Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
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“The number of abuse and harassment cases reported within the Public Healthcare Institutions (PHIs) have increased over the last four years. The cases increased from about 1,080 in 2018, to 1,200 in 2019, and 1,300 in 2020. As of end November 2021, there have been about 1,400 abuse and harassment cases reported. Over the same period, the number of cases of abuse or harassment of public healthcare workers while on duty that were reported to the Police, under section 6 of the Protection from Harassment Act (POHA), has also similarly risen from 40 in 2018 to 68 in 2021. Possible reasons for the rising trend could be the increase in number of patients seen in the PHIs, coupled with rising expectations from patients and their family members for high quality care and service from healthcare staff. COVID-19 safety precautions, such as hospital visitation limits, may also have resulted in heightened frustration for a handful of patients’ families. Staff are equipped with preventive and mitigation strategies to manage abuse and harassment. These include recognising high-risk situations and exercising care to maintain good communication with patients and their family members to reduce the risk of interactions escalating to abuse and harassment. Prominent signages are displayed at various touchpoints to remind patients and their family members about the culture of mutual respect in the hospitals. PHIs have established escalation processes for frontline healthcare staff who face abuse and harassment. These include notifying their immediate superiors, referring these cases to security officers on-site or reporting the incident to the Police, if warranted.”
“To strike a balance between maintaining sufficient manpower reserves for COVID-19 work and allowing staff to take time off, public healthcare clusters are encouraged to allow staff to rest and recharge by taking days off whenever possible. About two thirds of staff in our public healthcare institutions were able to clear their annual leave. Only less than one-third could not fully clear their accumulated leave in 2021. When there is a need to manage workload during surges, clusters have hired additional manpower and reduced non-urgent and non-life-threatening care treatments. MOH has also worked on measures, such as redeploying swabbers, who have been freed up after the change in testing protocols to public healthcare institutions, calling for more volunteers to join the SG Healthcare Corps and tapping on the private healthcare sector.”
“The broad terms of employment for unionised public healthcare staff are set out in Collective Agreements negotiated between each of the public healthcare clusters and the Healthcare Services Employees’ Union. These agreements are renegotiated and updated every two to three years. Staff who are covered under the Collective Agreements have a stipulated maximum of 38 to 42 hours per week, depending on whether the worker is engaged in shift work. Any work hours in excess of these would be entitled to overtime pay. Staff are also entitled to a given number of rest days within their work-rest cycle and also to paid annual leave. For junior doctors employed by MOH Holdings (MOHH), the Singapore Medical Council (SMC), MOH and the Specialists Accreditation Board (SAB) have guidelines on working hours, rest days and night calls and so on to ensure the well-being of junior doctors. One of the guidelines stipulates that, when averaged out over a month, the total work hours per week of junior doctors should not exceed 80 hours. Departments are required to comply with these guidelines for residents and medical officers. These guidelines aim to balance the well-being of junior doctors with their training requirements. Like other employers, MOHH is responsible for providing paid annual leave to its employees, including junior doctors. The Ministry does not impose a hard cap on the number of working hours and number of call-backs or enforce mandatory taking of annual leave. As the recent COVID-19 surge has shown, there will be times when there are exigencies of service that public healthcare clusters need to manage.”
“Some of these include the National CARE Hotline, Samaritans of Singapore (SOS) 24-hour crisis hotline, IMH’s Mental Health Helpline and so on. There are also online resources available to support and empower individuals in mental health and self-care. For example, on mindline.sg, individuals can understand their state of emotional well-being via a self-assessment tool and access mental health resources and self-help tools on the website.”
“At the public hospitals, the median waiting time for a new subsidised appointment to see a psychiatrist was 34 days in 2020. The reported median waiting time for a new subsidised appointment with a psychologist was 32 days in 2020. Public hospitals employ a triage system to ensure that patients are seen in a timely manner based on the urgency of their condition. The interval for follow-up reviews varies from patient to patient and is based on the healthcare professional’s assessment of the patient and their needs. Patients with mental health conditions can also receive care from primary care doctors, who are able to manage conditions, such as depression and anxiety, in the community. In the polyclinics, patients with mental health conditions will be cared for by a multi-disciplinary team comprising doctors, nurses and psychologists. In addition to in-person consultations at hospitals, IMH offers teleconsultations to stable patients for outpatient reviews to facilitate easy access to care. There are also community-based care and support services, such as the community outreach teams and community intervention teams, which persons with mental health challenges can tap on. These teams have reached out to over 383,000 persons to provide mental health information and support, and 63% of clients who had completed care by the intervention teams have reported improvement in their quality of life. Beyond the scheduled mental health appointments at healthcare facilities, persons in need of mental health care support, including crisis care, can access various mental health and counselling helplines operated by social service agencies, support groups and hospitals.”
“MOH has signed an agreement with MSD Pharma (Singapore) Pte Ltd to purchase Molnupiravir and is in advanced discussions with Pfizer Pte Ltd, Singapore, to purchase Paxlovid. Both are oral anti-virals for treating COVID-19 patients. We are unable to disclose the number of courses purchased or under discussion, due to contractual obligations on confidentiality. Pfizer has submitted a Pandemic Special Access Route (PSAR) application for Paxlovid to the Health Sciences Authority (HSA). HSA has commenced its review of the data to ensure that it meets the requirements for quality, safety and efficacy for interim authorisation before it is approved for use in Singapore. MOH will continue to monitor the development of COVID-19 therapeutics, including their effectiveness against prevailing COVID-19 variants, and purchase promising candidates to ensure Singapore has access to safe and effective COVID-19 treatments.”
“Peer-support networks, such as department well-being champions, have been expanded to cover all staff groups. Professional counselling services and helplines are available, with some offering extended hours. MOH will continue to work with PHIs to advocate for mental health and support mental wellness initiatives and encourage help-seeking behaviours amongst healthcare staff.”
“Public healthcare workers in our healthcare clusters have access to professional counselling services, including counselling clinics and helplines, as well as peer support schemes and networks. In 2019, such services were used around 330 times. This increased to around 890 in 2020 and 1,080 in 2021. There is rising awareness of support measures available and the increase in utilisation indicates a need to support the mental well-being of healthcare staff better. Organisations, such as the healthcare clusters, have also increased efforts, such as well-being offices, staff well-being committees, as well as planning and implementing new and enhanced mental wellness strategies for their staff. Campaigns have been launched to raise awareness of mental health issues and to encourage help-seeking behaviours. Surveys are conducted regularly to better understand staff morale, resilience and capacity to cope with adversity. New training programmes on mental wellness have been made mandatory for all public healthcare staff. Meanwhile, self-care and recharge programmes will continue to be conducted on a regular basis to ensure that staff have sufficient rest. Our Public Healthcare Institutions (PHIs) have introduced new technology-supported initiatives, such as online self-assessment tools and artificial intelligence (AI) chatbots, such as Wysa and BotMD. These assist staff to seek help early and prevent further deterioration of their mental well-being. Whistle-blowing avenues, such as in-house or third-party feedback channels, are available for public healthcare staff to raise their concerns on the mental well-being and safety of their colleagues or themselves. There are avenues for staff who require a listening ear or professional counselling.”
“When presented with a resignation notice, supervisors will speak with the staff to understand the reasons for leaving and discuss if there are other ways in which the institution might be able to render support. This includes encouraging staff to take a period of leave to attend to personal matters, offering part-time or other flexible work arrangements or exploring alternative jobs within the cluster. However, there may still be instances whereby, after exploring various options, the staff may still prefer to resign. In such cases, the public healthcare institutions would respect their wishes. MOH will continue with our efforts to recruit and build up a local core within our healthcare workforce to meet our future needs by improving the awareness of the professions and growing the local training pipelines for both fresh graduates and mid-career entrants. MOH has also put in place measures to better retain our healthcare workers, such as through salary enhancements over the years to ensure that our public healthcare institutions’ pay remains competitive.”
“MOH is working closely with our public healthcare institutions to shore up recruitment, for both local and foreign staff, to augment the healthcare workforce. The COVID-19 crisis has stressed the system tremendously. But because of our vaccination programme, SMMs and collective cooperation and the trust we place in one another, the healthcare system was not overwhelmed. Some of our good foreign staff were poached by other countries, some resigned, and recruitment of nurses, especially foreign nurses, has been challenging due to the strong international demand. That is the reality of the situation caused by the pandemic. The market for nursing manpower is now subject to global competition. That is why we have always emphasised on the need to protect our healthcare system and our healthcare workforce, and not subject them to excessive stress and demands. And our population has responded, by getting their vaccinations and boosters and bear with the SMMs to reduce transmission. We all deeply appreciate the work of our healthcare workers during the pandemic crisis, and our healthcare workers, in turn, are grateful for the cooperation of our population to protect our healthcare system. We do not take the position that let us open up all activities and let the healthcare system bear the brunt of it. Nor do we protect the healthcare system at all costs and subject the country to a severe social and border lockdown. Our ability to take a middle path approach is the hallmark of a high-trust society. To retain staff better, our public healthcare institutions have stepped up their outreach to staff on the well-being and support measures available to them. This includes counselling services, staff helplines and peer support programmes.”
“About 1,500 doctors, nurses and allied health professionals had resigned from our public healthcare institutions in the first half of 2021, which was a 4% resignation rate. Full year data for 2021 is not yet available. But if we do a simple extrapolation and assume 3,000 resignations for the year, this means roughly an 8% attrition rate for these groups. We expect that the data for the second half of the year will show an improvement, as it usually does with new inflow. As for the overall public healthcare workforce in 2018 and 2020, the resignation numbers were 4,600 and 3,700 respectively. So, resignations were, generally, on a downward trend before 2021. Members have asked for a breakdown of the resignations by age. Amongst the 1,500 nurses, allied health professionals and doctors from our public healthcare institutions who resigned in the first half of 2021, more than half of them were aged 30 to 39 years, a quarter were aged 20 to 29 years and the rest were 40 and above. This is roughly in line with the age profile of our public healthcare workforce. Members also asked if the resigned staff stayed in the wider healthcare sector. Based on self-declarations of registered nurses and allied health professionals, 90% were employed in the healthcare sector and less than 1% were employed in other sectors. The remaining were either not working or overseas at the time. As for recruitment, the number of newly recruited nurses and allied health professionals was on the uptrend from 1,900 in 2018 to 2,300 in 2020 and we have been experiencing a net inflow and growing of the public healthcare workforce. However, for the first half of 2021, the number of new recruits was about 1,300, slightly below the number of resignations.”
“Mr Speaker, Sir, just now, in reply to a question delivered by Senior Minister of State Janil Puthucheary, he mentioned that the incidence of myocarditis amongst young people is 45 per million and, during the supplementary questions, I referred to the same number. [Please refer to "Assessment of Effects of COVID-19 Vaccines on Younger Children and Singapore's Decision to Extend Vaccination to Younger Children" and "Vaccination for Primary School Students and Possibility of Vaccination-differentiated Measures for Preschools and Primary Schools", Official Report, 10 January 2022, Vol 95, Issue 44, Oral Answers to Questions section.] We now realise the number is inaccurate. It is actually 10 times less. What we said was 10 times less. It is actually 450 cases of myocarditis per million infections of COVID-19 on young people. This is in the preprint and the number is actually disproportionately weighted towards males. And the age group is actually 12 to 17, to be specific, and not below 12. I thought I would make that clarification.”
“I take the Member's point. In every country, they also have a concept of what they call "ascertainment rate", which is, of the underlying cases, how many are uncovered and reported. And every country knows that it cannot be 80%, 90% or 100%. Especially when you have a Delta wave or Omicron wave that is highly transmissible, you do want people to take self-responsibility, take care of themselves, isolate themselves and, in these cases, they may not be reported. So, they do happen in every country. To think about it, when we face an endemic disease, whether it is chicken pox or influenza, we cannot report every case and that is what endemicity means, which is, many people get it, many people are able to recover without it being officially reported. That is part and parcel of endemicity. But notwithstanding that, testing remains important for us, first, to exercise self-responsibility; second, to have a sense of what is the prevalence of the virus in the community. And we continue to do quite a fair number of tests: over 20,000 PCR tests a day; over 150,000 ART tests a day. Some self-monitored, not reported, but many are. That will always give us a consistent measure of the prevalence of the virus in the community. And we will continue to do so in a practical way.”
“On the second question first, to keep prices steady and affordable, I think competition helps, choices help. So, we are constantly on the lookout for kits that are effective as well as lower priced. In that way, we bring them in and, recently, we have done so – FlowFlex, for example, is below $5 – and we will continue to be on the lookout. There have been many kits out there that claim to be cheaper but are not as effective. So, HSA does not approve all of them just unquestioningly. And we will continue to do that. As to the Member's question on how to prevent a run on testing facilities, number one, is to try as much as possible to plan ahead, have supply agreements signed, stock up. This is what we have been doing. And we will continue to monitor the situation, bearing in mind that we have seen in other countries where there has been a run. Second, a run happens when people panic. So, to prevent a run, do not make people panic. Omicron can be scary, it can go up a few times, it can be 10,000 cases, 15,000 cases a day. That is why we are telling the people now that it can reach that level. That is why we started what we called "Protocols 1, 2, 3", specifically Protocol 2, which sensitises people to self-test, self-report and self-discipline. And we have extended this now to GPs to also trigger Protocol 2. That way, I think people are sensitised to "when I need a test, what do I do after a test?" And when people know what they need to do, they do not panic, there is much less chance of a run on any testing facility.”
“Restaurants did not close towards the end of the year, but they operated with dine-in group size of two. Hopefully, this year, we can ride through waves with a much more liberal posture and that is how we keep on improving. And that is most important to our businesses.”
“The Member reiterated his question, but I may have to reiterate my answer. As alluded to in the Member's supplementary question as well, we also do not want to be too rigid in setting the parameters or trigger points, for example, if we cross this, therefore, it will shut down from five to two and so on and so forth. I think there are so many twists and turns in this pandemic, we would rather be a bit more nimble and to be able to adapt. But we take the Member's point, and we have always adopted this position that we do not go for "Freedom Day", neither do we go for zero COVID-19. We want to strike a balance, preserve the healthcare capacity; at the same time, allow people to live life as normally as possible, businesses to be able to operate and survive. Each time we make a decision, we do explain why. We do show all the data – hospitalisation, ICU and so on and so forth – to give the full rationale, with numbers, why we decide that way. So, I also hope that, over time, people will begin to understand what our key considerations are, even though we may not be able to pinpoint trigger points. I should say that, ultimately, it is not about the numbers that cause all this uncertainty. It is a fact that we are in the middle of a pandemic and our society, for two years, we were not entirely ready in the first year in terms of our resilience. Last year, we were much better, and I do believe that, in 2022, we will be even better and that is most important. Remember, in 2020, when we faced a wave – it was hardly a wave, it was just clusters – we went into circuit breaker. Last year, in 2021, when we faced a wave, we went into what we called "Phase Two (Heightened Alert)". Group size was down to two.”
“I must apologise to the Member. I did not mean to drop her question but it will be addressed by Minister Iswaran later in the next set of questions, especially on the specific breakdown on the number of imported cases. As for booster jabs, it is a serious issue that the Member has raised because we do know that two doses do not last forever. The European Union (EU) has already implemented a guideline which is similar to ours: nine months' validity or 270 days. So, I think the world will converge towards some form of validity, I believe, and, naturally, this will become a requirement in due course. That is my conjecture.”
“Sometimes, when you tweak more, it becomes more complicated and people do compare: "Why is it for this setting I am allowed to do this? Why is it for that setting I am not allowed?" And you start to have invidious comparisons and people start to get confused. So, we are also very mindful to keep rules as simple as possible because simplicity is an essential ingredient for people to exercise self-responsibility. What they do not understand, they cannot self-enforce.”
“Thank you for those suggestions. Relying on individuals to self-report ART results, this, as Mr Gerald Giam has acknowledged, is actually in place. It is not quite in Parliament because you do get informed by an SMS that you are negative. But there are many settings where we do rely on self-reporting. Workplace, for example, a lot of meetings, events you go to, you do a self-test. We have an entire protocol, what we call a protocol tool, that is based on self-testing – that you self-test and, if you are positive, you stay home for 72 hours. After that, daily tests and only when you are negative, you come out. It is totally an honesty-based system. If you are negative, you come out; and if you are positive, you stay at home. So, the answer is, yes, we very much support what Mr Gerald Giam has said, and it is already in place. Can we do more? We are doing more. You will notice that, recently, MOH announced that we are now working with general practitioners (GPs) and primary care-providers. Previously, we could see a primary care-provider or a GP and when you say you are sick, he can only prescribe you a PCR test, which will be taken to a lab and reported by the lab. But now, he can also prescribe you an ART test. Essentially, he can trigger Protocol 2. So, we are moving in that direction. And I must say that, to overcome this crisis, it is really not just the Government, but it requires the cooperation, civic-mindedness and sense of self-responsibility of every individual in our population. The next question is more specific: rules on different settings. That is what we have been doing, too. If the Member has any specific suggestion on specific settings, we would be happy to hear them and we are constantly tweaking them. But just one word of caution.”
“As of now, we are quite encouraged that many parents are coming forward and the paediatric vaccination exercise is actually gathering pace, and many parents are coming forward to protect their children. On the question of Novavax, it is being assessed by the Health Sciences Authority (HSA). We need to let the scientists do their work. I think we should consider putting it into our National Vaccination Programme. We have always wanted a good portfolio of mRNA and non-mRNA vaccines. But, as for the timing, I think it may take a while more, including for delivery, plus another process for assessing whether it is suitable for children, there is another set of data, another set of trials. So, I do not know how long it would take. In the meantime, Omicron is upon us, highly transmissible, and we do not want to rule out that even a small percentage of children can get very sick; we might be looking at a significant absolute number. So, I would suggest, as Senior Minister of State Janil Puthucheary has advised, get your child vaccinated with mRNA, given the circumstances. It is not perfect, but I think, given the circumstances, cause and benefits, the right thing to do now is to get your child vaccinated as quickly as possible. Likewise, for the 270 days, I can understand what the Leader of the Opposition is suggesting – whether we should wait for Novavax. But again, Omicron is upon us. While I hope we have the luxury of time to wait for a non-mRNA vaccine to be available, but, with the impending Omicron wave, I think we should act quickly and, therefore, we set the validity period of 270 days.”
“Thank you. I can fully appreciate parents' concern about mRNA vaccines for children. They will be concerned about the long-term effects and whatever side effects there may be. Just a few facts. The children's vaccine, Pfizer-BioNTech/Comirnaty, has gone through extensive clinical trials. And during the clinical trials, it was proven and shown to be safe and effective. Specifically, myocarditis, which is what most parents are concerned about in children, it occurred. Currently, there are about 8.5 million already vaccinated in the US and the incidence rate is about one in a million. And as Senior Minister of State Janil Puthucheary mentioned, we have to balance this against the downside of getting infection. If you are infected, the chances of myocarditis are 45 in a million and also other effects, such as MIS-C, which can make the child really sick. [Please refer to “Clarification by Minister for Health”, Official Report, 10 January 2022, Vol 95, Issue 44, Clarification section.] And we have seen a handful, one or two a week, when Delta was at its peak and they are admitted to ICU. Thankfully, all of them recovered. So, there is a good track record of safety and efficacy for the children's vaccine. On the other hand, for children who are infected with COVID-19, while, generally, children are more resilient, we have seen cases of myocarditis and MIS-C. So, it is a pandemic crisis. We do have to weigh those costs and benefits. I do have to add one more fact, which is that, for the children's vaccine, it is a diluted form. They are not taking the same adult vaccine. Pfizer-BioNTech, for example, is one-third the dose of an adult's. So, these are the facts and parents will have to make the right decision.”
“If we have to tighten the restrictions, it will be as a last resort and when our healthcare system is under severe pressure. In conclusion, Mr Speaker, Sir, I believe that just as we have ridden through the Delta wave with unity and resolve, we will be able to do so again with the Omicron wave. Omicron is a different enemy, but we are much better prepared and much more resilient than before. And after the Omicron wave passes, which it will, we would have taken another huge step towards living with COVID-19. Singapore will be one of the best and safest places to live in on Earth.”
“This group has consistently taken up two-thirds of our ICU beds, throughout the pandemic. By restricting their social interactions, we protect them against infections and serious illnesses and taking up hospital resources. The rest of society who have been vaccinated can also then live life more normally. However, there are, presently, no plans to introduce VDS for children aged 12 and below in community, public, preschool and school settings. This is due to a combination of reasons, namely, children are less likely to develop severe illnesses when infected and we want to preserve as much as possible universal access to holistic education for children. Minister Chan will explain further. For now, children aged 12 and below who are Singapore Citizens, Permanent Residents or Long-Term Pass Holders and did not travel recently will continue to have their COVID-19 medical bills fully covered by the Government. This is regardless of their vaccination status. So, in general, while we have a strict VDS system in place, to enable society to carry on normal lives as much as possible while protecting the unvaccinated, the rules are much less strict on children, based on the reasons I have explained earlier. Members asked if we are likely to tighten up social activities because of the Omicron wave. When the Delta wave subsided late last year, we refrained from being too jubilant and over relaxing restrictions. That would have been a mistake. We kept our masking requirements, we did not allow night entertainment to restart, we kept group sizes at five. So, it is the MTF’s hope that we can ride through the Omicron wave with the current safe management measures posture.”
“Our objective is not to have more people falling very sick and admitted to ICU but, in fact, to avoid it. Hence, we size our emergency healthcare capacity based on what is sustainable and practical. Bearing in mind this is a crisis of a generation, the capacity needed cannot be provided within our redundancy provision and ICU-trained staff do not just increase multi-fold overnight or even over a few months. Hence, we have tried to temper the infection numbers through safe management measures and exercising self-restraint in our social interactions. So, vaccinations, expansion of healthcare capacity and safe management measures, the three must work in tandem and we must strike a balance among the three factors. We cannot, for example, over-liberalise, remove all social restrictions, let infections rise uncontrollably and leave the healthcare system to bear the consequences. Neither do we swing to the other extreme: protect the healthcare system at all costs, go for a zero-COVID-19 strategy and lock down our borders and society which will cause tremendous suffering to our people. How the three factors balance off one another is a matter of judgement, depending on the pandemic situation. It will be too rigid to set metrics and parameters to trigger social restrictions, as we need to respond flexibly and appropriately to the twists and turns that the pandemic situation may take. This brings us to the third response, which is safe management measures. In recent months, instead of imposing across-the-board social restrictions, we introduced more vaccination-differentiated safe management measures (VDS). This is because unvaccinated individuals are at far higher risk of falling severely ill.”
“We have made preparations to ramp up capacity and manpower of the Home Recovery Programme, Community Treatment Facilities (CTFs) and public hospitals. We stand ready to provide up to 350 ICU beds, 2,000 isolation beds and 4,000 CTF beds for COVID-19 cases with a couple of weeks’ notice. Particularly, for hospital ICU capacity, existing single rooms and isolation rooms can be repurposed into additional ICU beds when required. Medical equipment and consumables are ready. Manpower is always a limiting factor, but ICU staff has increased by 12% over the past year to about 1,800 now and we have trained or are training about 500 more staff to assist with ICU operations. Anti-viral medications for COVID-19 have been used to treat vulnerable patients who are at high risk of falling severely ill. When authorised for use and made available in Singapore, these oral anti-viral medications will be important additions to the range of COVID-19 therapeutic agents already in use locally. We have signed or are negotiating supply agreements for these medications but, unfortunately, I am not at liberty to release details due to confidentiality obligations in these contracts. Outside of the hospitals, we will be enhancing our health protocols to right-site patients, so that hospital resources go to those who need them most. The MTF has recently announced our partnership with primary care doctors to care for patients who are recovering at home after being tested positive with Antigen Rapid Tests, under what we termed Protocol 2. This will help them safely recover and return to normal activities as soon as possible. I should caution Members against thinking that coping with a transmission wave successfully is a matter of recruiting more healthcare workers and building more ICU facilities.”
“At this time, only the Pfizer-BioNTech/Comirnaty vaccine is authorised for use in ages below 18 years. We will continue to closely monitor the availability of other non-mRNA vaccines that are approved for use in children. At the same time, our vaccine booster programme is gathering pace. About 46% of our population has received their boosters. We have recently brought some 900,000 individuals aged 18 to 29 into the booster programme, of whom 700,000 are already eligible to receive their boosters today. Our booster coverage will continue to expand over the month of January. We have also set a validity period for full vaccination status of 270 days, as a strong signal to our population, "Please get your boosters promptly". As to whether there is a need for further booster shots – fourth shot, fifth shot – it is too early to tell. Today, Israel is the only country that has authorised a fourth dose for non-immunocompromised individuals. For an endemic infectious disease like influenza, we can draw some inference from there. This virus mutates frequently, so, people receive vaccinations every year to protect themselves against it, without many problems or the need for disruptive border closures and social restrictions each time there is an influenza infection wave. It is a possible future scenario when we live with COVID-19 as an endemic disease. MOH and the Expert Committee on COVID-19 Vaccination (EC19V) will continue to monitor local and international data on the durability of protection from vaccine boosters and the evolution of the virus to assess the need for further vaccinations. The second response: we continue to enhance our healthcare capacity.”
“Although the unvaccinated is a small proportion of our population, they contributed to 70% of the deaths in 2021. The remaining 247 were vaccinated with a range of locally available vaccines. I am going to read out some crude incidence rates but, be mindful we are calculating these based on quite a small sample of 247 deaths of individuals who are vaccinated. They are as follows: 79 deaths per 100,000 for non-fully vaccinated persons overall; 11 deaths per 100,000 for those vaccinated with Sinovac; 7.8 per 100,000 for Sinopharm; 6.2 per 100,000 for Pfizer-BioNTech and one per 100,000 for Moderna. These rates are only indicative. As I mentioned, the sample size is small and they also do not account for other factors which may affect mortality, such as the age and timing of vaccination. Around 132,000 individuals aged 18 and above remain unvaccinated, while around 300 persons are medically ineligible. We will continue to try to convince those who are medically eligible to get vaccinated, through their primary care physicians, public messaging and the media. But, as Members would appreciate, as the number gets smaller, it is also harder and harder to convince them. For those who are homebound, our Mobile Vaccination Teams can visit their homes to vaccinate them. Over the past months, we have managed to vaccinate well over 90% of every eligible age group. It is quite an achievement. We are especially happy to see that among seniors aged 60 to 69, and 70 and above, 96% and 95% have been fully vaccinated respectively. As for those aged 12 to 19 years, 95% are fully vaccinated. For the even younger ones aged five to 11, we have just started vaccinating them. The response has been good and operations smooth.”
“Given that it is less severe than the Delta variant and vaccines still work against it, our key objective remains, which is, to live with COVID-19 as an endemic disease. Then, we can lead life as normally as possible and continue to build a bright future for Singapore and our children. That includes not locking down our borders, which will inflict tremendous pain on families, workers, businesses and also the mental well-being of many people. In any case, a severe lock-down strategy will likely delay but not prevent the inevitability of Omicron finding its way into our community. There are two factors working in our favour. First, a high percentage of our population is vaccinated, and more are getting their boosters every day. Second, unlike many European countries which have to contend with a double whammy of a concurrent Delta and Omicron wave, we have only recently gone through a Delta wave. We are not likely to have to ride through two rapidly rising infection waves. In recent days, our overall local infection number is creeping up, to a few hundred a day, with Omicron accounting for about 40% of all cases. Given the transmissibility of Omicron, we expect the numbers to rise steeply in the coming weeks and Omicron will become the dominant variant within a few weeks. The responses that we have developed against Delta will continue to be relevant against Omicron, with some adjustments. And there are three responses, essentially. First, vaccination and boosters remain key. In countries where Omicron has spread, the unvaccinated and under-vaccinated are still the most prone to falling seriously ill when infected. Mr Dennis Tan asked for a breakdown of COVID-19 deaths. There were 802 such deaths in 2021, of whom 555 were not fully vaccinated.”
“Eight of the 4,322 needed oxygen supplementation, and all of them have been taken off oxygen after a short few days. None required ICU care as yet. In comparison, if these 4,322 infections had instead been caused by Delta, we would expect 50 to 60 patients needing oxygen supplementation, ICU care or to die. However, we should be careful in interpreting these observations. It is early days and the circumstances of each country are different. South Africa, for example, has a young population and a high level of natural immunity, even though their vaccination coverage is low. The UK has both high levels of vaccination and natural immunity, and this current Omicron outbreak is riding on the back of a protracted Delta outbreak, which worsens clinical outcomes. Further, Omicron transmits much faster and infects more people. So, even if a small percentage of infected individuals falls very sick, because of the large base of infections, it can still lead to many people needing ICU care or die. The third thing we have found out about Omicron is that vaccines, especially boosters, retain substantial protection against severe disease. Indeed, the most recent studies in the UK found that for vaccinated individuals, the risk of hospitalisation for Omicron is reduced by 72%, compared to the unvaccinated. With a booster shot, vaccine effectiveness against hospitalisation is estimated to be 88%. Currently, Omicron has spread to over 130 countries and has become the dominant strain in many places. Hence, we lifted the suspension of flights from affected African countries and aligned the healthcare protocols between Omicron and other COVID-19 variants. Members would like to know our strategy in responding to the Omicron wave.”
“Thank you. This graph describes the situation in South Africa. The blue line shows number of infections. Members can see three humps, reflecting the three waves that they have gone through: the first is Beta, then Delta in the middle, and the latest, the tallest is Omicron. And it is plotted against the scale on the left axis. The grey part for the top graph shows hospitalisations, plotted against the scale on the right axis. And so, Members can see that in the latest wave, the number of hospitalisations is proportionately lower than the previous two waves. The bottom graph is even more stark. The red area shows number of deaths, plotted against a separate scale on the right axis. Members can see that during the Omicron wave, the red area is actually very small; number of deaths is, proportionately, much lower than the previous two waves. The next slide is a similar analysis but now, it is for the UK. Members can see a similar pattern, proportionately fewer hospitalisations and fewer deaths. A study by health authorities in South Africa showed that 4.9% of cases were admitted to hospitals during the Omicron wave, compared to 13.7% during the Delta wave. Among the patients admitted to hospital during the Omicron wave, they were 73% less likely to have severe disease. In the UK, the risk of being admitted to hospital or emergency care with Omicron was about half that of Delta. Data from Denmark also showed that about 0.8% of Omicron cases were hospitalised, lower than the 1.2% rate of hospitalisation among cases infected with other variants. This has also been borne out by our own local experience. In Singapore, we have recorded 4,322 Omicron infections so far, including 308 seniors aged 60 and above.”
“So, if Delta infections reached a sustained incidence of about 3,000 cases a day, Omicron could perhaps reach 10,000 to 15,000 cases a day or even more. Cases are likely to double every two to three days. So, once cases start to rise steeply, within a couple of weeks, we may see 3,000 Omicron cases a day. Second, there has been consistent international evidence showing that Omicron infections are less severe than Delta. The incidence of hospitalisation and severe illness is lower and there are also indications that any hospital stays are also shorter. Indeed, the clinical outcomes, particularly the number of people who become severely ill or die, are much more important than the top line number of infection cases. Mr Speaker, Sir, may I show a couple of slides on screen, just to illustrate this clearly?”
“Thank you. Mr Speaker, Sir, Singapore just weathered a significant COVID-19 transmission wave caused by the Delta variant which is still active in many parts of the world. By working together, making collective sacrifices to restrain our social interactions, watching out for one another and implementing sound policies, we have overcomed perhaps the most difficult part of the pandemic. As of now, our hospital situation is stable, with 11 COVID-19-related ICU cases. Most activities have resumed and we are meeting up with friends and loved ones. Our society has become much more resilient to COVID-19 than before. This is an important milestone. But a new Omicron wave is upon us. If we work together, we can ride through the wave. Once we have done so, we will be even more resilient than now and even more prepared to live with COVID-19. When Omicron first burst onto the global scene, we immediately introduced measures, such as restricting travel from affected countries in Africa, enhancing testing for all travellers, isolating cases in hospitals and reinstating stringent contact tracing and quarantine for Omicron infections. These measures will not stop Omicron from taking root and spreading in Singapore, given its high transmissibility. However, they have helped to delay its emergence, giving us precious time to understand it better and to prepare ourselves. The characteristics of Omicron have now become clearer. This is what we know today. There are three key points. First, local and overseas evidence shows that it is far more transmissible than the Delta variant. We must expect a wave that could be a few times larger than the Delta wave.”
“Mr Speaker, Sir, Senior Minister of State Janil Puthucheary and Minister Chan Chun Sing will then address another set of questions on child vaccination. May I request that we deliver our replies and then all three of us take supplementary questions together, please?”
“Mr Speaker, Sir, as the first Member to speak in the first Parliamentary Sitting of the year, may I just wish all Members and Speaker a good 2022 ahead. Mr Speaker, Sir, with your permission, may I address Question Nos 1 to 12 and also written Question Nos 34 to 38 in the Order Paper, please?”
“The Ministry of Health (MOH), Health Promotion Board (HPB) and healthcare clusters have put in place a variety of programmes to support seniors to stay active and prevent or delay functional decline. The Healthy Ageing Promotion Programme For You (HAPPY) programme is one such example. Since April 2019, the programme has been progressively rolled out at new sites islandwide, including the Eldercare Centres (ECs). It is now available at more than 110 locations. COVID-19 has disrupted the pace of roll out, but we plan to continue the scale-up to new sites as senior activities are able to gradually resume. Within the community, primary care providers, healthcare clusters and community care providers are already working together to ensure that seniors receive the care they need. For example, the ECs link up seniors to care and social support services and ensure their medical issues are addressed and care provided is holistic and appropriate. Some of these sites are also supported by community nursing teams from the healthcare clusters. The community nurses provide a range of services such as health screening and coaching, falls and frailty assessment, chronic disease monitoring and caregivers’ education and training. They also refer the seniors to their regular primary care doctor if a medical consultation is needed and refer frail and pre-frail seniors for appropriate physical activity programmes based on their assessed needs and conditions. The Silver Generation Office (SGO) actively reaches out to seniors at their homes, identify vulnerable seniors including those who are frail, and link them up to care and support services such as the community nursing teams for their healthcare needs and social agencies for the identified social needs.”
“The question for written answer has been addressed by the Ministerial Statement delivered by Senior Minister of State for Health (on behalf of the Minister for Health) on 1 November 2021.”
“One of the recommendations of the COVID-19 Mental Wellness Taskforce (CoMWT) is to develop a National Mental Health Competency Training Framework, to align existing mental health trainings towards a common set of training standards and competencies expected of professionals and para-professionals who support persons with mental health conditions. To implement this recommendation, the Ministry of Health, Ministry of Social and Family Development, Ministry of Education, and the Institute of Mental Health are developing the framework to guide mental health capability building for organisations across different sectors. Training providers such as Institutes of Higher Learning and Social Service Institute, may also develop mental health-related modules that are aligned to the training framework. More details on the framework will be provided when ready.”
“I thank the Members for the questions. I have addressed them in my reply to Question No. 72 for oral answer on the Order Paper for 1 November 2021. [Please refer to “Assessment Criteria for Sinovac and Sinopharm COVID-19 Vaccines for Inclusion in National Vaccination Programme", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“I thank the Member for the question. I have addressed it in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“I thank the Member for the question. I have addressed it in my reply to Question Nos 77 to 85 for oral answer on the Order Paper for 1 November 2021. [Please refer to "Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions for Oral Answer Not Answered by End of Question Time section.]”
“The questions have been addressed by the Ministerial Statement delivered by Senior Minister of State for Health (on behalf of the Minister for Health) on 1 November 2021.”
“As at 16 August 2021, there were 32 COVID-19 confirmed reinfection cases. A third of them were dormitory residents; and the remaining were imported cases. From 16 August 2021, formal assessment of reinfections is no longer performed as the national strategy moved away from the eradication strategy. All infections are managed similarly to ensure optimal clinical management and prevention of spread. The duration between initial infection and subsequent reinfection varies, with an average of about 300 days. The measures to reduce the risk of transmissions and reinfections in dormitories are similar. First, over 97% of migrant workers, including recovered workers residing in dormitories have been fully vaccinated. Next, we have a multi-layered strategy to contain the spread of COVID-19 within dormitories. This includes implementing Safe Living Measures and infection prevention and control practices to limit transmission in the dormitories, Rostered Routine Testing, and testing workers with acute respiratory illness symptoms to detect outbreaks early. Upon detection, cases are isolated immediately.”
“In all cases where Police have been notified of a death, including when the person is believed to have died by suicide, the Police will inform the deceased’s next-of-kin of the death as soon as reasonably practicable. When attending to death cases, the Police may activate relevant support personnel from Social Service Agencies such as Samaritans of Singapore (SOS) who will then reach out to next-of-kin or loved ones in providing emotional support to the grieving family. SOS may also arrange counselling support for next-of-kin who need and wish to receive additional support. In addition to SOS, individuals can also approach counselling centres and other support groups for support. For suicide cases involving students in schools and Institutes of Higher Learning (IHLs), relevant trained school personnel will identify those who may be emotionally affected, and provide the appropriate support according to their needs. Teachers and staff will continue to monitor the well-being of students, and provide guidance and support. For students who require additional targeted support, they will be referred to the in-house counsellors and/or mental health professionals in the community and hospitals. Schools and IHLs also receive support by specialist teams from MOE and other agencies to render support to affected students and staff when needed. The Interagency Taskforce on Mental Health and Well-being will be conducting a public consultation for the National Mental Health and Well-being Strategy that is being developed by the Taskforce, and could look into how the deceased’s next-of-kin may be better supported.”
“The Ministry of Health (MOH) has received appeals from couples who were unable to continue their assisted reproduction (AR) treatment overseas due to the COVID-19 travel restrictions, and seeking to import their stored gametes or embryos for treatment in Singapore instead. To support these couples, the Ministry established a process for such appeals to be submitted by the AR practitioners on behalf of their patients. This allows MOH to review such requests expeditiously and facilitate the importation of the gametes/embryos where appropriate. Fully vaccinated couples may use the Vaccinated Travel Lanes (VTLs) to travel overseas to continue their AR treatment in these countries. Couples travelling to countries where no VTL arrangement has been set up will be subject to the quarantine requirements both abroad and locally. Alternatively, they may write in to MOH for us to review their request to import their gametes/embryos and continue with treatment locally.”
“In a pandemic crisis, Government has extended full subsidies for nationally recommended vaccinations, including boosters, that offer protection against COVID-19. As we progressively transit to living with COVID-19 as an endemic disease, we will monitor the global and local situation, and periodically review the need for booster doses of COVID-19 vaccinations, and whether they should remain fully subsidised.”
“We recognise that reduced social interactions can negatively impact the socio-emotional and mental well-being of seniors, including those with dementia. Hence, centre-based services, including exercise and cognitive activities, remain available, albeit at reduced capacities due to Safe Management Measures (SMM). For dementia patients who require mental health support during the ongoing COVID-19 pandemic, we continue to make available our community mental health services, with added precautionary measures, to monitor their condition and escalate them for timely interventions if necessary. Intervention and counselling are conducted through telephone or video consultations for suitable patients. Service personnel will conduct home visits with SMM in place for those unsuitable for online or remote intervention. While certain high-risk activities such as group activities, mask-off activities and door-to-door outreach services have been curtailed, in-person service is allowed to support patients with severe dementia, inadequate family support and intensive care needs, such as those at risk of injury or are at high risk of relapse of their dementia and/ or psychiatric conditions. As we move into the Stabilisation Phase, we aim to have more partners gradually resume their activities and dementia patients would be able to continue their social activities in the community with SMM in place.”
“I thank the Member for his question. I have addressed it in my reply to Question Nos 29 to 34 for written answer on the Order Paper for 1 November 2021. [Please refer to "Data on Severity of Illness Experienced by COVID-19 Vaccinated Patients and Evaluation of Effectiveness of Different Vaccines for Booster Jabs", Official Report, 1 November 2021, Vol 95, Issue 41, Written Answers to Questions section.]”
“The question for written answer has been addressed in the Ministerial Statement delivered by the Senior Minister of State for Health on behalf of the Minister for Health on 1 November 2021. [Please refer to "Update on ICU and Hospital Capacity", Official Report, 1 November 2021, Vol 95, Issue 41, Ministerial Statement section.]”
“The question for written answer has been addressed in the Ministerial Statement delivered by the Senior Minister of State for Health on behalf of the Minister for Health on 1 November 2021. [Please refer to "Update on ICU and Hospital Capacity", Official Report, 1 November 2021, Vol 95, Issue 41, Ministerial Statement section.]”
“With the revised protocols which started from 11 October 2021, we are now only issuing HRWs to close contacts of COVID-19 cases. SMS notifications sent to HRWs include links for translations of the message in Mandarin, Malay and Tamil.”