Healthcare Protocols

1. Last week, I said that the Ministry of Health (MOH) is taking a holistic relook at our healthcare protocols – what to do if you are tested positive, what to do if you are close contact, or live with somebody who has tested positive.

2. All the protocols we see today were developed over the past 20 months, mostly during a time when we were trying to eradicate the virus from our borders. But now, we are in a very different situation.

3. These protocols need to be updated for the following reasons:

· First, it has become confusing and frustrating for most people. If you live with someone at home who came down with COVID-19, you are quarantined, you cannot go out, cannot go to work, students cannot take their exams. Once on quarantine, you need a PCR test at the start and at the end, you have to take public transport to a testing centre, sometimes there is a long queue, all these add to the anxiety faced by many people. Some pre-school centres or companies, for example, may close after detecting an infected case, further disrupting the lives of many people. Some people tell me that they are more afraid of these rules than COVID-19 itself. This is a sentiment and a problem that needs to be addressed.

· Second, the characteristics of the Delta variant and vaccination have changed our risk calculations. The Delta variant viral loads tend to be higher than previous variants and rise very fast. That is one reason why the Delta variant is a lot more infectious. But there is a slight benefit to that, because with higher viral loads, antigen rapid tests (ART), including a self-swab, does a pretty good job at detecting someone who has been infected and is infectious. That makes ART more useful now than before in terms of detecting COVID-19 patients.

· Third, given ART is more useful now, there is potential to replace the 10-day quarantine for close contacts with a test protocol. Currently, about 10% of people under quarantine due to close contacts become infected. Out of the 10%, 8% points are tested positive at the point of starting their quarantine, and 2% points tested positive during their quarantine. Given this, a test at the beginning will catch the majority of close contacts who are already positive. Repeated ART can detect most of the rest. A system like that is less watertight than today’s quarantine system. But it can significantly and substantively manage the risks. We also need to take into account that as we move towards living with COVID-19, if we restrict large numbers of people every day over prolonged periods to weed out the last tail risk, it is actually not sustainable and in fact, very frustrating and disruptive to many people and families.

4. With these considerations in mind, we have reset all our testing and isolation procedures, into a simple set of 1-2-3 protocols, because there are only three procedures from henceforth. They are like three lines of source codes, or three building blocks, that can cater to almost all situations and circumstances. They are as follows:

· Protocol (1) You are unwell and tested positive – for example, you fell sick, you see a doctor, doctor prescribed a test and you turned out positive. You are then required to stay home, isolate yourself, and MOH will contact you on your recovery, whether through the Home Recovery Programme, or be brought to a healthcare facility. If you are vaccinated, you will be discharged in 10 days. If not, 14 days. There is no more Day 6 PCR swab for early discharge, and discharge will then be time-based. When the time is up, the alert in your TraceTogether will be automatically lifted.

· Protocol (2) You are well, no symptoms but tested positive – this usually happens when you participate in your company’s or employer’s routine testing operations. This is an existing protocol that has been published in the papers. You isolate yourself for 72 hours or three days, and thereafter, test negative for ART to exit isolation. If your condition worsens, see a doctor and the doctor will test you and see if you have been infected. If yes, follow Protocol (1).

· Protocol (3) You receive a text from MOH that you are a close contact (such as a colleague or family member). You use the notification to withdraw ART test kits at the vending machine, and then follow a 7-day procedure. First day, you are required by law to test yourself with an ART kit and then upload the results. After that, test negative before you go out on the same day. On day 7, test yourself for the last time and exit the procedure. Anytime you don’t feel well, go see a doctor. If positive, refer to Protocol (1). Anytime ART test turns out positive, refer to Protocol (2). With this, we effectively merge QO, HRW, HRA into one test procedure, and we have effectively replaced lengthy quarantine period with a testing procedure that allows for flexibility without compromising public health.

5. The new procedures will be effective next Monday 11 October. I urge various companies, employers and regulatory agencies to try to align existing practices to these protocols. I understand for many sectors and employers, the concern about risk is higher, and there is a need to impose additional measures at the industry or company level. We fully understand that. For example, a higher tempo of Rostered Routine Testing (RRT) based on ART is fully understandable, which MOH imposes in hospitals as well. But we should refrain from imposing PCR swabs purely for surveillance of our employees, who are not even displaying any symptoms.

6. For those already in the system and following the current procedures, we will need to make some transitional arrangements.

7. If you are currently a COVID-19 patient, you will serve out 10-day isolation if you are vaccinated or aged below 12, or 14-day isolation if you are not vaccinated.

8. If you are currently a close contact and on a quarantine order, you will no longer need an exit PCR test. If you test yourself with an ART kit and the result is negative, you may go about your normal activities for the day. Do so until Day 7, in accordance with Protocol (3).

9. To provide more support for regular self-testing at home, MOH will be conducting another round of distribution of ART kits, and this will last from 22 October to 7 December 2021. This will be done via SingPost. Each household will receive a package containing 10 ART self-test kits.

10. This is a significant change, and the pivot in our strategy. All the complicated rules frustrate people, and are a constant reminder to people that COVID-19 is a scary disease. In fact, the vast majority of people (more than 98%) who are infected exhibit mild symptoms or no symptoms. Our data shows clearly that the risk falls mainly on two groups – those not vaccinated and aged 60 and above, and those aged 80 and above.

11. If we recognise this, and change the protocols, I believe we can lift the fear and confusion surrounding COVID-19, and we can all exercise personal responsibility and do our part to overcome the pandemic. And then focus our efforts on the two vulnerable groups I mentioned earlier.

12. We now have a simple set of rules that we believe is effective, and easy to understand. I am sure there will be an initial period of getting used to them, but I am confident that things will settle down, and everyone will find that this is much easier to follow.

13. We have been talking about Total Defence, and the most important aspect is psychological defence. The reset of rules addresses the psychological state of our society as we overcome this pandemic.

Home Recovery Programme

14. Let me move on to Home Recovery Programme (HRP). We continue to make progress on the HRP. We have beefed up the team further. Today, other than the minority whose contact numbers are inaccurate, we are able to call all infected persons and onboard them within a day. As for incoming calls, we can now attend to the great majority of callers.

15. The Telemedicine team has also been bolstered, so that they can attend to those who need medical attention.

16. Everyone involved has been working really hard to make the programme work smoothly. I thank them for all their efforts, and I also want to thank all the individuals who are on home recovery for your patience and understanding as we continue to improve the system.

17. We wish we can be given more time to improve the processes and stabilise operations. But as we expect cases to rise further, we will need to press on and expand the programme even as we continue to make improvements. From next week, we will be making the following changes to the HRP:

First, we will make HRP the default setting for recovery for more groups of people, starting with unvaccinated persons aged 12 to 49 years. This is because the risk of severe illnesses for younger, though unvaccinated individuals is low, and it is safe for them to recover at home. Next, are vaccinated infected persons aged 70-79 years. There is concern about the risks of them falling in an unfamiliar environment, and it is actually safer for them to recover in the familiar surroundings of their homes. However, as a precaution, individuals from this group would be assigned to a healthcare provider, such as one of our hospitals, who will help them monitor their health, including their oxygen level, closely during the isolation period. If there is any emergency, we will ensure that they can be taken to a hospital promptly. Finally, children aged 5 to 11 years old, as we found that COVID-19 is not a serious illness in the vast majority of this group. Furthermore, parents have always requested that these children be allowed to recover at home, where there are caregiving arrangements. As for children aged 1 to 4 years, we will continue to extend home recovery to them, provided that they are first clinically assessed at the hospitals to be suitable for home recovery.

Second, we will gradually convert Community Care Facilities and some Government Quarantine Facilities (GQFs) to Community Isolation Facilities (CIFs). I am sorry to add one more acronym to the alphabet soup, but this is a necessary and sensible move. The CIFs will be part of the HRP operations. CIFs will allow those who are either not able to isolate themselves at home or who may have vulnerable persons at home to undergo recovery safely. As more travellers perform their SHN at home, we could also potentially convert some SHN facilities to CIFs as well.

Third, as we screen patients at the outset, we will also identify those who need more support, and provide targeted help to them, such as more active monitoring through Telemedicine, and activating community volunteers to support them in their daily living.

Boosters

18. Finally, let me touch on boosters. The programme is going well, with about 370,000 booster doses administered to date, and with a high take up rate of 70% amongst those whom we have invited.

19. The Expert Committee on COVID-19 Vaccination (EC19V) has studied international data on the efficacy and safety of booster shots amongst various segments of society, and has recommended to extend the programme. MOH agrees with their recommendations. The additional groups are as follows:

20. First, those aged 30-49 years old. Data has shown that a booster will enhance their protection against infection and severe diseases due to COVID-19, and the risks due to severe adverse reaction is low and not different from the first two doses.

21. Second, healthcare and frontline workers. Many have taken their shots earlier this year, and are due to take their booster shots. Further, due to their job nature, they are potentially more exposed to the virus. At the initial stage, we will reach out to all our COVID-19 frontline workers in hospitals, nursing homes, welfare and adult disability homes, dormitories, isolation facilities etc. We will also administer boosters to our travel frontline staff, at the checkpoints and airport.

22. After that, we will reach out to other frontline staff. We will come up with the details later, but some possibilities are public transport drivers, taxi drivers, security guards, hawkers and even retail assistants. But we expect many of them to have already been covered as we extend the age bands to 30 and above for booster shots administration.

23. The first batch of invitation will be sent out immediately after this press conference.

Conclusion

24. I met our healthcare leaders yesterday, shared with them the thrust of PM’s broadcast today, and the changes we are making to pivot away from treating COVID-19 as a threatening disease to everyone, to focusing on protecting the minority groups who are vulnerable.

25. They understood and support the approach. Everyone also knows that even a circuit breaker now will not stop cases from continuing to rise. So we will have to press on together.

26. But we must all appreciate the tremendous pressure hospitals and healthcare workers are put under and are going through. So if I may reinforce what PM had said to our healthcare workers – it is a difficult time, this is probably the toughest part of our transition to a COVID-resilient nation, but we are taking various measures to alleviate the pressure. There is light at the end of the tunnel, because no transmission wave will last forever.

27. For everyone else, let’s do our part to help our healthcare workers. Don’t leave them to carry the burden as the last line of defence, we can do our part to stand up as the first line of defence. We can do so by cutting back on our social activities. Get seniors whom we know to vaccinate. Get our own booster shots when we are invited. Please do not go to hospital if you are not seriously ill. Then hospitals can be preserved for people who are seriously ill, who need medical help the most – whether they are COVID-19 patients or not.

News Highlights