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Coronavirus Report: The Hill's Steve Clemons interviews Vivian Balakrishnan

The Hill's Steve Clemons interviews Singapore Minister for Foreign Affairs Vivian Balakrishnan.

Read excerpts from the interview below.

Clemons: Where do things stand with regards to the coronavirus today in Singapore? 

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Balakrishnan: Well, we're on the careful road to recovery. ... We have 5 1/2 million people on a tiny island, but we have 17 million tourists in a usual year, so it's no surprise ... it was one of the early destinations for the virus when it got out of China. So that was the first wave in late January and February. Well, as you mentioned, with good contact tracing with good care and isolation, we were able to deal with that first wave. The second wave began in February and March, and that's basically because we had lots of Singaporeans who were seeking safe refuge at the time when the virus was spreading across the globe and citizenship has its privileges. And, of course, they had a right to come home. We ended up with about 580 imported cases by the middle to late of March. That again, in turn was controlled. And then what happened at the end of March and across April really was a surge of cases in our migrant worker dormitories, and this is one key differentiator from SARS that we experienced 17 years ago, and that is that this virus is far more infective than SARS. And whenever you have living in close quarters, whether you're on an aircraft carrier or a six-star luxury liner or in our case, foreign workers living in a dormitory ... Whenever you get that kind of situation with this particular virus, it will spread exponentially. ... If you look at the total number of cases that we've had, it's about 38,000. 94 percent of that is really from the migrant worker dormitories, 1.5 percent imported, 4.5 percent cases in the community. If you look at the mortality rates, our figures are less than 0.1 percent. In fact, if we want to go to the second decimal point it’s 0.07 percent. Now, the point is this. Of course, the very low mortality rate can be ascribed to the excellent health care facilities and in particular, the wonderful staff that we have. But it can't be that Singapore’s health care facilities are 10 times better than those everywhere else in the world. So basically what you're seeing here is the fact that we are testing so extensively. In fact, most of the patients who turned out positive now are asymptomatic and in fact, probably passed their infective prime. So that's why we get apparently large numbers. But such good outcomes.

 

Clemons: Why do you think that is?

Balakrishnan: It's a combination of factors, and I wanted to say number one from a medical point of view we know that age makes a difference. Pre-existing diseases diabetes, hypertension, cardiovascular problems, stroke, obesity. That also contributes to mortality rate. But basically, if you have a young and fit population and a very important point, your health care facilities are not overwhelmed, you can get mortality rates around about 1 percent overall. But the point is, you've got to make sure you're not overwhelmed, and that means making sure that your health care capacity, which cannot be increased overnight. But in our case because we went through SARS 17 years ago, we invested heavily in health care facilities and testing facilities and having a system with sufficient buffers, sufficient resilience to deal with it. So that made a critical difference. But the other way to look at it is that in fact, for many countries, if they look especially for less developed countries with young populations and you told them well, the mortality rate is less than 1 percent, you know, sometimes even down to 0.1 less many people will be tempted to say well, then, perhaps this isn't such a significant condition, but here the point is because we know that it's asymmetrically heavy burden on the older population. In fact, what we have done is to make a choice that this is a values decision and that if you want to protect your old and vulnerable, you need to take this disease seriously. And in terms of impact, without a vaccine and without proven antivirals, you're left with what we call non-pharmaceutical interventions of which there are only three: social distancing, hand hygiene and masking, in that order. And what we have shown in the last eight weeks, when we went through what we call a circuit breaker is that social distancing is very, very effective. It really takes the edge off the otherwise pandemic rise, but it's also very, very costly. It has a huge impact on the economy, on society, and after a while people get restless, they get a form of cabin fever. But the point I'm making here is this. The reason why we are prepared to pay this price is because we want to protect the most vulnerable people in our society, so it’s a values judgment. It's a choice that we make. But having said that, there is a corollary to that, which is that if you have effective social distancing and the vast majority of your population in fact, remains immunologically naive, which means we don't have immunity to it. It means we remain vulnerable to secondary rises in the pandemic. And what that means, then, is that in this phase, when we're opening up, we've done three things in particular. Number one, ramp up medical capacity for any future increases. Number two, you need to increase your testing capacity considerably by several orders of magnitude. Number three, you need the ability to contact trace and contact trace very, very quickly and at scale. Because this is the only way you can reopen your economy in the presence of the vast majority of your population not having immunity and yet do it safely. 

 

Clemons: What is your strategy on contact tracing? 

Balakrishnan: Contact tracing is a professional act. It remains a human endeavor. It requires human judgment, and no technology is going to replace the human in the loop. ... Now, having said that, you can facilitate, you can accelerate their work. You can reduce the whole difficulty in doing what they need to do. ... A key ingredient of contact tracing is to jog people's memory and say, “Where were you over the last 14 days?” And the truth is for all of us, if I asked you that, you will have great difficulty reconstructing your movements, your calendar and even the people that you met, and that's even people that you know. What about the people who you don't know, whom you happen to have spent a significant amount of time with? So that's where technology comes in. It enables the human being making those decisions to quickly fill up that schedule of activities, identify risk events, identify potential contacts and then the key point is to be able to issue a quarantine or isolation orders and to institute treatment quickly. It makes a difference on two counts, one which we know that instituting early access to care makes a difference to outcomes, so that's clearly a benefit for the patient himself. Second, it prevents secondary or tertiary spread of the disease.

 

Clemons: How has diplomacy has shifted or changed for you? And are you worried, as someone who watches this relationship so closely and really is between them, that the world is in danger of coming around two hubs, the U.S. hub and the China hub?

Balakrishnan: Let's deal with the easy one first, the diplomacy. I think for anyone who has been a foreign minister for several years that the fact is, we've all been used to getting on a plane. We've met so many people over the years. In effect, we've all learned to use Skype, to Zoom, to make video conference calls. We're able to transact, we're able to negotiate, we're able to connect and communicate. But I will say this. I think we're all living off accumulated diplomatic capital, diplomatic capital because we've met each other. We know each other. We have shaken hands, we've looked into each other's eyes and it's so much easier. But if we had never met before, we never had a measure of the man or the woman, I think all these electronic means of communication would be far less effective. So in the short term, not a lot has changed, except for the fact that we are all not jumping onto a plane. ... Your latter part of your question is far more difficult. The way I look at this is I agree completely with Richard Haas, that this epidemic has not changed history. But it's accelerated the shifts and the trends, which were already evident before. So let's take a step back and say, well, what was happening before COVID-19 arose. First question, was the relationship between the United States and China fraught with difficulty as evidenced by sanctions, trade wars, tariffs, apparent reconciliation, a phase one deal. I think the point is there were already difficulties in that relationship. ... Second point, was there already a domestic political pushback against globalization and free trade, and in particular, its impact on jobs and inequality? And the answer is, that was already here on the political agenda. Third point, if we look at global supply chains for a long time, supply chains became more and more complex, more and more spread out in a network form across the entire globe because people were in search of efficiency. And, you know, the optimal way was to be just in time and have low inventories, and suddenly we're now confronted in a world where “just in time” needs to be supplemented with “just in case.” And you suddenly realize, “Hey, wait a minute,” for critical supplies chemicals, drugs, ventilators, even what should be simple, routine stuff, personal protective equipment suddenly became in short supply because no one had stockpiled enough and diversified resources enough, and suddenly it became a premium on reliable partners in your supply chain. So again, what I'm saying is this focus was enhanced by this crisis. But it's not really new. So the next question, then, is well what are the implications of all this, of a difficult and perhaps turbulent relationship between the two superpowers of the world, of a pushback against globalization and free trade and of the disruption and what you have indicated possible bifurcation of supply chains. If you look at just these three trends ... it means we are probably headed for a world that is far more difficult, far more disrupted. The easy, low hanging fruit of economic growth that came from globalization and free trade are not going to be there anymore. You will see a less prosperous world. You will see a less interdependent world, and we have to appreciate that in fact, globalization, free trade and interdependence was the formula for peace and prosperity since the end of the Second World War. So we are leaving that phase and we're headed into an unknown where many things can go wrong. So for all of us, and especially for us in Singapore and you need to appreciate our unique position, we are a city state. Trade is 3.5 times our GDP. China is our largest trading partner. In fact, we are the largest foreign investor in China. The United States is the biggest foreign investor in Singapore by a long way.