MINISTERIAL STATEMENT BY MR ONG YE KUNG, MINISTER FOR HEALTH ON DEVELOPMENT OF THE COVID-19 PANDEMIC, 26 JULY 2021

Mr Deputy Speaker Sir

1.   Today, my fellow co-chairs of the Multi-Ministry Task Force (MTF), Minister Gan Kim Yong and Minister Lawrence Wong, and I will be delivering Ministerial Statements to update members on the COVID-19 situation in Singapore.

2.   Our Ministerial Statements will address Oral Questions 1 to 5, and 26 to 28, and Written Questions 28, 29 and 31 to 33 of today’s Order Paper.

3.   It will cover questions on the KTV and Jurong Fishery Port clusters, our COVID-19 vaccination programme, and our plans to transit to live normally with COVID-19. 

4.   Mr Murali Pillai, Assoc Prof Jamus Lim, Mr Darryl David, Mr Xie Yao Quan, Mr Yip Hon Weng, Mr Seah Kian Peng, Ms Raeesah Khan, and Mr Sitoh Yih Pin - have filed Oral and Written PQs scheduled for future sittings on these issues. 

5.   As today’s Ministerial Statements would address those questions, Mr Deputy Speaker Sir, I would like to invite Members to seek clarifications on these issues after the Ministerial Statements. 

6.   Should their queries be sufficiently addressed, it may not be necessary for them to proceed with their PQs for the future sittings.

The KTV Cluster 

7.   On Monday 12 Jul 21, MOH detected several COVID-19 positive cases amongst individuals who frequented KTV bars and lounges.  

8.   These individuals included patrons of the bars and hostesses who worked in the lounges.  These activities were considered very high risk and had been disallowed since the beginning of the pandemic.   

9.   The cluster grew rapidly, and MOH moved in quickly to isolate infected persons, identify rings of contacts and tested them for COVID-19. 

10.   We ordered a two-week suspension of operations in all pivoted nightlife establishments from 16 July till 30 July. 

11.   The pivoted nightlife establishments cannot resume operations until they pass inspections to ensure that safe management measure protocols are in place, and they have received written approval.  

12.   Mr Xie Yao Quan asked if we would consider making the individuals in the KTV cluster pay for their COVID-19 medical expenses in full. 

13.   We are all upset by the irresponsible behaviour of individuals involved in the KTV cluster, but we have a public responsibility to ensure that everyone receives the medical care that they need. 

14.   We also do not want individuals, especially those who are infected, to avoid getting tested and treated, or hide where they have been from contact tracers, because they are afraid of getting penalised. This will make it harder to contain the spread, and could cost us more in the long run.

15.   We were on the path towards progressive opening, and the KTV cluster was a major unexpected bump on the road.  

16.   The MTF deliberated on the matter, and on the advice of our medical experts, came to the conclusion that given our extensive tracing and testing efforts, and our population vaccination rate for two doses was approaching 50%, the cluster ought not significantly change our plans to open up. 

17.   Hence on 16 July, the MTF announced our decision to maintain our then current safe management posture. We made some adjustments to the rules for eating in restaurants, to allow groups of five to dine together, provided everyone is fully vaccinated.  

18.   Based on how the cluster has developed, we still believe that was the correct call. As of 25 July 2021, the KTV cluster has a total of 237 infected persons. For the past three days, the daily increase in infection for the cluster was 6, 5 and 5 respectively.  It is coming under control. 

19.   Unfortunately, things got derailed due to the next and troublesome cluster that we detected. 

Jurong Fishery Port Cluster

20.   On the evening of Friday, 16 July 2021, we started to detect multiple infections at Jurong Fishery Port, as well as in Hong Lim market.  

21.   This involved fishmongers and stall assistants going about earning an honest living, collecting fish at the fishery port, but unwittingly getting infected, and then transmitting to more people in the markets and communities where they ply their trade.  

22.   MOH, with the help of NEA, took immediate steps to prevent further spread by stopping the fishmongers and their assistants from setting up their stalls on Sunday, 18 July 2021. We then issued Health Risk Warnings which required them to undergo PCR tests and isolated themselves until they get negative results. 

23.   Of the 1,548 tested, 43 were found to be COVID-19 positive, which indicated that significant community transmission had most likely already silently occurred in the days prior to 18 July 2021.  

24.   Markets are frequented by wide segments of the public, particularly seniors, of whom one quarter are still not fully vaccinated.  The risk of infections rising uncontrollably could not be ruled out. These infections could potentially result in more cases of severe illness and even deaths among our vulnerable senior population. 

25.   Hence, the MTF decided to pre-emptively dial back to Phase Two (Heightened Alert). This came into effect on 22 July 2021. We did this to buy ourselves precious time to get more of our population vaccinated, so that we can continue on our path towards living with COVID-19 safely.

26.   The preliminary phylogenetic findings suggest that while the KTV and Jurong Fishery Port clusters were all driven by the Delta variant, it is distinct from the Delta variant that infected Tan Tock Seng Hospital and Changi Airport clusters. 

27.   The recent clusters have a Delta strain that is more closely related to what we detected in imported cases from our immediate region. 

28.   However, there are also slight genetic differences between the strains in the two clusters, suggesting that there were multiple introduction points. 

29.   As of 25 July 2021, the Jurong Fishery Port has a total of 792 cases.  It is still growing, but now at a slower rate. The daily infections numbers over the past three days were 79, 79 and 46 respectively. 

30.   Overall, we have seen a high number of daily cases at over 100 for the past few days. But the situation is stabilizing, with daily infections trending down.  

31.   Percentage of cases isolated or quarantined before turning COVID-19 positive is something we watched closely and it is on an upward trend.   On 19 July, when the cluster first broke out, we had a total of 163 cases, with only 27% isolated before detection. Lately, it hovers around 40%.  Today, we should have more than half of our cases already isolated.

32.   If we can keep raising that percentage through tracing and testing, we can progressively suppress this wave of transmission.  But our objective is not to stop transmissions completely. That is no longer possible given how transmissible the Delta variant is, and as we open up and people circulate more.  

33.   The only possible way now to eradicate infections is to go into another hard Circuit Breaker for at least a month or probably two. But we don’t want to be locked up.  Even if we do, once we open up, cases will rise again.  

34.   Eradication is therefore not possible nor sustainable. We must instead find ways to live with this virus, safely.

35.   Several Members, namely Mr Yip Hon Weng, Assoc Prof Jamus Lim, Ms Raeesah Khan, were interested to find out more about our transition plans to live with COVID-19, as an endemic disease. 

Pushing Up Vaccination Rates

36.   Vaccinations are key to this transition, and the national programme is progressing well.  As of 25 July, 54% of our population has received two doses of a mRNA vaccine.  

37.   Our population vaccination rate is going up by about one percentage point a day. By National Day, almost 70% will have received two doses. By early-September, it should be almost 80%. 

38.   This means Singapore will have one of the highest vaccination rates in the world.  It puts us in a strong position to transit to a COVID resilient society. 

39.   Our main worry is that our seniors, especially those 70 and above, are not sufficiently vaccinated. Today, just over 70% of them have received two doses of the vaccines. 

40.   Ms Tin Pei Ling asked for an update on the home vaccination scheme.  We have launched nine home vaccination teams so far.  As of 23 July, 734 seniors have received vaccinations under the programme.

41.   Further, more seniors are coming forward to our vaccination centres and mobile vaccination teams. We have been seeing about 500 seniors coming forward daily. For the past few days, this has more than doubled to over 1,000 a day.  

42.   This may be due to heightened awareness as a result of more community transmissions, the lifting of rules that had previously deferred vaccinations of those with medical conditions, and our intense outreach efforts.  

43.   Our mobile teams have gone all the way to Pulau Ubin to administer vaccines to seniors living there. We know of GPs who persuaded their clients to go for vaccinations, and then allowed them to sit in their clinics for the entire day, to assure them that help is always nearby should they feel unwell after vaccinations.  

44.   Mr Deputy Speaker Sir, this is a measure of the kind of society we are. We are making such an extraordinary effort with our seniors because we are not prepared to accept the high fatality rates among the elderly that other countries had or are experiencing.

45.  As a result of all these efforts, 77% of our seniors 70 and above have now received their first doses. Within a month or so, they should all have received their second doses, and after another 14 days, they should all be strongly protected against COVID-19.

46.   Even at our current rate of vaccination, the preliminary evidence is that it has been effective in reducing the incidence of severe illnesses and deaths.  

47.   Mr Deputy Speaker Sir, may I show a chart on screen please?  

48.   As Members can see, while daily infections have gone up sharply for the past couple of weeks, the number of patients with severe illness who require oxygen supplementation or are in an Intensive Care Unit, remains relatively low.  

49.   Currently, all of these patients with severe illnesses, are either unvaccinated or partially vaccinated. But we are watching this closely, as there is a time lag of one to two weeks between infection and the onset of severe illness. 

50.   For now, it would appear that we have successfully weakened the link between infections and severe illnesses. 

We Must Be Able to Live Normally With COVID-19

51.   While we are making good progress in vaccinating our people, we acknowledge that the recent reversion to Phase 2 (Heightened Alert) has caused some confusion amongst members of the public. They ask: are we still committed to the path towards normalcy and living with COVID-19?

52.   The answer is a definite yes. For that is the only way for Singaporeans to regain our lives and livelihoods, and for Singapore to reconnect with the world again. 

53.   Some countries, like the UK, have declared a Freedom Day, where all social restrictions are lifted at once. Others, like Israel and Netherlands, opened up and saw sharp increases in infections and hospitalisations, and decided to dial back. 

54.   Ours will be a controlled opening. We are not going to do a big bang – and then predictably blow up. The MTF has been developing a roadmap, comprising packages of measures to be implemented step-by-step, over the next few months.

55.   But even as we do so, we must bear in mind that until we reach a sufficiently high vaccination rate, especially among our seniors, we will continue to be vulnerable to unexpected setbacks, like what we are going through now. 

56    A high rate of vaccination will provide us with a more solid and stable base as we proceed on this journey. The higher the vaccination rate, the more solid the ground we walk on.

57.   So, in a way, this is the most peculiar period of our transition: We are clear about the mission; our will is firm; and we have a broad plan. But we don’t have enough antibodies inside us to ensure that we can follow through with our plans without a hitch. 

58.   But let us not underestimate the progress we have made.  The roadmap is in fact being implemented as we speak.  Our attention is often on the Safe Management Measures such as whether we can eat in restaurants, but there at least three other important aspects, namely:

a.  Restoring economic and social activities, including connecting with the outside world;
b.  Remodelling COVID-19 healthcare protocols; and
c.  Shifting our collective psychology, which will probably be the hardest.

59.    Minister Gan will speak about restoring economic activities, while Minister Lawrence Wong will speak more about enabling more social activities.  Let me talk about healthcare protocols and our collective psychology. 

Shifts In Healthcare Protocols

60.   As we learn to live with COVID-19, our healthcare protocols must be remodelled.  If COVID-19 is indeed endemic, having 200 or more cases a day may not be unusual at all.  

61.   During an Influenza season, our daily infection can go up to 1,000 a day.  Imagine we treat Influenza like we treat COVID-19 now.  

62.   We will put everyone suspected of Influenza infections through PCR tests and long isolated stays in hospitals, and quarantine everyone they came into contact.  

63.   It will disrupt the lives of many people.  Further hospital beds will all be filled, and many other patients who are sicker will be turned away. The healthcare system will not be able to cope, and that is clearly not the way to deal with an endemic disease.  

64.   We cannot carry on with the current healthcare protocols for COVID-19.  They need to shift closer to how we treat Influenza today, without extensive contact tracing and quarantine in dedicated facilities, and hospitalizing only those who are very ill. 

65.   But that can only happen when the likelihood of developing very serious or life-threatening disease as a result of COVID-19 infection has been significantly reduced by effective vaccination of our population, especially among the vulnerable groups.  

66.   With our current rate of vaccinations, we have started to take the first transition step to remodel our healthcare protocols.  As of last week, we made the following changes:

67.   First, greater use of community care facilities instead of hospitals. Vaccinated individuals aged between 45 and 59 who test positive for Covid-19 and show no or mild symptoms, can be directly admitted to community care facilities instead of going first to hospitals. 

68.   This was already the practice for all cases aged between 17 and 45 years, but we are expanding the protocol to people up to age 59.  

69.    With this change, we expect up to 60% of infected cases to recover in community care facilities, instead of in acute care hospitals. Meanwhile, we will plan for the next step, where perhaps 80% can be admitted to community care facilities, and some can even recover at home. 

70.   Second, we have shortened the length of stay in hospitals and community care facilities.  Our tests have shown that the viral load in infected persons who are fully vaccinated falls very rapidly, to a very low level after nine days. 

71.   Previously, most people generally were discharged only after 21 days.  We are now discharging fully vaccinated persons from isolation after 14 days from onset of illness with a seven-day leave of absence, so long as their tests show that they are COVID-19 negative or have very low viral loads. 

72.   We are reviewing our policy to allow fully vaccinated patients to be discharged even earlier, and to complete the rest of the isolation period at home, if their home environment is suitable. 

73.   Third, greater use of home quarantine. For fully vaccinated persons, they can now serve their quarantine at home instead of at a government quarantine facility, provided that their home is suitable for isolation.  

74.   We expect up to 40% of persons under quarantine can serve their quarantine at home, and this will go beyond 50% in the coming few weeks as more people get vaccinated. 

Shifts in Collective Psychology

75.   These are among first steps we will take in the healthcare transition. In the meantime, what we are experiencing in this current wave of transmission is valuable, for we are also witnessing a palpable shift in our collective psychology.

76.   The first is a shift away from always focusing on infection numbers.  We used to get a shock when we saw high daily numbers, because that meant more severe illnesses and deaths. 

77.   However, in recent days, that mental link is starting to be broken, as we know that with vaccinations, high infection numbers need not necessarily mean more sickness and deaths.

78.   Many people are now rightfully focusing on the number of people with severe illnesses.  As of today, despite higher infection cases over the past few days, that number is 14, and does not threaten our hospital capacity. 

79.   Many friends, including some Members of this House, have been texting me asking why don’t we publish the number of people with severe illnesses so that we know vaccination works?  

80.   Actually, the media have been publishing these numbers every day for quite a while now.  But our attention has always been on infection numbers.  It is good that attention is now shifting.

81.   A second shift is a greater acceptance of differentiated safe management measures, between those who are vaccinated and those who are not. There have been many calls to do this. Mr Xie Yao Quan has also asked about this.  

82.   This is something which the MTF has always intended to do. That was why we decided on the 2/5 rule for restaurants recently, before it was scuttled with our reversion to Phase 2 (Heightened Alert).  

83.   When our whole society is very highly vaccinated and we have transitioned to living with COVID-19, we should make very little differentiation between the vaccinated and the unvaccinated.  

84.   But during the period of transition, when we are still building up our resilience, differentiation by vaccination status is a practical way to open up some activities first, while protecting those who are still vulnerable.  

85.   MTF will revisit this during our Phase 2 (Heightened Alert) midpoint review. Minister Lawrence Wong will speak more about this later. 

Addressing Other Questions

86.  Let me address several other questions from Members.

87.   Mr Murali Pillai will be comforted to know that MOH actively monitors international developments in medical treatment options for COVID-19, through the National Centre of Infectious Diseases (NCID) and an expert committee.

88.   They have developed national treatment guidelines which are constantly updated based on new evidence.  They provide guidance to our doctors on the use of evidence-based medical treatment options for COVID-19 patients.

89.   Our local institutions have also been participating actively in international multi-centre trials investigating novel COVID-19 therapeutics. These trials have generated important data on new COVID-19 treatments such as remdesivir. 

90.   We will continue to closely monitor developments in COVID-19 treatments, proactively procure therapeutic agents which are shown to be effective, and maintain a stockpile based on projected needs.

91.   To Mr Leon Perera’s question, factors that affect COVID-19 vaccine efficacy are an area of active study in Singapore. Persons who have contracted COVID-19 are clinically assessed for risk factors and scientific papers on the correlations may be published in future. 

92.   Antibody testing is not required after vaccination, under Singapore’s national vaccination programme, and we are actively reviewing the need for vaccine boosters.

93.   We are also continually reviewing Singapore’s portfolio of COVID-19 vaccines. We plan to bring in non-mRNA vaccines that are robustly assessed for quality, safety and effectiveness.  This should happen before the end of the year, subject to supply and regulatory approval. 

94.   Testing will remain important, even as we transit to living with COVID-19.  It is only through testing, that we can know if we are infected, and do the civic-minded thing in excusing ourselves from work and staying home. 

95.   But we have to make testing simple, accessible, and affordable – even more so than now -- so that we can all do our part.

96.   Since mid-June, we have progressively rolled out regular Fast and Easy Tests for staff working in higher-risk settings. This includes a network of sixteen Quick Test Centres, which we intend to expand further. 

97.   In response to Ms Joan Pereira’s question, the Quick Test Centres will support small businesses by allowing their staff to walk in and get themselves tested and have their results recorded. At some point, I believe some Quick Test Centres should also be using breathalyser tests.

98.   We will continue to work with NEA to deploy wastewater testing across Singapore. Currently, NEA has deployed 270 autosamplers across about 200 sites. We are increasing this to 500 autosamplers across 400 sites by end of this year. 

99.   Wastewater testing is an increasingly strategic resource as we learn to live with COVID-19.  We can deploy them in areas where we suspect transmission is happening such as around all the markets that are currently affected , or where we know many unvaccinated seniors live.  

100.   Such testing is non-intrusive, and would give us valuable early warning when COVID-19 starts to take hold in a locality, and prompts us to take further public health measures in the affected residential estates. 

101.   Mr Darryl David, Dr Lim Wee Kiak and Mr Murali Pillai, asked about the safety of the COVID-19 vaccines. MOH has been publishing monthly safety updates on our website.  It also gives an age breakdown of the affected persons, and indeed the majority are young people. 

102.   As of 30 June 2021, HSA had received 12 reports of myocarditis and pericarditis occurring in persons after receiving a dose of the mRNA-based COVID vaccine. While there is a small increased risk among those in the younger age groups relative to the baseline rate, the local incidence rate remains low. 

102.   One of the reported cases is a full-time national serviceman in the Singapore Armed Forces who is below 30 years old. None of the cases was from the Singapore Police Force and Singapore Civil Defence Force.

103.   We implemented the Vaccine Injury Financial Assistance Programme or VIFAP to give greater peace of mind to people taking the vaccination. 

104.   But remember that with or without vaccination, there is a baseline number of disease cases amongst our population. Since the vast majority of Singaporeans have stepped forward to be vaccinated, there will naturally be numerous incidents which just happen to coincide with vaccinations.  

105.   Hence, we have to do what is practical and reasonable, which is to have VIFAP applications reviewed by a panel of medical experts, who will consider them against known evidence about the vaccines.
 
106.   A few Members have also asked about the Sinovac-CoronaVac (Sinovac) vaccine. As at 25 July 2021, about 72,000 persons have received at least one dose of the Sinovac vaccine, and about 17,000 persons have received their second doses. Amongst them 28% are Singapore Citizens, and they are mostly young. For those who have taken the Sinovac vaccine and are seniors above 60 years old, less than 10% are Singaporeans.

107.   If the supply of 200,000 doses which the Government has procured is insufficient to cater to the demand, private clinics can bring in additional supply, as is the case for any other WHO EUL vaccine, under the Special Access Route. 

108.   As of 9 July 2021, HSA had received 10 adverse event reports following vaccination with the Sinovac vaccine comprising mainly allergic reactions such as itch and rashes.

109.   As for concessions on safe management measures, the data on the efficacy of the Sinovac vaccine against the Delta variant is still building up.  Sinovac has also recently submitted the required safety data for their application for the Pandemic Special Access Route approval.  

110.   The Health Sciences Authority and our Expert Committee are going through the various data.  When the evidence justifies it, we will certainly want to extend the concessions to individuals who have received the Sinovac or other vaccines which may qualify. 

Conclusion - Progressing with Unity

111.   Mr Deputy Speaker Sir, let me conclude. 

112.   As a Government, we need to recognize that our society is diverse, with different segments of the population having different opinions, needs and wants.  When these differences cannot be reconciled, we agree to disagree, and live and let live.  

113.   At the same time, we do our best to unite and forge a consensus, for what is a society without shared commonalities?

114.   This is what a responsible Government needs to do across a range of issues -- from education, healthcare and public housing, to racial harmony and free trade. We must always try to strike the right balance between forging consensus and respecting diverse views.  

115.   It is the same when it comes to learning to live with COVID-19.  

116.   On the one hand, we have the young, vaccinated individuals who feel that we should open up and allow vaccinated individuals to enjoy more social activities.  On the other,  we still have a sizeable segment of older Singaporeans who for medical or other reasons, are yet to be vaccinated, and who remain vulnerable.

117.   Differentiated safe management measures is something we have to put in place  for public health reasons, and to protect the unvaccinated.  At the same time, we must do our best to get more of the vulnerable vaccinated. As I reported just now, we are making progress.  

118.   And for the non-vulnerable, as more of you get vaccinated, when you show more consideration to others, you are also doing your part to better protect the vulnerable. Remember, our children, nieces or nephews or younger brothers and sisters, under 12, will not be vaccinated for a while yet.  

119.   When we work together as a people, we will bring ourselves to a much stronger and more resilient position, and our transition to living with COVID-19 will gather pace.

120.   Mr Deputy Speaker Sir, Singapore is one of the few countries to have come through the last 20 months of the pandemic with very few fatalities. And we can look forward with confidence to living with an endemic COVID-19 because a high proportion of our population will be fully vaccinated. 

121.   Most of the developing world still has little access to vaccines. But even among the countries and regions which have the vaccines, Singapore is unique.

122.   We have one group -- including the US, UK, Israel and many EU countries --  which went through major episodes of widespread transmission, their hospitals overwhelmed and with many fatalities. They are now highly vaccinated and opening up their economies and societies. 

123.   And then there are the likes of Australia, New Zealand, and Hong Kong, who kept the pandemic under control, but are now finding it a challenge to get their people vaccinated, partly because their lives have not been very threatened by COVID-19.

124.   This will make us perhaps the only country in the world, which has not suffered a collapse of our hospitals nor a high death toll, and at the same time achieved a very high vaccination rate in our population. 

125.   This uniqueness is due to the unity of our people, the trust amongst them, and between the people and Government. We can look towards The Road Ahead with confidence and optimism. Thank you.