Updated Protocols for COVID-19 Patients, Vaccination for Children and Delays in Response Time by Government COVID-19 Teams

Ms Sylvia Lim asked the Minister for Health (a) whether the Ministry is aware of cases of significant delay in transporting symptomatic COVID-19-positive persons to hospitals under the current COVID-19 management arrangements; and (b) whether such persons should instead contact SCDF ambulance services for more efficient transportation to hospitals.

Mr Leong Mun Wai asked the Minister for Health (a) what is the justification behind the latest vaccination-differentiation measures and how long will these measures last; (b) whether the Ministry intends to reclassify those who choose not to take booster vaccine shots as unvaccinated; (c) how many unvaccinated Singaporeans are there currently in the respective categories of (i) 13 to 59 years old and (ii) over 60 years old; and (d) whether the same justifications apply to the 13 to 59 years old category.

Mr Dennis Tan Lip Fong asked the Minister for Health whether the Government will allow better access for outside dining, grocery shopping in supermarkets, malls and other public places in respect of adults who have not received full COVID-19 vaccination due to medical reasons and in the interest of their mental health.

Mr Chua Kheng Wee Louis asked the Minister for Health whether the Government will consider exempting children under 12 years of age from the prevailing dining-in group size limit provided that they are dining-in with only family members residing in the same household.

Dr Wan Rizal asked the Minister for Health (a) what is the epidemiological situation for COVID-19; and (b) what is the effectiveness of the Home Recovery Programme with regard to easing the strain on the healthcare system.

Dr Wan Rizal asked the Minister for Health (a) what is the daily call volume to the National Care hotline; (b) what is the typical waiting time for a call to be answered; and (c) whether there are cases of call spamming that may prevent Singaporeans from receiving critical assistance.

Ms Yeo Wan Ling asked the Minister for Health whether there are special provisions and safety nets under the Home Recovery Programme for people who are living alone, in particular seniors and special needs adults should they exhibit symptoms and are unable to call for help independently.

I will address questions on the implementation of the latest Vaccination-Differentiated Safe Management Measures (VDS), vaccination booster programme, and the expanded Home Recovery Programme (HRP). I will also be addressing questions on these topics filed by Mr Chong Kee Hiong, Assoc Prof Jamus Lim, Mr Yip Hon Weng, Ms He Ting Ru, Mr Christopher de Souza, Mr Sharael Taha and Mr Dennis Tan Lip Fong for the next sitting on 2 November, and Mr Chong Kee Hiong1, Ms Yeo Wan Ling2 and Mr Saktiandi Supaat3 for the future Sitting on or after 3 November.

With the exception of a few days with unusual surges, our daily case numbers have largely stabilised for over three weeks now. We have observed that close to 99% of cases continue to have mild or no symptoms. The vast majority are fully vaccinated persons who are able to recover well at home. Of the cases with severe illness, a disproportionate number were unvaccinated. Today, unvaccinated seniors comprise only 1.2% of our population, but as of 29 October, they accounted for two-thirds of the individuals who are critically ill in ICU care and a similar proportion of those who have recently passed away.

Our national vaccination and booster programmes are integral to protecting the population from severe illness and death. We have been administering boosters under our National Vaccination Programme (NVP) since September 2021, starting with the elderly and the immunocompromised. We have progressively expanded the booster programme to persons aged 30 years and above, healthcare and frontline workers, and those working or residing in institutionalised settings.

To date, 84% of our population has completed the full regime of vaccinations and 15% have received boosters. While the percentage of unvaccinated persons in our population is small, in absolute number there remains a sizeable group of individuals who are vulnerable and can fall very sick if infected with COVID-19. As of 29 October, there are approximately 233,000 unvaccinated Singapore residents aged 12 to 59 years and 66,000 unvaccinated Singapore residents aged 60 years and above.

Mr Yip Hon Weng had asked whether the proportion of those issued Health Risk Warnings (HRWs) who subsequently tested COVID-19-positive varied according to their vaccination status. We do not track the precise data. However, a September NCID study of close contacts found that 11.3% of vaccinated household close contacts subsequently tested COVID-positive, but the proportion was more than doubled for unvaccinated household close contacts at 25.8%. This is further evidence showing that vaccination accords protection against infection.

As announced by the MTF Co-chairs, should our hospital and ICU situation remain stable and the weekly infection growth rate drop below 1, we will consider some calibrated easing of measures, such as resuming team sports at selected facilities in small groups, or allowing members from the same households to dine together at F&B establishments.

Meanwhile, VDS will better protect the unvaccinated while enabling social and economic activities to resume for fully vaccinated persons. This will be a key feature of our reopening strategy in the coming weeks and months. We have expanded VDS to cover entry into shopping malls, attractions, hawker centres and coffee shops from 13 October, given that these were found to be common transmission settings.

We recognise that there is a small group who are medically ineligible for both the mRNA and Sinovac-CoronaVac vaccines. From 1 December, as a special concession, we will exempt them from VDS for certain settings and details will be announced by the MTF shortly.

This concession will also be given to those aged 12 to 17 years who are medically ineligible for Pfizer vaccines and who have not opted to take the Sinovac vaccines under the dedicated public health programme set up under the NVP.

Several Members have asked about further VDS differentiation for those who have not received a booster. Currently, VDS do not differentiate between those who are fully vaccinated and those who are boosted because we have not set an expiry date for the vaccination status after two doses. This is something which the Expert Committee on COVID-19 (EC19V) is studying.

Ultimately, while the intent of VDS is to protect individuals with poorer protection against COVID-19, particularly the unvaccinated, from infection, individuals must exercise personal responsibility and keep ourselves safe. Even as we have extended the special concession to those who are medically ineligible, they remain at greater risk of COVID-19 and, if infected, face a higher risk of severe illness. They should thus limit their activities. Similarly, studies have shown that over time, persons who do not receive a booster have lower protection against COVID-19 and severe illness if infected. Getting boosted will keep us and our loved ones safe.

We have also adopted more sustainable healthcare protocols, so as to differentiate medical care based on the needs of each patient. This is necessary in order to safeguard our healthcare capacity and was the impetus behind the Home Recovery Programme (HRP) launched on 15 September.

As of 29 October, nearly 80,000 individuals have gone on the HRP, of whom more than 58,000 have recovered. Since 10 October, we have progressively opened the HRP to unvaccinated individuals from five to 49 years old and fully vaccinated individuals from 12 to 79 years old. Subject to clinical assessment, children aged one to four and fully vaccinated pregnant COVID-19 patients who are below 35 years and less than 26 weeks pregnant may also be eligible for HRP.

Members had asked about the likelihood of those on the HRP transmitting COVID-19 to their household members. Where homes are not conducive for HRP, such as due to being too crowded, we will convey the patient to a Community Isolation Facility (CIF). Having said that, transmission within households is more dependent on the behaviour and interactions of the household members, rather than the physical characteristics of the home. Between 1 April and 30 September this year, 13.8% of household contacts of COVID-19 positive cases eventually tested positive for COVID-19, compared to 1.1% for non-household close contacts. But about eight in 10 household transmissions were detected very shortly after the first household member was confirmed to be COVID-19 positive, which suggests that the household members were infected at the same time, or infection within the household happened even before HRP started.

Once HRP starts and precautions are taken, it can actually be a safe model of care for infected persons and their household members, especially if they are also fully vaccinated. Individuals can better protect themselves and their household members by getting vaccinated to lower their risk of onward transmission. It is for this reason that we had launched the HRP only after a significant majority of the population had been fully vaccinated.

Persons on the HRP can further reduce the likelihood of onward transmission to their household members by taking health precautions, including maintaining good personal and respiratory hygiene, wearing masks, avoiding face-to-face contact with the rest of the household and frequent cleaning and disinfection of shared spaces. There is no need for deep cleaning during or after going through the HRP. Soap water can kill the virus. Should households engage cleaning services, the cleaning businesses should ensure that appropriate SMMs are in place and provide workers with adequate Personal Protective Equipment. MOH and NEA have jointly published a set of cleaning and disinfection guidelines for households that are on the HRP.

The HRP has been instrumental in safeguarding our healthcare capacity as cases are high. We have taken steps to improve the HRP over the past month. First, we have reduced the time between the initial notification of a COVID-19-positive test result and the follow-up call from MOH. Today, more than 90% of COVID-19 patients are contacted within 24 hours of submitting their details via FormSG. The small minority who are uncontactable will be engaged via a house visit.

Second, we have expanded our call centre capacity significantly to improve the responsiveness of the Home Recovery Buddy (HRB) helplines. Through the Interactive Voice Response System, which diverts calls to the appropriate agencies, our HRB helplines have been able to respond to over 95% of the daily calls.

Third, we have improved telemedicine support throughout patients’ home recovery journey. The Telemedicine Allocation and Reconciliation System (TMARS) pairs adhoc consultation requests with available doctors more efficiently. We have also stepped up telemedicine support for vulnerable groups on the HRP to include regular follow-ups.

Seniors, persons with special needs and those who rely on informal carers may require additional support when on the HRP. While such persons should remain isolated to reduce their risk of onward transmission, their household members may assist them as needed, while taking the necessary health precautions. General information on precautions is available in the COVID-19 FAQs on the MOH website. We have also assigned dedicated care managers for vulnerable groups identified during the onboarding call for the HRP. The care managers regularly check in on patients to help and coordinate medical and social support during patients’ home recovery journey. They also work closely with the People’s Association and the Agency for Integrated Care to provide these patients with daily essentials and other forms of caregiving they require.

Individuals who are unsuitable for home recovery may also be conveyed to recover in CIFs or COVID-19 Treatment Facilities (CTFs), depending on their medical needs. We will continue to ensure that there is sufficient transport capacity to convey these individuals in a timely manner. MOH has also ramped up the capacity of CTFs to provide care for higher-risk patients who do not need to be hospitalised. This will help to ensure that there is sufficient hospital bed capacity and facilitate efficient conveyance.

In the initial phase of HRP implementation, there were many complaints and queries, as we encountered many teething issues. These were swiftly resolved. With the improvements we have made to protocols and procedures, the number of queries and complaints has dropped significantly. We thank Singaporeans for their patience during this period.

We recognise that there is still room for improvement. Between 15 and 24 October, MOH received 125 complaints regarding response times, of which 13 were on delays in conveyance to a hospital or other care facility. Over the same time period, MOH facilitated the conveyance of more than 8,200 individuals to hospitals and other care facilities. Majority of the COVID-19 patients who were ineligible for the HRP were conveyed to the appropriate care facilities within 24 hours of confirmation of their COVID-19 status.

We will continue to prioritise those at higher risk of developing complications for conveyance. Patients have access to telemedicine consultations should they need medical attention while waiting to be conveyed. They are advised to call 995 for urgent conveyance to a medical facility should they experience emergency symptoms such as chest pains and shortness of breath. To ensure that SCDF 995 Emergency Medical Services can provide responsive conveyance for both COVID-19 and non-COVID-19 patients with emergency conditions, those with mild symptoms should first seek medical help via their designated telemedicine service provider or their regular primary care provider. We will continue to review and refine the support we provide to patients on the HRP, to ensure that everyone has a smooth home recovery journey.

Even as we forge ahead with the HRP, we recognise the need for psychological and emotional support during this difficult period. These needs can often be urgent and require timely and effective responses.

To this end, we set up the National CARE Hotline (NCH) to provide psychological first aid and emotional support to COVID-19 patients and their household members, including those who are distressed by the stigma that they face, or experiencing emotional strain during recovery. Should the need arise, we will assist in conveying these patients to a care facility where they can safely recover.

The NCH has managed over 50,000 calls from members of the public since it commenced operations in April 2020. From 1 to 19 October, the daily call volume typically averaged 119 calls and the average waiting time for a call to be answered was 14 seconds. Typically, spam call incidents are sporadic and do not disrupt operations. We urge members of the public to refrain from spamming Government hotlines as this might hinder us from providing urgent assistance to those who need it. We take a serious view of such actions. Any deliberate attempt to disrupt the operation of Government hotlines through spamming will be referred to the Singapore Police Force for investigation and taken to task.

With the increasing uptake of boosters and increasing familiarity with the HRP, we are slowly but surely making progress towards a COVID-19 resilient nation. We will continue to monitor the incidence of severe illness and deaths due to COVID-19 and adjust our process to protect our healthcare system and ensure that we are able to provide timely and effective support to those who need it. At the same time, we seek the public’s cooperation to exercise personal responsibility in utilising the support systems available.