SINGAPORE (Apr 17): The Covid-19 pandemic will not end soon — not by a long shot. The coronavirus is more likely to become endemic to humanity like the flu, but not before a long and difficult period of adjustment to bring the contagion fully under control.
Such was the sobering prognosis of two public health experts and a behavioural economist at a webinar organised by the Lee Kuan Yew School of Public Policy (LKYSPP). Entitled Covid-19: Lessons learned? What comes next?, the session was moderated by Associate Professor James Crabtree. The three panellists took stock of the coronavirus situation and presented various scenarios of life after the pandemic.
“I feel this virus will become endemic just like seasonal flu, but with occasional outbreaks of severe disease, maybe due to relaxation of containment efforts or viral mutation,” said Tikki Pangestu, former Director of Research Policy & Cooperation at the World Health Organisation (WHO). “So we will have to learn to live with the virus but our health systems must have the capacity to fight fires where necessary.”
Associate Professor Joanne Yoong, Senior Economist and Director of the Centre for Economic and Social Research at the University of Southern California, agreed.
“What I hope to see in the very-long run is that maybe 50 years from now, we find we have reduced the occurrence of Covid-19 with the technology we have developed, where we do exactly what we do with flu today, where we urge people to take flu vaccination,” she said.
Meanwhile, Teo Yik Ying, Dean of the Saw Swee Hock School of Public Health, gave a more positive outlook as he highlighted the Singapore government’s strategy of containing and eliminating the virus, although he warned that “circuit breakers” may only be a temporary solution.
“The elimination strategy is a short-term strategy. It doesn’t mean that Singapore will forever be free from the coronavirus,” Teo said. “In the long term, it will very likely be a scenario of having a “circuit breaker” once every three or four months to allow the healthcare system to recuperate... until a vaccine becomes available.”
Research by Harvard University’s T H Chan School of Public Health, published on 14 April, similarly recommended that intermittent social distancing remain into 2022 unless hospital capacity is dramatically increased or a vaccine becomes available. Vaccine development will likely take 18–24 months, although an Oxford research team claims they will have one ready within six months.
The problem with a stop-and-start strategy is that from a business and continuity point of view, it creates uncertainty in managing supply-side risks, said Yoong. Although this is what we need to do epidemiologically, it will be economically very challenging, she added.
Is Asia turning a corner?
While the panel praised the decisive response of East Asian states in stemming the tide of infections, they did warn that the unique socio-political background of regional states would make such a model more difficult to replicate outside the region.
Singapore and Taiwan have been praised for their aggressive contact-tracing measures. South Korea has also been lauded for implementing what experts call the “the most expansive and well-organised testing program in the world”, while China, has also seen some success after implementing tough lockdown measures when the coronavirus first began to spread rapidly.
Pangestu observed that these are countries with significant amounts of resources and technical capacity. “There is [also] considerable trust in government,” he said, adding that the population is not likely to do large public demonstrations to protest against the tough actions the government has put in place.
Pangestu cautioned about applying such measures wholesale to the vastly different contexts of other countries. Describing Singapore’s intra-agency, intra-ministerial task force as a model of coordination and synergy of action, he highlighted that the strategy, tailored to Singapore’s unique conditions as a small developed country, may not translate well into a much larger developing state like Indonesia.
Nevertheless, Pangestu advised countries to work on Singapore Foreign Minister Dr Vivian Balakrishnan’s “tripod of criteria” — developing quality healthcare systems, strengthening social capital and practicing good governance — to better manage the pandemic. Pangestu also advocated transparent, evidence-based communication to foster public trust in government efforts to control viral spread.
Asia’s gains may yet prove short-lived. Yoong, who is a behavioural economist, warned that there are limits to human rationality and endurance that will be increasingly tested the longer fear and uncertainty continues.
“We are very bad in general as a human species at thinking about risk and uncertainty... we are vulnerable to fear, emotion, affect and a scarcity mentality,” said Yoong. “It makes us myopic, helps us focus only on the short term, reduces our ability to empathise with each other and leads us to behaviour like panic-buying which we know...is not the right thing to do.”
People are also very good at confirming what they already think, she added. “So we take in information,” she explained, “and process it in a way that conforms to what we already believe or exacerbates our existing biases. This makes it challenging for us to communicate in a rational way and help people follow through on policy decisions at the highest level.”
Sometimes, refusal to comply with government policies designed to fight Covid-19 stems just from the sheer fatigue of long-term constraints on freedom of movement and social interaction. Yoong observed that she was struggling to avoid touching her face despite, ironically, speaking at a webinar on Covid-19.
“In a situation where we cannot follow clear instructions, there is only so much policy can achieve,” she mused.
The price of inequality
Structural inequalities in both the domestic economy and the international system also risks becoming the weakest link in efforts to prevent Covid-19. Vulnerable individuals who lack the financial means to afford social isolation may be disproportionately exposed to infection, potentially becoming vectors of transmission into society at large.
“In Singapore, we are fighting the battle on two fronts,” Teo said, adding that in the community, we are seeing transmission that is somewhat manageable with the existing “circuit breaker”. He is optimistic that community spread will come under control in the coming weeks.
“What is worrying is actually our second front [involving] our migrant workers,” he warned. “Right now, there are a number of dormitories where these migrant workers live [that] house up to the order of 25,000 foreign workers... If we are unable to manage this situation, the transmission at the dormitories will be quite problematic for our country to manage.”
Similarly, developing countries with weaker healthcare systems are also at risk, with public health experts fearing that they will be ill-equipped to contain the virus in their own countries. This could delay the global economy’s resumption of full operations and heighten the risk of transmission throughout the rest of the world, though several African countries may be able to draw on their experience with ebola to cope with the crisis.
Calling for global multilateral cooperation and solidarity to deal with the pandemic, Tan and Pangestu noted that the global response to Covid-19 leaves much to be desired.
“In parts of Europe and America, countries have unilaterally decided to impose restriction measures and they are unilaterally unlocking,” Teo highlighted, pointing out that this would leave countries vulnerable to second waves of imported cases from more affected countries. “Unfortunately right now, there has not been global coordination on this front,” he said.
“Countries are not providing enough resources [to the WHO] and yet they are asking the organisation to do more and more,” Pangestu added, just a day before US President Donald Trump announced that he was cutting US funding to the WHO.
Brave new world
While it remains far from certain whether more stringent day-to-day hygiene practices like regular hand-washing with soap will persist beyond the crisis, Yoong suggested that the pandemic presents the international community with an opportunity to reform existing institutions to better cope with a future outbreak. States could respond by strengthening healthcare systems and changing crisis management systems in readiness for another future pandemic.
Pangestu is also hopeful of a possible strengthening of the WHO to ensure a more coordinated global response to a future global health crisis. In spite of rising distrust and geopolitical tension within states in a more insular world, he felt that the WHO could develop mechanisms to give the organisation some sanctioning powers, though he recognised this would likely remain more an aspiration than a reality.
The best outcome of Covid-19 appears to be the greater elasticity of imagination coming after having experienced the unimaginable, potentially leading to more effective solutions to other pressing global challenges.
“One good thing that has come out of [the pandemic] for other problems such as climate change is that we are at a moment where our imagination is so elastic that we can think about other crises...at a much larger scale,” Yoong said. “We can make sure that we have the institutional structures and social constructs to make our responses in those times more cohesive and more effective.”
Teo, however, is more cautious, noting that much of the damage from Covid-19 could have been avoided had lessons been learned from the 1918 Spanish flu outbreak a century earlier.
“The world actually has very short-term memory...It is very clear that after Covid-19, the world will need to remember this lesson,” he said, observing that there is always a disconnect between election cycles and the long-term commitment countries need to make to prepare themselves for a pandemic.
