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14 Dec 2021

14th Dec 2021

1.  We are in a good position now. Together, we have ridden through a significant Delta transmission wave, which peaked at over 3,000 cases a day. But if you look at the situation we are in now today:

  • Daily cases are three digits, and often below 500;

  • Total number of COVID-19 patients in our system is now under 4,000.

    At its peak, it was over 26,000. That was in end October;

  • ICU beds – at its peak, 160 or more. Now, just slightly above 30; and

  • Hospital beds/COVID-19 Treatment Facilities (CTFs) beds, all occupancies are at a healthy level.

2.  In other words, the bicycle we are riding is now on a gentle slope, the brakes lightly applied, and our ride is comfortable.

3.  Our healthcare workers are also getting respite because of this. They are able to take turns to go on leave. Foreign healthcare workers are able to use Vaccinated Travel Lanes (VTLs) to reunite with their families. These are all very important.

Impending Omicron Wave

4.  But this peaceful state may not last long, for there is a potentially big Omicron wave coming our way, and we need to get prepared.

5.  The question is what kind of transmission wave is Omicron? Data from overseas suggests that it will be more transmissible than Delta, so we may be looking at a large wave. But there are also indications that Omicron infections may be milder.

6.  
Some will ask: why not just shut our borders and prevent Omicron from coming?

7.  
There are two important considerations, having accumulated experience over almost two years. First, we have to ask, do we still believe in living with COVID-19? We cannot say for Delta variant, let’s live with COVID, but for Omicron variant, let’s have a zero-COVID policy. It is not coherent; it does not work that way. Especially given that we have come this far, we have ridden through a big Delta wave together, we have built up our defences, and we have gotten life somewhat back to normal. I do not think we would want to give all that up and go back to where we were last year, before Omicron.

8.  Second consideration is that it is actually not realistic to stop Omicron from coming into our small city state. We can, and we have, temporarily suspended short- term travel to affected countries in South Africa, and this is to buy us time so that we can understand the variant better. But Omicron, as of now, has spread to more than 60 countries, including those in Europe, the United States and some of our regional neighbours. Soon, it will be all around us. Like Delta, it is not possible to keep Omicron out even if we shut all our borders.

9.  So we have learn to live with Omicron, as we have with Delta. To do so, we will need to understand the variant, adjust our policies, because this variant will be different, with slightly different characteristics.

10.  There is a chance that it causes milder infections. South Africa and European countries are reporting fewer incidences of hospitalisation, and those hospitalised tend not to require oxygen supplementation and they stay shorter durations – typically one to three days. But I must caveat that it is early days, and so far, Omicron infections tend to be amongst younger patients. We need at least a couple more weeks for the transmission to play out, and for us to better understand the severity of the variant. With each week, the picture becomes clearer.

11.  However, even if Omicron infections are indeed milder, it can still cause us big problems. For example, if the risk of hospitalisation requiring oxygen supplementation or ICUs is, let us say half that of Delta, but the Omicron variant, let us say, can spread to twice as many people, the two factors cancel each other out. Which means our healthcare system will face the same pressure as when we had the Delta wave. If Omicron spreads faster to unvaccinated seniors, the problem is actually bigger.

12.  To reduce the number of people who fall very sick, we still need to fall back on vaccinations and boosters. That remains our primary response to deal with the Omicron variant. Today, we will present the following thrusts of this whole action plan:

  • First, step up vaccination and boosting;

  • Second, adjust our healthcare protocols;

  • Third, further strengthen healthcare capacity;

  • Fourth, prepare therapeutics to treat potentially severe cases; and

  • Finally, adjust our Safe Management Measures.

13.  Minister Gan has already mentioned the key changes. I will elaborate on the first two, Director of Medical Services (DMS) Associate Professor Kenneth Mak and SMS Janil will talk about the next two and also share further information on vaccination for children, and Minister Lawrence Wong will talk about Safe Management Measures.

Vaccination and Boosters

14.
 First, on vaccination and boosters.

15.  
A recent study in the United Kingdom revealed some important insights. For two doses of Pfizer-BioNTech, vaccine effectiveness against Omicron infection dropped from about 90 percent one month after the second dose, to about 50 percent after three months and then 35 percent four months and beyond.

16.  
This erosion of protection is quite fast. But then, two weeks after a booster, vaccine effectiveness against Omicron infection shot back up to 75 percent, which is encouraging. This means boosters work.

17.  This is protection against symptomatic infection. If we look at protection against severe illnesses, the protection level is likely to be much higher. Also encouraging.

18.  That is why vaccination will continue to be central to our response. We must continue to get the unvaccinated vaccinated. There are about 160,000 of them in Singapore today, with 40,000 who are seniors aged 60 and above. They are all at very high risk of falling very sick, needing ICU care or die, if they are infected with COVID- 19.

19.  We will also need to administer as many boosters as possible to those who are due to take them, to get them well-protected against Omicron early.

20.  As I mentioned at an earlier media conference, due to the emergence of COVID-19 variants, we need to treat COVID-19 primary vaccination as a three-dose regime. And our policies need to be geared towards that.

21.  We will therefore have to set a validity period for full vaccination status. This means that after two doses of mRNA vaccines and three doses of Sinovac/ Sinopharm vaccines, our full vaccination status will last a limited period. The Ministry of Health (MOH) is consulting the Expert Committee on COVID-19 Vaccination (EC19V) to determine what this duration should be.

22.  This is a clear signal that we all need to take our boosters. Because with waning protection, full vaccination status cannot last perpetually. Take our boosters, and our full vaccination status will be extended and we will be able to access various amenities under our Vaccination-Differentiated Safe Management Measures (VDS) framework.

23.  We expect to announce the new policy at the end of this year or early next year. But please be assured: We will design the policy such that if you have not been given a chance to get your booster, your full vaccination status will not lapse. Similarly, if you belong to a group not eligible for boosters, such as those aged below 18 years, your full vaccination status will also not lapse.

24.  Encouraging vaccination and boosters is also the context within which we announced two recent moves – vaccinating children aged five to 11 years old, and extending boosters to young people aged 18 to 29 years.

25.  These are significant moves. It means in December 2021 and January 2022, we will administer about 2.1 million doses of vaccines to individuals – about 700,000 more if we had not expanded the programme. If we follow through, at the end of January 2022, about 54% of our total population will be covered by boosters.

26.  The two mRNA vaccines can be used interchangeably as boosters. For the month of December, we have more Moderna supplies. So if you are eligible to receive your booster shot and if you choose to take a Moderna booster, you can just walk into a Moderna vaccination centre for your jab. There is no need to pre-book a slot.

27.  We are also making a few operational adjustments, for example the exemption of VDS for recovered patients will be adjusted downwards from 270 days to 180 days. This is to take into account the faster waning of their immunity due to the Omicron variant.

28.  We are also reducing the monitoring time after receiving boosters from 30 minutes to 15 minutes, because our data shows very low incidence rate of significant acute adverse reactions after taking boosters. This will expand our booster delivering capacity. We are also planning to set up more vaccination centres, to support children vaccination and also boostering during this period.

Health Protocols

29.  Next, let me talk about health protocols. We have made significant changes to our health protocols as we rode through the Delta transmission wave.

30.  And the primary consideration is this. Because with the great majority of us fully vaccinated, most infected individuals experience mild or no symptoms. Hence, it is no longer necessary or practical to put everyone in hospitals. Right siting COVID-19 patients is important, so that acute healthcare resources are available to those who truly need them.

31.  That is why we implemented the Home Recovery Programme (HRP). We want to thank everyone for your patience and understanding as we set up the programme, and for making the HRP a success.

32.  I want to especially thank our General Practitioners (GPs) for playing a very big and vital role in this regard. They administered Polymerase Chain Reaction (PCR) tests for their patients and they are also the ones to trigger the onboarding process for patients to be part of the HRP.

33.  Many GPs have been family physicians for their patients for many years. Hence, they have expressed a strong interest to continue to care for their COVID-19 patients, instead of having them onboarded into a national HRP. MOH supports this, because maintaining that long term doctor-patient relationship is actually the essence of primary care.

34.  We are therefore thinking through how to have our GPs play an even bigger role, especially if we ever have a big Omicron wave. One key idea that we are working on is this: in our simplified healthcare Protocol 1-2-3, most of you should be familiar with, we provided the option under Protocol 2 for those who feel they are well, and yet tested positive with an Antigen Rapid Test (ART) kit, to just rest at home and come out when they are tested ART negative.

35.  If Omicron is indeed milder, but transmits faster, we need to push the idea of right siting even further. Today, GPs only prescribe a PCR test to someone who feels unwell. If tested positive, the patient will most likely be put under HRP for 10 days.

36.  We can further empower our GPs, so that they can judge the disposition and risk profile of the patient, and order either a PCR or an ART test. For very mild or asymptomatic cases, the GP may want to just order an ART test, and if positive, the patient may be asked to go on few days of MC, rest at home, and come out when tested ART negative.

37.  In other words, Protocol 1-2-3 will remain, but the GP can now trigger not just Protocol 1, but also Protocol 2, with an MC. And GPs can even follow up to care for their patients. So even within the more formal HRP system, there is scope for the GPs to be providing follow-up care, instead of centralised coordinated care administered by MOH. This is an idea and proposal that we will be engaging the GPs on in the coming days.

38.   I will now pass the floor to SMS Dr Janil to further explain children vaccination.





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