Omicron Vaccinations and Healthcare Capacity

NOTICE PAPER NO. 1202
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 4 JULY 2022

Name and Constituency of Member of Parliament 
Mr Ang Wei Neng 
MP for West Coast GRC

Question No. 3055 

To ask the Minister for Health in the light of the recent rise of COVID-19 infections in Singapore, especially with the increase in the Omicron subvariants infection in the community, what steps will the Ministry take to (i) reduce the infection rate and (ii) encourage seniors to take their second COVID-19 booster shot.

NOTICE PAPER NO. 1181
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 5 JULY 2022

Name and Constituency of Member of Parliament 
Mr Yip Hon Weng
MP for Yio Chu Kang

Question No. 2979 

To ask the Minister for Health (a) whether our healthcare settings are adequately equipped to handle the next COVID-19 wave expected in July or August 2022; and (b) whether the Ministry can provide an update on the re-design of COVID-19 community treatment facilities. 

NOTICE PAPER NO. 1202
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 4 JULY 2022

Name and Constituency of Member of Parliament 
Ms He Ting Ru
MP for Sengkang GRC

Question No. 1887 

To ask the Minister for Health since the start of the COVID-19 pandemic (a) how much has been spent on subsidizing COVID-19 patients for (i) in-patient treatments and (ii) outpatient treatments; and (b) whether there are plans to cut down on the number of Public Health Preparedness Clinics. 

NOTICE PAPER NO. 1183
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 5 JULY 2022

Name and Constituency of Member of Parliament 
Mr Yip Hon Weng
MP for Yio Chu Kang

Question No. 1847 

To ask the Minister for Health (a) whether personal reminders will be sent to those eligible for their second COVID-19 booster shot; and (b) for those who have contracted COVID-19 recently, what is the advisory with regard to them getting their second booster shot. 

Answer   

Madam Deputy Speaker, with your permission, may I address the PQs for oral answer No.2 and 3 in the order paper, and in my reply, I will also cover written PQs No. 43 and No. 21 filed by Ms He Ting Ru¹ and Mr Yip Hon Weng² on the topic of COVID-19, filed for 4 and 5 July respectively, please. 

Mr Ang Wei Neng asked how we will reduce infection rates of the Omicron subvariant transmission. We anticipated this wave when we learnt about the subvariants BA.4 and BA.5, which have a significant growth advantage over BA.2. This wave however, arrived slightly earlier than the July - August timeframe that we expected. 

That is why we have maintained the indoor masking requirement even when cases were low and stable, in order to moderate the infection rate when this new wave arrives. High vaccination coverage that we have will also tamp the size of the wave. To reduce the infection rate further, all of us can play our part, stay at home when we do not feel well, test ourselves regularly, especially if we are meeting people who are vulnerable or attending big meetings or events, such as before coming to Parliament. 

And if we still want to reduce the infection rate even further, more stringent Safe Management Measures (SMMs) will need to be implemented. That means re-introducing things like group sizes, capacity limits, masking outdoors. 

As Minister for Health, I can never say we will rule out these steps if we are hit with a serious infection wave, but as far as possible, we should avoid them, especially if we are reasonably confident that our hospital capacity can hold up, and that we are determined to live with COVID-19 and continue our journey of endemicity. 

For this current wave, our assessment is that it will not be as severe as the Omicron wave we experienced earlier this year. This is because many more of us have gained stronger immunity either through booster shots or recovery from infections. And this will significantly impede the circulation and transmission of the BA.4 and BA.5 viruses. 

In South Africa, the second Omicron wave driven by these two subvariants was approximately a third of the peak of the previous Omicron wave. But every country’s experience will be different and unique. But we have good reason to believe that this will be a smaller wave than the last. 

Today is Tuesday. Tuesday is always the day where cases spike up. We should expect at the end of today, case numbers of over 12,000. This is a tad higher than the same time last week, which was over 11,000, 10% more than last week. So there are indications that we are near the peak, if not, at the peak. We should be relieved that the number did not double from last week, otherwise we would be at 24,000, or 22,000 this week.

The key is to ensure that hospital capacity is not overly stressed. And here, we have been relying on two strategies. First, ensure high vaccination and booster coverage so that as many people as possible are protected from severe illnesses if they are infected. Second, ensure that our healthcare institutions and facilities are prepared and able to ramp up, should there be increased admissions. These strategies continue to be relevant for this current wave. 

Let me talk about the first point, in response to Mr Ang Wei Neng’s and Mr Yip Hon Weng’s questions. The most important is for everyone who is eligible to take their first booster shot or their third shot (first booster, third shot). After several mutations, we now need three shots of vaccines to properly protect ourselves against the Omicron variant. The vaccines were developed in the early days - the wild type of the Alpha and the Beta only two shots were needed. With more mutations, we now need three shots. 

There are about 60,000 seniors aged 60 and above who have not taken their first booster or third shot. This number has come down from last week, when DPM Wong and I announced that there were 70,000 and it has now come down to 60,000.  So they are coming forward, which is a good thing but we urge all of our seniors who have not taken your booster shot, your third shot, to do so quickly. Because it makes a huge difference as to whether you will fall severely sick if infected. 

We have also recommended since March that vulnerable individuals should take a second booster, or a fourth shot. This includes all persons aged 80 and above, those living in aged care facilities, or those with underlying illnesses, and are vulnerable. 

In recent months, we have stepped up our efforts to remind seniors to do so. We made regular announcements and have been progressively sending out SMS notifications, reminders, to eligible individuals. They can walk into any Joint Testing and Vaccination Centre, participating Public Health Preparedness Clinics (PHPCs) or Polyclinics to receive their second booster dose. Alternatively, individuals can also book an appointment using your notification SMS. 

Since 27 June this year, we have also been sending out our mobile vaccination teams (MVTs) to our heartlands to make it even more convenient for our seniors to get vaccinated and boosted. We will cover a total of 60 sites. Last week, we planned for 50. We are going to increase it. Now it will cover 60 sites. Staff and volunteers from our partners, People’s Association (PA) and Silver Generation Office (SGO), they are also reaching out to our seniors through house visits, through engagement dialogues and to address many of the queries that our seniors may have. Many members of this House have been reaching out and talking to seniors and engaging them. Thank you very much for doing so. 

Persons who are recommended to receive the second booster under prevailing recommendations should proceed to do so, even if you have contracted COVID-19 previously. Ideally, an individual should wait 90 days after infection to take your second booster. It will help the booster shot work better. So wait 90 days to take your booster. But if you are in a hurry for whatever reasons, we will offer the second booster at least 28 days after your infection. So please, tell your residents, if you have been infected it does not mean that you are exempted from the booster. All of us respond differently. Some of us have hardly any response. So to be safe, take your booster shot.

The second prong of our strategy is to augment and optimise our healthcare capacity. While current international and local evidence show that severity of the Omicron subvariants are not worse compared to that of the earlier Omicron strains, our hospitals, GPs and other healthcare institutions are on standby to bolster their capacity to prepare for future waves. 

Our hospitals remain ready to ramp up dedicated ICU and isolation bed capacity should there be an increase in the number of COVID-19 patients who require hospitalisation. Actually, they are, and they are already doing so, and they are now very busy. We have also maintained sufficient beds in our COVID-19 Treatment Facilities (CTFs) to manage serious cases but do not need hospital care. We have recently consolidated our CTFs from about 2,000 over beds to 1,300 beds but with higher manning ratio, and this will make it easier to transfer patients from acute hospitals to the CTFs without a significant drop in level of care. They are now about 25% occupied. 

Our GPs continue to take care of COVID-19 cases within the community, and Nursing Homes are equipped to manage lower risk cases within their facilities. To help reduce risk of developing severe disease and hospitalisation, COVID-19 therapeutics such as the oral antivirals (e.g. Paxlovid) are made more readily available in primary care and Nursing Home settings as early treatment, and pre-exposure prophylaxis is available in hospital outpatient settings for at risk populations. As at 30 June, all polyclinics and 103 participating PHPCs can prescribe oral antivirals to clinically eligible patients in the community. 

With these measures, the vast majority of cases are managed outside of hospitals, which is appropriate, given the high level of vaccination in our population.

However, our public hospitals continue to face high demand from non-COVID-19 patients, what we call business-as-usual (BAU) patients. Over time, we hope more of our CTFs can be multi-purpose isolation and treatment facilities, for both COVID-19 and non-COVID-19 patients. We have already reconfigured one of our CTFs at Sengkang Community Hospital into this new model and we will explore converting other CTFs. 

Finally, Ms He Ting Ru asked about healthcare subsidies related to COVID-19 pandemic. As at end FY2021, the Government has spent about $730 million and $220 million on subsidising inpatient and outpatient treatments for COVID-19 respectively.

Since February 2020, we have progressively stood up more than 1,000 PHPCs. Alongside our polyclinics, the PHPCs play critical roles in providing government-subsidised swabs, COVID-19 vaccinations, and oral antivirals. We did not reduce the number of PHPCs earlier because we anticipated a new wave of infection, which did happen. And we are in the middle of this new wave now and it will be inappropriate to stand down PHPCs at this juncture. This is in response to Ms He’s question. 

So in conclusion, Singapore has been weathering the COVID-19 pandemic through a comprehensive approach. While we have assessed that there is no need to tighten SMMs for now, we urge everyone, play our part to take the necessary precautions, and exercise individual and social responsibility to keep the infection rates low, support our healthcare workers and healthcare institutions to weather through this wave.

[1] This refers to PQ 1887: To ask the Minister for Health since the start of the COVID-19 pandemic (a) how much has been spent on subsidizing COVID-19 patients for (i) in-patient treatments and (ii) outpatient treatments; and (b) whether there are plans to cut down on the number of Public Health Preparedness Clinics. 

[2] This refers to PQ 1847: To ask the Minister for Health (a) whether personal reminders will be sent to those eligible for their second COVID-19 booster shot; and (b) for those who have contracted COVID-19 recently, what is the advisory with regard to them getting their second booster shot.