A few weeks ago I started drawing attention to Singapore's Covid-19 response as one NZ can learn from. S'pore has pop 5.7 million, 73 Covid-19 deaths, 83K cases. After reopening commenced on 19 Aug, cases rose exponentially. What should we be learning? /1
Vaccination currently stands at 84% of the *population* has received 1 dose, 82% population has been fully vaccinated. Now, 5 weeks after reopening commenced, the Singapore government announced the need for increased restrictions. It *did not* lie down and scream "Freeeedom" /2
No, the Singapore government has (rightly) taken steps to protect it's population from Covid-19. The large majority of new cases (98%) have been mild or asymptomatic. This is thought due to the high vaccination rates. /3
Of 254 cases of severe illness in the past 2 weeks, 48% were unvaccinated. The S'pore MOH calculates vaccine efficacy against severe illness to continue to be high - 80-90%. The susceptible vaccinated are elderly and those with co-morbidities. /4
So, 10 days ago, they started to roll out a booster programme for people aged 60y and above, and residents of aged care facilities. According to S'pore MOH, within 1 week, 91,500 seniors had received booster doses. Boosters are also recommended to extend to those 50-59y. /5
To care for the large numbers of people with mild illness who were presenting to hospital, the government is establishing community treatment centres, which help monitor the progress of infected people with comorbidities. These centres will liaise with hospitals /6
School learning continues from home, social gatherings are slashed to 2 people max, masks are in place, and work from home is the default. BUT for those who are unable to work from home, self-test rapid antigen testing is recommended *weekly*. /7
Sporting, religious, and entertainment events can go ahead to a limit of 1000 fully vaccinated people, but if unvaccinated people are admitted, that maximum number falls to 50. The government is increasing financial supports to hard hit sectors. /8
About 1 month ago, *all* households in Singapore were mailed a pack of Covid-19 rapid test kits for free. People are now encouraged to use these before heading out or visiting. These I understand are also widely available for purchase. /9 straitstimes.com/singapore/heal…
From the 1st October, the S'pore MOH website will host a live time map of areas where there have been large numbers of confirmed Covid-19 cases. Citizens are asked to watch these hotspots, and self-test for 10 days after exposure. /10
It's important to recognise that S'pore has huge hospital capacity compared to NZ. Hospital care is used much more frequently for Covid-19. There are currently 1092 cases in hospital, of which 162 require O2, and 23 are critical /11 moh.gov.sg/news-highlight…
So we need to watch the hospitalisation numbers *for those requiring O2/ventilation/severe illness* over the coming weeks, as this gives us a good indication of how well their strategy is tracking, not cases alone, majority of which are now v mild. /12
Importantly, S'pore has excellent healthcare for a nation of it's size, with >2 x the ICU/critical care beds per 100,000 compared to NZ (11.4 S'pore vs 4.6 NZ) researchgate.net/publication/33… /13
Singapore's ICU capacity is more like that of Switzerland or England, while NZ's ICU capacity is at the bottom of the OECD. oecd.org/coronavirus/en… Improving NZ's capacity cannot be fixed overnight, or even in months, it requires sustained $ investment over successive govs /14
In summary, S'pore continues to be a rich source of novel Covid-19 mitigation strategies which NZ can learn from. As they navigate their re-opening with high vax rates, we can learn from their response, because their government HASN'T GIVEN UP PROTECTING THE PEOPLE'S HEALTH /15
Some are uncomfortable to learn and imitate S'pore. It is too 'authoritarian" they say. This was certainly the case under Lee Kuan Yew. But high public compliance isn't the only factor in play. /16
S'pore is wealthy, draws highly educated workers, has excellent science & technology. The government response has been proactive, transparent, intelligent, and coherent. An educated citizenry is more likely to comply when they see the value of public health measures. /17
NZ has shown itself to be able to mount a hugely effective collective response when provided good information and leadership. So we may be able to achieve the same levels of collective action, if we understand why it's important /18
Finally, before anyone asks, I am not advocating for us to blindly follow S'pore out of elimination, but rather to learn from their response. We need to find a strategy that fits our unique demographic profile, existing inequities, healthcare capacity /19
But continuing to learn from a government with an excellent track record against SARS and now COVID-19, that HAS NOT GIVEN UP and is still moving to protect it's people from Covid-19 using novel strategies is definitely one to watch. /20
The reference for much of the thread above on S'pore Covid-19 responsiveness is: moh.gov.sg/news-highlight… /end
Addendum: I think it hardly needs to be said but NZ should be looking to achieve VERY HIGH >>90% vaccinated proportion before it attempts to move out of elimination in this way. If broadly ~10% of S’pore popn is not eligible (<12y), that means they have ~93% eligible vaccinated.

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More from @DrJinRussell

14 Sep
Look I appreciate the need to get overseas experts commenting on the NZ response on telly but (a) none are experts on NZ hospital capacity or population health inequities, (b) continuing elimination while we achieve high vax rates does NOT mean we aren’t thinking about the future
I mean, here’s an actual verified Johns Hopkins expert @AmeshAA whom I do respect but who comes across as ridiculous at points simply because he doesn’t understand our extremely limited hospital capacity, need for equity, or long term planning. tvnz.co.nz/one-news/new-z…
If I were starting off a TV interview and speaking to a country that has done remarkably well with few resources and stretched healthcare, I would do the decent thing and say “Bravo NZ! Great you’re moving on vaccines now! Here’s some extra things to consider…”. Y’know. Tone.
Read 7 tweets
13 Sep
Kia Ora to the overseas folk. For those curious, NZ’s alert level 4 has managed to successfully reduce the R value of the delta outbreak from 6 to consistently <1. In 28 days we have stopped 955 chains of transmission. The lockdown has already lifted everywhere, except Auckland/1
Auckland remains in Level 4, where a handful of “mystery” cases mean we will stay the course. We have prevented hospital overwhelm, which modelling predicted would have occurred by now, had we not effected such a successful lockdown. So far we have had zero deaths from delta /2
We are vaccinating very fast. Some days this outbreak we have vaccinated 1.5% of the population in a single day. Thanks to new shipments of vaccines from overseas, we can keep up the pace. 68% of 12y+ population have had at least 1 dose, 35% fully vaccinated and forecasts high /3
Read 10 tweets
12 Sep
Delta is airborne, schools have been impacted in this current cluster. This morning I spoke with ⁦@SusieFergusonNZ on⁩ ⁦@radionz⁩ about the need to lift our game on ventilation in schools to make an end to damp, poorly ventilated classrooms /1 rnz.co.nz/national/progr…
2013 NZ study (Wang et al) has shown that often, levels of carbon dioxide in 3 of 6 NZ classrooms exceeded recommended levels (1000 ppm) for 50% of the school day. C02 levels here are a proxy for ventilation. As C02 levels rise, students may also feel headaches, sleepy /2
Not every child can mask, and emerging evidence suggests that improving ventilation maybe as effective as masking. So in looking to the future, and wanting to prevent covid closing schools, this needs to be a priority for investment. Our piece: blogs.otago.ac.nz/pubhealthexper…
Read 4 tweets
31 Aug
Another thread for the overseas people who are fascinated by New Zealand’s response to Covid-19, Kia ora. It is Day 14, and there already positive signs that we are flattening delta. Level 4 is indeed effective, new daily cases are suppressed. /1

(Graph by @TheSpinoffTV)
Genome sequencing has shown that we are dealing with a single outbreak of delta, which has been traced to an arrival from NSW in MIQ who tested positive 8 days before the first community case was detected. We know exactly when the outbreak started, it’s a short timeframe /2
After two weeks of national Level 4, wastewater testing showed that the virus was present in the community in Auckland and Wellington. Wellington’s cases are ring-fenced, so the government is already easing lockdown restrictions in all areas except for Auckland from tonight /3
Read 16 tweets
30 Aug
Me, an asian female medical specialist, listening to Mike Hosking’s mocking treatment of fellow doc Dr Ayesha Verrall today on radio. Training an infectious diseases physician takes 13+ years, & not all have the public health and medical leadership expertise Dr Verrall does.
Personally I’m bloody grateful we have her in cabinet
You don’t have to agree with all of governments decisions, but don’t use the airtime to mock the actual experts in the room - for - get this, *pausing before speaking* (her I bang my head against the wall). We have so few of them as it is and she is super competent at her job.
Read 4 tweets
23 Aug
To the overseas folks who find watching New Zealand’s Covid-19 response encouraging, Kia Ora. It’s Day 7 of lockdown. In the past 1 week, genomic sequencing has traced the outbreak to single person who went thru MIQ on 7th August.

We have stopped 107 chains of transmission /1
Our amazing contact tracers have contacted 13,000 possible contacts. Mass testing continues. In Auckland, the heart of the outbreak, over 10% of the region’s population (representative sample of households) have been tested in the past 1 week. /2
The short timeframe: 10 days only, between 7th and 17th August when the lockdown was announced means that we caught the outbreak relatively early. The Devonport man who got himself tested (sentinel case) when he became symptomatic is publicly praised for his actions /3
Read 9 tweets

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