Easing of COVID-19 Rules and Impact of Pandemic on Patient Treatment and Public Healthcare System

Mr Lim Biow Chuan asked the Minister for Health (a) what are the criteria considered by the Ministry in deciding tolower the DORSCON level from Orange to Yellow; and (b) whether the Ministry will relax the rules and allow unvaccinated residents to enter malls and to dine in the food and beverage outlets together with the rest of Singaporeans.

Ms Sylvia Lim asked the Minister for Health (a) in light of the easing of the COVID-19 safe management measures, whether community mask-off events, such as temple dinners where food is served, will be allowed; and (b) if so, under what conditions.

Mr Leon Perera asked the Minister for Health given a 7% increase in the age-standardised death rate in 2021 that bucked the downward trend in previous years (a) what is the Ministry's analysis of the reasons behind this increase; (b) what is the number of excess deaths due to COVID-19; and (c) what formula is used in the Ministry's calculation of excess deaths.

Mr Leon Perera asked the Minister for Health whether the Ministry will conduct a study on the impact of the COVID-19 pandemic on (i) non-COVID-19 patients facing delayed treatment, especially older ones with chronic conditions and (ii) the public healthcare system, in view of the patient backlog from the periodic suspension of non-essential services.

With the pandemic situation stabilised, the Multi-Ministry Taskforce (MTF) took decisive steps to open up social and economic activities to almost pre-COVID-19 norms. So, to Ms Sylvia Lim's question, temples can start to organise dinners, barring any changes in rules later.

Mr Lim Biow Chuan asked if individuals who are not fully vaccinated can be allowed to enter malls and dine in F&B outlets. I would like to clarify that they can enter malls as we have significantly removed vaccination-differentiated safe management measures (VDS) for non-fully vaccinated persons.

However, we still need to remain cautious because the next infection wave is highly possible. We also need to watch out for new variants that may threaten us again. Hence, MTF decided to maintain VDS for the three most risky settings: nightlife outlets with dancing, events with more than 500 participants at any point in time and then, F&B outlets where there is a constant flow of diners who are mask-off and interacting. For F&B outlets, we will, however, not deploy TraceTogether and SafeEntry, but instead put the onus on customers to ensure that they are fully vaccinated before visiting an F&B outlet.

We will continue to review our VDS measures as the pandemic situation evolves.

We are taking a cautious "step down but not dismantle" posture for our public health measures. If the situation requires, we will have to step up VDS and reactivate TraceTogether and SafeEntry. Ms Nadia Ahmad Samdin asked what the criteria are to reactivate these measures. It is a matter of judgement, depending on the severity of the situation. We will have to take into account if there is a new variant of concern, whether it is more severe or more infectious than the Omicron variant, whether past infections and current vaccines continue to confer strong protection against the new variant and how all these affect our hospital capacity.

I can understand that some members of the public and Members of the House want a system, with transparent and clear triggering points, but I am afraid this is not possible when we are in a pandemic crisis with fog of war. Through MTF's actions over the years, I hope the public would also appreciate where we are coming from. We do what is necessary to protect lives when danger is upon us and we will step down measures when they are no longer needed, no longer necessary, so that people can resume their normal lives.

So, the best step for the public to take is not to delete your TraceTogether app and not to throw away your TraceTogether tokens. Please keep them.

Members asked about the Disease Outbreak Response System Condition (DORSCON) framework. DORSCON was established after SARS in 2003, then reviewed and progressively improved upon from the experiences drawn from managing the H1N1 pandemic in 2009, and the coordination for the Middle Eastern Respiratory Syndrome Coronavirus and Ebola Virus Disease. Post-COVID-19, we will, certainly, review it further, along with our response measures, given all that we have learnt during this pandemic crisis.

The DORSCON framework was developed as a tool for Ministries and agencies to coordinate and execute the Government's response to outbreaks of infectious diseases. By and large, it has served its purpose well in this pandemic.

In the initial phase of the pandemic, MTF decided that, for transparency, we would announce the DORSCON level and colour code publicly, too. This would help alert the public to the need for personal vigilance and social responsibility. However, it had also led to certain public reactions, such as the rush to the supermarkets. This is one key issue for review as DORSCON is meant to bolster preparedness, not to induce public anxiety.

A key factor to consider in our review of the DORSCON framework is that after more than two years of the pandemic, the Government and our society have learnt a lot about pandemic response. We have developed a comprehensive response system, covering health protocols, border controls and safe management of social and economic activities. It is also tiered and differentiated, catering to different activities and settings, such as schools, offices, public spaces, eating places, nightlife, events and so on, with various severity conditions.

Therefore, from a public communications point of view, we believe that the public now pays much less attention to the DORSCON colour code and takes care to understand the various public health measures in detail, and then respond and do their part accordingly, be it taking vaccination, wearing masks or abiding by the safe management measures (SMMs). So, I am confident that today, we have a much more sophisticated public that understands what they need to do when a pandemic turns for the worse.

The response of the public and the contribution of everyone in our society are, ultimately, what give us resilience during a pandemic outbreak. So, the DORSCON framework is most likely still relevant, but it needs to be part of a larger emergency preparation and public communications framework that we have already developed and people now understand.

Members also asked about "excess deaths". Let me first explain what it is. It means comparing death rates across the years, taking into account the changing age profile of the population. If the death rate goes up in a pandemic, above that expected in the absence of a pandemic and over what is expected from population ageing, it means there are excess deaths.

For Singapore, our age-standardised death rate has decreased from 2017 to 2020, from 563 per 100,000 residents to 519 per 100,000 residents. In 2021, the rate increased to 557 per 100,000 residents, almost back to 2017 levels. So, 2021 is about the same as 2017, just a notch lower. So, there are excess deaths in 2021, compared to 2020.

Mr Leon Perera asked why that is so and how we calculate excess deaths. We used well-established, internationally-practised methods, including age adjustments. There are excess deaths in 2021 because there had been a global pandemic, causing millions of deaths around the world, and Singapore was not exempted.

During a pandemic, excess deaths will be higher than officially reported deaths directly caused by the disease. To illustrate, a recent WHO analysis of excess deaths found that while the officially reported number of COVID-19-related deaths around the world is slightly over six million, "excess deaths" during this pandemic is 15 million – about 2.5 times more.

There are a few reasons to explain the difference in the two numbers. One, in some parts of the world, there can be under-reporting in regions where testing is insufficient or where data is difficult to collate. But, in Singapore, this is not an issue. Two, there are infected persons who died of other illnesses, where the COVID-19 infection might have been a contributory factor but not the main cause. Three, care-seeking behaviours changed. For example, individuals with chronic conditions may put off their check-ups, treatments and medications during the pandemic, to their own detriment. Four, there are many regions where their healthcare systems were overwhelmed. When that happens, proper care is denied and the people who suffer are not just the COVID-19-infected patients, but everyone who needs hospital care.

Our excess deaths in 2021 among Singapore residents is about 1,535. That is for 2021, when we had a Delta wave, after accounting for ageing. COVID-19 deaths as at end 2021 among residents is 804, or about 52% of excess deaths. The remainder excess deaths could be due to some of the factors I explained earlier, except under-reporting, which is not an issue in an urban environment like Singapore; also, the last reason I mentioned, hospitals being overwhelmed. That is not a big factor here, because we prioritised the protection of our healthcare system, going into a circuit breaker when necessary. So, although our hospitals came under significant pressure at the height of the infection waves, they were not overwhelmed, and hospitals could continue to give priority to serious and urgent cases.

As mentioned in the Ministry of Health (MOH) press release on 24 March 2022, MOH is continuing to collect and analyse the data, particularly the recent Omicron data, to find out more comprehensively the impact of this crisis on Singapore residents and we will release a special report soon to estimate the excess deaths over the past two and half years of the pandemic and the key factors causing the excess deaths.

I should emphasise that whether it is official COVID-19 death toll or excess deaths, Singapore will have one of the lowest rates in the world, amongst countries that have chosen to live with COVID-19 and resumed normal lives, and that is because of the cooperation of everyone in Singapore and the effectiveness of protecting our healthcare system.

Thank you very much, Mr Speaker. I thank the Minister for Health as well for the response, including setting out some of the criteria which will be taken into consideration for the reactivation of the TraceTogether programme. I have a supplementary question and it was an article in The Straits Times yesterday, which said, and I quote, "TraceTogether tokens and even SafeEntry Gateway boxes are Government properties and throwing them away could be considered an offence", and it then goes on to list certain offences under the Penal Code, Vandalism Act and Computer Misuse Act.

I think, this has caused some alarm among people who may have inadvertently disposed of or misplaced their tokens. So, it will be very helpful to have some clarification on what to do with these tokens and what happens if there has been any inadvertent disposal, as well as some assurance in terms of the data that is or is not connected while the app remains in the phone.

I thank the Member for her question. I read the article as well and I thought there might be a supplementary question on it. I will need to check with GovTech with regard to the status of all the equipment. As for those who have inadvertently disposed of them, do report them. I am sure the Government agencies will be as helpful as they can to try to replace them. I think our key consideration is not so much about protection of the equipment, but to make sure that should we have another variant of concern, businesses, individuals, we are ready to respond.

Mr Speaker, Ms Nadia Ahmad Samdin also asked about the data. I mentioned this in an earlier reply, which is, that for events, for example, nightlife with dancing, where SafeEntry data is still collected, it will be purged very quickly.

Thank you, Mr Speaker. I have two supplementary questions for the Minister for Health. He mentioned earlier that vaccination-differentiated safe management measures (VDS) will still be needed for events of more than 500 participants. Can he clarify that this also applies to the community dinners that I asked for, meaning that, if the number of participants is expected to be more than 500, then the organisers would have to check that the participants are vaccinated?

Second, the Minister mentioned that these dinners can proceed. What about events or activities that are associated with the dinners, like auctions and stage performances like "getai"? Are all these also allowed?

The answer to both questions is yes. So, if the temple dinner has more than 500 people, they ought to install a SafeEntry check-in counter; and then the auction and performance can proceed.

Sir, I am trying to see whether the unvaccinated can live their lives normally, as with the other Singaporeans. I spoke to some unvaccinated people and they shared that, for many of them, they choose not to be vaccinated because they are worried about the severe adverse reactions.

The Minister had said that the health care system is not overwhelmed, the majority of Singaporeans are vaccinated. So, is there any way in which we can really consider removing some of the VDS, so that those who choose not to be vaccinated for whatever reasons can lead their lives as per the rest of Singaporeans? There are only about 3.5% of such people and, really, they ought to take responsibility for their own decision not to be vaccinated.

Indeed, we all take responsibility for our own health and make our own decisions regarding our own health status, including vaccinations. The issue that we do need to consider here is that, in a pandemic crisis, individual decisions also affect the society and the healthcare system.

The Member would remember that 3.5% of our population is not fully vaccinated. They accounted for 20% of ICU cases and deaths and also add on a certain workload to our healthcare system, which, in extremis, when the numbers are huge or when we have a big wave, may mean adding a lot of pressure to our healthcare system. When that happens, it is not just the unvaccinated who will suffer, not those who are infected that will suffer, but everyone who requires hospital care, acute care and emergency services will suffer. So, it is because of that, that the decision not to vaccinate yourself is no longer just about yourself; it is also a role for us to protect the whole society.

Having said that, the last time the Member asked me that question, since then to now, we have relaxed many of the VDS restrictions for this group, because, given the current situation, we do not think it is needed. But we do worry about the next variant of concern. Most likely, it will evolve and emerge in the months to come. So, given that posture, I think, just maintain these three most risky settings where VDS will still apply and we will continue to review the situation.

I thank the Minister for his comprehensive answers and just a procedural clarification. If I heard correctly, the Minister said he would answer all questions until Question No 13. I am just wondering if he has answered Question No 13 as well, which is about the impact of restraints placed on non-urgent treatments and testing during COVID-19 and what backlog has there been for such treatments and testing, and what has that impact been.

I thank the Member for the question, I intend to answer Question No 13. So, whether the Ministry will conduct a study on the impact of the COVID-19 pandemic on various aspects, as I mentioned, we have issued a Press Statement on 24 March, and said that we will collate all the data, and do a proper study. It is a special report on the impact of the entire pandemic and we will answer some of the questions, including the data required.