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Sunday, 24 October 2021

Why Singapore has a Sudden Increase in Covid New Case?

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3) Update : 11 December 2021
 
Lastest chart update about Covid situation in Singapore
Expert said Antigent Rapid Test or LFT works with Omicron
South Africa Adds Antigen Test


24 October 2021

Abstract:

Lockdown is an effective way to curb Covid from spreading.  It works by isolating all or part of the community,  trying to force the infected,  especially those asymptomatic to stay away from the rest of the community;  hopefully,  by testing or otherwise,  these infected people will disappear over time. 

Instead of using the Lockdown method,  Singapore implemented free and easily accessible Antigen  Rapid Test Kits (ART) in September 2021.  This has managed to flush out thousands & thousands of asymptomatic patients,  who otherwise will stay hidden in the Community,  spreading Covid silently.  The success will depend on whether this new method can flush out the asymptomatic patients in the Community.

Introduction

Singapore used to be one of the best in handling the spread of Covid pandemic disease.   It used to have the lowest Covid infection rate as well as the death rate.  Many countries have taken it as a model.    Lately,   Singapore's infection rate has risen exponentially;  at the same time, the death rate has also increased slightly as shown in the following chart.  It has recorded infection new cases hovering at around 3,000 to 5,000 recently.



Possible Reasons

The following might be the reasons:-

1.  Increase in a spread of Covid infection; 

2.  Increase awareness in the community to carry out frequent testings;

3.  Management lapse and negligence.

There were active web discussions about the reasons why.  Many are clueless.  Some attributed this to the pervasive Mandatory Fast and Easy Testing (FET) rules in September 2021.  Others blamed the mismanagement.  There are also people saying the mRNA vaccine is not effective.  This article will make an attempt to explain.


Why?

The recent rapid increase could be due to a combination of the above reasons.  

There could be a real increase in the spread of infection.  Many countries that opted to live with Covid also experienced the same. But many countries,  especially the European countries, are using  Antigen (ART) testings as an alternative to do away with Lockdowns.  This is because of the frequent street protests from the residents.



Singapore has just introduced this new rule using Antigen testing in September.  The new rule makes it mandatory for the residents,  especially those workers,  to do self-testing at regular intervals or whenever they are feeling unwell.   This move must have flushed out many hidden cases that otherwise will go unrecorded,  spreading Covid in the community.    

Sudden increase Not by Variants

The sudden increase in Singapore is not caused by variants.  If it was so,  the Authority would have reported it, and such statistics would have been reflected in the GISAID webpage
Click picture to go to the GISAID webpage


The "Silent Covid Spreaders"?

Although there was no known statistical testing done,  this technical article using a decision analytical model estimated that about 59% of Covid transmission came from people without any symptoms.  These people without any symptoms are known to be "Silent Covid Spreaders".

These people are always living real in the community,  spreading and transmitting Covid silently every day.  The Covid virus can also grow stronger by the day.   That is the reason why many countries failed to contain the disease.  Many countries have conceded and changed their strategies from "Zero Tolerance" to "living with Covid".

How Can We Flush Out these Silent Covid Spreaders?

Mass testing is always done to flush out these  "Silent Covid Spreaders".   Following up with Lockdowns is the way to complete the job.

In the past,  residents & visitors to the infection areas or clusters are always troubled and made to line up under the hot sun or corridors for many hours to get their Covid testing done.  This was when only a few hundred infected people were found daily. 
 
Today,   this scene is no more around but many thousands were found.   Some more,   about 99% of those found infected are without symptoms or with mild symptoms.  Why it is so?

Brought-in-Dead (BID)

Many countries with very high Covid infection rates often use BID (Brought-in-Dead) or DOA (Dead on Arrival) to measure the gaps in health services or the seriousness of the pandemic disease in the field.  It measures how many people are brought in Dead before any effort is put into resuscitation.  This indicator will often stand up when the health services are so loaded that they cannot handle the pandemic disease.  


So far,  there were no such BID reports in Singapore even though the new infection cases have been hovering around 3,000 to 4,000 daily at the moment.  The health services were still able to handle the new cases.   Why is it so?


Case Fatality Rate (CFR) vs Infection Rates

CFR is a ratio between confirmed deaths and confirmed cases.   CFR can be used roughly to indicate how serious is pandemic in a country.  Therefore,   countries with higher CFR can mean countries are having pandemic that is more serious than those with lower CFR.  The country with a higher CFR might have a lot of very sick people.   Presently,  Singapore has very high infection cases but very low CFR.  One reason is that 99% of the infection cases are asymptomatic.   How do they do it?






The Possible Answer
The sudden increase in infection rate happening in Singapore can be viewed as the result of the latest move by the Government to live with Covid and do away with "Circuit Breakers" aka lockdowns.  But at the same time,  they are flushing out the "Silent Covid Spreaders".  

First,  Singapore announced a new Covid testing rule in August/September.   It introduced and started ART,  the Antigen Self Covid Testing in September.  It made ART testing mandatory in some establishments in early September.  The month-long result must be good for them to extend mandatory ART testing to the rest of the community including the residents by 1st October.  Offenders would be taken to task and cases publicized.  

Second,  it has given every household a free blood oxygen meter and some free ART Self-Test kits to start with.    After that,  more ART Self Test kits were made available for free.


In addition,  the Government is making sure:-

a)  The free Self-Test kits are made readily available also to those infected.  They can draw the test kits from vending machines located all over the island on a 24/7 basis;

b)  The kits are also distributed to companies, factories,  construction sites,  offices & establishments for them to test each and every worker regularly daily.  

All those who tested positive using self-test kits & display symptoms (mild or otherwise) will have to submit the results to the Authority for PCR confirmation as required.  Once confirmed,  the patients will have to wait for the quarantine instruction from the Authority.  Home quarantine is only allowed for those aged below 60.  

Most Singaporeans are generally aware of the strict law enforcement in Singapore.   They don't want to be caught by the laws.  Many must have diligently carried out the self-testing at their premises. 

After such a move started on Sept/Oct,   PCR testing centres,  information service, and treatment facilities were overwhelmed and overloaded.   Those waiting for Authority's instructions were often seen complaining in the forum about the long waiting time.   The infection rate suddenly shot up.    It would appear that the Singapore Government's latest strategy of flushing the "Silent Covid Spreaders" started working.  

With ART testing kits easily available,  people are aware if they have been infected by the deadly Covid and seek medical attention at the earliest instant.  Hence, no BID reports so far.



Corresponding Increase in Hospitalisation and Death Rate

Although there was a corresponding increase in the number of hospitalization and deaths putting some pressure on the medical system,  this could be due to the emergence of a new infection wave or pattern.   But this did not attract the Authority to sound any alarm or raise the DORSCON (Danger) level because:- 

1)  The hospitalization number is rising slightly

This chart shows the number of infections vs the number of hospitalization. It indicates that the hospitalization number has risen only slightly. This was after they introduced ART testing.  It is not rising in tandem with the infection. 

2)  The majority of those infected were having either mild or no symptoms.  They have been put either in-home quarantine order or in Community Care Centre for observation.  


3)  The death rate per 100,000 is still very low. 


4)  The Weekly Ratio of Infection in the Community is falling

The Ratio of community cases in the past week over the week before has been falling gradually ever since August.















This Could be What Happen


1.  Before ART Testing is in place
The "Silent Covid Spreaders" would stay at home and would not pay money to visit the clinic when they have had flu-like symptoms,  like fever or sore throat.  They would visit the clinics only when they became very sick.  

Mass testing done can get at most,  a few hundred "Silent Covid Spreaders"

2.  After ART Testing is in place
The same "Silent Covid Spreaders"  will usually use the free blood oxygen meter to test for fun.  When reading is low,  they become curious and use the free ART testing kit to confirm.   With positive readings from ART testing,  they will get panic.   wondering if the sickness will get worst and they will want to visit the clinic or the testing centres in the next very first hour.  As a result,  clinics are lately seeing a lot more infection cases.

This explains why no mass testing was done but Authority can get several thousand in a day. 
 


What about Cost-Effectiveness?

Giving out free blood oxygen meters and ART testing kits to every household may look to be a wasteful and overkilled effort initially.  Many people did not expect it to be well-received because Singaporeans,  by nature,  are always reluctant to share personal information voluntarily even though submitting the test results is mandatory.    

Now it turns up that this strategy of self-testing is not only successful,  it is also cost-effective.  The Government can save at least the cost of the following items:-

a)  The first PCR testing which otherwise would cost another US$100/=.  This is because 2 PCR testing will be needed to confirm the infection;

b)  The cost of setting up and manning of field testing stations;
c)  The manpower and admin for tracing,  calling up & monitoring all the testing work.  The majority might not be even infected and PCR testings are always wasted.

As for the Singaporeans,  they can save themselves from the agony of spending valuable time,  lining up for hours to get mandatory PCR testing done.

Results:  

1) Flushed out Thousands of  "Silent Covid Spreaders" 

The following chart using Data from Our-World-in-Data illustrates that Singapore was able to use the latest ART testings strategy to successfully detect about 5,000 cases a day on 27 October.  They have not only reduced the frequency of PCR testings but also did it without using mass testing and other methods.  Thousands were found with no or mild symptoms.  The chart shows clearly that the infection rate increased in tandem with the increase in the positive rate in testings;  at the same time,  the testing rate was declining.  The positive rate went up 18 times from about 1% to about 18% with a 60% decline in testing rates.  This is not possible without the help of ART testings.


Note:  Positive Rate is the % ratio between Confirmed Case over the number of tests carried out

2) Rapid Increase and falling in Covid cases

Our World in Data compares countries in terms of how rapidly a country's Covid cases have doubled.  Singapore came second next to Barbados,  doubling the cases in 35 days.  Although there was no report in our World in Data about the rapid fall in Covid cases,  Singapore just announced to say that the new cases were only 1,723 on 14 November.  They managed to cut down by half the number of new cases from the record of 5,000 new cases on 29 October.  That is in less than 16 days.  


What Others Are Still Doing


The attached Appendix is showing some examples of what other countries are now doing to flush out the "Silent Covid Spreader".  Although some ideas like mobile testing are good, it is doubtful it will be as effective as giving out free ART Test kits idea.  

In Conclusion

We are of the view that this sudden increase in the infection rate in Singapore is mostly due to the Government's latest move to make self-testing mandatory.   It is good,  timely, efficient, and cost-effective.  

The "Silent Covid Spreaders" in the Community must always be flushed out as much as possible to stop Covid from having a chance to spread and grow stronger every day.  Singapore should be able to see very low new cases very soon.

3)  Update: 11 December 2021

This updated chart taken on 11 December shows that Singapore was able to tame the Covid in about 109 days;  this is less than half of the ttime taken by its neighbour,  Malaysia.  Both Malaysia and  Singaopre are having predominantly the Delta variant.   

The  abundant use of ART test kits must have help Singapore to achieve this better than expected results.




2) Update: 8 December 2021

  • Individuals getting tested will likely not know which specific variant of the virus they have based on a basic PCR or antigen test.
for more information:  Read here


1) Update 28 November

South Africa Adds Antigen Test

South Africa Health Authority found 20,000 new cases by Nov 8 and this is about 26% of the 75,000 Antigen tests (ART) done.  They are now adding Antigen testing to the National count.   They said " Analysis of the mutations in the nucleocapsid (N gene) of B.1.1.529 viruses suggests that rapid antigen tests should be unaffected, however, verification of this is underway."

References:


Appendix:   What others are still doing



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