COVID-19 Excess Mortality

NOTICE PAPER NO. 1378

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 3 OCTOBER 2022

Name and Constituency of Member of Parliament

Tan Wu Meng

MP for Jurong GRC

Question No. 3428

To ask the Minister for Health (a) whether there will be a continued, further, and deeper study of excess mortality from the COVID-19 pandemic including the impact of COVID-19's long-term effects and how this may contribute to excess mortality; and (b) what is being done to identify potentially preventable causes of excess mortality.

NOTICE PAPER NO. 1390

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 4 OCTOBER 2022

Name and Constituency of Member of Parliament

Mr Yip Hon Weng

MP for Yio Chu Kang

Question No. 3498

To ask the Minister for Health (a) among excess deaths due to COVID-19 in the first half of this year, what is the percentage of those who are ineligible to be fully vaccinated; and (b) how do the figures for excess deaths and vaccination eligibility in the first half of this year compared to those in 2021.

Answer

Mr Speaker Sir, my response will also address the PQ filed by Mr Yip Hon Weng, which is scheduled for a subsequent sitting.

The COVID-19 pandemic has posed a severe dilemma – summarised as lives versus livelihoods - for all regions in the world.  Closing the borders and locking down society can save lives, but people would suffer tremendously from economic paralysis, and children held back, perhaps permanently, in their learning.  You open up society and economy to resume normalcy quickly, but many people would suffer from falling severely ill, and die, from infections.

Every region in the world knows it has to strike a very careful balance between lives and livelihoods.  Three years into the pandemic, Singapore has been able to open up our society and economy, with life almost going back to normal, and yet we maintain an excess mortality rate that is one of the lowest in the world. 

In September 2022, MOH released a public report on the excess deaths in the Singapore resident population over the pandemic. Between January 2020 and June 2022, there was an increase of 24.9 deaths per 100,000 persons per year, using pre-COVID year of 2019 as a baseline. Our death rate during this pandemic essentially brought us back to 2018 levels, wiping out improvements over a few years. 

The World Health Organization (WHO) uses a slightly different methodology to compute excess deaths, but the results are similar. Based on the WHO estimates for the years 2020 and 2021, Singapore experienced 26 excess deaths per 100,000 persons per year, compared to our estimates which is 24.9, but is still, again, much lower than many countries, especially those that have opened up like us. 

Members have asked for a breakdown of the numbers by year. If we break up our estimated excess deaths, there were 1,140 from January 2020 to December 2021, and then 1,350 from January to June 2022 respectively. 

There are two ways to reduce excess deaths associated with COVID-19 pandemic: First is vaccination.

COVID-19 vaccination plays a big part, because it significantly reduces the risk that infections translate into severe illness and deaths. The fact that Singapore got 93% of our population vaccinated, and that base includes children that are not eligible, and 80% boosted, is a key reason why we have low excess deaths. 

In the same vein, in Singapore and elsewhere in the world, unvaccinated persons disproportionately contributed to COVID-19 deaths. In the first half of 2022, about 5% of eligible population are not fully vaccinated, but they contributed to 28% of COVID-19 deaths.

MOH does not comprehensively track the number of persons who are medically ineligible for COVID-19 vaccination.  However, as of 30 June this year, the number of persons who applied to be exempted from Vaccination-Differentiated Safe Management Measures (VDS), who claimed they had adverse reactions to COVID-19 vaccines and we have granted, 2,100 of such exemptions.

For this group, the observed rate of COVID-19 deaths in these individuals was about 2 in 1,000, compared to 0.3 in 1,000 observed in the whole population.  This is the group who applied to be exempted from VDS.  In reality, the number of people who are medically ineligible for COVID-19 vaccines is very small, given the choice of vaccines that they have access to.

It is worth reiterating here that to be properly protected against the Omicron virus of COVID-19, we need to get a booster, in other words, three doses of mRNA vaccines.  It will reduce the risk of severe disease and deaths significantly.  Two shots do not do the job properly.  We are currently bringing in the updated bivalent vaccines that can offer better protection against variants.

The second factor is whether the healthcare system had been overwhelmed at any point during the pandemic. Overwhelmed is not the same as hospitals being very busy, which ours have been and are still very busy.  Overwhelmed means there were so many severely ill COVID-19 patients, that the hospitals ran out of beds, ran out of oxygen, and ran out of medical staff to take care of them.  Patients are essentially left to demise.  Whenever a bed or an equipment becomes available, doctors have the unenviable task of choosing who  should they save amongst everyone that is waiting.

When that happens, many non-COVID-19 patients, such as those with heart attacks, injuries, strokes will be affected.  Without proper care, many of them will also die. And that happened in many countries.

In Singapore, we did not let that happen. Mostly because when there was a risk of that happening, we went into circuit breaker mode or heightened alert mode, to slow down the rate of infection, and to protect our healthcare system.

Hence, throughout the pandemic, despite our public hospitals being strained while coping with the pandemic, our hospital and ICU beds were able to support patients with urgent medical needs.  Looking ahead, we can continue to prevent deaths by preserving healthcare capacity and ensuring that our healthcare workers are well-resourced in such situations. If and when there is a surge in infection and severe illness numbers, we cannot rule out the re-imposition of safe management measures. But we will only do so when it is absolutely necessary to save lives and protect the healthcare system.

What we managed to achieve is due to the fact that the great majority of our people did their part, and did the right thing. The pandemic is not entirely over, but we hope we are at the end game, and will continue to navigate through the crisis with resilience and unity. Thank you.