Singapore, along with the rest of the world, is currently engaged in battle against the growing COVID-19 pandemic that first emerged in Wuhan, China, in December 2019. While Singapore has been praised for her effective response towards containing the first wave of infections, the battle is far from over as the nation is currently facing its second wave.
What has worked so far in this fight against coronavirus, and what are the lessons that can be learned for the next stage of the pandemic in Asia and elsewhere around the world? This was the focus of the first virtual panel in the Lee Kuan Yew School's Asia Thinker series, moderated by James Crabtree, Associate Professor in Practice, Lee Kuan Yew School of Public Policy.
A battle on two fronts
Kicking off the discussion, Professor Teo Yik Ying, Dean of the Saw Swee Hock School of Public Health, National University of Singapore shed light on the current situation in Singapore, citing how the sudden spike of cases in the past week is truly the "hallmark" of the coronavirus. "Things can change very quickly. Within a few days, you could suddenly see an explosion of cases that happen within a geographical region and, in our instance, in the country," he said.
In Singapore, the battle is being fought on two fronts: in the community and within the migrant worker population living in dormitories. While Professor Teo believes there are encouraging signs that the situation in the community is being managed with the existing circuit breaker measures, he expressed concern over the second front involving Singapore's migrant worker population.
"What we are seeing in the dormitories is an important reminder and warning to other countries out there, particularly poorly resourced countries and low or middle income countries, with a larger congregation of people living in informal housing arrangements where human density is much higher."
Re-evaluating our way of life
Shifting the discussion towards the economic point-of-view, Associate Professor Joanne Yoong, Senior Economist & Director, Center for Economic and Social Research, University of Southern California, shared how the pandemic has forced us to relook the economic paradigms that we have taken for granted in the past years. "Today, what we're seeing is a radical remaking of how we work and how we live with the support of technology."
The pandemic has exposed numerous vulnerabilities in the ways in which people live. She continued, "We are rethinking, at the highest levels, some of our assumptions about globalisation and what that means, and the risks that are inherent in some of our supply chains." She identified the flow of migrant labour, the gig economy and social protection policy as areas of risk that society needs to be concerned about.
Professor Yoong went on to explain how behavioural economics can interpret the way people are reacting to this crisis. "In the environment of this pandemic, the psychology of fear and panic really drives us, in many ways, to our worst selves."
Such a mindset impairs the ability to behave rationally. "It makes us myopic, it helps us focus only on the short term. It reduces our ability to empathise with each other. And it leads us to behaviour like panic-buying, which we know when we are our better selves is not the right thing to do," stressed Professor Yoong. In times of uncertainty like these, she cautioned against the danger of confirmation bias — where people process information in a way that conforms to what they already believe or which exacerbates their existing biases.
With this pandemic unfolding all around the world, the traditional model of rational decision-making breaks down. Moving forward entails much more than just being prepared for subsequent waves of infection, but also how to live with this uncertainty.
Lack of information still a problem
Citing Europe and North America as the current epicentres of the pandemic, Professor Tikki Pangestu, Visiting Professor, Lee Kuan Yew School of Public Policy, went on to mention that various countries are at different stages of the pandemic and hence implementing different strategies to contain it.
"You have... very severe lockdown strategies such as in New Zealand and India. On the other end of the spectrum, you have countries which are quite relaxed about it. Sweden is one example where they're taking a laissez-faire approach. There are also countries which are a little bit fragmented in their strategies, like what we are seeing in the United States."
Professor Pangestu also explained that it still holds true that most people who catch the virus only suffer from fairly mild symptoms, and among the underlying conditions, those with heart disease are at the highest risk of death.
Despite these facts, he stressed that there is still much that experts do not know about the coronavirus, such as its true transmissibility and mortality rates.
"We don't know the role of the asymptomatic carriers, which has been very much in the news recently. And finally, we also don't know what's going to happen when the virus spreads to regions with weak, fragile health systems like Sub-Saharan Africa or India." And this in itself makes for a precarious situation that the world finds itself in.
Will this become the "new normal"?
In response to questions regarding what might be the new "normal" in the aftermath of this COVID-19 crisis, Professor Pangestu has an interesting take: "In my own personal view, I feel this virus is going to become endemic just like seasonal flu, but with occasional outbreaks of severe disease, maybe due to a relaxation of containment efforts or even a viral mutation. So we will have to learn to live with the virus, but our health systems must have the capacity to fight fires where necessary."
Rather than allowing a situation of endemicity, Professor Teo leaned towards the opposing view. "Based on what Singapore has done in terms of national measures, the signal is clear. We are trying to contain this, even perhaps to the point of complete elimination, which is what countries like New Zealand and Australia are trying to do as well."
Professor Yoong, speaking from a health systems perspective, also hoped to see the existence of robust healthcare systems in the future that can treat even the most severe cases, and possibly also develop a vaccine.
Dealing with the migrant worker clusters
Professor Teo also shared his thoughts on the recent spike in cases from the migrant worker dormitories in Singapore, stressing the importance of universal healthcare. "One of the overarching principles is that we have to care for our migrant workers as we do for anyone in the society, that they are all a part of Singapore, helping Singapore grow and develop."
He continued, "Healthcare financing to support the migrant workers, if they do get infected, has to remain, and I'm very glad to see that the Singapore government has stayed true to that promise."
Referring to the efforts of many who have volunteered to be trained and deployed to manage the outbreak in the dorms, Professor Teo said, "If we're able to continue what we are doing, which is swabbing and testing as many of the dormitory workers as possible, isolating those that are believed to have been exposed, and thirdly, having a clinical team we deployed specifically to care for this foreign workers — I think that will help to improve the situation."
But going forward, Professor Teo explained that Singapore may need repeated circuit breakers "every three to four months to allow the healthcare system to recuperate".
How long before we ease the lockdown?
One common question from viewers was: How much longer until countries get to unlock? For Professor Pangestu, it depended on a few different factors. "The obvious one — you must have evidence of control over transmission over a certain period of time, depending on the situation in each country. I think that is probably the most important criteria."
He also reiterated that healthcare systems must be ready to deal with any sort of adverse events before countries can consider easing these lockdown measures, in case the situation takes a sudden turn for the worse. A continual, evidence-based, transparent and timely communication between the government and the public has to be established as well.
Professor Teo added, "How long the lockdown lasts would really depend on when the leaders of various countries are able to come together and coordinate a global lockdown."
He goes on to elaborate, "What we are seeing right now, happening in parts of Europe and America, is that countries have unilaterally decided to impose restriction measures, and right now they are unilaterally unlocking."
"This staggered approach is not going to help the global community because what is likely to happen, is what we are seeing in China, South Korea and Singapore. We will see second waves of imported cases come into countries like Italy, Spain, Australia, Germany, as they decide to relax some of their measures."
To prevent additional imported cases and subsequent waves of infection, there has to be global coordination efforts to contain the virus before any measures can be eased.
SEA: the next epicentre?
With Singapore being situated in a region that still has a large number of emerging economies, there are concerns as to what might happen if the pandemic takes a hold in these low and middle income countries.
There is a need to understand the cause of the rise in these nations. Is there an actual rise in the number of cases, or is it because they are testing for the virus more frequently than they did in the beginning?
"Having the ability to test now will provide a much more accurate picture of what is happening in some of these countries in Asia, and I see this as absolutely crucial for us to understand to what extent the coronavirus is spreading in these countries," Professor Teo continued. "There is always the fear that countries in South Asia, in Southeast Asia may become the next epicentre after America is able to get this situation under control."
"Some of the statistics coming up from countries in Asia do suggest that the epicentre is likely to shift back to Asia, and that is of great concern. Singapore, being in Southeast Asia, being a part of Asia — we have to watch this space very carefully," he added.
Looking ahead: long term behavioural changes
Will some of the more positive behaviours that have emerged during this crisis stay and stick around even after this pandemic blows over?
For Professor Yoong, this remains to be seen. Under external pressure, people can be good at adopting new personal habits like hand-washing or not touching their faces. But the same cannot be said for what might happen after, she cautions.
"Habit formation is a tricky thing. We like to believe in it. We hope that it takes root and it does for some people, but what's actually most important is that we take advantage of this moment to put in place institutional changes that are commitment devices for the longer term."
It may be hard to dictate individual behaviour, so improvements in a coordinated response to such crises are much more meaningful. "To the extent that we do see institutional change, we can take the moment to strengthen our health systems the same way that the SARS epidemic in Singapore led us to a better-prepared response to COVID-19," she surmised.
"We will see changes in the way that we approach crisis management, but when we see changes in the day to day behaviour of individuals, I think that's a much more open question."
Watch the full recording of COVID-19: Lessons learned? What comes next?