫德納（Moderna）生產的疫苗，一些私人診所也給青睞中國疫苗的人注射科興的疫苗。
當?shù)氐母呓臃N率讓人們避免因為病毒承受最嚴重的后果。有關部門周日表示，9月，98%的感染者都是輕微癥狀或無癥狀。新加坡正在通過檢測感染者的密切接觸者發(fā)現(xiàn)無癥狀病例。新加坡醫(yī)藥服務總監(jiān)麥錫威向新加坡《海峽時報》表示，當?shù)匾呀臃N疫苗的人死亡或住院的可能性比未接種疫苗的人低12倍。
在新加坡和世界其他地方，德爾塔病毒引發(fā)的疫情導致已接種疫苗者中出現(xiàn)突破性感染的比例上升。但是，由于疫苗減少了重癥和死亡，人們并不需要為這類感染擔憂。
“全世界最終都將把新冠肺炎視為地方病。”杜克-新加坡國立大學醫(yī)學院的免疫學家阿什利·圣約翰說，“不可能在短時間內徹底擺脫疫情，但我們有管理疫情的工具，包括有效的疫苗。”
香港大學流行病學家本·考林表示，即使疫情出現(xiàn)了新的爆發(fā)，新加坡仍然為新西蘭、澳大利亞和中國等“零病例”國家提供了一種擺脫疫情的模式。
“隨著新加坡繼續(xù)放松管控，未來幾周病例數(shù)可能會進一步增加。”他說， “(但)我認為重癥數(shù)會很少。”
向“與新冠共存”轉變還需要改變心態(tài)，將關注對象從絕對病例數(shù)轉向可能需要住院治療的病例。新加坡當局已經將每日健康通報改為僅公布重癥病例和死亡人數(shù)，而非新增感染人數(shù)。該國衛(wèi)生部門也不再提供感染病例是否可以追蹤的數(shù)據(jù)，以減少大眾對輕度感染的關注。
政府在9月9日的一份聲明中說：“在當前‘與新冠共存’的策略下， (每日感染數(shù)據(jù))不再像以前那么重要。”
隨著新加坡等地走上重新開放之路，可以對容忍某種程度的社區(qū)感染的成本和重新開放的經濟效益進行評估。今年8月，新加坡政府將2021年的經濟增長預期從4-6%上調至6-7%，原因是國際旅行有望恢復。
“新加坡有什么其他選擇呢？重新恢復零病例策略將對經濟產生巨大影響，”考林說。（財富中文網）
譯者：Agatha
新冠肺炎疫苗接種率很高的新加坡正計劃重新向世界開放，卻迎來了一波史無前例的感染潮。但新加坡80%的疫苗接種率使重癥病例和死亡人數(shù)均保持在較低水平，或許可以證明，與試圖清除病毒相比，與病毒共存是結束疫情的最可靠方式。
新加坡新冠肺炎確診病例近來連創(chuàng)新高，但死亡人數(shù)仍然很低。上周，這個570萬人口的國家平均每天死亡人數(shù)為3。
新加坡的優(yōu)勢是它的疫苗接種率。
新加坡目前已經有80%的人完全接種了疫苗，是世界上疫苗接種率最高的國家之一。據(jù)彭博社報道，中國的接種率為73%，而歐盟和美國分別為65%和55%。
某種程度上，新加坡的高感染人數(shù)和其“與病毒共存”的計劃密切相關。過去18個月，新政府試圖找到每一起病例的源頭，但現(xiàn)在，新加坡的部長們說，打算在幾周內取消隔離措施、重新向世界開放，盡管短期內仍會施行一些保持社交距離的措施。
專家表示，在新加坡不斷攀升的病例中，超過一半是已經接種過疫苗的人，這可能意味著，新冠肺炎正在成為這個國家的一種地方病，也就是說，新冠肺炎病毒像它的四種冠狀病毒表親一樣，在人群中傳播，但由于群體的大范圍免疫力，不會顛覆人們的生活。只要死亡率保持在低水平，新加坡就可以為其他國家、特別是對新冠肺炎病例保持零容忍的國家，樹立如何走出疫情的榜樣。
與病毒共存
今年5月，新加坡總理李顯龍推出了“與病毒共存”的計劃，打算從“零病例”模式做出轉變。
“我們的目標是在保證社區(qū)整體安全的前提下，允許個別人的感染個案存在。”李在今年5月宣布，新加坡將逐步放開內部限制，之后再向外國旅客開放。
新加坡在很大程度上遵循了李顯龍?zhí)岢龅闹匦麻_放計劃。6-7月，新加坡開始放寬對餐飲、工作和娛樂場所的限制。到了8月，許多企業(yè)可以接近或完全滿員運轉。
但新加坡不斷增加且快速攀升的病例數(shù)還是引起了人們的警惕。
7月和8月，新加坡的病例上升至每天100多例，而此前由于新政府的零容忍政策，近一年來幾乎沒有感染病例。上述政策包括居家令、密集檢測和病例追蹤溯源，以及禁止外國旅客入境。本月，病例呈指數(shù)級增長，從9月1日的180例增至9月中旬的500例，9月最后一周更是增至近1500例。
9月27日，新加坡表示將重新執(zhí)行一些保持社交距離的政策，包括將聚餐人數(shù)從5人減少到2人，以及允許員工居家辦公。新加坡政府表示，這些措施將實施至少一個月，以防止醫(yī)療系統(tǒng)被病例壓垮，使新加坡能夠擴大幫助感染患者在家康復的醫(yī)療服務規(guī)模。目前，新加坡因新冠肺炎需要重癥監(jiān)護室床位的人數(shù)為30人，本月初為5人。
杜克-新加坡國立大學醫(yī)學院衛(wèi)生服務助理教授約翰·安薩博士說：“疫情這一波爆發(fā)將減緩新加坡重新開放的速度，還可能會延長這個過程。”
9月初，新加坡開通了“已接種疫苗旅客通道”，來自中國香港和德國等低風險地區(qū)、接種過疫苗的旅客進入新加坡后無需隔離。新加坡曾希望在今年晚些時候擴大范圍，努力實現(xiàn)邊境的全面開放。新政府表示，盡管疫情復發(fā)，但上述計劃仍在按計劃推進。
“我們的整體戰(zhàn)略沒有變。” 新加坡副總理兼經濟政策統(tǒng)籌部長王瑞杰周一接受彭博社采訪時說，“我們計劃逐步重新開放經濟和社會，但目標始終是在不給我們的醫(yī)療系統(tǒng)帶來太大壓力的情況下做到這一點。”
地方疫情的尾聲
這波疫情部分程度上歸因于德爾塔變種和突破性感染的增加。新方數(shù)據(jù)顯示，上個月有52%的感染者接種了疫苗，而48%的感染者未接種疫苗。
新加坡在全國疫苗接種行動中用的是美國制藥商輝瑞(Pfizer)和莫德納（Moderna）生產的疫苗，一些私人診所也給青睞中國疫苗的人注射科興的疫苗。
當?shù)氐母呓臃N率讓人們避免因為病毒承受最嚴重的后果。有關部門周日表示，9月，98%的感染者都是輕微癥狀或無癥狀。新加坡正在通過檢測感染者的密切接觸者發(fā)現(xiàn)無癥狀病例。新加坡醫(yī)藥服務總監(jiān)麥錫威向新加坡《海峽時報》表示，當?shù)匾呀臃N疫苗的人死亡或住院的可能性比未接種疫苗的人低12倍。
在新加坡和世界其他地方，德爾塔病毒引發(fā)的疫情導致已接種疫苗者中出現(xiàn)突破性感染的比例上升。但是，由于疫苗減少了重癥和死亡，人們并不需要為這類感染擔憂。
“全世界最終都將把新冠肺炎視為地方病。”杜克-新加坡國立大學醫(yī)學院的免疫學家阿什利·圣約翰說，“不可能在短時間內徹底擺脫疫情，但我們有管理疫情的工具，包括有效的疫苗。”
香港大學流行病學家本·考林表示，即使疫情出現(xiàn)了新的爆發(fā)，新加坡仍然為新西蘭、澳大利亞和中國等“零病例”國家提供了一種擺脫疫情的模式。
“隨著新加坡繼續(xù)放松管控，未來幾周病例數(shù)可能會進一步增加。”他說， “(但)我認為重癥數(shù)會很少。”
向“與新冠共存”轉變還需要改變心態(tài)，將關注對象從絕對病例數(shù)轉向可能需要住院治療的病例。新加坡當局已經將每日健康通報改為僅公布重癥病例和死亡人數(shù)，而非新增感染人數(shù)。該國衛(wèi)生部門也不再提供感染病例是否可以追蹤的數(shù)據(jù)，以減少大眾對輕度感染的關注。
政府在9月9日的一份聲明中說：“在當前‘與新冠共存’的策略下， (每日感染數(shù)據(jù))不再像以前那么重要。”
隨著新加坡等地走上重新開放之路，可以對容忍某種程度的社區(qū)感染的成本和重新開放的經濟效益進行評估。今年8月，新加坡政府將2021年的經濟增長預期從4-6%上調至6-7%，原因是國際旅行有望恢復。
“新加坡有什么其他選擇呢？重新恢復零病例策略將對經濟產生巨大影響，”考林說。（財富中文網）
譯者：Agatha
Highly-vaccinated Singapore is battling a record wave of COVID-19 infections just as the city plans to re-open to the world. But Singapore's 80% vaccination rate has kept severe cases and deaths down, potentially proving that living with the virus—versus trying to eradicate it—is the surest path out of the pandemic.
On Monday, Singapore recorded 1,647 cases of COVID-19, bringing its seven-day daily average to 1,545 cases, higher than any other previous wave of the pandemic. But even as cases soar, COVID-19 deaths in Singapore have remained low. The city-state of 5.7 million people has averaged three deaths per day in the last week.
Singapore’s saving grace is its high vaccination coverage.
Singapore has now fully vaccinated over 80% of its population, one of the highest rates in the world. China's fully vaccinated rate is 73%, while the European Union and U.S. have fully vaccinated 65% and 55% of their populations, respectively, according to Bloomberg.
Singapore’s high caseload was, in part, baked into its plan to ‘live with COVID’ after 18 months of trying to every case, and ministers say that the city still plans on dropping quarantine requirements and re-opening to the world in coming weeks, even as the government reimposes some short-term social distancing measures.
Experts say that Singapore's climbing cases, more than half of which are in vaccinated individuals, may signal that COVID-19 is becoming an endemic disease in the city-state, meaning COVID-19 circulates in a population like its four coronaviruses cousins but doesn't upend lives due to widespread immunity. As long as deaths remain low, Singapore can set an example for how other countries, especially those that have maintained zero tolerance for COVID-19, can emerge from the pandemic.
Living with COVID
In May, Singapore Prime Minister Lee Hsien Loong introduced the government’s plan to 'live with the virus' and transition away from a 'COVID-zero' approach.
“Our aim must be to keep the community as a whole safe while accepting that some people may get infected every now and then,” Lee said in May, announcing that Singapore would gradually open up internally and then to foreign visitors.
Singapore has largely followed the re-opening plan Lee laid out. In June and July, Singapore began loosening restrictions for dining establishments, workplaces, and entertainment venues. By August many businesses were allowed to operate at or near full capacity.
But Singapore’s growing caseload has raised alarms nonetheless because of the speed at which cases have climbed.
Throughout July and August, cases in Singapore ticked up to over 100 per day after nearly a year of almost no infections due to the city’s previous zero-tolerance policy. That policy included stay-at-home orders, intensive testing and contact tracing, and a ban on foreign visitors. This month, cases have risen exponentially, from 180 on Sept. 1 to roughly 500 by mid-September and to nearly 1,500 this week.
On Monday, Singapore said that it would reintroduce some social distancing measures, including reducing dining groups from five to two people at restaurants and directing companies to allow employees to work from home. Singapore's government said the measures will be in place for at least one month to prevent the health care system from being overwhelmed and allow the city to scale up services to help infected patients recover at home. Currently, 30 people in Singapore require ICU beds due to COVID-19, up from five cases at the start of this month.
"The current outbreak will slow Singapore’s re-opening and potentially prolong the process," says Dr. John P. Ansah, assistant professor in health services at the Duke-NUS Medical School in Singapore.
Singapore in early September opened up 'vaccinated travel lanes,' through which vaccinated travelers from low-risk places like Hong Kong and Germany can enter Singapore without quarantines. Singapore had hoped to expand the program later this year in an effort to fully reopen its border and says those plans are still on track despite the ongoing outbreak.
“Our overall strategy has not changed,” Finance Minister Lawrence Wong said in an interview with Bloomberg on Monday. “We are committed to reopening our economy and our society progressively, but our aim has always been to do this without putting too much stress on our hospital system.”
Endemic endgame
The rise of the Delta variant and breakthrough infections is partly to blame for the surge of infections. Singapore’s data shows that 52% of infections in the last month have been among the vaccinated while 48% have been unvaccinated.
Singapore has used COVID-19 vaccines from U.S. makers Pfizer and Moderna for its national campaign, while some private clinics have also distributed doses from China's Sinovac for individuals that prefer the Chinese jab.
But the city's high vaccination rate is keeping people from suffering the worst effects of the virus. Authorities said on Sunday that 98% of people infected in the last 28 days have recorded mild or no symptoms of COVID-19. Singapore is discovering asymptomatic cases by testing close contacts of infected individuals. Kenneth Mak, Singapore’s director of medical services, told Singapore’s Straits Times last week that the vaccinated in Singapore have been 12 times less likely to die or require hospitalization than the unvaccinated.
In Singapore, and elsewhere, Delta-driven outbreaks are leading to higher rates of breakthrough infections among the vaccinated. But such infections are not necessarily a cause for concern due to the protection from severe disease and death that vaccines offer.
"The whole world is going to be transitioning to considering [COVID-19] as being endemic," says Ashley St. John, an immunologist at Duke-NUS medical school in Singapore. "It will not be possible to eliminate it any time soon, but we have the tools now to manage it, including vaccines that work."
Ben Cowling, an epidemiologist at the University of Hong Kong, says that even amid its new outbreak, Singapore still provides a model for how COVID-zero countries like New Zealand, Australia, and China can successfully emerge from the pandemic.
"It is likely that case numbers will further increase in the coming weeks as Singapore continues to relax measures," he said. "[But] I would expect very few severe infections to occur."
The shift to 'living with COVID' also requires a change in mindset, from an obsession with absolute case counts to focus instead on cases that may require hospitalization. Singaporean authorities have begun to lead daily health briefings with the number of severe cases and deaths as opposed to the number of new infections. Health authorities also have stopped providing data on whether cases were traceable or not in their effort to deemphasize mild infections.
"[Daily infection data] is no longer as relevant as before, given our current strategy of living with Covid-19," the government said in a statement on Sept. 9.
And once on the re-opening path, places like Singapore can evaluate the costs of tolerating some level of infection in the community with the economic benefits of re-opening. In August, Singapore's government raised its 2021 economic growth forecast from a 4-6% GDP growth in 2021 to 6-7%, citing the prospect of resumed international travel.
"What are the alternatives for Singapore? Reverting to a COVID-zero strategy would have enormous economic consequences," says Cowling.
