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21 Jan 2022

21st Jan 2022

        Today, I will take stock of 2021, and then talk about what more we will do to help us prepare for this Omicron wave that we are already in. 

2.     What we are going to present, will hold fast to a few key principles. First, we continue to aim to live with COVID-19, including the Omicron variant. Second, we must understand the variant scientifically, so as to better shape our policies and responses. Third, focus our energy and resources on the risk areas, and on the vulnerable. It is very important once the wave becomes very big. Finally, count on everyone to do our part in the united national response. 

Taking Stock of 2021

3.     First, let me take stock of 2021. It was a difficult year, but fortunately, we ended the year with a subsiding Delta wave. 

4.     The Ministry of Health (MOH) has been compiling data on the incidence of infected individuals needing ICU care or died, broken down by age and vaccination status. We have released this data twice last year and now, we have updated the numbers until the end of 2021. 

5.     This set of data is predominantly related to the Delta variant, and we are now in an Omicron wave. So it is timely and useful to do this year-end stocktake on the incidence rate of severe illnesses and deaths.

6.     The conclusion of the updated dataset is consistent with our last two releases: 

• Number one, unvaccinated individuals are at far higher risk of falling severely ill or die, and this increases especially with age. 

• Number two, the chances of unvaccinated COVID-19 patients needing ICU care or dying is many times that of the fully vaccinated – it ranges from seven times more for those aged 80 and above, and 50 times more for those in their 30s.

• Specifically, the chances of unvaccinated individuals falling severely ill or dying are: for those in their 60s – 7.2%; for those in their 70s – 14%; for those 80 and above – 24%.

• And in contrast, for fully vaccinated individuals in their 80’s, the corresponding percentage is only 3%. 

7.     I cited this data because I have come across the argument from individuals who do not want to take COVID-19 vaccines, that there should not be Vaccination-Differentiated Safe Management Measures (VDS). 

8.     Their view is that the number of unvaccinated people in our population is not large to start with, and since only a small percentage, if infected, will fall severely ill or die, the load on our healthcare system caused by the unvaccinated will not be significant. We should therefore remove VDS and allow the unvaccinated free access to various premises. 

9.     I want to just point out that based on all these numbers – as I have said, our response must be scientifically backed up – this argument is not correct. Throughout the pandemic, two-thirds of our ICU beds were occupied by people who were not fully vaccinated. And very likely for Omicron, it may turn out the same way.

10.     If you look at the numbers, today we have about 120,000 adult individuals above the age of 20 who are unvaccinated, so this is the unvaccinated adult population, and very few are due to medical ineligibility. Most are due to choice. Based on the incidence rate of severe illnesses and deaths that I just presented, and the age profile of the current unvaccinated population, if all of them were infected with the Delta variant, we expect about 5,800 of them to require ICU care or to die. 

11.     5,800 is not a small number. Remember, at the peak of the Delta wave, our maximum ICU occupancy was 176,. And 176 ICU beds occupied contributed to a severe strain on our healthcare system. Of course, in reality, not all unvaccinated persons will be infected and for those who are, not all will be infected at the same time.  

12.     However, even if say, a quarter of the 5,800 ICU cases occur over a duration of four to eight weeks, it will be a significant load on our healthcare system. 

13.     A significant load enough to displace many patients – suffering from acute complications of cancer or severe chronic diseases – who may need urgent medical care. Enough load to consume a lot of costly COVID-19 therapeutics. Enough to degrade the overall quality of care of the healthcare system, which will ultimately affect everyone, especially non-COVID patients who are critically ill.  

14.     All these can be avoided if unvaccinated individuals had chosen to take their jabs instead. 

15.     Some may argue that my data and my analysis is based on Delta, and Omicron is less severe. Indeed, from the experiences of other countries, we know that Omicron infections are much less severe for the vaccinated and boosted, and for those who were infected and recovered. 

16.     But we are not so sure that the same is true for individuals who are unvaccinated and COVID naïve. We have not seen the full impact of the Omicron wave in Singapore. Now is not the right time to take a gamble to remove VDS, on the hunch that Omicron may be less severe for the infected unvaccinated. We cannot gamble on the health of Singaporeans. 

17.     Even if, hypothetically, someday the number of unvaccinated people falling severely ill because of COVID-19 infections works out to be very a low number, and does not impact or burden the healthcare system excessively, remember the credit goes to the rest of the population. The rest of the population – which is the great majority – chose to vaccinate themselves. A significant number, in fact, were worried about vaccinations too, but nevertheless decided to do their part for their family and for the society.  

18.     And conversely, if everyone adopts the attitude that they need not get vaccinated because others will, and then we free ride on the rest, then our society would never have achieved the high level of resilience it has today.

19.     The vaccination exercise for children is now ongoing. It is a teachable moment for them, and I hope we teach them the right lessons. 

20.     It is important for children to get the vaccinations. In countries experiencing Omicron waves, hospitals are seeing a sharp spike in paediatric admissions, mostly because children are not vaccinated. While the great majority of these children recover quickly, this is not something we can take lightly. Director of Medical Services (DMS) will explain this further.  
  
Preparing for Omicron

21.     Now, let me talk about the Omicron infection wave. It is all over the world and dominating the Delta variant – and this is already happening  in Singapore.  

22.     The good news is that our existing vaccines are working against the Omicron variant, and people are generally having less severe symptoms as compared to the Delta variant. Given that, we will be making a few further changes to our vaccine policies and our health protocols to further prepare ourselves to ride this Omicron wave.

23.     First, the Expert Committee on COVID-19 Vaccination, EC19V, has recommended, and MOH has accepted, that young people aged 12 to 17 can now receive boosters. Other countries such as the US, Chile, Qatar and Israel have already extended boosters to this age group. The EC19V has reviewed the data, and is satisfied that boosters are safe and effective for individuals in this age group.  

24.     We will progressively roll out booster vaccinations for this age group, and SMS invitations will be sent out to the 16- and 17-year-olds from early February onwards. Younger children, or teenagers, will then be invited gradually.    

25.     With this change, the 270-day validity period for two shots of mRNA vaccines and three shots of Sinovac/Sinopharm vaccines, will be extended to those aged 12 to 17.

26.     But it will start later than the rest of the population. As you know, for the rest of the population this will kick in from 14 February 2022. For those aged 12 to 17, we will kick this off one more month later, on 14 March 2022. This will give the young people aged 12 to 17 more time to get their boosters. 

27.     In the meantime, if you are in this age group, and you have received an SMS invitation to receive your booster shot, go and get the jab promptly. 

28.     Second, we will further rationalise health protocols at the borders and in the community.  

29.     Minister Gan explained the changes for travellers, so I will not repeat. Let me instead briefly talk about community health protocols. 

30.     NCID studies showed that while the Omicron variant is more transmissible, infected individuals carry a lower viral load and generally recover faster. We will therefore reduce the isolation period for the fully vaccinated individuals and children under 12 years old from 10 days to 7 days. 

31.     We will also allow for the wider application of Protocol 2. As you know, Protocol 2 is where individuals perform ART self-test, self-isolate for 72 hours, and once you are Ag-, you can then go out and resume normal activities. 

32.     It is important for us to make this move, because that way, we can handle this large wave without overburdening the health response system, and medical care can go to those who need it most. Protocol 2 is based on personal responsibility and civic consciousness, and with the cooperation of Singaporeans, it has actually worked very well. 

33.     These are quite detailed changes and DMS will elaborate later. 

34.     Third, we would have to change the case definition for daily reporting.  

35.     It used to be that when you see a doctor - a General Practitioner (GP) - he can only order a PCR test if you are suspected to be infected with COVID-19. And if you are PCR-positive, you are either sent to a medical facility, such as a hospital or a COVID-19 Treatment Facility (CTF), or you are placed under the Home Recovery Programme for ten days. We are changing this to seven days. This is essentially called Protocol 1. Essentially GP, primary care providers, they could only order Protocol 1.

36.     On 6 January this year, we changed this arrangement. We empowered our GPs and other medical providers to also be able to order Protocol 2 if they encounter a patient who might be of low risk and experiencing very mild symptoms or in fact, no symptoms. For simplicity, let’s call these GP Protocol 2 cases. Last time, GP could only do Protocol 1, so now there are GP Protocol 2 cases.

37.     This change makes a lot of sense. Because whether an individual undergoes Protocol 1 with a 10-day (and now 7-day) home recovery or Protocol 2 with a 72-hour self-isolation, it should depend on the risk profile and the severity of the symptoms of the patient, not because of whether he decided to go to a GP or do a self-test. 

38.     Hence, under the new arrangement, GPs and medical providers will look at the patient, do a  clinical assessment, refer to MOH’s guidelines, and decide whether to prescribe him Protocol 1 or Protocol 2. 

39.     Consistent with the ART self-test under Protocol 2, we had not been reporting the GP Protocol 2 cases in our daily updates. The numbers were not large, about 100 to 200 cases a day when we first started the arrangement on 6 January this year.  

40.     However, as it becomes increasingly evident that Omicron is a less severe disease than Delta, GPs also started to see more and more mild Omicron cases and they prescribed more and more Protocol 2 to these patients. Hence, GP Protocol 2 cases rose quickly, to about 400 to 500 daily cases a day last week, and this week, over 1,000 cases a day.  

41.     MOH has reviewed the situation and decided that it is better to include the GP Protocol 2 cases in our daily updates on infection numbers. It will give a better picture of the epidemic situation in Singapore, and which part of the epidemic curve we are on. In other words, the number that you will be reporting will be higher.

42.     But let me caveat that is still not the full picture, and neither is it possible to get a full picture. This is because many cases with no symptoms and very mild symptoms may remain undetected, and others may choose to self-test and self-administer Protocol 2, which is also not possible to be captured. This was the case during the Delta wave, and is now more apparent with the Omicron variant, because it is generally a milder disease. 

43.     We will therefore be releasing two numbers every day – one for infections confirmed by PCR tests, which is the number reported currently, and then another for the GP Protocol 2 cases. We will backdate the numbers to 6 January 2022, when GPs started to order Protocol 2, for the purposes of calculating total number of infections in Singapore, as well as the week-on-week increase in infection numbers. To satisfy your curiosity, with this new method, the week-on-week increase in cases will remain largely unchanged compared to now, at around 2.5.  

44.     As Omicron has clearly dominated the current infection wave, MOH will also stop differentiating between Omicron and non-Omicron infections in our daily updates. 

45.     This is a change in case definition and how statistics are compiled. In reality, the way we lead our lives, the way we respond to the disease, nothing has changed. Only the statistics and the numbers have changed. It does not change the actual epidemic situation we are experiencing. Over the past weeks, we have been living with COVID-19 and Omicron variant quite carefully and calmly with a less restricted posture where we can meet in groups of five. This attitude should not change because of an adjustment in case definition and reporting methods.  

46.     The fact is that with vaccinations working well, and the Omicron variant being less severe, the top line infection number is becoming less meaningful in our response to COVID-19. This top line infection number comprises mostly people who are vaccinated, who are experiencing mild symptoms or no symptoms, which from a public health point of view is not something we should be overly concerned about. We watch it, but should not be overly concerned about it. 

47.     This is an issue I discussed with World Health Organization Director-General Dr Tedros last week when we were on a Zoom call, and it was well acknowledged by him and his experts, that in time, when we start to live normally with the disease, the world needs to move away from focusing on the top line infection numbers.  

48.     The more important statistics are in the bottomline – how many people are severely ill needing oxygen supplementation, how many in ICU care, and how many died.  

49.     To date, of the 12,078 individuals confirmed infected with Omicron – and there are many others whom we cannot ascertain – 34 or less than 0.3% of them required oxygen supplementation. Most needed oxygen for one day, with the longest duration of five days for one patient. So, compare Delta and Omicron. For Delta, the numbers were 0.8% needing oxygen, 0.2% in ICU, 0.2% died. Altogether 1.2%. Omicron, so far, what we are seeing, is less than 0.3% needing oxygen.

50.     I should point out there is one senior in his 80s infected with Omicron, he was admitted to the ICU as he required high flow oxygen. He was not intubated, and he was given the oxygen and discharged from ICU the next day.  

51.     So in the 20 days since the start of this year, we have nine days without any COVID-19 related deaths, seven days with one death, and the rest of the days three or fewer deaths. 

52.     In terms of healthcare capacity, we now have 14 COVID-related patients in our ICU, all due to Delta. We have about 300 patients occupying about a quarter of our 1,100 isolation beds, which we can ramp up to 2,500 at short notice. We have about 200 patients occupying 6% of our 3,200 CTF beds, which we can ramp up to 4,000 by the end of January and 5,000 by the end of February. 

53.     All in all, we are in a good position now. But when cases start to rise further, we must expect ICU cases to rise, and some deaths to happen, and healthcare capacity will also be filled up. But so far, our experience with Omicron is similar to other countries that encountered it before us – it is a less severe disease.  

54.     Nevertheless, we need to be psychologically prepared for big infection numbers – 10,000, 15,000, maybe and probably more. We all need to stay vigilant and do our part, to get ourselves vaccinated, and protect the vulnerable amongst us.  

55.     If the situation in our hospitals is stable, we should ride through the Omicron wave with the current safe management measures, through Chinese New Year. 

Conclusion

56.     In conclusion, I have earlier said that going through the Omicron wave is like the game of snakes and ladders – it may set us back or it may take us forward. We will find out the answer quite soon. Whatever the outcome may be, we need to once again call on everyone to support our healthcare workers, and do our part to ride through this wave. 

57.     I will now hand the floor to DMS, to talk about child vaccinations, and elaborate on the changes to health protocols. 




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