SINGAPORE TO EXIT ACUTE PHASE OF PANDEMIC

Singapore’s COVID-19 situation has remained stable in recent months. This is despite increased travel over the year-end holiday period, the Northern Hemisphere winter season and China’s shift away from a Zero-COVID policy. We are therefore able to step down the remaining few COVID-19 measures, and establish an endemic COVID-19 new norm.

2. That said, the virus will continue to evolve, and we should expect new infection waves from time to time, and over and over. An endemic COVID-19 new normal will therefore not be static, and we will adjust our measures when necessary. But unless it is a very dangerous and virulent variant, we should be able to manage these subsequent waves with an appropriate level of measures that does not deviate significantly from the new norm, and continue to live our lives normally.

Updates on Global Situation

3. Globally, the number of new COVID-19 cases has been declining since late December 2022, and viral variants of higher severity have not emerged. Infection waves in the Northern Hemisphere and in China are rapidly subsiding. Locally, there was no significant increase in the number of imported cases. The World Health Organization has recently acknowledged that the pandemic is nearing a turning point, signaling that the global COVID-19 emergency may be ending soon. Amidst the improving international situation, several countries have recently eased COVID-19 measures or signaled further steps towards treating COVID-19 as an endemic disease.

Updates on Local Situation

4. Our population has developed a high level of hybrid immunity and is well protected from severe COVID-19. Around 80% of our population have achieved minimum protection, and around half are up to date with their vaccinations. Many have also recovered from infection during previous COVID-19 waves. With this, the risk of COVID-19 infections leading to severe illness or death has become very low, comparable to other endemic respiratory diseases, such as influenza or pneumococcal infections. Over January 2023, the daily number of COVID-19 related hospitalisations stayed below 100, and daily COVID-19 related patients in the Intensive Care Unit (ICU) remained in the single digits.

Stepping Down to DORSCON Green

5. The Disease Outbreak Response System Condition (DORSCON) framework gives an indication of the current disease situation. With the stable global and local situation, the mild nature of the disease especially among vaccinated individuals, and the minimal disruption posed to our healthcare capacity and daily lives, we will adjust the current DORSCON level from Yellow to Green from 13 February 2023.

Stepping Down Community Measures

6. From 13 February 2023, we will step down the following community measures:

Mask-Wearing

7. Mask-wearing on public transport and indoor healthcare and residential care settings will no longer be required under the temporary COVID-19 regulations.

8. However, the Ministry of Health (MOH) will retain the practice of mask-wearing for visitors, staff and patients in healthcare and residential care settings, where there is interaction with patients and in indoor patient-facing areas (further details in Annex A and Annex B). Examples are hospital wards, clinics and nursing homes. This will be a MOH requirement rather than mandated under the COVID-19 regulations. This is to better protect patients and healthcare workers from infectious diseases in general.

9. Besides healthcare, other authorities may also require mask-wearing, just as the Singapore Food Agency has required food handlers to wear a mask or spit guard for food safety reasons. Private enterprises may also opt to maintain mask-wearing requirements as company policy for workplace health and safety or business continuity reasons.

10. As mask-wearing is an effective way to minimise the risk of infectious diseases, we encourage members of the public, especially the elderly and immunocompromised, to wear masks in crowded places, or when visiting or interacting with vulnerable persons. We strongly advise individuals who are unwell with symptoms of COVID-19 or other respiratory infections to wear a mask when they need to leave their homes.

Revised Health Advisory

11. We will stand down Protocols 1-2-3 from 13 February 2023. Henceforth, unwell or infected persons should follow the updated general advisory as follows:

• Medically vulnerable persons (i.e. seniors and those with chronic medical conditions) that have Acute Respiratory Infection (ARI) symptoms, as well as persons with severe, prolonged or worsening ARI symptoms, should see a doctor. The updated advisory for persons who are at increased risk of severe COVID-19 can be found at this link.

• Persons with mild ARI symptoms should stay at home until symptoms resolve

• If there is a need to go out while symptomatic, or if asymptomatic but tested positive for COVID-19, we should exercise social responsibility – minimise social interactions, wear a mask, avoid crowded places, do not visit vulnerable settings such as hospitals and nursing homes, and do not have contact with vulnerable persons, such as the elderly.

Public Health Measures for Migrant Workers Living in Dormitories

12. From 1 March 2023, the Ministry of Manpower (MOM) will also align measures for migrant workers (MWs) living in dormitories with the new general advisory for the community. MWs with mild ARI symptoms may recover in their dormitory or see a doctor if they wish at any primary care provider clinic. COVID-19 tests will only be administered for symptomatic vulnerable MWs or those with severe ARI symptoms. In addition, MWs who test positive for COVID-19 will not need to be conveyed to COVID-19 recovery facilities but may recover within their dormitories. MWs with more serious symptoms (e.g. shortness of breath, chest pain) will be conveyed to the emergency department of public healthcare institutions.

13. Migrant workers have been free to exit dormitories and visit community areas since the beginning of 2022. The Popular Places Pass is a contingency measure to manage crowding in four designated popular locations on Sundays and public holidays. Notwithstanding, passes have been ample and no migrant worker had been prevented from visiting the community. In line with the move to DORSCON Green, the Popular Places Pass will be discontinued from 13 February 2023.

Stepping Down TraceTogether (TT) and SafeEntry (SE)

14. TT and SE served us well during the acute phase of the pandemic by accelerating our contact tracing efforts and enabling the implementation of community safe management measures. Over the past few months, as the pandemic situation stabilised, the Government has progressively stepped down TT and SE. We no longer require infected persons to submit TT data, SE data is no longer being collected, and MOH has deleted all identifiable TT and SE data from its servers and databases.

15. The TT data pertaining to a murder case in May 2020 will be retained indefinitely. This is especially necessary for serious cases such as murder, where legal applications may be made to challenge the conviction or sentence many years after the case has concluded, and the Singapore Police Force (SPF) may be obliged to disclose the data.

16. It is nevertheless useful to keep both the TT and SE systems ready for reactivation for the contingency when a new, more dangerous Variant of Concern breaks out. For this purpose, registration details such as name, business UEN, and mobile number will be retained in the system, to minimise the steps taken by individuals and companies to set up and re-register for TT and SE, should it be needed.

17. Members of the public can uninstall their TT App, and enterprises may do the same for the SE (Business) App. Both the TT and SE (Business) Apps will remain available on the App Store, Google Play Store and Huawei AppGallery for quick reactivation if needed.

18. A TT Token return exercise will take place from 13 February to 12 March 2023. Members of the public can return their Tokens at TT Token counters that will be open at all 108 Community Clubs/Centres (CCs). We strongly encourage the public to return their Tokens so that they can be refurbished and recycled for distribution to those who need it, should digital contact tracing operations have to be reactivated.

Regularising COVID-19 Financing Schemes

19. As we treat COVID-19 as an endemic disease, we will further scale back pandemic subsidies and re-align the provision of financing support for COVID-19 testing and treatment to that of other acute illnesses. The following changes will thus be implemented with effect from 1 April 2023^[1]:

a) Hospitals and COVID-19 Treatment Facilities (CTFs). All patients, including Singapore Citizens, Permanent Residents and Long-Term Pass Holders (SCs/PRs/LTPHs) regardless of vaccination status, who visit a hospital or CTF for COVID-19 treatment will no longer be accorded 100% subsidy. Instead, our regular healthcare safety nets, namely, Government subsidies, MediShield Life and MediSave will apply to SCs and PRs and defray their healthcare expenses. We wish to assure lower income Singaporeans that financial assistance will be available to ensure that healthcare cost remains affordable.

b) Community Isolation Facilities (CIFs). CIFs will no longer be required for COVID-19, just as they are not required for other endemic diseases like influenza or chicken pox. Nevertheless, we will maintain some CIFs for COVID-19 patients who want to self-isolate for valid reasons. However, all occupants, including SCs/PRs/LTPHs, will be charged for their stay. As CIFs are not medical facilities, SCs and PRs will not be able to tap on Government subsidies, MediShield Life or MediSave to pay for their bills.

c) Primary care settings (Polyclinics and GP clinics). All patients will be required to pay for any COVID-19 testing, subject to prevailing subsidies.

20. COVID-19 vaccines and therapeutics. COVID-19 vaccinations and COVID-19 oral antivirals will remain fully subsidised for clinically eligible patients in outpatient (including primary care), ambulatory settings of public hospitals and nursing homes, until further notice. This is because these are important preventive steps and treatments to avoid severe disease and hospitalisations, and will remain an important part of living with COVID-19. Additionally, patients with a higher risk of severe COVID-19, such as the immunocompromised and individuals with some comorbidities, may be referred by their doctors for free telemedicine support.

Stepping Down Border Measures

21. We launched the Vaccinated Travel Framework (VTF) in April 2022 to facilitate the safe resumption of international travel. In view of the stable and improving global COVID-19 situation, and the low impact of imported cases on our healthcare capacity, we will stand down the remaining COVID-19 border measures. From 13 February 2023, all non-fully vaccinated travellers entering Singapore will no longer be required to show proof of a negative Pre-Departure Test. Non-fully vaccinated Short Term Visitors will no longer be required to purchase COVID-19 travel insurance. However, the VTF will remain in place for reactivation if there are international developments of concern, such as new severe variants or signs that our healthcare capacity is strained by imported cases.

22. MOH continues to screen travellers for other infectious diseases of concern, such as Yellow Fever, Middle East Respiratory Syndrome and Ebola. All travellers entering Singapore via air or sea (including Singapore residents), and Short-Term Visitors entering via land, must continue to submit a health declaration via the SG Arrival Card e-service. Travellers are advised to check the ICA website for the latest border measures before entering Singapore.

Vaccination as our Primary Defence in Living With COVID-19

23. Vaccination remains our first line of defence against COVID-19. Our high vaccination rates have been pivotal to enable us to weather successive waves of COVID-19 infections, build up our societal resilience, protect our healthcare system, and arrive at the endemic COVID-19 norm today. Given our high level of resilience and with the transition to an endemic COVID-19 new normal, the Expert Committee on COVID-19 Vaccination (EC19V) has reviewed our vaccination guidelines, and MOH agrees with the updated recommendations, as follows:

a. Everyone aged 5 years and above should achieve at least Minimum Protection – that is, three doses of mRNA or Novavax vaccine, or four doses of Sinovac vaccine.

b. Persons at higher risk of severe disease from COVID-19, that is, persons aged 60 years and above, medically vulnerable persons, and residents of aged care facilities, are recommended to take the booster around one year after the last booster dose. We urge them to receive their booster dose this year when they become eligible for it.

c. Persons aged 12 to 59 years who are healthy have a lower risk of severe disease. Nevertheless, a booster around one year after their last booster dose will be offered to enhance their protection.

d. Persons aged 5 to 11 years continue to be recommended to achieve Minimum Protection. They are neither recommended nor eligible for additional doses at this time.

e. Children aged 6 months to 4 years continue to be recommended to complete two doses of Moderna/SpikeVax or three doses of Pfizer-BioNTech/Comirnaty. They are not recommended nor eligible for additional doses at this time.

24. As mentioned earlier, COVID-19 vaccinations under the National Vaccination Programme will continue to be offered free to all Singapore Citizens, Permanent Residents, Long Term Pass Holders and certain Short Term Pass Holders. All persons eligible for COVID-19 vaccination may book an appointment at the Joint Testing and Vaccination Centres, participating Public Health Preparedness Clinics, polyclinics and Vaccination Centres.

25. As part of ongoing efforts to ensure vaccination remains convenient for our seniors, we will continue deploying mobile vaccination teams (MVTs) to heartland locations. Between 15 February and 2 April 2023, MVTs will be deployed to multiple heartland locations for three days each. The full list of MVT sites and schedules will be continually updated at https://gowhere.gov.sg/.

26. MOH, with the advice of EC19V, will update our vaccination recommendations in future and when needed.

Vaccination Requirements for Permanent Residence, Long Term Passes and Work Passes Remain in Place

27. The COVID-19 vaccination requirements for new Permanent Residence, Long-Term Pass and Work Pass applications, as well as the renewal of selected Work Permit Holders and S Pass Holders in the construction, marine shipyard and process sectors or residing in dormitories, will remain in place to maintain the high level of vaccination coverage nationally. From 1 April 2023, persons who recently recovered from COVID-19 will no longer be given temporary exemption from COVID-19 vaccination requirements. Applicants are advised to check the ICA and MOM websites for the latest requirements before applying.

Standing Down of the Multi-Ministry Taskforce

28. The Multi-Ministry Taskforce (MTF) was convened in January 2020 to mount a swift and coordinated whole-of-Government response against COVID-19. With the transition to DORSCON Green, the MTF will be stood down and the Ministry of Health will assume the management of the COVID-19 situation. However, if the situation worsens significantly, we will reactivate an appropriate multi-agency crisis management structure.

Staying Vigilant

29. MOH will continue to keep a close watch on the evolving COVID-19 situation. Ongoing surveillance of local and imported cases and through international partnerships, such as GISAID, will help to provide early warning signals of new variants with greater transmissibility or severity.

30. We will also continue to monitor our healthcare capacity. If there are signs that our healthcare capacity is becoming strained or a new and more dangerous variant has emerged, we may have to revise the DORSCON level, and reactivate some of our community and border measures again at short notice. There may be a need for the population to urgently receive boosters to ensure that we remain protected. Should this happen, we seek the support of everyone in Singapore to rally together again as we have over the past three years to overcome any new threat.

Reflecting on Our Fight Against COVID-19

31. We have engaged in a long campaign against COVID-19 and have emerged as a more prepared, resilient, and united nation with one of the lowest COVID-19 death rates in the world. We thank all Singaporeans for playing a part in keeping themselves and others safe, and exercising social responsibility to prevent COVID-19 infections, such as getting vaccinated, mask-wearing and adopting good hygiene practices. We encourage Singaporeans to continue these good practices.

32. We would like to express our deepest appreciation to healthcare workers, who stood at the frontlines of our battle with COVID-19 and tirelessly supported the pandemic response effort over the last three years. We are also deeply appreciative of all those who have contributed to our fight against COVID-19, whether in developing policies and plans, in procurement and logistics, in enforcement and engagement, and a whole spectrum of backend support operations.

33. We have been reviewing our experience in grappling with COVID-19 over the last three years. We will learn from this experience, so that Singapore can be prepared to respond to future pandemics.

MINISTRY OF HEALTH

9 February 2023

^[1] Applies to new admissions in public hospitals, COVID-19 Treatment Facilities and Community Isolation Facilities from 1 April 2023.