Protecting the vulnerable, Securing our future

     Singapore entered the Stabilisation Phase on 27 September 2021 to slow down the rate of transmission and protect our healthcare system. We have used this time to do several things. We have built up COVID-19 Treatment Facilities to complement our hospital and community care facilities. We have also bolstered manpower, employed technology, and streamlined processes for the Home Recovery Programme (HRP), which allows the majority of individuals with mild or no symptoms to recover safely in their own homes.

2.      We thank all Singapore residents for reducing their level of activity and social interactions in the past two weeks. Your efforts have helped to slow down the rise in daily cases. However, the present wave of infection has not crested, and we must be prepared for cases to continue to increase and remain high for some time.

3.      We will ride this wave while ensuring that our healthcare system is not overwhelmed. Most vaccinated persons who catch the virus have only mild or no symptoms. Children aged 12 and below generally have mild or no symptoms as well, even though they are unvaccinated. However, for seniors who are unvaccinated, they are at great risk of falling very sick if infected. Although this group accounts for 1.5% of our population, they account for two-thirds of the individuals who need ICU care or have died.

4.      We will therefore need to expand our vaccination-differentiated safe management measures to protect the unvaccinated. We will also simplify our testing protocols to make these easier to understand and adhere to. We will extend booster vaccinations to healthcare and frontline workers, and persons in institutionalised settings, followed by all individuals aged 30 and above, to ensure continued high levels of COVID-19 immunity in the population.

Updates on Local COVID-19 Situation

5.      The vast majority (98.8%) of cases continue to have mild or no symptoms. This is due to our high vaccination coverage, with 83% of the population having now completed their 2-dose regimen. Of the 423 cases with severe illness in the last two weeks, a disproportionate proportion (53.9%) were unvaccinated, and the rest were vaccinated individuals with co-morbidities.

6.      The number of persons requiring ICU is continuing to rise at the same rate as our overall case numbers, albeit with a lag. We have had 51 new cases in ICU over the past two weeks, as compared to 32 over the preceding two weeks. Although we have increased our hospital capacity, bed occupancy rates are rising, and our healthcare manpower has been stretched.

Home Recovery Programme

Extending the enrolment criteria

7.      Since the start of the HRP on 15 September 2021, more than 19,000 individuals have been recovering at home, of which more than 8,000 have fully recovered and been discharged. As our population has become more familiar with the HRP, and our healthcare professionals have become more experienced in handling the medical needs of those on HRP, it is timely to extend the HRP to a wider range of individuals, especially for those with mild or no symptoms. This will allow us to better prioritise healthcare resources in our hospitals to take care of the severely ill or vulnerable patients, without compromising care to those who may be younger with milder or no symptoms.

8.      We will extend home recovery to unvaccinated persons aged 12 to 49 years as the severity of illness for such younger and unvaccinated individuals is low, and it is safe for them to recover at home. Given the clinical observations to-date of vaccinated infected persons aged 70 to 79 years, and the fall risks associated with such elderly persons in an unfamiliar environment, it will also be safer for them to recover in the familiar surroundings of their home ¹. However, as a precaution, individuals from both groups would be assigned to a healthcare provider and should monitor their health closely, including their oxygen level, during the isolation period and consult the healthcare provider early should there be any significant deterioration in their health.

9.      We will also extend default home recovery to children aged 5 to 11 years old, as we found that COVID-19 is not a serious illness for the vast majority of them. Furthermore, parents have often requested that children be allowed to recover at home, where there are caregivers from the family. As for children aged 1 to 4, 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.

10.      The combined outcome of these changes is that from 10 October 2021, we will make HRP² the default care arrangement for everyone, other than for the following persons:

• partially or unvaccinated individuals aged 50 years and older;

• vaccinated persons 80 years and older; and

• children aged less than 1 year, and children aged 1 to 4 years who have been assessed to be clinically unsuitable for home recovery.

Please refer to Annex A [PDF, 118 KB] for more details.

11.      Individuals who are on HRP will continue to have 24/7 access to medical support. This may be available through existing telemedicine providers as well as a strengthened network of medical support with the Public Health Preparedness Clinics (PHPCs) or polyclinics who have come onboard the programme to help provide continuity of care for their patients. For non-medical assistance, individuals can reach out to the Home Recovery Buddy Hotline (6874 4939).

Timed discharge from home recovery

12.      Evidence has shown that viral loads in infected individuals will decline and reach undetectable or non-infectious levels with time. This happens in vaccinated individuals and young children (even if unvaccinated) earlier than in unvaccinated individuals. Hence, COVID-19 infected individuals enrolled in the HRP will be discharged based on the time since diagnosis, without the need for further tests.

For vaccinated individuals and children aged 12 years and below, the HRP isolation period will last for 10 days, while the HRP isolation period for unvaccinated individuals above the age of 12 years will last for 14 days. Thereafter, they will be provided with an electronic discharge memo upon the end of their isolation period. For simplicity, we will remove the Day 7 discharge for vaccinated person based on a PCR test that is negative or of low viral load.

Expansion of Vaccination-Differentiated Safe Management Measures (VDS) Coverage

14.      Epidemiological investigations have identified food and beverage (F&B) settings such as hawker centres, retail establishments, and shopping centres as settings frequently visited by a significant proportion of COVID-19 positive cases, including those who are unvaccinated, and later on fell very sick.

15.      We already have vaccination-differentiated safe management measures (VDS) for dining-in at F&B establishments³.To protect the unvaccinated individuals and reduce the strain on our healthcare system, we will expand the VDS for entry into shopping malls, attractions, hawker centres, and coffee shops from 13 October 2021. Enterprises that are able to implement the expanded VDS coverage earlier are strongly encouraged to do so. Please refer to Annex B [PDF, 123 KB] for details.

16.      The expanded VDS means that only groups of up to 2 fully vaccinated persons will be allowed to dine-in at hawker centres and coffee shops, like all other regular F&B establishments. Individuals who do not meet the above criteria can still buy take-away food. The relevant agencies will provide more details.

17.      Similarly, under the expanded VDS coverage, only groups of up to 2 fully vaccinated persons will be allowed to enter shopping malls and attractions.

Protecting our vulnerable groups

18.      As announced on 7 October 2021⁴, the Ministry of Education (MOE) will progressively bring Primary 1 to 6 students back to schools for face-to-face lessons from11 October 2021 (Monday) to ensure physical schooling resumes in a safe manner. This is in line with MOE’s approach to minimise prolonged Home-based Learning (HBL) where possible, for the social-emotional well-being of students.

19.      In line with the return of students to primary schools, face-to-face lessons for students aged 12 years and below at tuition and enrichment centres, and Private Education Institutions (PEIs) may also resume from 11 October 2021, with strict Safe Management Measures in place. Nevertheless, centres and PEIs serving students aged 12 and below are still strongly encouraged to continue conducting lessons online as much as possible to protect the young.

Updates to Testing Protocols

20.      The protocols and procedures for testing and isolation have been developed over the past months and became complex and difficult to understand. We will significantly simplify these procedures. A key move is to reserve PCR testing mainly for individuals who feel unwell and have symptoms5. Antigen rapid tests (ART) will be used for people who are well, such as for community testing and for the management of contacts of COVID-19 cases, so that we can still detect infections early and are able to exercise precaution to self-isolate early to protect ourselves and persons around us.

Revised Protocols for Positive Cases

21.      The streamlined new protocols, are as follows:

Protocol 1: For those who are unwell and tested positive, they should see a doctor. They will either be placed on the HRP by default, or if the home environment is not suitable, they can recover at the appropriate care facilities. They will be isolated for 10 days if they are fully vaccinated (or are young children aged 12 years or less); or isolated for 14 days if they are unvaccinated. They will be discharged after their respective isolation periods without the need for further tests at the point of discharge.

Protocol 2: For those who are well and tested positive, they should self-isolate at home for the next 72 hours. After 72 hours, they can re-test and if negative, they may exit isolation and resume normal activities. If they become unwell at any time, they should see a doctor.

22.      Previously, we differentiated contacts of COVID-19 cases into various risk levels and imposed several measures including Quarantine Orders (QO), Health Risk Alerts (HRA), and Health Risk Warnings (HRW). There will now be a single approach – a HRW that lasts seven days from the day of its issuance, that is based on ART self-testing. It will comprise the following:

Protocol 3: Upon being notified of the HRW (Day 1), the person should immediately self-isolate, and test himself with an ART on the day of the HRW issuance and upload the Day 1 ART result based on the instruction in the HRW notification. He can continue with normal activities for the day if the test is negative. For subsequent days, i.e. Day 2 to 7, the person should test ART negative on same day before going out. If the person tests positive on any of these ART tests, he should follow Protocol 2 above. On Day 7, he must test himself with an ART, and if the test is negative, there is no further need for tests after that.

Please refer to Annex C [PDF, 46 KB] for the summary of protocols.

23.      These revised protocols will start from 11 October 2021. They mark a shift in emphasis towards personal responsibility and self-management.

24.      For those already in the system and following previous protocols, we need to make some transitional arrangements. If you are a COVID-19 patient, you will serve out the 10-day or 14-day isolation, depending on your vaccination status. If you are currently on a quarantine order, you will no longer need an exit PCR test. If you test yourself with an ART and the result is negative, you may go out for the day. At the end of Day 7, you may exit quarantine. In other words, you can follow Protocol 3.

25.      To provide greater support for regular self-testing at home, the Ministry of Health (MOH) will be conducting another round of distribution of ART kits from 22 October to 7 December 2021, via SingPost. Each household will receive a package containing 10 ART self-test kits.

Updates to Travel Protocols.

Changes to border measures

26.      As part of our regular review of the COVID-19 situation in countries/regions and border measures, we have updated the list of countries in the various categories and made some adjustments to the categories of some countries/ regions. Details of the updated country/region classification and their corresponding border measures may be found in Annex D [PDF, 138 KB] and would be effective for arrivals from 12 October 2021, 2359 hours. We will continue to adjust our border measures as the global situation evolves.

Extending Vaccinated Travel Lanes

27.     On 8 September 2021, we launched the Vaccinated Travel Lanes (VTLs) with Brunei and Germany to allow entry for fully vaccinated persons from these countries into Singapore for general travel. With VTLs, we replaced SHN with a regular testing regime for lower risk countries. As of 8 October 2021, 2359 hours, of the close to 2,000 VTP holders who entered Singapore, there have only been two imported COVID-19 cases. Both were tested COVID-positive on arrival and isolated immediately. There were no imported cases detected through the post arrival tests on Days 3 and 7 in Singapore.

28.     With the experience gained from the VTLs to Brunei and Germany, we will be extending the VTLs to eight more Category II countries/regions, namely Canada, Denmark, France, Italy, Netherlands, Spain, United Kingdom, and the United States for entry into Singapore from 19 October 2021. Applications for short-term visitors and Long-Term Pass Holders will commence on 12 October 2021 for travel into Singapore from 19 October 2021.

29.      We will also jointly launch VTLs with the Republic of Korea (ROK) for travel between our countries from 15 November 2021, with application for the VTP for Short Term Visitors and Long-Term Pass Holders commencing on 8 November 2021. Returning Singapore Citizens and Permanent Residents who are vaccinated will not need to apply for the VTP to travel under the VTLs.

30.      We will also be making changes to the VTL testing regime which will apply to all VTL countries. All travellers entering Singapore under the VTLs from 19 October 2021 will only be required to present a valid negative COVID-19 PCR test result taken within 48 hours before departure to Singapore and undergo an on-arrival PCR test upon arriving in Singapore. They will not be required to undergo additional PCR tests on Days 3 and 7 of their stay in Singapore.

31.      The Civil Aviation Authority of Singapore will provide more details separately.

Expanding the Booster Vaccination Strategy

32.      On 3 October 2021, we commenced the booster programme for persons aged 50 to 59 years, in addition to those aged 60 years and above. As of 7 October 2021, almost 372,000 individuals have received their booster dose. 57% of individuals 50 to 59 years and 72% of seniors aged 60 years and above who are eligible for their booster dose have either booked an appointment or already received their booster dose.

33.      he Expert Committee on COVID-19 Vaccination (EC19V) has further recommended for the following persons to receive a booster dose of the Pandemic Special Access Route (PSAR) mRNA vaccine from six months after completing their primary series of vaccinations (please refer to Annex E [PDF, 56 KB] for more details):

      a. Healthcare and frontline workers,

      b. Persons and staff in institutionalised settings, and

      c. Persons aged 30 years and above.

34.      MOH has accepted EC19V’s recommendations. Our healthcare and frontline workers are more likely to come into regular contact with COVID-19 cases in the course of their work and are at greater risk of infection. Persons and staff in institutionalised settings, such as prisons and residential care facilities, live in indoor settings of increased human density which are predisposed to large outbreaks of COVID-19. Expanding the booster programme to persons aged 30 and above will also help to raise the overall level of protection in the population.

35.      From 9 October 2021, we will start offering booster vaccinations to healthcare workers, as well as frontline COVID-19 workers who have completed their primary series vaccination regimen around six months ago. We are also working with various institutions to progressively roll out booster vaccinations to eligible persons in institutionalised settings.

36.      From 9 October 2021, we will also progressively invite persons aged 30 years and above who have also completed their primary series vaccination regimen around six months ago to make an appointment for their booster dose. An SMS with a personalised booking link will be sent to the mobile number that they had earlier registered for their first two doses, to book an appointment on www.vaccine.gov.sg. These individuals may receive their booster dose at any vaccination centre or participating Public Health Preparedness Clinic (PHPC).

Towards a COVID-19 Resilient Singapore

37.      We are staying the course to transit towards a COVID-19 resilient nation. We will progressively re-open our society and economy, and resume travel, which is the lifeblood of our economy. But for now, the Stabilisation Phase is necessary to protect our healthcare system.

38.      We seek everyone’s cooperation to observe all safe management measures and testing protocols so that we can lower transmission risks and slow down the pace of community infections. Everyone needs to be socially responsible to take care of themselves and minimise unnecessary movement and social interactions. If you have been exposed to positive cases, please isolate yourself, test yourself regularly and seek medical treatment if you have any symptoms. Vaccination boosters will also be a key enabler for us to protect ourselves and our loved ones, particularly our seniors. Hence, we urge everyone to be vaccinated when it is offered to you.

MINISTRY OF HEALTH
9 OCTOBER 2021

^[1] This will commence from 16 October 2021.

^[2] Previous eligibility criteria for HRP: (a) fully vaccinated, (b) aged 12-69 years old, (c) mild or no symptoms, (d) no severe comorbidities or illnesses, (e) household members do not include elderly who are more than 80 years old or people in the vulnerable group, such as pregnant women or those with weakened immune response or multiple comorbidities and (f) can self-isolate in a room, preferably with an attached bathroom.

^[3] Under the current VDS, groups of up to 2 fully vaccinated persons are allowed to dine-in. Children aged 12 years and below, recovered individuals, and unvaccinated individuals with a valid negative pre-event test (PET) result can be included in the group of 2.

^[4] More information on the resumption of face-to-face lessons for primary schools is available here:https://www.moe.gov.sg/news/press-releases/20211007-phased-resumption-of-face-to-face-lessons-for-primary-schools-from-11-october

^[5] Mild symptoms: Fever, cough, fatigue, new loss of taste or smell, sore throat, runny nose, muscle aches, diarrhoea, nausea or vomiting; Severe symptoms: shortness of breath, chest pain or pressure, loss of speech or movement.