Could Germany show Singapore the way to endemic-COVID life? Big events, a return of nightlife, and regular self-tests
The International Motor Show in Munich was Germany’s first major trade show since the pandemic. It drew about 400,000 participants from 95 countries.
SINGAPORE/ MUNICH: In Singaporean Laura Low’s household, guests who do an antigen rapid test for COVID-19 before showing up for a social gathering are very much appreciated.
For her family, self-tests have become a matter of routine. They test themselves every three days if they have social engagements on their calendar.
It’s a form of social responsibility as life goes back to normal in the presence of COVID-19, said Low and her husband Stefen Schleser.
The couple, who have two children, live in a country that adopted an endemic COVID-19 approach months earlier: Germany.
In the state of Bavaria, nightclubs reopened this month and large events have returned. Children resumed face-to-face lessons and sports months ago, and people can dine in big groups and walk around maskless outdoors. Travel restrictions have also lifted.
Could this offer a glimpse of what’s to come in Singapore? Talking Point’s Steven Chia finds out what the people of Munich are doing, and asks an infectious disease expert how Singapore can move towards COVID-19 as an endemic disease.
WITH SOME PRECAUTIONS, A FAMILY GETS ON WITH LIFE
While COVID-19 dominated their lives last year, “that’s not the case anymore”, said Schleser, a corporate consultant who has lived in Munich, the capital of Bavaria, with his family for several years.
People are less fearful and “a bit more relaxed” about COVID-19 now that there is more data on the disease and knowledge of what measures work, he said.
This could be partly due to the way Bavaria is tracking the coronavirus. Instead of reporting daily cases, the state has used a “hospital signal light” system since September to track the coronavirus’ burden on its healthcare system.
Level yellow is when there are more than 1,200 COVID-19 patients admitted to hospitals within each of the last seven days, while level red is when more than 600 COVID-19 patients are in intensive care units in the state.
At level yellow, people may have to return to wearing N95 masks, among other restrictions, said Professor Ulrike Protzer, a virologist at the Technical University of Munich. At level red, a new partial lockdown could be imposed, she said.
An endemic COVID-19 approach would mean a country stops counting the number of confirmed positive cases, or "PCR positivity", said Professor Ooi Eng Eong, an infectious disease expert at Duke-NUS Medical School. PCR refers to polymerase chain reaction tests.
Going forward, Singapore may need to categorise cases as “flu-like COVID”, “COVID with warning signs” and “severe COVID”, for example, said Ooi. “I think that might actually help the public to accept that, ‘okay, I have flu-like COVID, it’s no big deal’.”
Low, a senior project manager in the healthcare industry, says vaccination has been the main difference between last year and this year. While her husband still works from home, she goes back to the office regularly now.
“I went back to the office yesterday, met my colleagues and they actually hugged,” she told Chia, an old friend, when he was in Munich on a work holiday last month. “They’re like, ‘You’re vaccinated, I’m vaccinated, so let’s hug’.”
Low is also grateful that the children, Max and Valentina, are back in school. Students in the city had to do remote learning during two state-wide school closures that lasted a total of three months.
“They're happy to see their friends again, the sports club has opened, so they're going on with their normal lives,” she said.
But because COVID-19 still poses some threat, the family takes certain precautions to protect the children – those under 12 do not yet have an approved vaccine – as well as other people.
Low advises the children to put on their masks in crowded places, even though it is not mandated outdoors.
Where, in the past, Max and Valentina would take the tram to school in winter or bad weather, they now cycle to school daily. “Our parents were a bit scared because it’s quite squeezy (on the tram),” said Valentina, 14.
Valentina likes the fact that classes are no longer split into separate groups that take turns to attend school. “Feels great, I can see all my friends again,” she said.
What also makes her glad is the re-opening of the sports club where she does competitive trampoline training. It opened in June after being closed for a year. The athletes do not have to mask up while jumping, but do so when they are setting up the trampoline, she said.
Her brother Max, 12, plays table-tennis at the sports club and says he doesn’t have to wear a mask while playing, only when going to get his water bottle.
Self-swabbing lends extra peace of mind. Low took an antigen rapid test before she met up with Chia. When case numbers were higher, the family tested themselves more frequently. They now do so every three days if they have social gatherings with friends or family members.
“This is a kind of social responsibility,” said Schleser. “Everybody wants to protect themselves.”
Not only are home test kits easily available at supermarkets and pharmacies, they are also very affordable in Germany, costing the equivalent of S$1.50, noted Chia. This is over six times cheaper than in Singapore, where the kits cost about S$13 for a single pack, before any discounts.
HOW A SCHOOL KEEPS STUDENTS SAFE
With children still a vulnerable group without access to an approved vaccine, Chia checked out a secondary school 15km from Munich to find out how it would keep its students safe when the new term began.
Children from as young as six in Germany do self-tests, and they can follow an instructional video featuring puppets produced by the Bavarian Ministry of Culture and children’s theatre group Augsburger Puppenkiste.
Since Oct 4, schools in Munich have dropped the mask requirement in class, at school events and during meal times.
WATCH: Talking Point: What Does It Take to Become COVID-19 Endemic? (22:08)
Unvaccinated students do regular self-tests thrice a week, on Monday, Wednesday and Friday, said Birgit Korda, principal of the Gymnasium Grünwald, which has over 800 students between the ages of eight to 18. Vaccinated students do not have to do the tests, she said.
Students who test positive have to go into quarantine and those sitting next to them who are unvaccinated will have to stay home for five days. But vaccinated students will not have to. In this way, the school tries to keep the children in face-to-face lessons, said Korda.
Asked if the school would close if there were too many cases, Korda said she would first get in touch with the Health Department, which would quarantine single students or a single class. The authorities’ aim for the school year is not to shut schools completely again, she added.
There is also an air purifier in every classroom of the school. Another device shows how clean the air in the classroom is. When its green signal turns to yellow, the students can alert the teacher to open the door to get fresh air in, she said.
EASING RESTRICTIONS AFTER THE THIRD WAVE
How did Munich relax restrictions for its residents a month after Germany’s third wave of COVID-19 in April, which saw over 20,000 new confirmed cases daily at one point?
In late-March, more than half of Bavaria state was determined to be a coronavirus hotspot and rules were tightened. To date, the country has had over 4.5 million confirmed cases and over 95,000 deaths from the virus.
Clear guidelines and a strong sense of social commitment played a role, Chia discovered.
Home recovery has been the default for people in Bavaria who tested positive since March 2020 and only those with severe symptoms are sent to the hospital.
The federal disease control and prevention agency, Robert Koch Institute, put together specific instructions for people recovering at home – including how they should minimise contact with other members of the household, advice to dine at a different time and in a different room from the others, and how to collect and wash the infected person’s laundry.
While Germany has eased up on mask-wearing rules, it is stricter about the types of masks allowed – cloth masks are not allowed, only surgical and N95 or KN95 masks, which are similar to FFP2 masks in the country.
The mask mandates eased when cases of infection dropped, explained Dr Dieter Hoffmann, medical specialist and head of the clinical virology laboratory at the Technical University of Munich. Outdoors, the risk of transmission is “much lower” if people keep 1.5 metres apart from one another, he said.
And due to vaccination – more than 66 per cent of Germany’s population is fully vaccinated – “you hardly see any very severe cases that have to be treated in intensive care”, he said.
Singapore’s current approach is a legacy of the “zero COVID” days when it was trying to stamp out the virus altogether, said Ooi. But the reality is that the virus is here to stay.
Vaccines are “not designed to prevent us from testing PCR-positive”, he said. “They are there to prevent ourselves from getting severe COVID."
“I think that conceptually, people get it, but to… now say, ‘I’m going to let go because this is not feasible’, that’s a hard thing to do,” he explained. “It’s like if a certain formula has led you to success, then you keep wanting to repeat that formula... And I suspect we’re caught in that kind of cycle right now.”
Prime Minister Lee Hsien Loong has said that while Singapore cannot go into an indefinite lockdown, it cannot “simply let go and let things rip”. It wants to get to living safely with COVID-19 with “as few casualties as possible”, he wrote on Facebook last week.
Earlier in the month, he said Singapore residents would know they have arrived at a “new normal” when “light safe management measures” are in place and cases “remain stable – perhaps hundreds a day, but not growing”. Hospitals would be back to business-as-usual and people can see crowds again without getting worried or feeling strange.
He acknowledged that a few countries have reached this state, but said “they have paid for it dearly, losing many lives along the way”.
Like Singapore, one way in which Germany is keeping its defences up is by giving booster jabs to its people.
Since September, Germany has given boosters to nearly 800,000 people belonging to specific groups. They include the elderly in care and nursing homes, those with weakened immune systems and those who previously received the AstraZeneca and Johnson & Johnson vaccines.
Protzer said a study has shown that after six to eight months, people tend to become ill again and have to go to hospitals. While scientists do not know how long boosters will offer protection for, Protzer said “what we know from other vaccines, is that you very often have to give three shots”.
“And after the third shot, you have a certain time, like five years or sometimes even 10 years, where you don’t have to give anything,” she said.
It could also be important to adapt the vaccines to the Delta variant for booster shots, she said.
HOW A SHOW WENT ON
Munich’s approach to COVID-19 saw it going ahead to host the International Motor Show in September. It was Germany’s first major trade show since the pandemic, and continued even while cases of infection were on the rise.
The weeklong event attracted about 400,000 participants from 95 countries. Besides the main event site, a quarter of the show was held across seven open spaces in the city.
The event organisers relied on the country’s border control measures as the first line of defence against the virus entering Munich.
Organisers made mask-wearing mandatory, even outdoors, and performed strict checks, said Clemens Baumgärtner, head of the City of Munich’s department of labour and economic development.
Germany has a 3G rule for indoor spaces – allowing access to only geimpft (vaccinated), getestet (tested) or genesen (recovered) persons. The rule doesn’t apply to schoolchildren or on public transport.
Chia did indeed feel nervous when he first stepped foot into the motor show, but was enjoying himself in no time. “It’s really exciting to… be back at an event like that with a huge crowd,” he said.
Looking at the people of Munich out and about on the streets in seemingly normal fashion, he said: “I’m really looking forward to the day when Singapore gets there.”
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