Saturday, February 5, 2022

Explainer: Why EU nations are lifting Covid-19 restrictions despite high case numbers and should Singapore do the same?

Several European Union countries are doing away with infection controls for Covid-19
Denmark has had none since Feb 1 and France said on Feb 2 that it will be lifing most restrictions
This is even though they have a high number of Covid-19 cases
The World Health Organization is, however, cautioning against relaxing curbs too quickly
Infectious diseases experts in Singapore said that the Government here may consider easing some restrictions


February 4, 2022

SINGAPORE — Several European Union (EU) countries are lifting most, if not, all of their Covid-19 restrictions, despite recording high number of Covid-19 cases.

Denmark removed all restrictions, including mask-wearing and Covid-19 vaccination passes, on Tuesday (Feb 1) — the first EU country to do so. 

Last week, Danish Prime Minister Mette Frederiksen announced the country's return "to life as we knew it" even though it was registering 40,000 to 50,000 new cases a day.

The hope is that the high vaccination rate there will be enough to cope with the Omicron coronavirus strain, which has shown to have less severe outcomes for infected patients.

A day later on Wednesday, France also announced that it will be loosening several of its infection controls, with the authorities hoping that a recent decline in daily cases will soon ease pressure on overburdened hospitals.

Sweden and the Czech Republic are following suit — they have announced plans to ease restrictions even though both countries have record levels of infections.

Yet, the World Health Organization (WHO) cautioned on Tuesday against relaxing Covid-19 curbs prematurely since many countries have not reached the peak of the Omicron infection wave, adding that public health and safety measures imposed to curb the spread of the coronavirus should be relaxed gradually.

TODAY explains the differing stances between EU governments and WHO, and what it could mean for the situation in Singapore.


Associate Professor Alex Cook, vice-dean of research at the Saw Swee Hock School of Public Health, said that even though the number of Covid-19 cases are high, the number of patients in the intensive care units (ICU) in Denmark has been falling and France's level of infections are lower than the first three waves it witnessed.

"So while the number of cases is high in both countries, the impact on the health system is less than what they have had to deal with in the past," he said.

“In both countries, the number of cases has seemingly peaked, which may give more confidence to the governments to proceed with reopening."

Professor Dale Fisher, an infectious diseases expert from the National University of Singapore (NUS) Yong Loo Lin School of Medicine, echoed similar sentiments, saying that case numbers are no longer an important metric in most countries.

"Many countries now have very high levels of immunity due to vaccination, infection or both. This will reflect on the hospitalisation rate. If severe disease and hospitalisation rates are low, the easing of the restrictions — which have social and economic impact — makes sense," he added.


WHO's warning on the premature lifting of infection controls is targeted towards the global population, and a substantial fraction of them still remain unvaccinated, Assoc Prof Cook said.

However, it is up to individual governments to apply WHO's advice to their own local context.

“Many countries now have very high levels of immunity due to vaccination, infection or both... If severe disease and hospitalisation rates are low, the easing of the restrictions — which have social and economic impact — makes sense."
Professor Dale Fisher, infectious diseases expert from the 
National University of Singapore Yong Loo Lin School of Medicine

Assoc Prof Cook added that the governments of Denmark and France have to consider the overall impact of Covid-19 measures on their populations, not just the effect on disease spread.

He noted that at some point, once vaccines have been availed to high-risk individuals and when the healthcare system is not under threat of being overwhelmed, the benefits of removing the strict measures outweigh the harm they cause.

"Paris and Copenhagen will have judged that based on the evidence that they passed that point."


Given Singapore's high vaccination rate, some infectious diseases expert believe that Singapore should also start easing some of these restrictions imposed to curb the spread of the coronavirus.

Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, pointed out that the restrictions no longer have any impact on the case numbers here, for instance.

The number of Covid-19 cases in Singapore started climbing exponentially in the beginning of September last year, and continued to rise when restrictions were tightened on Sept 27.

After peaking at more than 5,000 at the end of October, the numbers started trending downwards, and continued going down when some restrictions were eased on Nov 22.

In addition, Prof Tambyah noted that the most recent exponential surge in cases has occurred without any change in the infection controls at all.

"There is really no good public health reason not to lift the restrictions, especially the most onerous such as the limits on visits to elderly people at home and in nursing homes," he said.

Even though it is not yet clear when the Omicron wave will peak in Singapore and how high it will go, Assoc Prof Cook said that the number of ICU patients, which is the key determinant of Singapore's healthcare system's ability to cope with the pandemic, offers some clue as to whether restrictions can be further eased.

As the number of ICU patients is hovering at between 10 and 20 per cent of the number during the height of the Delta wave, he said: "This gives confidence that we can handle even a large rise in the number of cases in the community caused by easing of restrictions."

Instead of declaring a “freedom day” like what other EU countries have done, Prof Fisher said that the more conservative approach of gradual easing adopted by the Singapore authorities has served the nation well as it had not had to "flip flop" like some other countries.

However, he said that the national Covid-19 task force may eventually need to "take some bold steps that may make us feel uncomfortable".

"Larger groups socialising, encouraging tourists more, reigniting food-and-beverage establishments and easing mask restrictions all would be on the radar of decision makers," he said.

However, Dr Asok Kurup from Mount Elizabeth Hospital noted that it is better to err on the side of caution since the number of Omicron cases here have not peaked, there are vulnerable people who have not received their vaccine booster and there is a risk of a new strain emerging that is more virulent.

Some restrictions may be relaxed, such as allowing a higher number of people to dine out in a group, but mask-wearing should still stay for now, Dr Asok said.

Prof Tambyah said that it would "take a lot of courage for the (multi-ministry Covid-19) task force to make bold decisions based purely on the local evidence base".

"Public health policy is a combination of science, epidemiology and a lot of politics — sensing what people are willing to put up with."

Associate Professor Natasha Howard, who is also from the Saw Swee Hock School of Public Health at NUS, said that no matter how governments calibrate the appropriate level of restrictions, the pandemic will not end until it can be controlled at manageable levels in most countries.

"This means that all countries that are able must contribute to global vaccine equity — increasing vaccination coverage in all countries currently left behind," she added.

"(This would be) the most viable way for all of us to exit this pandemic. Otherwise, we may keep seesawing between higher and lower domestic restrictions as new variants emerge and spread."

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