Adequacy of Healthcare Settings to Handle Next COVID-19 Wave and Steps to Reduce Infection Rate Given Increase in Omicron Variants

Mr Yip Hon Weng asked 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 redesign of COVID-19 community treatment facilities.

Thank you. 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 and 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. The high vaccination coverage that we have will also temper 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 if we attend 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. And that means reintroducing things like group sizes, capacity limits and masking outdoors. As the Minister for Health, I can never say we will rule out these steps.

We cannot rule out these steps when 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. 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 one-third of the peak of the previous Omicron wave. 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 when cases spike. 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. And we should be relieved that the number this week did not double from last week. Otherwise, we will 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 that I will go through today: 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 capacity, 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 and Mr Yip Hon Weng’s questions. The most important is for everyone who is eligible to take their first booster or their 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 – or Alpha and Beta – when you need only two shots. 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 Deputy Prime Minister Lawrence Wong and I announced that there were 70,000. It has now come down to 60,000. So, they are coming forward, which is a good thing. But we urge all our seniors who have not taken your booster shot, your third shot, to do so quickly because it makes a huge difference whether you will fall severely sick if infected.

We have also recommended since March that vulnerable individuals should take a second booster, or your 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 and reminders to eligible individuals. They can walk into any Joint Testing and Vaccination Centre or participating Public Health Preparedness Clinic (PHPCs) or polyclinic to receive their second booster dose. Alternatively, individuals can also book an appointment using their notification SMS.

Since 27 June this year, we have also been sending out 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 we will cover 60 sites.

Staff and volunteers from our partners, People’s Association and Silver Generation Office, are also reaching out to our seniors through house visits and engagement dialogues to address many of the queries that our seniors may have. I also know that many Members of this House have been reaching out, 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 work better. So, wait 90 days and 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 you are exempted from the booster". All of us respond differently. Some of us hardly have 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 is 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, there is and they are already doing so and are now very busy.

We have also maintained sufficient beds in our COVID-19 Treatment Facilities, or CTFs, to manage serious cases that do not need hospital care. We have recently consolidated our CTFs from about 2,000-over beds, to about 1,300 beds, but with a higher manning ratio. This will make it easier to transfer patients from acute hospitals to 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. 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 oral antivirals, for example, 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 of 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 the "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, 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. We are now in the middle of this new wave and it will be inappropriate to stand down PHPCs at this juncture. This is in response to Ms He Ting Ru's question.

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 to play our part to take the necessary precautions, exercise individual and social responsibility to keep infection rates low, support our healthcare workers and healthcare institutions to weather through this wave.

Thank you, Mdm Deputy Speaker. I also thank the Minister for the very comprehensive reply. Can I ask the Minister what is the percentage of the recent COVID-19 infections that are caused by the two subvariants BA.4 and BA.5 and whether MOH is considering sourcing Moderna and Pfizer-BioNtech's updated COVID-19 booster shots that can better target the Omicron subvariants?

Thank you. Of all infections now, the latest number is about 50% are the BA.4 or BA.5 – mostly BA.5 – subvariants. It has been doubling every week. It started with 3%; then 5%; then 8%; then 16%; then 30% last week and50% this week. By next week, I would expect it to be 70%, 80%. It is clearly a more dominant subvariant, compared to BA.2.

Pfizer-BioNTech and Moderna, as the Member pointed out, are, indeed developing bivariant vaccines, which means these target two viruses: the original wild type that started in Wuhan as well as the Omicron variant.

Early data does show that these bivariant vaccines elicit a stronger immunity response in individuals who have taken them but it is very early days. We will continue to study the risks and benefits of using such a bivariant vaccine, how to apply it in Singapore. As of now, our contracts with both pharmaceutical companies do allow us to accept shipment and implement them when ready, probably by end of the year, if they are approved, the data shows it is alright and we receive the shipment.

But – I should add the very important "but" – do not wait for this bivariant vaccine and hold back taking your booster. We have 60,000 seniors, and also those with health conditions, they are vulnerable. If you have not taken your first booster, you need to take it now. And if you are 80 years old and above, living in an aged care facility and vulnerable, you do need to take your second booster now. The current booster, the current formulation works very well in preventing you from falling very sick. So, do not delay taking your booster.

Thank you, Mdm Deputy Speaker. I thank the Minister for his reply. I have two supplementary questions. First, it was previously reported that there was a wave of manpower leaving the public healthcare sector. Have we been able to hire new staff to make up the shortfall? Is it enough for the next wave?

Second, the number of hospitalised COVID-19 cases has increased over the last three weeks. Will there be a cutting back of elective surgeries in our hospitals on the horizon, due to the COVID-19 situation?

Let me answer the second question first. The answer is yes. The number of hospitalisation cases has reached almost 700 now. So, it has increased quite significantly. This is as compared to the height of the Omicron variant wave earlier this year, where we have about 1,700 hospitalisation cases. Now, it is close to 700.

At that time, we cut back business-as-usual (BAU) surgeries by 15%. We have now started to trigger some cut-back of BAU, mostly electives, and it is at about 4%. So, about 700 beds, 4% cutbacks in BAU, compared to the height of the Omicron variant, 1,700 beds, 15% cut.

As I have mentioned earlier, from today's number, we have reason to believe the wave should be near its peak and I hope, from here, things will be better.

Manpower, indeed, is a challenge. The current attrition rate is comparable to what we had experienced in 2019. In February, there was a slight spike after bonuses have been received. But, otherwise, in the latest number, month-on-month, it is comparable to what we experienced in 2019, pre-COVID-19.

Having said that, it is increasingly difficult to hold on to and to recruit foreign nurses, because, with COVID-19 being a global pandemic, the hiring of nurses is a matter of international competition. The good thing is that, locally, young people's perception of the nursing career is, by and large, a positive one. I am very thankful, actually, that, in MOH and healthcare, we have our fair share of talent. And when Nanyang Polytechnic, Ngee Ann Polytechnic or SIT open up their courses, it is always oversubscribed, lots of competition. People cannot get in and they have come to us to appeal to get into nursing courses. Mid-career conversions also have a healthy pipeline.

But our cohort size is limited. Our healthcare demand is growing. So, therefore, we must be able to accept that, over time, we have to recruit more foreign nurses from different sources, be able to take them in, train them and, over time, recognising that there is international competition, be able to review their pay and pay them competitively. The good ones, over time, should be able to become part of our community and become PRs, live with their family here, go to the local schools.

This is the only way for us, to not just weather through this wave, but, also as our population gets older, the size of our healthcare workforce will have to increase and we have to tap on both a strong local pipeline, as well as foreign recruitment.