New stricter measures may not have a major impact but will “buy time”: Prof Paul Tambyah

Infectious diseases expert Professor Paul Tambyah says that while the measures may not have a “major impact” on the situation, it does “buy time”.

In a live interview with TOC Editor in Chief Terry Xu on Saturday, 15 May, the Senior Consultant in the National University of Hospital’s Infectious Diseases Division in the Department of Medicine touched on a wide variety of issues pertaining to the COVID-19 pandemic from the effectiveness of various policies in measures implemented in Singapore as well as the vaccines.

When asked about his views on the recent enhanced measures implemented in Singapore following an increase in unlinked community cases, Prof Tambyah explained: “I think this is what happened last year with the circuit breaker, you know, that the (Health) Minister at the time (Gan Kim Yong) pointed out that the point of a circuit breaker is to allow you to have some time to try and fix the situation.

“So there are multiple active clusters. Some of the source patients for the clusters, we don’t know where they came from, in particular the Tan Tock Seng (Hospital) cluster, which is the largest cluster before the Changi Airport cluster,” he said, adding that further investigation is needed to pinpoint the exact index patients in both clusters.

He added that shutting things down or coming close to that via the circuit breaker measure last year will “naturally slow down cross-infection”.

“So you know, when you stay at home, you’re not going to spread your infection to another home,” he said.

However, the circuit breaker may pose challenges or risks to people living in high-density spaces.

Prof Tambyah said, “Unfortunately, if you’re infected, you’re going to spread it to everybody at home … If your home has got two people or four people, it’s not a big deal, but if you got a hundred people living in one block or one floor, or 25 people living in one room … a very large proportion of them are going to get infected.”

“We’ve learned a lesson about locking large numbers of people into their own home, and hopefully, you know, we won’t have the same problem this year.”

Speaking on the TTSH cluster, Prof Tambyah noted that it was “premature and unfair” to present the nurse as patient zero, since at least one or two patients were infected before she was. One of these patients, he pointed out, had even developed symptoms at least a week before she did.

“So it’s most likely that the nurse got infected from one of the patients,” said Prof Tambyah.

He added, “Somebody at the beginning of the outbreak, maybe in the third or fourth week of April, who was shedding large amounts of virus and caused a number of the patients to be infected and a small number of the staff.”

He added that it is a concern that we don’t know how the patient could have gotten infected as they could have a child “who is flight attendant with some airline and then this person has gone off to seed a cluster somewhere else.”

“So I think that’s one of the key challenges that need to be addressed during the Phase Two restrictions,” added Prof Tambyah.

As to what he might have done differently if he were indeed been appointed into the Multi Ministry Task Force, Prof Tambyah said that moving forward, he would “critically evaluate” the measures implemented about a week or two after it begins to see how effective they are.

He also stressed that he would make the data widely available to members of the public and the wider scientific community.

On top of that, Prof Tambyah said that he would “be frank with Singaporeans” on what the government’s approach is, be it a zero-COVID or living-with-COVID strategy, and what that would cost.

Prof Tambyah went on to note that the government is already trying to accelerate the vaccination programme but that there are constraints with supply.

On this note, he said he thinks that if the World Trade Organisation does in fact suspend the patent for the vaccine in India and Africa, it would enable them to manufacture enough vaccines for the world as they have that capacity.

He stressed that if the WTO could be persuaded to do that, “the epidemic could be brought under control.”

When asked when he thinks Singapore would be able to go back to normal, Prof Tambyah candidly noted that his “not very optimistic” prediction would be next year, though it could be sooner if the WTO suspends the vaccine patent.

While there is a chance that the vaccines could help bring the pandemic under control, this is difficult given how slow the vaccine rollout is in many bigger countries like India and China, and many parts of eastern Europe.

Prof Tambyah explained that no one is safe until everybody is safe and that this is “explicitly true about Singapore” given the country’s openness.

“Even now with the ban on travellers, we still had to make exceptions for construction, marine, processes and domestic workers because we are just so dependent on them, so there’s always of risk of leakage coming out unless we can succeed in providing vaccines for all the origin countries,” he added.