Singapore : a exemplar of suppression of community transmission protecting the populations Right to Health.

Stopping the Spread is Spreading the Love. 


Finally, a Welsh (British) political leader tells it like it is, in clear everyday language.

A government that refuses to protect the populations right to health is a murderous government.

There are lots of things wrong with many Governments, and many mistakes have been made. The worst deliberately bad policy choices have been made by USUK, Brazil and some EU States, because they make the same choices, repeatedly, in spite of the evidence of the harms they are causing. This means they are not 'mistakes', they are deliberate, intentional policy choices. And thus the population are forced to bear the costs. Who profits from all of this? Who is gaining?

Singapore chose to avoid making the mistake it made first time around. Their treatment of migrant workers was harsh, and they corrected that error

This piece that follows is adapted from a Tweet by Dr. Dan Goyal.

https://twitter.com/danielgoyal/status/1479078027141259265

Singapore - population 5,918,960, total cases 283,214, total deaths 835


President Halimah of Singapore
Population is 5,453,5600
GDP per Capita c. $59k

Singapore is similar in population and GDP to Ireland. Singapore is just one example of best practice in handling the Pandemic. There are many others countries following similar principles and practice, including China, which when put together covers a global population of  2.4 billion people.

USUK is not in this group.  Why is this the case after two years of this pandemic?

Singapore's COVID-19 response: 

"In April 2020, in light of the COVID-19 pandemic in Singapore, President Halimah approved her in-principle for the government's request to draw S$21 billion from the past national reserves, aimed at subsidising wages of 1.9 million workers and preserving jobs and businesses.[66] 

On 7 April 2020, the Supplementary Supply Bill was revised for the Resilience and Solidarity Budgets and the revised bill was asserted by President Halimah on 9 April 2020.[67] 

On 5 June 2020, the Parliament of Singapore passed the Second Supplementary Supply Bill for the Fortitude Budget, to allow for the government to draw an additional of S$31 billion from the reserves, aimed at securing employment for those who lost their jobs due to the pandemic as the country loosens restrictions after the circuit breaker.[68] 

On 16 June 2020, President Halimah assented to the Second Supplementary Supply Bill, which enacted the Second Supplementary Supply Act, to allow the government the additional requested funds to ease the effects of the pandemic.


This marks the second time that the past reserves of Singapore were drawn in the financial year of 2020 and it was also the largest amount drawn from the reserves since Singapore's independence, with the funds totalling S$52 billion. She was the 2nd president to exercise the President's discretionary powers for this purpose, after President S. R. Nathan in 2009 for the financial crisis of 2007–2008."


From the very start, Singapore's Government took the view that they would seek to suppress the virus in hospitality, recreation, and work environments to permit schools, hospitals and other essential services to continue.

In other words they recognised that protecting the populations Right to Health demanded that they develop and maintain suppression of community transmission in order to protect all the services and utilities that support the population, including their Health Services. In order to avoid overloading their Health Services, they knew they had to suppress community transmission. 

They focused on suppression of transmission in the community with the following strategies.

- Masks (promoting PPF2 masks, making them available for free)

- Ventilation (HEPA Filters and other air movement measures to reduce viral loading)

- Testing and Tracing - to see where the virus, and suppress it (not merely as a generic diagnostic tool for individuals to use)

- Supported isolation. (Financial support and superb medical advice, with rapid access to more intense treatment at medical centres)

Singapore has a highly vaccinated population, an excellent Covid Clinical Care Pathway, and a functioning Contact and Isolation service. 

Singapore's Government and population, working together, have diminished the threat posed by Covid. 

Take a look at their approach to schools.

https://www.orfonline.org/expert-speak/singapores-school-management-policy-during-covid-19/

"Singapore’s predominantly state-based school system and agile policymaking ensure minimal impact of the pandemic on its children.

In an ideal year, students in Singapore attend school for 200 days. However, in 2020, Singapore’s primary and secondary school students physically attended 150 days (approx.) of school. The rest of the days of schooling were completed through home-based or blended-learning model. This article takes a look at the challenges faced by students during the COVID-19 pandemic and the policies adopted by the Singapore government to alleviate them.

Since the beginning of the pandemic, the Singapore government took an incremental and adaptive approach to school management. It implemented staggered breaks in school and suspended large whole school assemblies as early as 4 February 2020. This was followed by suspension of inter-school activities and reduction in tutorial class sizes. The government also imposed additional precautionary measures such as cleaning of school premises and limiting the number of visitors to create a safe physical learning environment."

Mask wearing is mandated for all age groups. Because it works. By operating an suppression of community transmission across all areas of life, Singapore has maintained high levels of safety for their children - their schools are safer than those in the UK. Such measures allowed Singapore to have  face-to-face classes for students without creating a burden of community transmission.

Compare and contrast that to the experience of English school children, who were deployed as immunity boosters by the JVCI, according to their minutes, and the actual practice. It failed. Miserably. We have seen multiple waves driven by school based infections, and we are about to start yet another one. It is quite clear now that allowing school children to become infected does not provide the immunity boost the JVCI and the Government assumed. The English Government policy is a dead unicorn. Even still the Johnson Government, and Parliament, is riding that badly flogged horse. No ifs, no buts.

IndependentSAGE, a team of highly qualified experts and professionals in epidemiology, virology, public health, behavioural science and other related areas have consistently urged the English Government to take the necessary measures to protect schools.

https://www.independentsage.org/category/education/ - their latest report on making schools safe in January 2022 is now available.

Here's a series of articles looking at the lived experience of school children during the ongoing pandemic.

https://www.orfonline.org/series/children-and-the-pandemic-an-analysis-across-countries/

Covid Resilience stands on suppression of community transmission.

The Singaporean Government and population are now looking to "Covid Resilience Phase", that is to say maintaining lowest possible levels of community transmission, remaining vigilant in order to keep the economy open and safe. They fundamentally understand that a health economy rests upon a healthy population. 

This stands in stark contrast to the position of USUK.

1. Singapore's response remains dynamic, shifting protective measures depending on level of cases

2. They have limited work environments to max of 50%, sometimes only vaccinated, and all require LAT flows to enter work environment. Employers have guidance on ventilation.

https://www.moh.gov.sg/covid-19-phase-advisory

3. Schools intermittently move to online learning, again if case numbers are high. 

4. They are also moving further towards community management of low risk cases by providing financial and practical support to GPs to facilitate at the local level.

5. Shortened isolation period under certain conditions


There is very clear public messaging and instructions on how to self-isolate at home, regular support and clear criteria for escalation: prolonged fever, shortness of breath, chest discomfort..

The object of the exercise is to suppress community transmission and to achieve that the people affected must feel they are fully supported, they must trust the Government and the services. 

This short video outlines their 'buddy' system of getting the best information out to the population.


Home Recovery Buddy

Summary

Singapore have enjoyed more freedom than many countries, better economic recovery, and MOST importantly, they have saved thousands of lives through a combination of public health interventions and good clinical care.

Singapore now face the more transmissible Omicron variant with...

- a good level of vaccine derived immunity,

- a highly efficient well resource working Contact and Trace service at all levels

- evidence based criteria for relaxation/escalation of protections

- clear home treatment pathways

- significant increase to healthcare capacity

China, Taiwan, New Zealand, Iceland, Finland, Denmark and a good number of other countries have prevented the levels of harm that the USUK has not avoided.

Community Transmission is the key - if we can reduce it to bare minimums, (and we can) and then keep it there, then we will move towards the end of the Pandemic.

England's open borders policy allowed the seeding of the original virus (from Northern Italy, Austria and Spain) into the UK, then Alpha, first discovered in Kent, and allowed to spread, was exported to India, where it evolved into Delta, and it was re-imported into the UK (and spread across the globe) with disastrous consequences.

The airline lobby are powerful. The WHO does not have any authority to close borders or even advise - that responsibility rests entirely with each countries Government.

What can we learn?

1. Diminish the threat posed by the virus

- good clinical care pathways

- support primary care

2. Dynamic response to keep essential services open

- prioritise schools, healthcare, etc...

3. Maintain good public health controls

4. Clarity of information, in a timely fashion prepares the population for engagement with the protocols to suppress community transmission, and prevent lockdowns.

5. Success in suppressing community transmission builds trust between Government and population.

6. Tight quarantine on all borders to prevent accidental importation of the virus, or any of it's variants.

7. Transition to "Living with it" in Singaporean terms means they all know that have to work effectively and efficiently to protect the population from community transmission - a soon as transmission goes beyond surveillance, it is likely to become uncontrolled. 

This is in contrast to USUK 'Living with it' where there are no effective efforts to suppress community transmission - efforts are aimed a merely ensuring Health Systems to not collapse, and this is political choice, because any Government that allows a Health Service to crumble will lose all popular support, rapidly, and even within it's own ranks that support will wane accordingly.

USUK 'living with it' entails a constant state of attrition rather than suppressing community transmission, and this state of attrition will lead to surges that can only be stopped by lockdowns.

Therefore testing is best used to find where the virus is (and is not) in order to focus efforts on limiting spread. 

The population deserve efficient financial and logistical support to achieve this.

That is our right, under various international treaties. Governments are bound by Law to protect the populations right to health.

https://www.hhrjournal.org/2020/11/the-right-to-health-in-times-of-pandemic-what-can-we-learn-from-the-uks-response-to-the-covid-19-outbreak/

The People's Covid Inquiry, led by Michael Mansfield, QC have issued a detailed report proving beyong any doubt that the Johnson Government (and others) have undermined the English populations Right to Health.

https://www.peoplescovidinquiry.com

As they say, 'Houston, we have a problem.' Well, in the UK, we the population have a problem and it is sitting in the Houses of Parliament and on the editorial boards of billionaire owned news media, walking hand in hand in avoiding the obvious - suppression of community strategy is the only viable short, medium and long term strategy.

With all of the above in mind, I suggest my readers view the first briefing of 2022, by IndependentSAGE, from 7th January.


It is quite clear what needs to be done, and it is quite clear that the UK Government is deliberately failing to take the correct action to protect and uphold the populations Right to Health. Parliament is enfeebled at a time of continuous crisis.

When the videos of anti-vaxxers, anti-maskers and various critics of Government COVID strategy that reject suppression of community transmission and call for 'opening up' and 'protect our freedoms' such as CRG and HAART and others gain millions of views, and Independent SAGE's videos have less than 50,000 views, one has to wonder what is going on here?

We know what to do, but what can we do?

This situation is FUBAR!

Kindest regards


Corneilius

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