奥密克戎肆虐，但这个小国准备放弃管控

Last August, Singapore became the first country in the world to pivot from a zero-tolerance approach to COVID-19 to a strategy of living with the virus. “Living,” however, meant existing in a state of extreme watchfulness.

The government introduced quarantine-free travel for the first time in 18 months, but the scheme began with only two countries, expanded to just 24 by December, and didn’t apply to every flight from those destinations. Meanwhile, some domestic restrictions remained in place. Singaporeans still had to wear masks indoors and out, were required to use contact-tracing technology wherever they went, and could not meet in groups larger than five. The government may have relaxed its policy of stamping out COVID, but its foot still loomed over everyday life.

Now Singapore is facing the prospect of losing control of COVID. The country detected its first cases of the Omicron variant in early December, and since then the numbers have been rising fast. As of January 17, Singapore was reporting 1,000 new cases a day, but earlier this month, the Ministry of Health predicted that figure would climb to between 10,000 and 20,000 by February. Others think the number may go higher.

"When we look at Australia, it's off the charts, and I don't see why it would be different here," says Alex Cook, an associate professor at Singapore's Saw Swee Hock School of Public Health, who models the spread of the virus. Both countries have vaccinated over 90% of adults, and around 40% have had a booster. Australia’s rate of infection “would translate to about 30,000 cases a day in Singapore,” Cook says.

Compared to many other countries, those numbers are paltry, but for Singapore they're vast. Between August 2020 and August 2021, average daily infections barely topped 30, and most of those were among residents returning from overseas who quarantined upon arrival. The height of Singapore’s Delta wave in October and November last year was 10 times lower than the predicted peak of Omicron, and even that surge led the government to tighten restrictions. (It limited group size to two, down from five, for example.)

So how will the country react to Omicron's unstoppable spread? After the variant emerged in late November, the government seemed to follow its usual pandemic playbook: It slammed on the brakes, suspending the vaccinated travel lanes, sending anyone who tested positive to a government facility by ambulance, and isolating all their close contacts. Singapore, which had announced its determination to live with the virus, seemed to be heading back to the dark days of 2020.

But since that initial reaction, authorities have become surprisingly relaxed. There are two main reasons for the shift. First, the world has learned that Omicron is more infectious but less virulent than previous strains, and far less likely to lead to hospitalization and death. Singapore's Ministry of Health is confident that even if the wave rises as expected, the health care system, and, in particular, intensive care capacity can tolerate the demand.

Second, as the inevitable scale of infection became obvious, the government realized it had no hope of accommodating positive cases in state-run facilities. Its approach has transitioned from government control to self-control. If you test positive, you are no longer required to quarantine for 14 days, as before. Now you can stay at home for three days, and then return to normal as soon as you test negative with a self-administered rapid antigen test. Close contacts of positive cases can forgo quarantine altogether provided they test negative each day for a week. In Singapore, unlike in the U.S., rapid tests are widely available and can be delivered within 30 minutes by Grab, a ride-hailing and food-delivery app.

The reliance on self-testing will mean more cases slip through the net, but the authorities have accepted this reality. “Omicron has changed the minds of policymakers,” says Hsu Li Yang, vice dean of global health at the Saw Swee Hock School. “They see that it's almost impossible to stop it from spreading in the community. The current thinking is that everyone will get infected eventually."

The public appears to be loosening up along with officials. Vaccination, which more than two-thirds of Singaporeans thought should be mandatory, has made them less fearful of the disease. A recent survey by the Institute of Policy Studies (IPS), a local think tank, shows 60% support for the recent changes to quarantine and testing, which have been heavily promoted in full-page newspaper adverts and on public radio.

Two lingering unknowns remain, however. For one, there’s no guarantee predictions of Omicron’s spread will be accurate. Its trajectory in Singapore "can only partially be assessed by watching how it affects other countries," Cook says. Whether or not Omicron disrupts the health care system is another uncertainty. As countries like the U.K. have learned the hard way, even if hospital admissions are manageable, Omicron-related absences among hospital staff can create gaps in care. In a world of widespread infection, contact-tracing apps and limits on group sizes may seem redundant. But the government will keep them in place for now, hoping its restrictions will mitigate these risks in the short term.

But in the longer term, the Omicron wave may carry Singapore back to the shores of normality. According to Cook, once local transmission really takes off, imported cases make a negligible difference to the numbers. In that situation, he says, "I don't see a reason to continue to restrict international travel."

As for domestic restrictions, if Omicron leads to widespread infection and increased immunity, the case for keeping them in place weakens. "I would anticipate that once the threat of Omicron has abated, either because the wave has peaked or the local data give us confidence the health care system won't be overwhelmed, domestic restrictions will be pared back," Cook says. "That would give a welcome respite from the last two years."