Singapore and Denmark, Both with Highly Vaccinated Populations, offer interesting insights for other countries. Although similar in population size (5.9 million in Singapore, vs. 5.8 million in Denmark) as well as vaccination levels (81% fully vaccinated in Singapore, 74% of the population and 87% of adults are fully vaccinated in Denmark), Denmark recently lifted all COVID-19 restrictions within the country, no longer requiring proof of vaccination, negative test results or face masks to dine in restaurants or to go to the gym or entertainment venues. Singapore, however, has postponed its reopening, urging all who can work from home to continue to do so and to limit non-essential social gatherings.
Different Trends, Converging Data
Looking at the past 30 days, Singapore's new COVID-19 cases increased from a 7 day average of 62 new daily cases, to a 7 day average of 432 new daily cases, nearly a 7-fold increase. Meanwhile, Denmark's 7 day average of 995 new daily cases declined to a 7 day average of 485 new daily cases; still more than Singapore's, but more than a 50% decline. So somewhat similar recent numbers for the two countries look different in light of where the countries were just one month ago, especially in the case of Singapore, which only recently, in August 2021, pivoted from its previous zero COVID stance to living with COVID as an endemic disease.
Vaccine Type Matters
Both Singapore and Denmark have used the highly effective mRNA vaccines Pfizer and Moderna when vaccinating their population. However, Singapore has also allowed Sinovac's CoronaVac vaccine to be used by private clinics, even though Sinovac's vaccine hasn't been as effective at preventing infection, and Denmark has used more Moderna doses in its vaccination program, having been able to pick up an additional 5 million Moderna doses when some of the other European Union members countries declined their full Moderna allotment, for a total of 6 million doses, enough for over half of its population. Moderna has been shown to offer greater protection than Pfizer against the more infectious Delta variant that has become dominant in Singapore, Denmark, and most other countries. In a Mayo Clinic study of fully vaccinated individuals in Florida in July 2021, those fully vaccinated with Moderna had a 60% lower risk of infection compared to those fully vaccinated with Pfizer.
While both have similar population sizes, Singapore is far more densely populated than Denmark. Singapore has an average of 21,646 people per square mile, many of them in small apartments, while Denmark has just 354 people per square mile. Even in Copenhagen, Denmark's most populous city, population density is 18,000 per square mile, but that only affects 583,000 people, just ~10% of Denmark's population.
Indoors vs. Outdoors Matters
Singapore has a tropical climate, which would seem to facilitate outdoor activity all year round. The reality of its hot, humid weather, however, means that many locals prefer air conditioned environments. The Four Seasons Singapore, for example, is one of very few hotels in the world with indoor air conditioned tennis courts. COVID-19 more easily spreads in cool, dry environments, unless there are HEPA filters, such as on airplanes or in hospitals.
In Denmark, where COVID-19 new cases have been declining, the warm summer weather and inclination of Danes to spend as much time outdoors during the warmer months likely plays a role. Even commuting patterns contribute: while Copenhagen has excellent public transit, many Danes prefer to get around town outdoors by bicycle, which further reduces opportunity for viral spread.
While many Asian countries' populations skew younger, while European countries skew older, Singapore has fewer children as a percentage of the population than Denmark. Singapore's fertility rate has declined over the past 20 years while Denmark's has held stable. While that would appear to help Singapore in that a slightly greater share of its population is eligible for vaccination (since children under age 12 aren't yet eligible to be vaccinated), we'd argue that this has actually worked against Singapore, because very young children tend to have a smaller number of kids and adults they socialize with (primarily just their immediate family and caregiver or classmates), compared to college students and young adults, who are more likely to socialize with friends outside their immediate families, classmates, and colleagues. All the same, since Singapore has just a few percentage points more of young adults ages 20-39 than Denmark has, age is a smaller contributing factor than vaccine type and population density. Age tends to be a bigger factor when it means that a very significant part of the population isn't eligible to be vaccinated, such as in Israel.
The Only Constant is Change
In today's world of the COVID-19 Delta variant (and other variants) case numbers can change quickly. It's very possible that Denmark will have to reimpose COVID-19 restrictions this fall or winter in the face of rising cases, or that Singapore will fully approve the mRNA vaccines (which to date have only been approved for emergency use) and start to mandate COVID-19 vaccination to those medically eligible, as suggested in this Straits Times piece, in order to lower new case numbers.
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