Janil Puthucheary
Singapore
“Sir, I thank Ms Lee for her two supplementary questions, which address what are our targets and what is it that we measure. Indeed, the issue of how we should think about recycling and waste disposal will be at the heart of our review of our Zero Waste Masterplan.”
“Another strategy that we are embarking on is the strengthening of the reuse of waste residue and treated toxic industrial waste before and after they are landfilled.”
“Sir, about half of our recycling material is exported. It is processed overseas. There are business arrangements between businesses here in Singapore and businesses in the region or overseas, to be able to handle the recycling of waste and recycling of material, whether domestic or non-domestic, already today.”
“Sir, I thank Ms Poh for her questions. Indeed, we do have to shift behaviours. The incentives and disincentives around recycling and waste disposal are an important part of it. We will consider her suggestion on looking at the fees.”
“The heat advisory that goes out is clearly defined. In my original answer, I explained what a heat wave was. There are clear definitions that we have been using in Singapore since 2016, if I recall. It was then last revised in 2023.”
“Sir, in the planning of schools, the Ministry of Education ensures that our students can access a primary school near their homes. Except for a small number, 15 of Special Assistance Plan schools, all primary schools offer the three official mother tongue languages.”
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“I hope my explanation has helped Members understand why although we say we are living with COVID-19, we cannot just open up and risk having the number of cases shoot up, because more and more cases will translate into more and more ICU beds used. Beyond a certain point, that will force us to accept a lower standard of care, and hence, have more deaths that could have been prevented. Despite our best efforts, events may overtake us and we may have no choice in the matter. If, despite our caution, ICU cases rise sharply, we will still do our very best to look after every patient. But at what level of care? I would strongly prefer if we can avoid that dreadful scenario. We need to continue to manage the overall number of cases in our population, even as we continue to increase our hospital capacity. In all of this, there is hope. The main reason why we got to this point in the fight with COVID-19 with such low mortality rates is our people. I have spoken at length about the staff that I met at the ICUs and this applies to all our healthcare workers in the emergency departments, the clinics, the PHPCs, our swabbers, our contact tracers. Across every sector, everyone has given their all, together with an ongoing commitment to excellence in service. MOH and the healthcare teams will continue to train staff, increase beds and expand ICU capacity. My MOH colleagues and I will keep working directly with the ICU directors and clinical leads to help them. They know better than me how to manage the patients, to provide clinical care, but they need support, resources and policies that allow them to optimise their outcomes. We will help to look after them and their staff. All of us can continue to play our part.”
“Most of these will be the elderly and those who are already unwell. In comparison, every year, in peacetime, pre-COVID-19, about 4,000 patients pass on as a result of influenza, viral pneumonias and other respiratory diseases. These are also mostly the elderly and the unwell. That is why we keep emphasising the importance of vaccination and boosters. We must make sure that everyone who is infected with COVID-19 will receive proper medical care by our healthcare workers and hospital system and be given the best possible chance to fight the disease. We have got to this point in our fight against COVID-19 without excess mortality. We have managed to continue to provide excellent healthcare for all COVID-19 and non-COVID-19 patients. I am extremely proud of my colleagues, co-workers and friends who man the wards, clinics, and many other sites where they perform their duties and we should place a high value on maintaining the standard. What we are trying to do has not yet been done by any other country. We are trying to get to the point where the combination of high vaccination rates, booster jabs and even more boosting from mild infections means that COVID-19 will no longer spread as an epidemic in Singapore. And we are trying to get there without excess mortality. But no other country has done that before. In other words, though we will have fatalities as a result of COVID-19, we will not see more overall deaths than we would in a normal non-COVID-19 year. Nearly every other country that has arrived at that destination has paid a high price in lives.”
“These other countries experienced what is known as excess mortality, as the pandemic spread rapidly through the population and hospitals were overwhelmed. Excess mortality is when a lot more people die in a year than you expect. We are trying very hard to avoid that, by keeping restrictions tight last year when our population was vulnerable to the disease and then cautiously opening up after we vaccinated the vast majority of our population. Even then, we have to accept there will be some deaths. Our goal is to make sure that there are no significant excess deaths, as a result of an inability to provide adequate medical care. And so far, that is something that we have been able to do and that we want to keep doing. Up until recently we kept the absolute number of deaths small by ensuring that few people caught COVID-19 and also that those who were infected got good treatment and care. Now that we have to live with COVID-19, we will continue to protect people from getting infected through vaccination and safe management measures, but this protection is not complete. And that is why much larger numbers will get infected. But we will continue to make sure that those who are infected get good treatment and care, and so keep the death rate from COVID-19 as low as possible. Hence, we are doing everything we can to expand our ICU capacity and protect our healthcare system. These efforts have succeeded. Our death rate is 0.2%, compared to 3% or more in countries that experienced a surge in cases before vaccination. This rate of 0.2% is comparable to catching pneumonia – pre-COVID-19. But it does mean that over time, the absolute number of deaths from COVID-19 will rise despite the best possible medical care. We could have, perhaps, 2,000 deaths per year from COVID-19.”
“Underlying conditions add risks, even if the conditions are well controlled before the patient encounters COVID-19, especially if the patient is elderly. There is not yet conclusive information about the long-term health consequences of COVID-19. An NCID study found that one in 10 COVID-19 patients who recovered after the initial infection continued to display symptoms such as coughing or breathlessness six months after recovering from the acute illness. A study in the UK found that those who are vaccinated are half as likely to continue having symptoms about a month after COVID-19 infection as compared to those who are unvaccinated. While most of our cases recover fully from COVID-19, we do see instances of re-infection. Up to mid-August, we had detected 32 re-infected cases and all of them were unvaccinated. The risks of being unvaccinated are high. Compared to the vaccinated, someone who is 60 years old and above and unvaccinated, is six times more likely to need oxygen, eight times more likely to become critically ill and need the ICU and 17 times more likely to die. So far, we have had one of the lowest fatality rates in the world. At the beginning, it was because we had such tight restrictions, rapid contact tracing and low total number of cases in the community. But with cases rising fast, the case fatality rate remains low now because we have reached such a high vaccination rate and because all those who have become sick have been able to receive the care that they need. Our healthcare system is stressed, but it has not been overwhelmed, unlike many countries last year, where patients had to be turned away and doctors had to choose amongst many patients whom to save.”
“We will continue to need care for heart disease, diabetes and cancer. We will have accidents and broken bones, and all of the patients, all of us, will need care, comfort and healing. Our ICU staff have been stretched to their limit in the last two weeks. At its peak, we had 171 COVID-19 cases in ICU. But the situation has eased a little. Today, this has come down to 130. The booster doses have helped in reducing severe illnesses among vaccinated seniors, but the unvaccinated continues to be at risk. That is why we continue to monitor the situation very closely, especially the number of unvaccinated seniors who get infected. Every day, there are about 60 of them and six are likely to end up in the ICU. We need to keep this group as small as possible to ensure everyone who needs care can receive it. Thankfully, because of our high vaccination coverage, almost all cases, about 99%, have had no or mild symptoms. We have also managed to keep our fatalities very low. But sadly, we have seen 407 deaths so far. Each death is a tragedy and a loss felt by the family, the patient's loved ones and the care team. Of these, 395 of them passed away in a hospital, eight at home and four in a care facility. The number of deaths has increased in the past two months as the overall number of cases increased. Seniors who are unvaccinated and have underlying medical conditions are at much greater risk of severe illness and death. Close to 95% of those who died in the last six months were seniors aged 60 and above, and 72% of all deceased cases had not been fully vaccinated. Almost all of the remaining 28% who were fully vaccinated, suffered from underlying medical conditions such as high blood pressure, diabetes, cancer and heart, lung, or kidney diseases.”
“Any redeployed staff or new hires would also have to undergo training to operate the specialised equipment and medical devices in the ICU to care for their COVID-19 patients. Logistically, we can keep stepping up our ICU beds. We have ventilators, we have equipment, consumables, all the things that are needed, but not enough people. As a result, if we keep increasing our beds, we stretch and stretch our healthcare workers. We will come to the point that they will no longer be able to provide that continuous excellent care. Our nurse-to-patient ratio will also be lower, which means each nurse will have to take care of more patients than they do today. In a normal ICU – peacetime, pre-COVID-19 – one nurse would look after one or two patients. If she has to look after four, she will not have enough hands or time to provide the same level of care. There will come a point where even as the healthcare professionals are doing their very best, they are trying their hardest, more patients will die. And this will affect both COVID-19 and non-COVID-19 patients. As more healthcare resources are diverted to support COVID-19 services, our hospitals' ability to sustain regular non-COVID-19 services will be reduced. So, while we may have plans to step up to a certain number of ICU beds, the real situation on the ground, the operational considerations, are not straightforward. We do not want to go anywhere near to this theoretical limit. If we do, the situation can easily get out of hand. It will affect the unvaccinated disproportionately, but it will also affect all the rest of us. MOH has strategies to restrict the number of cases, not only to try to shield our healthcare workers and hospitals from the large surges, but also to protect all of us.”
“We are continuing to add further capacity to our CTFs, with a view to reach around 4,000 beds in November. We will expand our ICU capacity further, in preparation for a potential rise in severe cases. We are currently working with our hospitals to ramp up from 219 to 280 ICU beds for COVID-19 patients. These can be ready this week. If needed, our next expansion will be to 350 beds. We have been repurposing existing hospital wards, such as single rooms and isolation rooms, into additional ICU beds. We have been augmenting ICU manpower by deploying previously trained ICU staff to help with patient care. Non-ICU staff have also been brought in, as I described earlier, and they work under the supervision of ICU-trained staff. The shift pattern of nurses may have to be adjusted in order to cater to these needs and this has already started to happen in some hospitals. At the same time, we are also asking the private hospitals to set aside ICU beds to assist in managing both COVID-19 patients and non-COVID-19 patients who are critically ill. Increasing ICU beds takes time and it affects regular hospital operations. Converting non-COVID-19 ICU beds for use by COVID-19 patients who need intensive care has a limit, as it diverts resources from non-COVID-19 patients who also need care. The most important limit is the manpower required to staff ICU beds. Patients in ICU need trained staff, who must be able to provide individualised care, including round-the-clock monitoring and continuous care. So, any increase in ICU bed capacity must be supported by an increase in manpower, which has to be diverted away from non-COVID-19 ICU duties.”
“And despite having to do difficult work in unfamiliar environments they have kept the clinical outcomes excellent, through hard work, professionalism, dedication and resilience. But this is taking a toll. They are getting tired. They are carrying a burden of care that is sometimes unimaginable. Having to hold a phone for a patient so that the family can say their last goodbyes. Holding their patient's hand, to keep them company, on behalf of the relatives. They need all the support we can give them. At MOH, we are redeploying manpower, to serve as healthcare or patient care assistants at our institutions. We are reaching out to more volunteers to join the SG Healthcare Corps and support this important work. We are collaborating with private hospitals to ease some of the load on our healthcare workers in our public hospitals. We are stepping up the recruitment of healthcare workers from overseas. Our public healthcare institutions have also stepped up their outreach to staff to support them through measures that will safeguard their well-being, including counselling services, staff helplines and peer support programmes. To Dr Tan Wu Meng's question about hospital departments factoring in sick leave as one of the indicators of work performance, there have previously been isolated incidents, but this practice has ceased. Healthcare workers who are concerned about the way sick leave affects their performance appraisals can approach their union, MOM or MOH for assistance. Besides addressing the issues of manpower, we have also been working with public, community and private hospitals to set aside more beds for COVID-19 patients. We have also stood up COVID-19 Treatment Facilities (CTFs), which have close to 2,000 beds with an occupancy of 50% or less.”
“Close to 500 foreign doctors and nurses, healthcare workers, have resigned in the first half of 2021, as compared to around 500 in the whole of 2020 and around 600 in 2019, about double the usual rate. These resignations were mostly tendered for personal reasons, for migration, or moving back to their home countries. But it is also in such trying circumstances that we find stories of inspiration, stories of commitment to public service. On a recent visit to a COVID-19 ICU, I met a nurse who had been redeployed from her usual job in the Orthopaedic Department into the COVID-19 ICU. In the Orthopaedic Department, they look after bones, joints, muscles and she was now redeployed into a COVID-19 ICU. She had had a short training and orientation course, and then subsequently on-the-job training from her ICU colleagues. She is senior, she is a Nurse Clinician and an Advanced Practice Nurse, with many, many decades in public service. And although it is a challenge to work in a new environment and with a new set of equipment, drugs and protocols, because of her excellent fundamentals and her experience and resolve, she demonstrated confidence and competence in delivering care that the ICU patients need. On the day I visited, she was looking after her first ever obstetric patient. After many years, this is her first ever obstetric patient, a young lady who had to have her baby delivered prematurely because of COVID-19 and was now needing treatment in the COVID-19 ICU, not in a post-natal ward. An orthopaedic nurse, deployed to a COVID-19 ICU, now looking after an obstetric patient. And there are many others like her, doctors, nurses, therapists, social workers – re-deployed to do what is urgently needed.”
“A large proportion of our healthcare workers have not had the opportunity to take leave since 2020 and over 90% of them will not be able to clear their accumulated leave for 2021. This is clearly a much higher proportion compared to the past two years. Our healthcare workers have gone and continue to go way beyond the call of duty to care for their patients. The hospitals are trying to minimise having staff work overtime. For the month of September, our nurses worked for an average of 160 to 175 hours per month. I received a WhatsApp message from a senior member of the clinical teams. It says, "We are getting increasingly stretched, overworked and fatigued... We are uncertain how long we can keep this up. Morale is slipping." Another colleague sent me a WhatsApp message and it goes: "It feels like what started as a 2.4km run became a marathon and just as we are reaching the finishing line, we have to run a second marathon. Our people are exhausted physically, mentally, emotionally – whether they will admit it or not." I know this person as a professional colleague. I know both of them. Their roles to look after ICU patients also extend to looking after their staff, managing their teams, making sure that people are in a position and have the ability to perform at their best. So, when people like them say words like these, "exhausted physically, mentally, emotionally – whether they will admit it or not", I take it very, very seriously. It is therefore not surprising to find resignation rates going up this year. About 1,500 healthcare workers have resigned in the first half of 2021 compared to about 2,000 annually pre-pandemic. Foreign healthcare workers have also resigned in bigger numbers, especially when they are unable to travel to see their families back home.”
“Even though this is a small proportion, it translates into a large absolute number of ICU patients when case numbers are high and will place a serious strain on our ICU capacity. There are currently 130 patients who are critically ill in the ICU. Some are intubated and require a mechanical ventilator. All of these patients require the continuous care of the ICU team. They occupy around 60% of the 219 ICU beds currently reserved for COVID-19 patients. These patients stay for an average of 11 to 15 days in the ICU and some stay for up to a month in the ICU. Besides COVID-19 cases, there are also non-COVID-19 patients with life-threatening medical conditions who require ICU care, adding to the sustained load that our hospitals have to bear. Our public hospitals currently operate about 163 adult ICU beds for these patients, with an average occupancy of close to 80%. In comparison, in 2019, before COVID-19 struck, we had 298 adult ICU beds, and the average occupancy rate was 63%. So, we have been reducing the non-COVID-19 ICU beds, in order to cope with more COVID-19 patients. This is one of the key trade-offs when we increase the number of COVID-19 ICU beds. We have had to increase the total number of ICU beds to 382 for both COVID-19 and non-COVID-19 patients over the past two months. And the need to increase the capacity of our healthcare system is a heavy burden carried by the staff, our healthcare workers. Already, our hospitals are feeling the manpower crunch. Signs of fatigue can be seen amongst our healthcare workers. It has been over 20 months of continuous daily battle against the pandemic.”
“Thank you, Sir. Sir, from today's Order Paper, I will address Oral Questions Nos 1 to 10 and Written Question No 40, as well as questions filed by Ms He Ting Ru, Assoc Prof Jamus Lim, Mr Liang Eng Hwa1, Mr Leong Mun Wai, Ms Mariam Jaafar2 as well as Mr Murali Pillai for future Sittings. Members may wish to withdraw the questions filed for future Sittings if they have had their questions addressed. Sir, it has been five weeks since we entered the Stabilisation Phase. We had tightened restrictions to slow the growth in the number of cases and to further expand and stabilise our healthcare system. I would like to explain to the House the current situation in the Intensive Care Units (ICUs) and hospitals and address questions about deaths and severe cases from COVID-19. I have been meeting the clinical teams that run the ICUs, visiting them on site to go through operational details and speaking to their staff to understand the challenges that they face. These discussions and the insights shared are vital in helping us plan ahead should infection rates climb and severe cases increase. As of yesterday, we have 1,672 COVID-19 patients admitted into our acute hospitals and they take up about 18% of hospital beds in our acute public hospitals. The occupancy rate of all our general ward beds is currently at about 90%. For isolation beds, it is now at 85%. Of the COVID-19 patients who are hospitalised, the more serious cases will need oxygen supplementation. This number of cases continues to increase, with 284 cases currently needing oxygen support in the general wards. The most serious cases need ICU care. The proportion of COVID-19 cases requiring ICU care is at about 0.3% today.”
“Mr Speaker, may I have your permission to deliver this Statement on behalf of the Minister for Health.”
“Mr Speaker, may I have your permission to answer Question Nos 1 to 10 as part of a Ministerial Statement delivered on behalf of the Minister for Health later in this Sitting?”
“Whether it is about bed space or having your call answered, making sure that those resources that we have, and those officers, are deployed to deal with the people who need help most, will also help in reducing the wait time. But, ultimately, we do need the manpower and we are working on ramping up that capacity as well.”
“Sir, I thank the Member for the questions. For the first part, we set aside COVID-19 beds currently because our approach is to isolate them and separate them from the rest of the patients in the healthcare facilities. But as you go towards endemic COVID-19, COVID-19 will have to be treated like any other infectious disease. In peacetime, in the endemic situation, we do not have influenza beds, dengue beds or chickenpox beds – and all of these are infectious diseases. What we have are beds on the basis of the patients' needs. Increasingly, the COVID-19 patients in hospitals will have other types of diseases. They will have kidney problems, heart problems and neurological problems. So, it is a bit hard to then delineate, in the steady state, once we are done with the surge, once we are done with this current strategy, as we move towards endemic COVID-19, I do not think we will be in a position to then say, these are the COVID-19 beds and these are the non-COVID-19 beds. We will have to treat COVID-19 like other infectious diseases. Nevertheless, in the middle of the surge now, we are ramping up our capacity, mobilising resources, as we have described in our answers to Parliamentary Questions and supplementary questions, but also trying to improve the flow of patients through our system, so that these resources are made available. But the most important strategy is to focus the resources that we do have on those who need it the most. Vaccination is part of reducing the number of people who need those resources. The well, who are asymptomatic, being able to stay home, or go to CCFs or CTFs, is part of that strategy as well, as are our attempts to then slow down the transmission in the community. All of these, then, feeds into the issue of wait time.”
“Sir, I thank the Member for his question. He has identified the direction in which we are moving with these strategies. We have opened up more centres. We have 22 Regional Screening Centres, 20 Quick Test Centres and five private Quick Test Centres. We are already working on opening up these areas to other users and working with the employers as well, just to make sure these resources are made available to as wide a base as possible, to speed up the processes that he talks about. The sector leads among the employers are encouraged to move towards the fast and easy testing RRT, primarily with the employer supervised self-swab model, so that people could self-test at their own location, at their own convenience. Some sectors will still keep going with the Quick Test Centres. And the ones, particularly in the hawker centres, that the Member talked about, are available, but they are prioritised on the basis of how they were set up for the employees that they are meant to serve. But in the medium term, we are working with other parts of the Government to incentivise private vendors; perhaps, through a grant scheme, and our intent is to then set up more centres which can be more convenient in other locations for the community and larger groups of workers. This is an important part of our strategy going forward for COVID-19 resilience.”
“Sir, I thank the Member for the question. The whole of our healthcare system has been mobilised for this effort: public and private. And they are different institutions, but they are working as a team. It is a bit hard to quantify because the private sector is looking after COVID-19 patients under their roof, but they are also looking after other patients with other conditions. Their doctors and nurses have been deployed elsewhere into other sites. So, has it helped? The answer is yes, because manpower, beds and resources are available. But to put a specific quantification on it, I do not think I am able to adequately answer the Member's question. The way I would look at it is this. We have a healthcare system here in Singapore that is made up of public and private providers, volunteers as well. And the healthcare is not just about the bed, doctor or nurse. It is the entire system working together and everyone is mobilised to try to do their best to deal with this crisis in front of us. So, I suppose the shortest answer to the Member's question is yes.”
“Sir, I will address the Member's first question. Indeed, we do need to communicate. The relative risks of COVID-19 infection and getting the infection and then perhaps risks of complications and severe disease and put these in context relative to other common diseases, such as influenza, or even not so common diseases, such as dengue, for the public to understand how they should go about their business when we reach some sort of equilibrium. We will be putting more information out to the public. But, at the moment, we have not reached that equilibrium yet. We are in the middle of quite a large wave and there are very real anxieties around COVID-19 and, especially for the elderly, the vulnerable, the under-vaccinated. So, I thank the Member for his suggestion that we do need to put some of these numbers in the context of a lot of other diseases that we are used to dealing with. We will do so when we are approaching an equilibrium and we have plans to do so. But, at the moment, the anxieties are around the large number of cases, the wave that we are experiencing. It is very real and we should not underplay it. I understand that Minister Ong Ye Kung will address the second question.”
“In truth, much of the exposure and the risk will happen before the COVID-19 index case is detected. Hence, that is why we are requiring the whole household to limit their movement and their exposure to people outside of the household.”
“Sir, I thank the Member for his questions. For the first question, I think he is, essentially, asking why does it appear as if there are different standards for someone who is travelling, versus someone who is given a Home Quarantine Order or a Health Risk Alert here in Singapore. Partly, this is a result of the changing situation and, actually, today, an increasing number of travellers are allowed to do an SHN and you will see that we will have further and further streamlining, optimising and alignment of our various measures. The situation is moving quite fast. We will review and align these measures. But if I could go into the specifics of the Member's question or, at least, what I think are the specifics of his question, the risk associated with travellers is partly to do with variants; it is partly to do with the robustness of the information that we are receiving, depending on where they are coming from, what we understand about the situation they have in their home country as well as the particulars of that individual's likely location if they are not in a dedicated facility here, in the stay-at-home facility. So, we do take all these factors into account when dealing with the appeals, with respect to travellers. For the Member's second question, I did not quite understand what he was asking. The call is for all of us to be responsible and for the household members of a contact, indeed, to register. We are not asking for only some of them to register. We are asking for all of them to register. And, indeed, the risk to the whole household is pretty much the same as a caregiver that accompanies someone who is vulnerable. Hence, our request for all of them to register.”
“This is what it means for us to work together to be a COVID-19 resilient nation.”
“These strategies will allow us to ride the wave of infections without overwhelming our healthcare and public health response resources. To this end, regular testing in the workplace and at home remains key. We have made ART kits widely available, through sale at major retailers, free through nationwide household distributions and supplying kits to companies for mandatory routine testing regimes or voluntary regular testing. Individuals who are exposed to the virus and issued health warnings or alerts may also collect ART kits for regular self-testing from our vending machines island-wide. To make the test kits on sale more competitively priced, we are actively reviewing new brands of equally effective kits to bring into the market. We will also evaluate if there is a need to conduct another round of nationwide household distribution of kits to support regular self-testing. These fast and easy tests have been effective in augmenting our case identification efforts. Of the total COVID-19 cases identified in the last eight weeks via the PCR test at Swab and Send Home (SASH) clinics, 7% had, initially, tested positive using the self-test ART kits before coming forward for their confirmatory PCR test. Sir, as we move towards living with COVID-19, each of us must play our part to lower transmission risks and slow the pace of community infections. While the Government will continue to make adjustments to augment our healthcare and public health response capacity, all of us need to be socially responsible to take care of ourselves and others around us through regular testing and adherence to isolation protocols if we have been exposed to positive cases. Continued adherence to our safe management measures will also help to dampen the rate of transmission.”
“Those serving home quarantine or home SHN are also given information on transmission prevention, including isolation protocols and good personal hygiene practices. ART kits are provided to household members for them to monitor their own health. Those on home isolation requiring dedicated care arrangements may also apply for assistance ahead of, or during the SHN. Vulnerable persons serving SHN or QO who need support for their activities of daily living, such as minors and the disabled, may also be accompanied by a caregiver. We will continue to review our protocols and measures. There is a financial impact on businesses or individuals whose livelihoods are affected by QOs. Between January and September this year, around 3,300 point-to-point (P2P) drivers and riders have been placed on QOs. These individuals, along with others whose livelihoods have been affected by QOs, can apply for a QO Allowance to help cushion the financial impact. Mr Speaker, the public health actions that are triggered upon confirmation of COVID-19 infection for an individual are disruptive. But it remains important that we detect possible COVID-19 infections early, so as to minimise the impact of transmission to their loved ones at home, or to their friends or colleagues. There are some who have a misconception that we are testing widely to attempt to eliminate the virus. This is not so. We have many community cases around us. Our widespread testing aims to reduce the overall rate of transmission from each COVID-19 infection, slowing the spread in the community. ART testing also enables individuals to perform self-testing and do our own part to slow down transmission of the virus.”
“We have put out more public communications materials, in print media and on our websites, so that individuals affected by COVID-19 can potentially self-help themselves as well as their families and friends. We will continue to scale up the Home Recovery Programme (HRP). This ensures that our hospital and medical treatment resources are prioritised for those who are, or could be, severely ill. We have also adjusted our QO regime to allow individuals who are less likely to fall severely ill with COVID-19 and whose homes are suitable for home recovery, to quarantine at home. This regime places the responsibility on the confirmed COVID-19 cases and their household members, including minors and caregivers to self-register. After the original quarantined individual is confirmed to have COVID-19 and has been served an Isolation Order, the other household members should self-register for quarantine as well, in order for the whole family to recover and be quarantined together at home. We will also increasingly allow fully vaccinated travellers who need to serve an SHN to do so at home. Currently, such travellers from Categories II and III countries may already apply to serve their SHN at their place of residence or other suitable accommodation that they have secured. Almost all travellers from Category II countries and around half the travellers from Category III countries fulfill the criteria and have optedout of the dedicated SHN facility. We will, progressively, review and adjust our border measures, but, for now, fully vaccinated travellers from Category IV countries must still serve their SHN at the SHN dedicated facilities.”
“This process augments our efforts and allows us to focus the work of the 350 full-time contact tracers that we have today. We must optimise the deployment of these officers. As cases have increased multiple fold in the community, it is not always useful to comprehensively contact trace around every case detected by conducting extra interviews and manual case detection. Instead, we are focusing these intensive contact tracing efforts on cases and clusters detected in vulnerable settings like hospitals, nursing homes and schools. These are areas where contact mapping and comprehensive identification of close contacts have the greatest public health benefits today. Individuals who are tested positive have also been asked to self-declare their household members so that they can be placed under quarantine. What we are doing is calling on the self-responsibility of our people to aid our officers and our efforts. Next, if I may speak on our quarantine and isolation operations. The Quarantine Order (QO) and Stay-Home Notice (SHN) processes are administered by around 300 officers from MOH and the Immigration and Checkpoints Authority (ICA). These officers handle around 6,700 daily queries, on average, on issues, such as quarantine status, quarantine conveyance and testing, as well as QO rescindment requests. While such queries should be resolved within three working days, the current surge has resulted in some, especially the complex ones, taking longer to resolve. This also increases the waiting time for others before their calls can be connected, even if their queries are not as complex. We will continue to enhance the resourcing to manage surges and seek the public's understanding of the longer response times during this period.”
“We are closely monitoring ICU trends, in particular. We have increased the ICU bed capacity by 74 beds, for a total of 187 beds dedicated to COVID-19 patients with severe conditions. More ICU beds can be opened on short notice, if needed. We are also closely monitoring the hospital manpower situation, given that close to 400 healthcare workers have tested positive for COVID-19. Our hospitals will continue to dynamically cross-deploy their resources to ensure that our manpower needs are met. We are also working with private healthcare providers to augment our manpower. To further preserve our healthcare capacity in the face of future waves of infections, we must also adopt more sustainable healthcare protocols based on the medical care required. The vast majority – over 98% – of infected individuals have mild or no symptoms and only 0.3% have needed ICU care or have, sadly, passed on. This is a result of having vaccinated most of our population, who will only experience mild illness if they suffer a breakthrough infection. Thus, we are making home recovery the default protocol for infected individuals, unless they have severe symptoms, are elderly, or have underlying co-morbidities that make them more susceptible to severe disease outcomes. Besides focusing our hospital and medical treatment resources on those who need it most, we are also ensuring that our COVID-19 response systems are directed appropriately. We will continue to use technology, such as TraceTogether and SafeEntry systems, to automatically and quickly identify the majority of close contacts and to prompt these contacts to self-monitor and take precautions against unknowingly infecting others.”
“Mr Speaker, the recent exponential rise in cases has impacted our healthcare capacities. Currently, about 15% of hospital beds in the acute public hospitals are used for around 10% of all COVID-19 cases. Those requiring oxygen supplementation or ICU care account for 2% of total cases, most of whom are unvaccinated or the elderly. In the last three months, ICU bed occupancy has increased from 26% to 53%. Occupancy of isolation beds has risen from 58% to 86%, while the occupancy of community care facility (CCF) beds has gone up from 10% to 35%. Public hospital emergency departments have seen up to an eight-fold increase in the number of patients with ART or PCR positive results seeking medical attention. Prior to the last 14 days, we conveyed COVID-19 patients above 70 years old to a hospital within 12 hours from the time they had a PCR positive test. With the current high caseloads, we are now taking, on average, between 48 and 72 hours to do so. SCDF ambulances are reserved for patients with emergency conditions, hence, MOH has set up a dedicated fleet of 95 additional ambulances to convey COVID-19 patients to the different healthcare facilities. We are taking steps to expand our hospital and treatment resources to ensure that everyone who requires medical care, whether for COVID-19 or other conditions, will receive it. We have asked hospitals to prioritise resources for COVID-19 patients by reducing non-essential elective appointments. We have been shifting asymptomatic and lower-risk COVID-19 patients from hospital to COVID-19 treatment facilities (CTF), as well as the Community Care Facilities (CCFs) and the Home Recovery Programme. This allows acute hospital resources to be focused on managing patients who need urgent or essential care.”
“Sir, the issue of not being able to take for medical reasons, unfortunately, is not an absolute cut and dry, because some of it is a continued assessment. For example, you are waiting for your chemotherapy to be completed, or as you recover from the surgery and so forth. So, it is not a fixed number. We will pay very close attention to it. It is a small number, relatively speaking. For the second question, individuals who are unable to take the vaccine for medical reasons have some degree of vulnerability. So, perhaps, they may need to be careful about their exposure to the wider community, because the issue of testing is not going to protect them from the vulnerability they have as a result of their medical condition. So, it is not quite the same as the circumstances where you have someone who, for some reason, is allergic to the vaccine and then cannot complete a vaccination regimen, but would like to then go out and work and is otherwise healthy, and this is the situation in which we are then providing subsidies for the ART kits.”
“The Member is quite free to disagree with me. We had the doses delivered to us as part of the advance purchase agreement. The manufacturers were under some strain to produce as much as they can, not just for us, but for the whole world. But I think our contractual agreements were honoured. If the Member was suggesting that perhaps we should have renegotiated the agreements or not honoured the agreements in some way or changed it, he can hold on to that opinion. But I thank him for agreeing that, now, we have, indeed, done relatively well compared to perhaps, what the situation looked like in March. Ultimately, it is that destination which is of importance and will protect us. At the beginning of the vaccination rollout, our pace was constrained by the supply that was made available to us from the manufacturers. And I think this is something that we have explained several times.”
“Mr Speaker, I thank the Member for her question. Firstly, the testing regime is only one part of our overall effort to combat the pandemic. We have the social measures, we have the vaccination, we have the healthcare system and we also have the whole process of ring-fencing, quarantining and isolating people. Testing runs throughout all these. But, again, there is no single testing regime. You have ART, PCR test, Rostered Regular Testing and so forth. All of these require a certain personal responsibility for an individual. They have to conduct the tests properly. They have to adhere to instructions when they are given, but we do not rely only on that. So, we have a web of processes, an ecosystem of processes. There is room in there for people to not perhaps execute some of this properly, but there is also plenty of room for people to exercise diligence and personal responsibility; and each of us then can play a part in terms of protecting ourselves, our family and our entire country.”
“That then allows us to activate our third layer of defence, which is laboratory surveillance when specimens are submitted, to then look for the analyses that will tell us whether it is COVID-19 and, if so, whether it is a new variant or it is a strain that we are already familiar with. We do have a process in place and that process has been going on for some time and it is what we have used to be able to get us to this point in the COVID-19 fight already.”
“Mr Speaker, for full approval to be granted for any of the vaccines, not only do we need the data, but we also need the application from the manufacturer. So, the manufacturer has to make the application. The appropriate data needs to be available for our own Health Sciences Authority (HSA), and our professional experts here will need to be able to study the matter. So, we are not in a position at this point in time, to be able to answer that. As to making the vaccine compulsory, well, firstly I think we do need to wait for that process if it happens at all. We also need to then look at our context and I imagine the Member is referring to what has happened in the US, where there has been that consideration. Our context is different. Our vaccine rates are much higher, the acceptance by our population of vaccinations has also been very different. So, well, we will look at the matter, but I think, at the moment, there is no full approval anytime soon. We will study the matter when it arises. As for the third question about long-term plans with respect to variants, we have a number of surveillance systems in place. The first layer of defence is our integration into the international network, where variants of interest and variants of concern, the markers for that are shared through a network of professionals. The second layer of defence is our clinical staff on the ground. You have a patient in front of you and you have to make the assumption that maybe this might be COVID-19, maybe I need to send a test for this.”
“Mr Speaker, the short answer is we continue to study the matter and we have not completed that process yet. When we do, we will have a full explanation and discussion.”
“The F&B industry, the companies and their staff, have been responsive and adaptive in implementing VDS requirements for dining in, and have been educated on the digital and non-digital forms of verification. There have been some teething issues when this was first implemented but, over time, they have been sorted out. Mr Speaker, earlier in August, we outlined a four-stage roadmap comprising the Preparatory Stage, Transition Stage A, Transition Stage B and a COVID-19-resilient nation. We continue to work on the basis of this roadmap. Our vaccination and testing efforts, along with our SMMs and all of us exercising social responsibility, implemented together, are vital to us staying the course towards becoming a COVID-19-resilient nation.”
“This is an option to consider taking up if one wishes to communicate with a loved one who is hospitalised, without needing to make a physical visit to the hospital. To encourage vaccination take-up, MOH has been working closely with stakeholders to address the concerns of those who have not yet taken COVID-19 vaccination because of medical complications due to pre-existing diseases, or misinformation over the vaccines and their side effects, or those who simply do not see the need for vaccinations. MOH has issued clarifications and corrections and, where necessary, applied the Protection from Online Falsehoods and Manipulation Act (POFMA) to debunk the falsehoods. Vaccines can keep down the numbers of serious cases of COVID-19, but vaccination alone is not enough to prevent infections. It needs to be complemented by pervasive testing and safe management measures to detect and ringfence infections in the community early, so as to control community transmission. We have made available Quick Test Centres to administer supervised self-swabs, but it is also the personal responsibility of individuals to conduct these tests properly. The Vaccinate or Regular Test regime will be introduced on 1 October 2021 for workers in higher-risk settings. The Government will fund, until 31 December 2021, the test kits for employees working in these sectors who are medically ineligible for mRNA COVID-19 vaccines. We will continue to review the regime and will make changes later, on the basis of the public health assessment. Vaccination differentiated SMMs (VDS) were introduced to protect unvaccinated individuals from being infected with the COVID-19 virus.”
“Due to commercial sensitivities and confidentiality undertakings in our agreements with vaccine manufacturers, we are unable to disclose more information regarding our current stock of COVID-19 vaccines, the remaining number of doses to be delivered and their delivery schedules. This also applies to our dose-sharing arrangement with Australia. We do not need those particular doses at this point in time, but Australia’s vaccine programme does. We will need more doses in the future as we increase our booster programme and Australia will return the favour by sending us some doses at the appropriate time. With 81% of our population fully vaccinated, we will close four vaccination centres on 30 September 2021 and may scale down other centres. We will also increase the number of Public Health Preparedness Clinics (PHPCs) which offer vaccinations from 79 currently to around 100 by end of October 2021. Those who are unable to go to our vaccination centres or PHPCs will be visited by our mobile and home vaccination teams. Pregnant and breastfeeding women are strongly encouraged to take up the COVID-19 vaccination because they will benefit from the protection. They are more likely to develop severe symptoms if infected with COVID-19. All of our experts and professionals, such as the EC19V, the College of Obstetricians and Gynaecologists in the Academy of Medicine Singapore, and the Obstetrical and Gynaecological Society of Singapore, have advised that pregnant and breastfeeding women can receive a COVID-19 vaccination. Since last year, hospitals have facilitated patients who are nursed in isolation settings to have contact with their family and loved ones through video-conferencing.”
“In fact, 81% of our population have completed their full regimen and 85% have received at least one dose as of 9 September. Members have asked about the criteria for moving from one stage to the next. I can understand the desire for transparent and pre-determined criteria. This is of great interest to all of us. But other than vaccination rates, we also need to consider case numbers, the transmission trajectory, our social behaviour in adherence to the Safe Management Measurements (SMMs) and the status of the testing regimes. So, while we have achieved our vaccination target of 80%, taking all this into account, we have decided to pause the transition plan, given the rising number of cases currently. We are not reversing course; neither are we charging ahead. Having studied the safety and efficacy data, we will commence our booster programme for the vulnerable. Persons aged 60 years and above may receive a vaccine booster six to nine months after their second dose, while immunocompromised individuals will receive a third dose of the vaccine two months after their second dose. The Expert Committee on COVID-19 vaccination (EC19V) will continue to observe global and local data, particularly on the risk of adverse reactions, before recommending additional population groups for booster vaccines. They are also actively studying a heterologous strategy involving non-mRNA vaccines. We are negotiating with suppliers to provide us non-mRNA booster shots and a few are preparing their applications. We have a deliberate strategy to procure a portfolio of vaccines that use different technologies to improve our chances of securing vaccines that will continue be safe and effective against COVID-19.”
“Sir, we have achieved an 80% COVID-19 vaccination rate as at the beginning of September and a number of Members have asked for greater clarity on our vaccination and booster strategy, and our approach on community measures as we transition into a COVID-19 resilient nation. Sir, we have been experiencing an exponentially rising wave of infections in the community since 23 August. To curb the spread of infection in previous waves, we implemented circuit breaker and Heightened Alert measures, which significantly suppressed the rise of infections. The measures worked. But they were painful. They were painful to many families, workers and businesses. It is also not a sustainable way to battle the virus for the long term. So, we will need to open up social and economic activities, otherwise many people and businesses will suffer and we risk permanently damaging our ability to earn a living. But we have to do so safely, which means reducing the number of people falling very sick to a minimum and, for this, vaccination continues to be key. When we achieved 70% of our population having received the full regimen of the vaccine, the Multi-Ministry Task Force, presented a four-stage transition plan. It is a cautious, calibrated approach, not a sudden opening. At this point let me address Assoc Prof Jamus Lim’s question on delays in our vaccination programme. Our vaccination programme has not been slow at all. We were one of the earliest countries to secure vaccine supplies, with the first shipments of the Pfizer-BioNTech vaccines arriving in mid-December 2020, one of the fastest to roll out a vaccination programme, and we now have achieved a vaccination coverage that is one of the highest in the world.”
“Mr Speaker, with your permission, may I take Question Nos 3 to 16 together?”
“Mr Speaker, we will continue to study the data from overseas. Some of it will depend on the applications made by the vaccine companies. But I think when the decisions are reached, we will certainly be quite clear and make full explanation to the public.”
“Sir, I thank the Member for the questions. The short answer to the first question is no. There are no paediatric cases, such as what he has described. As for the different experience overseas, indeed, the lessons learnt are something that our various expert committees and professionals in various disciplines are looking at very, very closely. There are a lot of lessons to be learnt but if I could summarise a few things. Our context matters. So, when we take these lessons from overseas, how they are applied here will depend, for example, on the baseline health of our population, whether it is child or adult; on access to care, and we are very fortunate that within the confines of our city, tertiary medical care is a very short distance away; on the general level of hygiene; and also, on the ability for our population to comply with various procedures or requirements, whether medical or social. So, context is everything and the baseline health of our population is also very, very important. We cannot just simply take the raw numbers or the raw experience from overseas and expect that exactly the same thing will happen here in Singapore. But we must learn the lessons of their experience, often hard-won, so that we can better protect our population here.”
“When out, keep your masks on and cut back on social activities where masks are off or the interactions are prolonged, because such interactions account for the large majority of infections. When unwell, do a self-test or see a doctor immediately. These effective safe management and surveillance have been implemented to further keep our children safe, particularly in large settings where children congregate, such as preschools and schools. These include mask-wearing, limiting the group size, personal hygiene and requiring those children with a higher risk to take leave of absence. Family members should also get vaccinated to reduce the risks of being infected and transmitting COVID-19 to the child. Immunocompromised children are at risk from COVID-19 and other infectious diseases. They and their family should exercise additional precautions, such as avoiding crowded places and minimising the number of visitors. As for "long COVID", it is an informal term that refers to persons who have continued symptoms of COVID-19 infection. The underlying reasons for continued symptoms vary, as do the symptoms themselves. Locally, infected children have, generally, not had prolonged symptoms. We will offer care to all patients with long COVID, if this occurs, and especially those that require support from different clinical teams, depending on their conditions.”
“Mr Speaker, in Singapore, we have had 367 COVID-19 paediatric cases to date, with 172 infected with the Delta variant. Children below the age of 12 account for 0.6% of all local infection cases. Amongst these COVID-19 paediatric cases in Singapore, 13.6% or 50 cases were aged zero to one, 22.6% or 83 cases were aged two to four, 20.7% or 76 cases were aged five to six and 43.1% or 158 cases were aged seven to 12. Global data show that a very low proportion of COVID-19 infected children experience a severe illness, as compared to adults. The percentage of infected children who experience severe illness and require intensive care is 0.7% in Israel, 0.3% in the Republic of Korea and 0.6% in France. There is evidence suggesting that children with underlying medical conditions, such as genetic, neurologic, metabolic conditions, medical complexity, congenital heart disease, obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression might be at increased risk for severe illness from COVID-19. Fortunately, in Singapore, no child thus far has developed severe illness requiring oxygen supplementation or ICU care. So, the percentage of infected children that experience severe illness in Singapore is zero. We are, however, mindful that the number of cases in the community is rising and there may be more children infected with COVID-19 in the future. We will ensure that these children receive appropriate care, if their illness is more severe. There are things parents can do to minimise the risk of their children getting infected or developing severe illnesses. All family members should maintain good hygiene and keep their home clean.”
“Mr Speaker, may I have your permission to take Question Nos 1 and 2 together, please?”
“Mdm Deputy Speaker, I thank the Member for her questions. The withdrawal limits are always under a regular review. The principle is not so much to make sure that there is a completely flat equivalence for all conditions and for all circumstances, but what is the outcome in terms of access and affordability, both bill size, out-of-pocket and the number of incidents of care-seeking behaviour within a period of time for an individual. So, I think it is the outcome that we want to drive in terms of setting withdrawal limits, together with the outcome of a sustainable healthcare system. As for the provisions of infrastructure in terms of dealing with the pandemic and its effects on mental health, this is a matter that the COVID-19 Mental Wellness Taskforce is looking at, as well as the new Inter-Agency Taskforce on Mental Health. We will be looking at the infrastructure and the service provisions that we need for our mental health needs. As to whether provision for an extra tertiary hospital is necessary, it is one of the possibilities that the Member has suggested. It is not going to be the only issue that we will be studying. So, it will be looked at and reviewed.”
“Mdm Deputy Speaker, I thank the Member for her questions. Let me answer the second point. As far as working with insurance companies to further optimise the coverage process and ensure affordability, that is an on-going piece of work. It will continue and the Ministry is committed to working with the stakeholders in order to ensure that it happens. So, the short answer is yes. To her first question, if I understand her question correctly, it is about the issue of health records and the confidentiality of health records. I think she had asked about the difference in the confidentiality of health records between private practitioners and public practitioners. We should be clear that your health record is held in confidence by your medical care provider, regardless of whether it is a public practitioner or a private practitioner. We have a fair amount of regulation and legislation in order to protect and reinforce that process. I hope I have understood her question correctly.”
“Since 1 March 2021, the MediShield Life claim limits for inpatient mental health treatment has been raised to $160 per day for up to 60 days per policy year, from the previous $100 per day for up to 35 days per policy year, which will help to improve patient affordability.”
“Madam, the Ministry of Health (MOH) has put in place various support measures to ensure access to affordable mental health services. At our public health institutions (PHIs), eligible patients can receive up to 80% subsidies for inpatient mental health treatment. They are also covered under MediShield Life and can tap on MediSave to offset their remaining bills, up to prevailing limits. For outpatient treatments, eligible patients can receive up to 75% of subsidies at polyclinics and public specialist outpatient clinics. Patients can also enjoy subsidies of up to $500 per year at participating private general practitioner (GP) clinics via the Community Health Assist Scheme, for the management of mental health conditions under the Chronic Disease Management Programme (CDMP). In addition, patients can also tap on their MediSave to pay for their outpatient treatment of mental health conditions under the CDMP. Those who are 60 years old and above can additionally tap on the Flexi-MediSave scheme for outpatient expenses. To ensure that no Singaporean is denied access to appropriate treatment due to inability to pay, MediFund is available at PHIs as a safety net to assist Singaporeans who are unable to afford their mental health treatments despite Government subsidies, insurance and MediSave. MOH reviews the various financial schemes regularly to ensure they meet the needs of Singaporeans. For example, the MediSave annual withdrawal limit for patients with complex chronic conditions was increased from $500 to $700 from January 2021. The annual limit for Flexi-MediSave was also increased from $200 to $300 from June 2021.”
“Mdm Deputy Speaker, I thank the Member for the questions. The process is ongoing. In general, we will apply similar principles which are around risks and whether the person is at risk in terms of COVID-19. So, age is, of course, a consideration, as well as risks to the people around them – the settings in which they live, the circumstances in which they find themselves. So, there are a variety of considerations that we take into account.”