Commentary: Why Singapore’s travel restrictions will keep changing for a while more

Commentary: Why Singapore’s travel restrictions will keep changing for a while more

From the on-off Singapore-Hong Kong travel bubble to the simultaneous tightening and loosening of rules depending on travel history, this responsiveness is a boon to be preserved, says NUS Saw Swee Hock School of Public Health’s Dr Alex Cook.

People in masks at Changi Airport 15
Changi Airport staff members wearing personal protective equipment assist travellers at the check-in counters. (File photo: Calvin Oh)

SINGAPORE: Last week’s announcement that Singapore was stopping travel from India the next day was another display of a pattern shown throughout the pandemic.

It was another example of Singapore rapidly implementing policy changes in response to the changing epidemiology of the pandemic, in particular, the surge in cases in India.

Early last year, Singapore was one of the first countries to screen for COVID-19 at the border, and later to ban entry to travellers from high-risk countries. Since then, border measures have continued to evolve.

Arguably, Singapore’s policy response and readiness to adapt policies as needed, is the major reason why the death rate is less than 1 per cent of that seen in most other industrialised countries.

That fact is gaining international recognition: A Bloomberg story on Monday (Apr 26) ranks Singapore as the best place to be, looking at its infection and death rates, and as the country ramps up vaccination.

READ: Commentary: Here’s why taking the vaccine is necessary even if it’s optional

RULES TIGHTENED AND RELAXED AT THE SAME TIME

Travel rules are a big part of this story. Singapore’s variegated border policy, which puts travellers from different countries into risk groups based on their current epidemiology and imposes different requirements for each, is a pragmatic approach to border control.

On the one hand, with India’s outbreak having spiralled out of control in recent weeks, the decision to close the border for the time being is a sensible one, despite the disruption it will cause.

In contrast, however, border policies were last week relaxed for travellers from the UK and South Africa — to bring them in line with travellers from most of the world — and from Hong Kong.

Travellers at Changi Airport (1)
People are seen at Changi Airport in Singapore on Mar 15, 2021. (Photo: AFP/Roslan Rahman)

This seems contradictory on the surface. But for the UK and South Africa, this was a reflection of the variants bearing their names now being found in many other countries, and the falling transmission rates in both countries meaning they no longer warranted additional measures.

Similarly, travellers from Hong Kong, whose winter outbreak has subsided, will now be able to serve a shorter period of quarantine — just seven days — than most overseas arrivals, and may do so at home rather than a hotel.

STAYING AT ZERO CASES ISN’T PRACTICAL

People have asked, why not close our borders to travellers entirely rather than expose Singaporeans to COVID-19 risks.

But this zero-tolerance approach, similar to that taken by New Zealand or Taiwan, requires an impervious border, laying aside the need for no leakage from quarantine into the community and strict response should any leakage occur.

Such a strategy would not be practical in Singapore, given its dependence on labour and goods from overseas and over the Causeway.

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Rather, Singapore’s approach is to reduce, but not eliminate, the risk. Each layer in the border fence, from pre-departure testing, to testing after arrival, and quarantine, filters out some additional infections from reaching the community.

This approach works because we have identified a combination of policies over the last year that have kept the reproduction rate of the virus within the community below the level at which epidemics grow.

This combination — the availability of testing in primary care, routine use of testing among high-risk groups, the mask wearing, social distancing, and use of TraceTogether and SafeEntry — has been shown to mop up any spill-over from the border.

Nasal swab worker dormitory Singapore
A healthcare worker dressed in personal protective equipment collects a nasal swab sample from a migrant worker for COVID-19 testing at a foreign workers' domitory in Singapore on Apr 27, 2020. (File photo: AFP/Roslan Rahman)

Over the last six months, there have been almost 3,000 imported cases, yet fewer than 100 community cases. This represents 100 chances to have sparked an epidemic, yet none led to a self-sustaining outbreak.

The virus’ failure to do so is not because of our good luck. It’s a reflection of a policy that works.

TAKING A RISK-BASED APPROACH

Allowing shorter quarantine for low-risk travellers, and longer quarantine for higher-risk ones, allows the economic gains from travel while keeping the risk of disease spread in check.

Take a city like Hong Kong, where the incidence is similar to that of Singapore, for example. An exchange of travellers — one planeload going each way — does not change the risk ledger for either place.

If you come into contact with a traveller from Hong Kong on the MRT, there isn’t any extra risk compared to a Singaporean in the same carriage, and vice versa on the MTR.

If anything, because travellers have to take COVID-19 tests, you are less likely to acquire infection from a travellers from a low-risk country than a general member of the population in Singapore.

(Listen to experts discuss what a post-pandemic travel world will look like on CNA's Heart of the Matter podcast:)

 

THE TROUBLE WITH TRAVEL BUBBLES

However, two opposing forces are at play on travel bubbles between countries of a similar risk.

One is the need to respond quickly to a worsening situation at the other side of the bubble, potentially requiring one side unilaterally to pop the bubble.

Examples include the Hong Kong–Singapore bubble, which was stymied by Hong Kong’s winter outbreak, and the Tasman Sea bubble, which was partially paused last week after a case in Perth was identified.

READ: Commentary: I never planned to visit Hong Kong anytime soon, but the air travel bubble might change that

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However, the second force is predictability. The popping of the Hong Kong–Singapore bubble, and earlier examples such as rushed quarantine imposition by the UK in the midst of the European summer holiday season, disrupted many people’s plans to reunite with family, meet friends, or go on a honeymoon.

The cessation of travel from India will undoubtedly have economic repercussions for Singapore.

The unpredictability of border changes, and the fear that many Singaporeans overseas had in March 2020 — of being left stranded far from home as borders closed — led to a rush back that, arguably, we were unprepared for.

Then, many brought SARS-CoV-2 infections with them, leading to local spread and the eventual need to launch the circuit breaker.

empty spaces - a look at singapore during covid-19 circuit breaker
Lau Pa Sat food centre at mid-day during the circuit breaker. (Photo: Jeremy Long)

For individuals and families, the unpredictability of travelling within a bubble, without knowing whether one side will pop it, is a substantial disincentive to planning a trip.

VACCINATIONS MAY CHANGE THE PICTURE

The ever-increasing roll out of vaccines, however, may change the picture favourably for the travel industry.

Vaccination acts like a further filter on top of the other border measures in place. A traveller from the US, for example, who has been vaccinated may have the same risk of spreading disease as an unvaccinated traveller from China and if so could potentially be subject to light-touch measures on arrival without exposing the community to excessive risk.

Infectious disease experts think the vaccinated passenger is less likely than the unvaccinated passenger to develop disease and pass the infection, though to what extent and how to deal with vaccinated passengers from countries with high infection rates are still under study.

READ: Commentary: Why many under 45 are hoping vaccination slots open in June

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But the flattening of the epidemic curve in Israel, where new cases have come down to fewer than 100 each day from a high of 10,000 after vaccinations started in December 2020, is cause for optimism.

Policy changes to make it easier to travel into Singapore if vaccinated would bring economic benefits and be in line with the pragmatic approach the government has taken to date.

At the same time, policies allowing vaccinated Singaporeans to return from overseas travel may also need to be tuned to the level of risk in their destination. Doing so is made harder by the ever-changing epidemic situation overseas.

Nevertheless, travel could be facilitated by establishing clear guidance on the criteria a destination must continue to meet for vaccinated Singaporean travellers there to have shortened or no quarantine on their return, similar to the explicit thresholds for locally-transmitted cases set in our bubble with Hong Kong.

Israel masks off Apr 18 COVID-19
Youths gather on a street in the Israeli coastal city of Tel Aviv on Apr 18, 2021, after authorities announced that face masks for COVID-19 prevention were no longer needed outside. (Photo: AFP/JACK GUEZ)

READ: Commentary: Hong Kong and Singapore air travel bubble could be a game-changer

Importantly, these criteria need to be clear to the public, who will want to have some confidence that a trip booked months in advance will not be cancelled at the last minute.

Authorities should also provide updates on how close destinations are to bursting the threshold on a daily basis, so families can make alternative plans.

Our responsive policies have shielded Singapore from the worst of the pandemic, while remaining pragmatic to economic and social needs.

Having clear criteria determining what borders will remain open and under what conditions for vaccinated Singaporeans will be an important step towards normalcy.

​​​​​​​Listen to aviation observers dissect the future facing national flag carriers after the pandemic and the role of Singapore Airlines on CNA's Heart of the Matter published in September 2020:

 

Alex R Cook in an associate professor who leads the Biostatistics and Modelling Domain and serves as the vice dean of research at the NUS Saw Swee Hock School of Public Health.

Source: CNA/sl

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