Target Criteria Before COVID-19 Restrictions Are Lifted and Normal Dining and Socialising Allowed

Mr Lim Biow Chuan asked the Minister for Health what are the target criteria before COVID-19 restrictions are lifted and Singaporeans are allowed to dine and socialise normally again.

I will address this question along with Question No 39 for Written Answer on the Order Paper for 14 February 2022, and Mr Gerald Giam's Parliamentary Question filed for a subsequent Sitting.

Members have asked if we can ease up on safe management measures and, specifically, to allow more social activities and groupings of more than five. As earlier indicated by the Multi-Ministry Taskforce, once conditions permit, we will do so and, like most Singaporeans, I am looking forward to it.

Whether and when we can do so depends on the epidemic situation.

One aspect is the daily infection numbers, which are around 10,000 cases a day. The week-on-week infection growth rate is close to two. All these are within our expectations. As I have updated the House earlier, because Omicron is highly infectious, we should expect daily cases to reach 15,000 to 20,000, or even more.

The top line daily infection number tells us where we are on the epidemic curve. But as we have emphasised before, what is more critical is its impact on disease severity and on our healthcare capacity.

So far, the impact has been significantly more moderate for the Omicron variant, compared to the Delta variant. There are two reasons. One, Omicron is, inherently, a less severe variant compared to Delta, as it tends to infect the upper respiratory airways. Two, the high percentage of our population having received vaccinations and boosters. Today, we still observe a significant difference in incidence of severe illness amongst the vaccinated and boosted, and the not fully vaccinated, especially amongst seniors. So, vaccines continue to make a huge difference.

Because of these reasons, while the daily infection numbers are high, the vast majority of cases have mild or no symptoms, and very few develop severe illness and require oxygen supplementation or ICU care or have passed away.

Let me start with what concerns us most, which is deaths. During the peak of the Delta wave, from late October to early November 2021, we saw about 13 COVID-19 deaths a day. In the past two weeks, despite cases being three times more than during the Delta wave, we saw on average two to three deaths a day. But there had been days where deaths were also more than five. We have to watch the trend very closely, but, for now, the case mortality due to the Omicron variant is not very different from the number of deaths related to various viral infections pre-COVID. Prior to COVID-19, over 4,000 patients a year (or over 10 a day) passed on due to pneumonia, usually caused by infections.

Next, ICU. Currently, about 0.05% (five in 10,000) of our COVID-19 cases ever required ICU care. At the peak of the Delta wave, about 170 ICU beds were occupied by COVID-19 patients. Now, despite three times the daily caseloads, we have about 30 patients in the ICU across our hospitals. Of these, about 60% are intubated. Further, duration is also shorter, typically three to five days, compared to patients infected with the Delta variant, who would stay on average, 11 days.

We have 113 ICU beds now and we can ramp up to 350 at short notice. This can be further stepped up to 500 ICU beds should the need arise. So, unlike during the Delta wave, the ICU wards are not coming under pressure and is in good shape.

As for oxygen supplementation, about 0.3% of Omicron cases ever required it. Currently, we have around 130 patients who require oxygen supplementation, which is about 40% of the peak of the Delta wave. As cases rise, we expect this number to increase in parallel but with every hospital bed equipped with oxygen supply capability today, this is not a constraint.

Finally, hospitalisation. There are about 1,200 COVID-19 cases who are currently hospitalised. Of these about 30% are "incidental cases". This means they are admitted for non-COVID-19 conditions and subsequently found to have COVID-19 during their stay because we test every patient. This group, typically, has no or very mild symptoms. In other words, they do not take up extra beds due to their infection. So, the extra workload on our hospitals is two-thirds of the 1,200 hospitalised cases. Further, most Omicron patients also have a short hospital stay of about three to four days, compared to five to eight days for patients infected with the Delta variant. It means beds are freed up faster.

I would say hospital beds are probably the biggest constraint now. However, as symptoms of Omicron patients are often not very severe, there is a lot of scope for us to right-site the patients at COVID-19 Treatment Facilities (CTFs) instead. Today, we have approximately 3,800 CTF beds and only a quarter are occupied. We also have plans to ramp up to approximately 4,600 beds by the end of February.

So, looking at these indicators, our healthcare system is able to handle the Omicron wave. But beyond beds and equipment, we need to monitor the state of healthcare manpower. Our healthcare workers have been battling the pandemic at the frontlines for more than two years now. They have persevered through the Delta wave and are now fighting the Omicron wave. I want to convey my deepest appreciation to them.

While our healthcare workers are very busy and stretched, it is a different level of intensity as during the Delta wave. Some countries have reported that their healthcare workers are resigning in droves. Here, the attrition rates of doctors from our public acute hospitals have remained comparable to 2019, before COVID-19 hit, about 3% to 5%. For nurses, the average attrition during the two COVID-19 years of 2020 and 2021 is about 8%, comparable to 2019. Absenteeism rate due to COVID-19 has been manageable and is about 2% now. We do not take this for granted, and will continue to support our healthcare professionals. We are also working closely with clusters to help them recruit new healthcare workers.

We will continue to monitor the key indicators closely to make sure our healthcare system can cope as we ride through the Omicron transmission wave. Once it has peaked and start to subside, we can look forward to easing our safe management measures.