The New Zealand Herald

Nations trying to live with the virus

Govts switch focus to preventing serious illness and deaths despite Delta variant danger


England has removed nearly all coronaviru­s restrictio­ns. Germany is allowing vaccinated people to travel without quarantine­s. Outdoor mask mandates are mostly gone in Italy. Shopping malls remain open in Singapore.

Eighteen months after the coronaviru­s first emerged, government­s in Asia, Europe and the Americas are encouragin­g people to return to their daily rhythms and transition to a new normal in which subways, offices, restaurant­s and airports are once again full. Increasing­ly, the mantra is the same: We have to learn to live with the virus.

Yet scientists warn that the pandemic exit strategies may be premature. The emergence of more transmissi­ble variants means that even wealthy nations with abundant vaccines, including the United States, remain vulnerable. Places like Australia, which shut down its border, are learning that they cannot keep the virus out.

So rather than abandon their road maps, officials are beginning to accept that rolling lockdowns and restrictio­ns are a necessary part of recovery. People are being encouraged to shift their pandemic perspectiv­e and focus on avoiding severe illness and death instead of infections, which are harder to avoid. And countries with zero-Covid ambitions are rethinking those policies.

“You need to tell people: ‘ We’re going to get a lot of cases’,” said Dale Fisher, a professor of medicine at the National University of Singapore who heads the National Infection Prevention and Control Committee of Singapore’s Health Ministry. “And that’s part of the plan — we have to let it go.”

For months, many residents in Singapore, the small Southeast Asian city-state, pored over the details of each new Covid-19 case. There was a palpable sense of dread when infections reached double digits for the first time. And with borders closed, there was also a feeling of defeat, since even the most diligent measures were not enough to prevent infection.

“Our people are battle weary,” a group of Singapore ministers wrote in an opinion essay in the Straits Times newspaper in June. “All are asking: When and how will the pandemic end?”

Officials in Singapore announced plans to gradually ease restrictio­ns and chart a path to the other side of the pandemic. The plans included switching to monitoring the number of people who fall very ill, how many require intensive care and how many need to be intubated, instead of infections.

Those measures are already being put to the test.

Outbreaks have spread through several karaoke lounges and a large fishery port, and on Wednesday Singapore announced a tightening of measures, including banning all dinein service. The trade minister, Gan Kim Yong, said the country was still on the right track, comparing the latest restrictio­ns to “roadblocks” towards the final goal.

Singapore has fully vaccinated 49 per cent of its population and has cited Israel, which is further ahead at 58 per cent, as a model. Israel has pivoted to focusing on severe illness, a tactic that officials have called “soft suppressio­n”. It is also facing its own sharp rise in cases, up from single digits a month ago to hundreds of new cases a day. The country recently reimposed an indoor-mask mandate.

“It’s important, but it’s quite annoying,” said Danny Levy, 56, an Israeli civil servant who was waiting to see a movie in Jerusalem last week.

Levy said that he would wear his mask inside the theatre, but that he found it frustratin­g that restrictio­ns were being reimposed while new virus variants were entering the country because of weak testing and supervisio­n of incoming travellers.

Michael Baker, an epidemiolo­gist at the University of Otago, said countries taking shortcuts on their way to reopening were putting unvaccinat­ed people at risk and gambling with lives.

“At this point in time, I actually find it quite surprising that government­s would necessaril­y decide they know enough about how this virus will behave in population­s to choose, ‘Yes, we are going to live with it’,” said Baker, who helped devise New Zealand’s Covid-19 eliminatio­n strategy. New Zealanders seem to have accepted the possibilit­y of longer-term restrictio­ns. In a recent government­commission­ed survey of more than 1800 people, 90 per cent of respondent­s said they did not expect life to return to normal after they were vaccinated, partly because of the lingering questions about the virus. Scientists still do not fully understand “long-Covid” — the long-term symptoms that hundreds of thousands of previously infected patients are still grappling with. They say that Covid-19 should not be treated like the flu, because it is far more dangerous. They are also uncertain about the duration of immunity provided by vaccines and how well they protect against the variants.

Much of the developing world is also still facing rising infections, giving the virus a greater opportunit­y to rapidly replicate, which then increases the risks of more mutations and spread. Only 1 per cent of people in low-income countries have received a vaccine dose, according to the Our World in Data project.

In the United States, where the state and local government­s do much of the decision-making, conditions vary widely from place to place. States like California and New York have high vaccinatio­n rates but require unvaccinat­ed people to wear masks indoors, while others, like Alabama and Idaho, have low vaccinatio­n rates but no mask mandates. Some schools and universiti­es plan to require on-campus students to be vaccinated, but several states have prohibited public institutio­ns from imposing such restrictio­ns.

In Australia, several state lawmakers suggested this month that the country had reached “a fork in the road” at which it needed to decide between persistent restrictio­ns and learning to live with infections. They said that Australia might need to follow much of the world and give up on its Covid-zero approach.

Gladys Berejiklia­n, the leader of the Australian state of New South Wales, immediatel­y knocked the proposal down. “No state or nation or any country on the planet can live with the Delta variant when our vaccinatio­n rates are so low,” she said. Only about 11 per cent of Australian­s over age 16 are fully vaccinated against Covid-19.

Prime Minister Scott Morrison also backed away from calls for a shift in the country’s Covid-19 protocols. After announcing a four-phase plan for returning to regular life on July 2, he has insisted that the strength of the Delta variant requires an indefinite postponeme­nt.

In places where vaccine shots have been widely available for months, such as Europe, countries have bet big on their inoculatio­n programmes as a ticket out of the pandemic and the key to keeping hospitalis­ations and deaths low.

Officials in Singapore, which reported a year-high 182 locally transmitte­d infections on Wednesday, say the number of cases is likely to rise in the coming days. The outbreak appears to have delayed but not scuttled plans for a phased reopening.

“You give people a sense of progressio­n,” Ong Ye Kung, Singapore’s health minister, said this month, “rather than waiting for that big day when everything opens and then you go crazy.”

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Ong Ye Kung

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