COVID-19 Infections within Residential Healthcare Facilities

From 1 April 2022 to 30 September 2022, there were around 330 reported cases from COVID-19 clusters in hospitals. Over the same period, around 3,000 COVID-19 cases were reported by the nursing homes. These constitute a small proportion – less than 1% – of total reported community cases. As we move towards living with COVID-19, we no longer adopt a zero-COVID posture in hospitals and nursing homes, where all patients or nursing home residents need to be tested before admission and where infected patients are isolated in hospital COVID wards.

Notwithstanding, we continue to take necessary precautions to protect patients and residents, and are ready to step up the COVID-19 measures, such as visitor restrictions, when necessary. Vaccination is our primary defence. It cannot completely stop infections but is very effective in preventing severe illness from COVID-19. We have provided COVID-19 vaccinations to over 90% of eligible nursing home residents. With these measures, we have kept Singapore’s overall case fatality rate at about 0.1%, well below the global average of around 1%.

Thank you, Speaker. I have three supplementary questions for the Senior Minister of State. Earlier, he cited some figures about patients and residents who had contracted COVID-19 from within these facilities. I think he mentioned 330 in hospitals and about 3,000 in nursing homes over that period of time. May I ask him how confident is he that these are not under-estimates of the actual situation because some patients could be asymptomatic and I am not sure whether there is 100% testing daily?

The second question is that, there are some studies in the UK which suggest that within healthcare facilities, patient-to-patient transmission was more a common cause of infections rather than, say, from healthcare workers to patients. I wonder whether the Ministry has been studying this issue and whether the Senior Minister of State can elaborate on whether it is the case that it is more likely to be patient-to-patient transmission rather than healthcare worker-to-patient, or whether the Ministry has some other grasp of the nature of the transmissions?

And finally, I understand from some other overseas studies as well in the UK that hospital-acquired infections may be affected by things like ventilation systems and design of wards. Is the Ministry looking into these methods as well?

Sir, the numbers may be an under-estimate. We did not do daily testing on everybody. I think the Member would agree this would be inappropriate to subject every person within this space – whether a healthcare worker, a patient or a visitor – to daily testing. We took a risk-based approach within nursing homes and hospitals, as we did within the community and in different locations. Under different circumstances, the risks change, and so, we did a risk-based approach on testing.

Having said that, we have quite a lot of data over the last three years. That data is applicable to the community setting, the hospitals as well as the nursing homes. This has allowed us and the scientists in our system to model the transmission and the clusters and the spread of COVID-19 within different settings. So, to answer the question, yes, it may be an under-estimate, but I think we are confident that we have a robust handle on the relative proportions. So, it is approximately correct – 330 versus 3,000. I do not think our under-estimate is so far off that the numbers would be reversed, for example, or that we are in the order of magnitude of a significant percentage off. We are about right and we have some confidence that we are about right.

Her second question was whether patient-to-patient transmission or healthcare worker-to-patient transmission, which was a greater contributory factor in our setting, in our system. I do not have the data in front of me. I would encourage the Member to file a separate question if she would like further information on that. But if I may make a related, tangential point, which is that the COVID-19 circumstances changed quite significantly over the three years. Simplistically, we had different variants with different transmissibility and infectivity characteristics, but we also had very significantly different measures in place at different time periods over the nearly three years. And so, I would think it would be too much, too reductionist, too simplistic to look at the overall picture. This would require quite a detailed study to be able to come to a conclusive position as to which was a greater risk at any one point in time. I think it is a little bit too simplistic to say it is one or the other. But I would be happy to take this up if the Member would like to file a question and we will try our best to provide her what data we may or may not have.

Her third question was whether the design of the wards, the ventilation, can affect hospital-acquired infections. Indeed, there are things that have been studied prior to COVID-19. There are people looking at this and looking at this not with respect to just one infection but a wide variety of infective agents which may affect our patients within the hospitals. So, the short answer is yes.