Cases
Throughout the COVID-19 pandemic, cases were traced to clusters that several cases had visited during a particular time period in the whole of Singapore. [38] [39] [40] [41] [42] [43] [44] [45] [46] In 2020, new cases are only at foreign worker dormitories and construction sites while Singapore had followed zero-COVID strategy. [47] [48] while local cases formed the bulk of new cases from April 2021, driven by SARS-CoV-2 Delta variant, and rose rapidly to 4-digit numbers. At the final recording dated 31 January 2023, there were 2,124,199 local cases and 92,911 imported cases. [49] [a] 22 February 2022 saw its highest daily count at 26,032 cases, with 24 February 2022 seeing its highest active case count at 73,540 cases; 20 October 2021, 16 November 2021 and 4 March 2022 saw its highest daily fatality count at 18 deaths. [7] The last recorded date of any patient in the ICU was 12 February 2023. [50] It was only on 14 August 2020 that there were no reported community cases for the first time since June, [51] while 1 October 2020 was the first time since April that the daily number of imported cases exceeded that of dormitory cases. [52] 13 October 2020 was the first time in over six months that no dormitory cases were reported, [53] with 15 June 2021 being the first time in over eleven months that no imported cases were reported. [54] At the end of September 2021, the number of confirmed cases in Singapore exceeded the number of confirmed cases in China, with the country also reaching the first grim milestone of 100,000 cases on 2 October 2021. The total number of community cases exceeded that of dormitory cases on 14 October 2021, and passed 100,000 cases on 27 October 2021. Singapore also broke its monthly death record in October 2021 with 312 deaths, breaking its previous monthly death record of 40 in September 2021. The total death count exceeded 1,000 on 27 February 2022, with the total case count crossing the 1-million mark on 19 March 2022. Singapore reported its first death of a patient under 12 years old on 27 June 2022. [55]
Internationally, the case fatality ratio (CFR) for COVID-19 has been much lower than SARS in 2003. [56] [57] The transmission of the SARS-CoV-2 virus powering the COVID-19 pandemic has been significantly greater, with a significant total death toll. [58] [56] However, Singapore's death rate has been one of the world's lowest, both in terms of CFR and per capita. [59] [60] This may be attributed to the fact that the bulk of the cases are restricted to the migrant workers living in dormitories away from the general population. [59] These migrant workers tend to be younger, [59] with an average age of 30 years and 2 months old when surveyed in 2015, and the healthcare system was never overwhelmed. [61] [62] The authorities also tested the entire dormitory population for COVID-19 infection, leading to many otherwise asymptomatic infections being picked up. [63] [64] Research by the European Commission suggests that the CFR for SARS-CoV-2 virus picks up in cases 50 years of age and above. [65] The elderly in the general population in Singapore have been advised to stay at home as much as possible, [59] while resident-facing staff in old folks homes are being housed on site or separately in hotels. [66]
Other factors contributing to Singapore's exceptionally low CFR include the country's use of extensive contact tracing and testing to identify cases, mandatory mask-wearing, and hospitalisation of all high-risk patients. Singapore has comparatively strict criteria for classifying COVID-19 deaths, counting patients who were infected with COVID but died of other causes as non-COVID deaths. [67] [68]
Prevalence studies on the population have shown that 4 in 1600 in the community, or about 0.25%, have previously been infected with COVID-19, while at least 47% of migrant workers living in dormitories have tested positive by PCR or serological tests. [69] [70]
Initial wave of COVID-19 (2020)
National authorities began reporting suspected cases on 4 January, [71] however the first confirmed case was reported on 23 January, a tourist from Wuhan. [72] Until 30 January, there were a total of 13 confirmed cases, all of whom were visitors to Singapore from China. [73] [74] The first case involving a Singaporean was confirmed on 31 January after returning from Wuhan. [75] Contact tracing procedures were put in place to identify close contacts of the confirmed cases who were placed under 14-day quarantines to ring-fence the potential spread of the virus. [76] [77]
These imported cases eventually lead to clusters of local transmissions being formed. The first local cluster was reported on 4 February at Yong Thai Hang, a Chinese health products shop. It was identified as the locus of the infection where four women without recent history of travel to China contracted the virus. [78] The shop was affected when a tour group from Guangxi, China visited it along with other locations such as the Diamond Industries Jewellery Company at Harbour Drive, where another case occurred, while touring Singapore. [79] The tour group had returned to China and the Chinese authorities had confirmed that two of the group was infected. [78] Authorities raised the DORSCON level to Orange with the impending COVID-19 cases of infection, [80] [81] with Prime Minister Lee expressing his worry about some cases with no known chain of transmission of the infection directly from Wuhan or indirectly via cases traced in Singapore. He suggested that it might become "futile to try to trace every contact". [82] [83] More clusters emerged at various locations, where there were large scale gatherings such as a business conference, Chinese New Year dinner gatherings and church-related activities. [84] Two clusters were linked when several cases in each cluster was found to have infected each other through serological tests, the first such successful test in the world. [85]
In March, as the number of cases began to rise exponentially around the world, the Ministry of Foreign Affairs (MFA) and the Ministry of Education (MOE) began to encourage Singaporeans to return home. Various institutes of higher learning recalled their students currently on overseas internship or exchange, and the MFA began liaising with airlines to facilitate flights to key cities when necessary during this period, to cater to demand for return flights to Singapore. [86] This led to an increase in number of imported cases, in which over 70% of cases from 16 to 19 March were Singaporeans and long-term pass holders returning from overseas. [87]
Plans for the lockdown began in February but waited until late of March. Various mask-off activities were prohibited such as dining in and all exercise activities and many people were remote working starting from early April; from 5 May till 1 June, gatherings and social visits were only allowed up to two per day. The bulk of cases began to shift from imported cases to migrant workers living in dormitories, resulting in the authorities imposing a mandatory quarantine of 20,000 migrant workers in two dormitories gazetted as isolation areas, namely the S11 Dormitory and Westlite Toh Guan. [88] Following which, the number of cases in migrant worker dormitories began to soar as more clusters were detected in other migrant worker dormitories, reaching a single-daily high of 1,426 cases recorded amongst migrant workers on 20 April. [89] On 21 April, the Ministry of Manpower (MOM) announced that all foreign workers in dormitories were to stop work until 4 May to curb the rising spread of COVID-19 among the groups that were hit the hardest. [90] The number of daily cases amongst migrant workers living in dormitories gradually decreased but continued to remain in the hundreds until early August, with aggressive testing by the authorities. [91] April also marked a shift in policy. The government stopped automatically admitting the infected in hospitals and instead created community care facilities for those who were at low risk, which allowed hospitals to focus only on those in higher risk categories. At the peak on 12 May, there were 19,667 patients in community care facilities. This allowed hospitals to reduce bed take up related to COVID-19 from more than a thousand to several hundred in a few weeks. 18 September saw the first time since the crisis spread to work dormitories that the daily dorm case number fell into single digits. [92]
From May onwards, the vast majority of cases were reported in dormitories, with community cases never rising above 24 cases, which was reported on 11 July. [93] Nevertheless, while numbers in the dorms remained elevated in May, 20 April in fact represented the peak of daily cases reported among dormitory workers. By August, it was clear that the situation in dormitories was being brought under control, with new daily cases among dorm workers finally falling below 100 on 11 August. On 11 August, Ministry of Manpower announced that all dormitories had been declared cleared of COVID-19 (except for those blocks that were being used for quarantine facilities). [94] By 1 October less than 300 people were being housed in community care facilities, down from the almost 20,000 from the May peak. [95] However, it also became clear that controlling the disease was going to be extremely difficult. While total case numbers had continued to decline, unlinked community cases had begun to edge up and some dorms that had been cleared of infection were once again put on lockdown. A significant milestone was achieved on 13 October when it was announced that, for the first time since March, there were no local cases of infection. This was followed shortly by 16 October, when the number of active cases fell to less than 100 –the first time since 12 March, [96] [97] and by 25 November, when it was announced that there were no active clusters for the first time since the pandemic began. [98]
On 24 December, Singapore confirmed its first case of the Alpha variant. [99] With Singapore entering the COVID 2020 Phase 3 on 31 December 2020, 2 new clusters were formed out of the 5 community cases reported that day, all of whom were linked to the marine sector. [100] Two additional clusters were formed on 17 and 19 January 2021; the first was from 2 community cases linked to a para-vet working with the Singapore Police Force's K-9 unit, [101] with the second from 2 community cases linked to a worker at Golden Bridge Foods Manufacturing. [102] Another cluster consisting of four community cases linked to an employee at BS Industrial & Construction Supply was formed on 20 January. [103]
After banning short term arrivals in March, imported cases fell dramatically. However, since the beginning of July, there was a steady trickle of imported cases as the government loosened arrival requirements, with the majority of cases arriving from India, Indonesia, and the Philippines. January 2021 saw a sharp spike in imported cases, of which foreign domestic workers formed the bulk due to the high demand for them amidst the pandemic. [104]
Delta wave of COVID-19 (2021)
On 23 April 2021, Singapore tightened restrictions due to the rising Delta wave of COVID-19. 2 new localised clusters were identified on 21 and 24 April; [105] the first was a household cluster of 3 community cases linked to a 43-year-old Indian national and work pass holder who was possibly re-infected, [106] while the second was a group of 4 community cases who were linked to a 39-year-old Indonesian sailor. [107] On 29 April, a new household cluster was formed out of 7 community cases that were linked to a 38-year-old Singaporean ICA officer working at Changi Airport, with another cluster formed out of 8 community cases linked to a 46-year-old Filipino nurse working at Tan Tock Seng Hospital. [108] It was announced that Singapore would temporarily revert to Phase 2 from 8 May, but because of the rising Delta variant at Changi Airport Terminal 3, Jurong East (Jem) and several institutes of education, it was tightened to Phase 2 Heightened Alert from 16 May to 13 June. [109] [110] Dining-in would no longer be allowed, and the maximum number of persons in a social gathering would be further reduced to two, among other restrictions. [111] MOE also announced that all Singapore primary schools, secondary schools and junior colleges were to move to full home-based learning starting on 19 May. [112]
After a decline in community cases, it was announced that Singapore would re-enter "Phase 3 Heightened Alert", with re-opening to commence in two stages. The first stage would begin on 14 June with the limit on social gatherings increased to 5 people, while the next stage would begin on 21 June with the resumption of dining-in with 5 people. [113] MOE further announced that Primary 4–6, Secondary 3–5, and junior college and Millennia Institute students would be able to return to school on 28 June, and Secondary 1–2 students on 1 July; all students from other levels would return on 6 July. [114] However, a new cluster was formed at the 115 Bukit Merah View Market and Food Centre that was linked to a 74-year old store owner who tested positive on 9 June, which resulted in a fresh surge of community cases. Consequently, the second stage of re-opening was adjusted so that only 2 persons would be allowed for dining-in. [115] With the stabilisation of community infections in early July 2021, it was announced that dining-in with groups of up to 5—along with wedding receptions—would resume on 12 July.
In mid-July 2021, a new cluster was formed at several KTV lounges out of 3 community cases linked to a short-term visit pass holder from Vietnam who first tested positive on 11 July, leading to another massive surge in cases. [116] [117] [118] Another new cluster that contributed to the surge was formed on 16 July at Jurong Fishery Port, thereby it reverted to the semi-lockdown called "Phase 2 Heightened Alert" from 22 July to 10 August. [119]
On 6 August 2021, it was announced that due to Singapore having successfully vaccinated 66% of its population, restrictions would be eased in two phases; from 10 August, dining-in at restaurants would resume with a limit of up to 5 fully-vaccinated persons, while the limit for non-vaccinated persons and dining-in at hawker centres would remain at 2. From 19 August, half of employees currently remote working could return to offices. [120] The following weeks saw another steep rise in dormitory and community cases with the formation of new clusters at North Coast Lodge on 23 August and Bugis Junction on 24 August, [121] [122] as well as 8 bus interchanges. [123] In this situation, Singapore has only been able to toggle between 2 and 5 person gatherings and are unable to ease back to 8 person gatherings from 8 May 2021 all the way to 28 March 2022. Singapore has removed restrictions relating to Variant of Concern from 29 March 2022.
Just after Singapore's COVID-19 vaccination rates increased to 80%, cases rose rapidly by 500 - 1,000 on 30 August 2021, after the public feedback, MOH has announced that Singapore will enter the Stabilisation Phase, dining-in group size at F&B outlets are reduced to two vaccinated people from the current five. Singapore has abandoned the zero-COVID strategy. When the situation improved, dining-in were reverted to five persons who are from the same household, then from 22 November, Singapore had entered Transition Phase after two months, dining-in were reverted to five vaccinated persons and hawker centres and coffeeshops joined the five vaccinated persons strategy, if checks took place. [124] The government did not ease any remote work until the introduction of Workforce Vaccination Measures (WVM), those coming back to work were complemented by ART testing on weekends only. In addition, Singapore has changed the "clusters" to "Health Risk Warning (HRW)", where those who are close contact will have to take Antigen Rapid Testing (ART) under Protocol 3, those who took 5-day MC and on self-isolation/quarantine, hence those who are under Protocol 2. [125] [126]
From 1 October 2021, MOH announced that it would unveil COVID-19 maps daily showing where COVID-19 cases have visited frequently. The first map released on 1 October, had 12 sub-zones shown which were frequently visited by infected cases. [127]
Omicron waves of COVID-19 (2022)
On 4 January 2022, the week-on-week infection increase rate crossed 1 in Singapore. This has happened for the first time in approximately two months since the COVID-19 Omicron variant cases increased in the city-state. As per statistics, most of the cases detected on each day have entered Singapore from abroad, precisely, 502 out of 842 cases. Despite the increase in cases, hospitalization in Singapore has remained low, with more ICU beds available than in use. [128] Following reports that the current wave was subsiding, MOH announced that COVID-19 safety measures would be streamlined, effective from 15 March 2022 onwards. [129] On 29 March 2022, the measures were further eased, with the limit on group sizes and dining-in increased to 10, masks made optional outdoors and the full reopening of borders for fully-vaccinated travellers, as well as the lifting of restrictions on live performances. [130]
On 22 April 2022, MOH announced that due to the stabilising situation, it would lower the DORSCON level to Yellow from 26 April onwards; limits on group sizes would be removed, and TraceTogether and SafeEntry would cease operations at most settings. [21] In addition, the Ministry of Sustainability and the Environment (MSE) announced on 24 April that it would gradually reduce the number of safe-distancing ambassadors on patrol. [131]
On 15 May 2022, three cases in the community were found to be infected with the new BA.4 and BA.5 sub-variants. [132] Health Minister Ong Ye Kung predicted that the next wave would arrive in July or August 2022. [133] As the situation stabilised in late August, it was announced that safety measurements would be further eased, with masks only required for transportation that is meant for public access (e.g. Mass Rapid Transit, Light Rail Transit, Causeway Link, SBS Transit, SMRT Buses, Tower Transit, ComfortDelGro, Strides Transportation, TransCab, Sentosa Express, Changi Airport Skytrain and those shopping mall services) and healthcare facilities; non fully-vaccinated travellers to Singapore would also no longer be required to serve a 7-day SHN. [134]
The first week of October 2022 saw an increase in cases due to the F1 Grand Prix. [135]
On 6 October 2023, Health Minister Ong Ye Kung announced that Singapore was experiencing another COVID-19 infection wave, with the recent spate of cases mostly driven by two variants, EG.5 and its sub-lineage HK.3. Both of these are descendants of the XBB Omicron variant. These two variants accounted for over 75% of the daily cases in Singapore. The estimated daily cases had risen from about 1,000 in the second week of September 2023 to about 2,000 in the following two weeks. [136]
On 22 December 2023, Health Minister Ong Ye Kung indicated that the latest wave of COVID-19 cases in Singapore had possibly peaked and there was therefore no need for additional measures, such as a mask mandate, to be implemented. The seven-day moving average estimated daily number of COVID-19 cases in Singapore had dropped in the days before — it had decreased from 7,730 on 17 December 2023 to 6,820 the following day, and then 6,530 on 19 December 2023. [137]
FLiRT waves of COVID-19 (2024)
On 18 May 2024, it was reported that there had been a near-doubling of COVID-19 cases from the previous week, with the estimated number of COVID-19 infections increasing from 13,700 to 25,900 week-on-week. The KP.1 and KP.2 strains of the COVID-19 virus accounted for more than two thirds of cases in Singapore at the time. The two strains belong to the FLiRT group of COVID-19 variants, which are descendants of the JN.1 variant. [138]
Cautious reopening
The authorities took cautious measures as the economy began to reopen to more regular outside travellers in August 2020. Travellers who did not quarantine in a dedicated facility would have to wear an electronic tag throughout the 14-day period. [139] Singapore also implemented a Reciprocal Green Lane (RGL) and Periodic Commuting Arrangement (PCA) with Malaysia, allowing limited travel between the two countries. Later in the month, arrivals from certain countries had their 14-day quarantine reduced to 7 days; those arriving from Brunei and New Zealand who were tested negative upon arrival would be allowed in without any quarantine. [140] On 30 September 2020, the Singapore government announced that the country will lift border restrictions for some visitors from Australia, excluding Victoria state, and Vietnam, beginning from 8 October 2020; [141] quarantine requirements for Victoria state and mainland China were cancelled on 6 November. [142] In October 2020, then-Minister of Transport Ong Ye Kung suggested that Singapore would be looking to open travel bubbles with various countries such as those with similar risk profiles, but also for those countries from higher risk locations. [143] One such travel bubble between Singapore and Hong Kong was to have started on 22 November; initially postponed to 2021 due to the resurgence of COVID-19 cases in Hong Kong, [144] it was eventually cancelled in August 2021 due to conflicting strategies between the city-state. Singapore cancelled the quarantine arrangement for Hong Kong and Macao, allowing all arrivals quarantine-free under the Air Travel Pass (ATP). [145] [146] This came 9 months after Singapore cancelled the quarantine requirement for China.
