Compared to the other variants, Delta appears to create more viral material and there is also prolonged shedding by those infected, according to Leo Yee Sin, the executive director of the National Centre for Infectious Diseases.

She told local media that a study by the centre found that patients with the Delta variant tended to have pneumonia and were in greater need of oxygen supplementation.

Singapore sees record 5,324 new coronavirus cases in ‘unusual surge’

Dale Fisher, a professor at the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine, said the surge was expected. While vaccines are very effective in preventing severe illnesses, they do not protect well against mild and asymptomatic disease, he told This Week In Asia.

“All countries will expect a surge in mild cases when restrictions are eased. Delta means that the surge will occur more quickly as transmission occurs among many vaccinated people and also, of course, the unvaccinated,” said Fisher, who is also chair of the WHO’s Global Outbreak Alert and Response Network.

Apart from that, Alex Cook, an associate professor at the NUS Saw Swee Hock School of Public Health, suggested that the relaxation of contact tracing, quarantining and isolation of cases has also contributed to the current wave.

Most of Singapore’s cases now recover from home, and with lighter quarantine measures imposed on their contacts, there are more opportunities for interaction between those who are infected and those who have yet to be.

Can the health care system cope?

Singapore had 1,717 Covid-19 patients in hospital as of Monday. The occupancy rate for all general ward beds is 90 per cent, and 85 per cent of isolation beds are now filled.

There are about 380 ICU beds in total across all hospitals, and 219 of them are reserved for Covid-19 cases. Close to two-thirds of them are now occupied. With expectations that this could increase, authorities have been reducing the number of ICU beds available for other patients. Hospitals will also further increase ICU capacity for Covid-19 patients from 219 to 280 this week, officials say.

Singapore has the equipment and space to increase its ICU capacity. In a forum letter to The Straits Times, Lee Heow Yong, the director of the Hospital Services Division of the Ministry of Health, said: “We are able to ramp up ICU capacity to 1,000 beds, having made the necessary room conversions, stockpiled specialised equipment and medications, and trained medical professionals on ICU protocols”.

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The issue is down to staffing. Health Minister Ong Ye Kung said handling ICU beds would likely result in a “major degradation of care”.

Janil Puthucheary, senior minister of state for health, on Monday told lawmakers that ICU patients require continuous care, and staff are carrying a heavy burden. “Already, our hospitals are feeling the manpower crunch, signs of fatigue can be seen among our health care workers,” he said.

Many health care workers have not been able to take leave since 2020 and over nine in 10 would not be able to clear their accumulated leave for this year.

Puthucheary also pointed out that 1,500 health care workers had resigned in the first half of this year, compared to about 2,000 annually pre-pandemic, which has weighed on the health care system.

What could Singapore have done earlier?

Opposition politician Jamus Lim on Monday questioned if there had been concerted efforts to raise the ICU capacity and bring in relevant manpower earlier on in the pandemic, when cases were lower.

Puthucheary said the city state had about 300 ICU beds pre-pandemic and the average occupancy rate was about 63 per cent. If authorities had opened up more ICU beds and left them empty, it would have had an impact on resources that could be applied elsewhere, he said.

Likewise, if more specialised health care workers were brought in earlier on, they would not have gained much experience as the surge in demand for ICU care happened only recently. The thing about specialised care for ICU patients, he said, was that “you can’t stand it up and have it lying around waiting”.

“What we have been doing is opening up capacity ahead of the curve [but] not so far ahead … that we are having people sit around idle while other services are undermanned or unmanned,” he said.

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Other countries like South Korea and the US dealt with similar shortages of ICU beds last year, and Singapore had learned from those experiences, said Jason Yap, vice dean for practice at the Saw Swee Hock School of Public Health.

The occupancy of ICU beds is a “dynamic balance” between demand and supply, he said, and having two-thirds filled is a “decent balance point”.

“Too many unfilled ICU beds waste resources but too many patients may overwhelm the system. Singapore now flexes between increasing community curbs to bring demand down, while holding in reserve the ability to expand (although at a cost) the supply if needed,” said Yap.

How long will the current wave last?

About 98 per cent of Covid-19 patients in Singapore have mild or no symptoms, which authorities see as a positive indicator. But ever since this current surge which started in September, there has been no sign that cases are falling.

Singapore has one of the highest vaccination rates in the world, with about 84 per cent of its 5.45 million population fully inoculated. Some 16 per cent have received their booster jabs and authorities have said that as more people get these shots, immunity will increase and cases are likely to fall. Restrictions can then be eased.

Singapore extends Covid restrictions as hospitals risk ‘being overwhelmed’

“It may happen to us too, but we take it one step at a time,” he told the media after the G20 summit in Rome.

“So far it has taken us a while, it has been very wearing on our people because each time we think we have arrived, something new turns up and you have to carry on a little bit longer.”

The current social distancing restrictions are set to expire on November 21 though authorities have said they may ease measures earlier if the infection growth rate drops below 1, and if hospitals and ICU numbers are “stable”. The weekly virus growth rate was 1.05 as of Monday.

How does Singapore’s fatality rate compare with other countries?

Singapore has one of the world’s lowest fatality rates for Covid-19, at 0.2 per cent of all cases. Almost two years into the pandemic, there have been a total of 421 deaths as of Monday. This compares to about 3 per cent or more in other countries, according to Puthucheary.

He warned that the absolute number of deaths from Covid-19 will rise over time and Singapore could well hit 2,000 deaths per year, with most of the casualties being the elderly and those who are already unwell.

Puthucheary said the current 0.2 per cent rate was comparable to the fatality rate of those who catch pneumonia, while about 4,000 patients – also mostly the elderly and unwell – died from influenza, viral pneumonias and other respiratory diseases each year pre-Covid.

Singapore, he said, wanted to avoid “excess mortality”, which was when more patients than expected die in a year “as a result of an inability to provide adequate medical care”.