They Had the Vaccines and a Plan to Reopen. Instead They Got Cold Feet.They Had the Vaccines and a Plan to Reopen. Instead They Got Cold Feet.

Singapore’s experience offers lessons for other countries that want to reduce pandemic restrictions but have yet to deal with widespread infections.

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SINGAPORE — The vaccines were supposed to be the ticket out of the pandemic. But in Singapore, things did not go according to plan.

The Southeast Asian city-state was widely considered a success story in its initial handling of the coronavirus. It closed its borders, tested and traced aggressively and was one of the first countries in Asia to order vaccines.

A top politician told the public that an 80 percent vaccination rate was the criterion for a phased reopening. Singapore has now fully inoculated 83 percent of its population, but instead of opening up, it is doing the opposite.

In September, with cases doubling every eight to 10 days, the government reinstated restrictions on gatherings. The United States said its citizens should reconsider travel to the country. Long lines started forming at the emergency departments in several hospitals. People were told once again they should work from home.

The country’s experience has become a sobering case study for other nations pursuing reopening strategies without first having had to deal with large outbreaks in the pandemic. For the Singapore residents who believed the city-state would reopen once the vaccination rate reached a certain level, there was a feeling of whiplash and nagging questions about what it would take to reopen if vaccines were not enough.

“In a way, we are a victim of our own success, because we’ve achieved as close to zero Covid as we can get and a very, very low death rate,” said Dr. Paul Tambyah, an infectious diseases specialist at National University Hospital. “So we want to keep the position at the top of the class, and it’s very hard to do.”

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Lawrence Wong, the minister for finance, in Singapore.Credit…Ore Huiying for The New York Times

Singapore’s careful, some say overly cautious, approach to reopening contrasts with that of the United States and Europe, where vaccinated people are already gathering at concerts, festivals and other large events. But unlike Singapore, both of those places had to manage substantial outbreaks early in the pandemic.

Lawrence Wong, Singapore’s finance minister and a chair of the country’s Covid-19 task force, said the lesson for “Covid-naive societies” like Singapore, New Zealand and Australia is to be ready for large waves of infections, “regardless of the vaccine coverage.”

“Once you open up, more social interactions will happen,” he said. “And given the inherently highly transmissible nature of the Delta variant, you will get big clusters emerging.”

The vaccines have worked to keep most of the population out of the hospital, with 98.4 percent of cases presenting mild or no symptoms. The deaths have occurred mostly in seniors, usually with comorbidities, and account for 0.2 percent of the cases over the past 28 days. But the shots cannot protect against infection, especially when up against the Delta variant, Mr. Wong said.

“In Singapore, we think that you cannot just rely on vaccines alone during this intermediate phase,” he said. “And that’s why we do not plan an approach where we reopen in a big bang manner, and just declare freedom.”

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A near empty dining scene in Singapore in September.Credit…Ore Huiying for The New York Times

The country is set to review its restrictions on Monday, two weeks after they were put into place, and to make adjustments depending on the situation in the community. For Mr. Wong, one vision of how the pandemic might play out in Singapore and elsewhere would include face masks, limited travel and social distancing, perhaps until 2024.

He stressed that Singapore was still on a path toward living with Covid and said he recognized that any form of tightening, no matter how small, would be met with anger and frustration because people are anxious to move on. “But we have to adjust based on the realities, based on the situation we are facing,” he said.

Last month, officials scrambled to set up community treatment facilities equipped with oxygen tanks and asked those with mild or no symptoms to recover at home. Many Singaporeans said there was confusion about what to do and that the government appeared ill prepared.

“If the health care system gets overwhelmed, that’s when we know from experience everywhere that doctors are unable to cope and you have death rates start to go up,” Mr. Wong said. “So we are trying very hard to avoid that.”

Several doctors have disputed the government’s claim that the health care system is under immense strain. Dr. Tambyah, who is also chairman of an opposition party that recently drew up an alternative strategy for dealing with the pandemic, said there was enough of a buffer in hospitals because Singapore had canceled all elective surgeries.

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For many, the repeated tweaks to the restrictions have taken a toll. Credit…Ore Huiying for The New York Times

The problem for Singapore’s leaders, he said, is that they are “essentially doing a transition from zero Covid toward living with the virus.”

For many, the repeated tweaks to the restrictions have taken a toll. The number of suicides in 2020 was the highest since 2012, a trend that some mental health experts have attributed to the pandemic. People have called on the government to consider the mental health concerns caused by the restrictions.

“It’s just economically, sociologically, emotionally and mentally unsustainable,” said Devadas Krishnadas, chief executive at Future-Moves Group, a consultancy in Singapore. Mr. Krishnadas said the decision to reintroduce restrictions after reaching such a high vaccination rate made the country a global outlier.

“And, importantly, it moves Singapore in a complete 180 degrees, opposite direction from where the rest of the world is headed,” he said. “That brings us to the strategic question of where will this leave Singapore — if we don’t get off what I call the hamster wheel of opening and closing.”

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A neighborhood food stall operator waiting for customers.Credit…Ore Huiying for The New York Times

Angeline Ng, a marketing manager, said this year was tougher than the last. Before her father died in May, she had to navigate the strict visitor limits in the hospital, which was emotionally taxing. In July, the government’s announcement that it would once again tighten social restrictions added to her weariness.

The State of Vaccine Mandates in the U.S.

Vaccine rules. On Aug. 23, the F.D.A. granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.Indoor activities. New York City requires workers and customers to show proof of at least one dose of the Covid-19 for indoor dining, gyms, entertainment and performances. Starting Nov. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.At the federal level. On Sept. 9, President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.In the private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden’s announcement.

“I think a lot of times we are so focused on wanting to get good results that we just have tunnel vision,” she said.

Ms. Ng lives across from a testing center. Almost daily, she watched a constant stream of people go in for tests, a strategy that many public health experts say is a waste of resources in such a highly vaccinated country.

“Freedom Day — as our ministers have said — is not the Singapore style,” said Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, referring to England’s reopening in the summer. But moving too cautiously over the potential disadvantages of restrictions is a “bad public health” strategy, he said.

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Working and studying at home in Singapore.Credit…Ore Huiying for The New York Times

The government should not wait for perfect conditions to reopen, “because the world will never be perfect. It’s so frustrating that the politicians are almost like waiting for better circumstances,” Dr. Lim said.

Sarah Chan, a deputy director at Singapore’s Agency for Science, Technology and Research, said she had a fleeting taste of what normal life was like when she arrived in Italy last month to visit her husband’s family.

No masks were required outdoors, vaccinated people could gather in groups, and Dr. Chan and her son could bop their heads to music in restaurants. In Singapore, music inside restaurants has been banned based on the notion that it could encourage the spread of the virus.

Dr. Chan said she was so moved by her time in Italy that she cried.

“It’s almost normal. You forget what that’s like,” she said. “I really miss that.”

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Exercising in a park while wearing a face shield.Credit…Ore Huiying for The New York Times

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