Germany and Singapore have moved away from tying pandemic restrictions to COVID-19 case counts, a change reflecting the progress of vaccination campaigns.
With high rates of vaccination, the rate of COVID-19 infections may reflect primarily the breakthrough infections of vaccinated people who are not likely to get seriously ill and thus overwhelm hospitals and other healthcare resources.
“Because the at-risk groups are vaccinated, a high incidence doesn’t automatically mean an equally high burden on intensive care beds,” German Health Minister Jens Spahn said in July as the country was considering the change. “The incidence is increasingly losing significance. We now need more detailed information on the situation in clinics.”
The change also reflects new thinking, as some officials consider moving away from policies with the aim of “zero transmission” of the coronavirus to ones of managing outbreaks so that life can get back to something approaching normal.
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In late June, Singapore’s COVID-19 task force outlined a new plan that moves away from the heavily restrictive approach the nation had been following since the beginning of the pandemic.
In an op-ed outlining the new plan, three members of the task force, Trade Minister Gan Kim Yong, Finance Minister Lawrence Wong, and Health Minister Ong Ye Kung, wrote, “The bad news is that Covid-19 may never go away. The good news is that it is possible to live normally with it in our midst.”
The Biden administration, too, has endorsed similar thinking.
“It is really important that we convey that success does not equal no cases,” Surgeon General Vivek Murthy recently said. “Success looks like very few people in the hospital and very few dying.”
Before late August, Germany determined which restrictions to impose based on the number of COVID-19 cases per 100,000 people. For example, at 35 cases per 100,000 people, public gatherings were limited to 25 people and private gatherings to 15. At 50 cases per 100,000, private gatherings were limited to 10 people and restaurants were forced to close at 11 p.m.
In August, German Chancellor Angela Merkel announced that Germany would no longer be using the incidence rate and instead would focus on hospitalizations as a metric to determine when the healthcare system was overburdened.
Merkel has not yet announced what the new hospitalization metric will look like. She is in talks with health ministers in Germany’s 16 states over how to define the new metric.
About 61% of Germany’s population is fully vaccinated.
In Singapore, over 80% is fully vaccinated.
Until recently, Singapore had placed heavy restrictions on its population of 5.7 million to combat the virus, including imposing strict limits on social gatherings, quarantining immigrant workers, and barring most foreign nationals from traveling to the island country. The restrictions got results, as only 55 people in Singapore have succumbed to COVID-19.
But the restriction on travel has taken a heavy economic toll. Air transit to and from Singapore adds $36 billion to the economy. During much of the pandemic, the airport has operated at 3% capacity.
With Singapore’s high vaccination rate, Yong, Wong, and Kung argued that Singapore could “turn the pandemic into something much less threatening, like influenza, hand, foot and mouth disease, or chickenpox, and get on with our lives.”
Instead of monitoring the total number of COVID-19 cases in the future, Singapore will monitor how many people fall seriously ill and are in intensive care units to gauge the severity of the pandemic.
In August, Singapore began loosening some of its restrictions, allowing people to dine indoors in restaurants and increasing the number of people able to gather in groups from two to five. It also permitted some travelers from Germany, Hong Kong, Brunei, and Macao to enter the country without having to quarantine.
However, Singapore’s new policy is in jeopardy because new COVID-19 cases doubled to 1,200 in the last week.
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“If despite our best efforts, we find that the number of serious cases needing oxygen in ICU care goes up sharply, then we may have no case but to tighten our overall posture, so we should not rule that out,” Wong said.
