Safeguarding Singaporeans' Health during Occurrence of Haze

Dr Lam Pin Min asked the Minister for Health (a) what is the short- and long-term effects of air pollution from the haze on the health of Singaporeans; and (b) what contingency plans are being considered to safeguard the health of Singaporeans should the haze continue for the next two to three months.

Madam, Dr Lam asked about the short- and long-term effects of air pollution. For healthy individuals, short-term exposure to haze may cause temporary minor irritation of the eyes, nose, throat and skin. Such irritation typically resolves on its own in most cases.

However, the haze particles can aggravate lung diseases, cause asthma attacks and acute bronchitis in people who already have chronic lung diseases, and trigger off heart attacks and irregular heartbeat in people with heart problems. Thus far, there has been no clear evidence of long-term health effects of short-term haze, like that we have experienced.

Mr Gerald Giam asked about the impact of the haze on healthcare services. So far, the impact has been manageable. When the haze was more severe in the week of 17 to 23 June, we saw a 16% increase in polyclinic attendances for relevant conditions compared to the week before, but attendances at hospitals' accident and emergency (A&E) department did not show any significant increase. The air quality improved in the last week of June and polyclinic attendances correspondingly decreased to just 4% higher than the level before the onset of haze. Attendance at A&E departments for the relevant conditions actually decreased by 23% in the last week of June.

Ms Lee asked about N95 masks. The N95 masks are not specifically designed for use by children, nor have they been certified for effectiveness for such use. To be effective, N95 masks need to maintain a well-fitted seal at all times, which may be difficult to achieve in young children who are smaller and of varying sizes. It is possible for the older children who may be able to fit smaller sized N95 masks for adults. Parents who wish to buy these masks for their children should ensure proper fit and usage of the mask.

When haze reaches unhealthy levels, children should really be kept indoors as much as possible. This has been communicated to the public through various platforms including the mass media and online media. Since schools reopened last week, MOH has been working with MOE and schools on the various

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mitigation measures, based on the health advisory of the day.

Dr Lam and Mr Giam asked about long-term measures to protect the health of Singaporeans. MOH has worked with our healthcare institutions to put in place plans in three areas, to ensure that we are "haze ready".

First, managing the expected surge of patients at our polyclinics and hospitals for haze-related conditions. The Ministry has already implemented a special scheme where those who suffer from respiratory problems or conjunctivitis because of the haze need only pay $10 when they seek treatment at participating general practitioners (GPs). The scheme applies to Singaporeans aged 18 years and below, or 65 years and above, and those in low-income groups. The scheme will enhance the accessibility and affordability of primary care for haze-related conditions.

There are now more than 600 GP clinics participating in this scheme. Information on the participating GP clinics is on the MOH website, and also shared through community organisations. The Agency of Integrated Care (AIC) has been actively reaching out to individual GP clinics to encourage them to sign on. To increase awareness amongst members of the public, posters have been distributed to GPs so that the participating clinics can be easily identified.

MOH had also earlier worked with the hospitals to retrofit suitable spaces within the hospital campuses to ready additional bed capacity in the event of a demand surge due to an increase in dengue cases. We have stepped up efforts to transfer stable patients from the hospitals into community hospitals and nursing homes to free up acute bed capacity.

Should the haze worsen and there is a need to free up bed capacity further, non-urgent services and elective cases at the hospitals may be scaled back.

Secondly, we will take care of the patients in our public sector hospitals and healthcare institutions so that they are not adversely affected by the haze. If the haze situation is bad, these institutions will close their windows and doors to reduce the inflow of dust particles. And if necessary, air coolers and fans will also be used to improve the ventilation for patients in non air-conditioned wards. For especially vulnerable patients, we will put in place air purifiers to help reduce the impact of the haze on these patients during significant haze.

We will also facilitate home delivery of medication for chronic patients – if necessary – so that they can get their needed medication without having to visit

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our clinics.

Third, our hospitals and polyclinics have adequate equipment and supplies, including adequate medication stocks, on standby to support the continuation of critical services. Our hospitals also have plans in place to ensure adequate manpower to staff critical services such as the A&E, Intensive Care Unit and operating theatres.

At the national level, we are re-building our stockpile of N95 masks so that we will be ready, should there be a disease outbreak during this period.

I would like to thank the Minister for the comprehensive reply. With regard to the use of N95 masks, we all know that only proper fitting and proper use of N95 masks will provide the necessary protection to the user. So, I would like to ask the Minister if there are plans to work with other relevant agencies, including the People's Association, on the proper use of N95 masks amongst residents, especially in cases where certain residents may not be suitable in the use of N95 masks such as those who are suffering from chronic obstructive lung diseases and heart diseases, the use of N95 masks can be counter-intuitive.

Mdm Speaker, I would like to thank Dr Lam for raising this question; in fact, it is a very important question. MOH officials have been working with grassroots organisations not only to distribute masks to needy residents but also to take the opportunity to explain to residents the proper usage of the mask and we have also distributed pamphlets and posters to explain how to use the mask properly. The Member is right that the masks ought to be used properly to provide adequate protection. And for patients who are suffering from chronic diseases, the use of the mask may not be appropriate. For these patients, we advised them to consult their doctors if they find that wearing the masks create problems for them, especially in their breathing. So, it is important for the masks to be used in an appropriate manner.

Mdm Speaker, two supplementary questions for the Minister. Number one, will the Ministry consider working directly with manufacturers or industry to come out with something for children given that the haze is a decade-long problem and we do not know whether it will be back again? Children being younger are more prone to health effects.

Question two, the MOH clarified to the public that N95 masks are not certified for children's use on 23 June. This came three days after the three-hour

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PSI reading soared to an all-time high of 321 at 10.00 pm on 20 June. Many parents were not aware that the masks were not suitable for children and were using it when the haze was at its worst. The question is: why was this piece of information not publicised earlier and what can we do in the future to disseminate crucial information in a more timely manner?

Mdm Speaker, MOH will continue to explore the different masks available in the market and to see which of them would be suitable for use by our children. At the same time, we would also consult relevant authorities worldwide, including the Food and Drug Administration (FDA) in United States, to see which of the masks would be suitable. As I have explained, some of the children who are older, who may be bigger in size, the small-sized mask would be suitable for them, and this is on a case-by-case basis.

For haze, as Dr Vivian Balakrishnan has explained, is unlike a virus attack. For children who are outdoors for short-term exposure, it is not required that they wear the mask for as long as the exposure is limited to a short period of time. For children during a heavy haze period, the real advice is to stay at home, which is what we had given to the parents, to encourage them to keep the children at home – minimise exposure in the open air when the haze levels have reached unhealthy levels – rather than to rely on the masks. But we noticed that some parents are asking their children to wear the N95 mask and therefore, we reminded them that the N95 masks are not certified for use by children. It is much better for them to keep their children at home rather than to rely on masks.

But for children who need to travel to schools or to tuition centres, when they need to take a bus or when they need to commute short distances, they really do not need to wear a mask in any case unless the haze has reached very, very unhealthy or hazardous levels. Then please refer to the advisory provided by NEA jointly with MOH and we will advise the children and parents accordingly.

Madam, now that the haze seems to be behind us at least for this year, will the scheme offering subsidised treatments for haze-related illnesses continue or will it be revived when the haze comes back again? Is there a certain threshold PSI that will trigger off the scheme and will the GPs who have signed up this year continue to be on the scheme next year?

Mdm Speaker, I would hesitate to say that the haze is over for this year as I think Dr Vivian Balakrishnan has reminded us all that the

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dry season is not yet over so we have to remain vigilant and to be well prepared. So, for the time being, the scheme will still remain in place and will be reviewed again at the end of the dry season to see whether it is necessary to be continued, whether we will re-introduce it next year or we could refine the scheme to make it a better scheme when the haze does return. We hope it does not, but in the event that it does return – whether we will need the scheme or whether we need a different scheme – we will look at the situation at that point in time but for the time being – this being the dry season – the scheme will remain in place.