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Daily Covid-19 numbers should not blur the bigger picture and cause unintended pain

SINGAPORE – The Covid-19 numbers released every day by the Ministry of Health (MOH) are quite troubling.

In all, more than 1,000 people are in hospital on account of Covid-19 and more than 200 among them are seriously or critically ill.

The number of daily Covid-19 cases reported in September has crossed more than 1,000 with regularity. Five people died on Tuesday (Sept 28) and eight on Wednesday, and 56 have died over the past two months, taking Singapore’s total number of fatalities since the first death in March 2020 to 93 as at Wednesday.

It is all very well to talk about moving towards accepting the disease as endemic and knowing that deaths will occur. It is different when the number of those falling sick and dying is thrown at us.

But the way I see it, these daily figures are not helping Singapore transit towards becoming a Covid-19-resilient nation. They do not paint the full picture but can still dampen spirits; and basing our responses on an incomplete picture can do more harm than good.

Since Aug 1 this year, a total of 56 people have died from Covid-19 – roughly one a day. This is just a fraction of the 60 people who on average die every day in Singapore.

Influenza alone kills two people a day, or about 60 a month. Flu patients can die from an overwhelming immune response, from a secondary infection in the lungs, or from multi-organ failure. But no one is panicking about these avoidable deaths – simply because we do not hear about them day in and day out.

That is why the multi-ministry task force on Covid-19 should consider issuing weekly bulletins instead of daily ones to update the nation on the current situation.

Transiting to living with Covid-19 might be easier if people are not being bombarded – and frightened – by numbers every night.

The comparison with influenza is instructive, even though experts disagree on whether Covid-19 should be treated like the flu even for those who are vaccinated.

Last week, Norway declared that Covid-19 is on a par with influenza for people who have been vaccinated, and life can return to normal.

Infectious diseases expert Dale Fisher of the National University Hospital agreed that for those vaccinated, Covid-19 “can be treated like the flu”.

But he cautioned: “For the tens of thousands of unvaccinated seniors, it is much more dangerous than the flu.”

Associate Professor Hsu Li Yang of the National University of Singapore Saw Swee Hock School of Public Health, also an infectious diseases expert, does not think Norway’s approach can apply to Singapore just yet.

The situation in Europe, where large segments of the population had been infected, is different from that of Singapore. There, a combination of vaccination and infection confers greater protection to the population.

In Singapore, even with more than 80 per cent of the population vaccinated, the Delta variant will cause more severe illness and deaths than seasonal influenza in a largely Covid-19-naive community at the population level, he said.

Agreeing with him, Professor Teo Yik Ying, the dean of the school, added: “It is quite clear that the death rate for Covid-19, even after vaccination, is going to be higher than the flu.”

Associate Professor David Allen, an infectious diseases expert at the NUS, also did not agree with Norway’s stance. He said that while the post-infection consequences of influenza were well defined, there remains many unknowns with Covid-19.

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However, standing with Prof Fisher, Professor Ooi Eng Eong, an expert in emerging infectious diseases at the Duke-NUS Medical School, said that in the long run, Covid-19 should be treated as a common cause of respiratory tract infections.

He said: “Among the vaccinated, there is no need to view Covid-19 with the same dread as we did last year, when it was neither a vaccine-preventable nor treatable disease.

“Obviously, Covid-19 is still a threat to older adults with other chronic diseases and who have remained unvaccinated.”

Vaccination, all experts agree, does confer strong protection, and booster jabs given to people at higher risk will hopefully prevent more deaths.

As at Wednesday, 93 people in Singapore have died of Covid-19, with more than half the deaths occurring over the past two months. Since vaccination became available to the population only this year, many of the earlier deaths were among people not vaccinated.

All except one of the 56 people who have died since August would have been offered the jab. The sole exception was a Ukrainian seaman who arrived infected and sick.

Still, only 12 of these 56 had been fully vaccinated. And all 12 had serious underlying medical conditions, such as stroke, heart disease and chronic obstructive pulmonary disease which affects the lungs.

No vaccinated resident below the age of 70 has died, although there have been 12 deaths in people aged 34-69, including the Ukrainian.

Unintended consequences

That said, Singapore’s focus on Covid-19 is causing other problems.

Elective treatments, including those for cancer, at public hospitals are currently postponed because of the rising number of Covid-19 cases. Are these delays resulting in poorer health outcomes for patients?

Since the impact is not immediate, we will only know years down the road if the past 20 months will lead to higher rates of death and morbidity among those suffering from ailments like kidney failure, heart disease and cancer.

Covid-19 measures such as working and schooling from home and limited social interaction have also had an impact on people’s mental health, with spillover effects on other ailments.

Dr Jerry Tan, an ophthalmologist in private practice, said he sees one to two mental health-related eye problems daily. These include eyelid twitching, eye ache and headaches, and blurring of vision. Before the pandemic, he saw about two such cases a week.

Prof Teo said: “It is clear there is significant impact to the rest of our health indicators, including prevalence of binge drinking, tobacco use, rising sedentary behaviour, and worsening mental well-being.”

He added: “A life lost due to suicide or excessive alcohol or tobacco use is just as regrettable as a loss from Covid-19, and we should not overlook that.”

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Associate Professor Alex Cook, vice-dean of research at the NUS Saw Swee Hock School of Public Health, said: “I’m really worried about the looming public health issues that will come after the pandemic is past us.”

Some have coped with Covid-19 measures by over-eating, smoking, drinking and forgoing physical activity.

“There will be a lot of work to do in the years ahead to reverse the negative impacts of the pandemic on other aspects of our health,” he said.

While it is important to minimise serious illness and deaths from Covid-19, this should not be at the expense of other health issues.

The spotlight today is on Covid-19, but the rest of the picture where the light does not shine is something the task force needs to also bear in mind.

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