It’s September 25th, 2021. Two days before Singapore’s COVID-19 measures are due to tighten again – among other things, the group size limit for social gatherings and dining-in is to be reduced from five to two.

Singapore, which has so far managed to avoid mass deaths due to the virus and has one of the world’s highest vaccination rates, faces a rapid rise in case numbers and has decided to turn back the clock. The measures are due to last for almost a month until October 24th, with a review by the Ministry of Health (MOH) after two weeks.

There’s a palpable sense of frustration across social media following the announcement, made just the evening before. Popular local YouTuber YEOLO expresses this sentiment with a meme playing on the lyrics of this year’s National Day song.

/r/singapore, Singapore’s main subreddit, explodes in a flurry of posts from locals – as is our national pastime, the people of Singapore complain. Some of the top posts for the day are entitled “I just feel so frustrated right now”, “This incompetence is truly astounding.” and “This is depressing.”

An expat, expressing his desire to leave, quips:

I have not yet decided, but when the UK looks more appealing, I think something is wrong.

I’m no expert, but I do think we could do better at avoiding this sort of thing in the future – and I think one way is to make reporting that you might have COVID-19 less painful for individuals and those around them.

Hidden reservoirs and “dark cases”

When Singapore first entered its “circuit breaker” in 2020, there were serious concerns about a “hidden reservoir” of cases in the community.

Such hidden reservoirs were then attributed to asymptomatic and pre-symptomatic spread. They were suspected to contribute to the number of cases that were otherwise unlinked despite intensive contact tracing measures – as last announced by the MOH on 7th September 2021, this number stood at 185.

Since then, in its move towards an endemic state of living with the virus, Singapore has stopped counting the number of unlinked cases. This is a move backed by credible medical experts for several reasons – including that vaccinated individuals who don’t experience symptoms can still spread the virus, making it harder and less impactful to trace and link cases.

While the number of unlinked cases is no longer of concern, however, the existence of “hidden reservoirs” may hint at another, linked issue.

When a person is suspected to have COVID-19, the current procedure as of 25th September 2021 is to place them under quarantine (archived link) – either at home or in a quarantine facility. Household members and close contacts of a confirmed case are also required to self-isolate and are not allowed to leave their homes.

Taken together, Singapore’s quarantine and isolation measures, while part and parcel of sensible COVID-19 management, inevitably disrupt the ability to work for COVID-19 cases and their household members.

This, of course, sucks.

For example, while those under quarantine can use paid hospitalisation leave to offset their period of quarantine, this doesn’t account for people who aren’t entitled to sick leave such as casual employees, self-employed individuals, or employees covered by the Employment Act who haven’t served their employers for at least 3 months.

The disruption to work itself also poses a challenge – even where leave is available, enforced absences due to quarantine or self-isolation can potentially cause work to pile-up and managers to cast sideways looks at employees.

This is only made worse by the fact that many people in Singapore live in multi-income households. This includes more than half of married couples, as well as single working adults who live with their working parents and/or siblings. A disruption that starts with one household member can affect multiple careers and sources of income.

Beyond the individual reluctance to risk one’s career, then, is a recognition of risk to the careers and incomes of other household members. The result, it seems, may be a reluctance to risk getting tested or reporting sick – a problem whose beginnings were already noted by some in the government, unions, and businesses back in March.

There may well be, as a result, “dark cases” who go unreported and undetected by contact tracing, at least until they contribute to transmission – in the workplace, or anywhere else that people gather.

Slowing the spread

As it stands, there are already some welcome measures in place to mitigate the impact of measures to slow the spread of the virus and reduce the burden on Singapore’s healthcare system.

For example, self-employed Singaporeans and permanent residents (PRs) on quarantine orders, as well as employers whose employees are under quarantine, can currently apply for claims of $100 per day in quarantine.

However, Singapore could do more to counteract the impact of disruptions to work for COVID-19 positive individuals and those around them, reducing “dark cases” and further curtailing the spread.

For example, close contacts of a COVID-19 case, who are issued Health Risk Warnings, are required to self-isolate but not entitled to compensation for time lost at work. Extending compensation to anyone required to self-isolate, including those under Health Risk Warnings, would be a good first step.

As an alternative, Singapore could treat quarantine and self-isolation like National Service obligations for our NSMen – as mandatory time off work necessary for Singapore’s continued prosperity and security, at full pay and without consuming medical leave. This would need to exclude travel-based SHNs for non-work reasons, of course.

Another suggestion, targeting the indirect consequences of COVID-19 related disruptions to work, is to protect employees from workplace discrimination as a consequence of quarantine or self-isolation. This puts us in good stead not only to keep living with the virus, as cases will inevitably rise, but to create a culture of confidence and security during future outbreaks. 

On this note, there are welcome plans to enshrine in the law protections from workplace dscrimination along a number of protected characteristics, including disability. Using this as an opportunity to include rules against unfair penalisation (not just dismissal) for medical absences, including quarantine and self-isolation, may help encourage people to report, get tested, and avoid becoming “dark cases”.

The road ahead

I’m all for us continuing on to an endemic state, especially given our very high rate of vaccination compared to other countries that have already reopened. I think this continued oscillation between periods of tightened and loosened containment measures helps nobody.

However, I do think that slowing the spread of COVID-19 will be necessary, if not now, then in the future. While we can debate means and thresholds, it needs to be done, and it needs to be done sustainably.

Making it easier and less painful for people to report that they might have COVID-19 might well be part of the answer.