The easing of community measures as we exit Phase 2 (Heightened Alert) has led to an increase in COVID-19 cases, which is not unexpected. Nevertheless, the number of individuals with severe illness requiring oxygen supplementation and ICU remains under control. These point to our heightened COVID resilience – the ability to live with COVID-19 cases amongst us, with sufficient healthcare capacity for those of us who do fall ill. We will continue to strengthen our tools for achieving COVID resilience, by calibrating our safe management measures, testing more extensively and contact tracing more surgically to reduce and identify infections early. We will also begin transiting towards the next phase of our National Vaccination Programme by commencing a booster programme in September 2021.
Updates on Local COVID-19 Situation
2. While COVID-19 case numbers have increased recently, the high vaccination coverage in our population has allowed us to keep the incidences of severe illnesses and deaths low thus far. This is particularly important for those who are vulnerable to COVID-19, such as our seniors. We will need to monitor the situation closely, as there is a time lag between the onset of infections to serious illnesses and deaths. In the meantime, we will stay in the current Preparatory Stage, while we refine our public health measures and embark on pilot projects such as the Vaccinated Travel Lane with Germany and Brunei and the home recovery scheme for infected individuals with mild or no symptoms.
3. Among the 2,369 infected individuals in the last 28 days, 1.1% of vaccinated persons had severe illness compared with 8.2% among unvaccinated persons. The number of persons requiring ICU has held stable at around 6 to 7 in the last week, with those requiring oxygen supplementation trending downwards.
4. We have also continued to make good progress on our National Vaccination Programme. As of 2 September 2021, 80% of our total population have completed their full regimenand 83% have received at least one dose of the COVID-19 vaccines. In terms of eligible population, 88% have completed their full regimen.
5. Coverage among our seniors continues to increase, and has also reached 84% for those aged 70 years and above, and 90% for those aged between 60 and 69 years. With such a high vaccination rate, and because it is still possible to get a post-vaccination infection, we must expect to see more vaccinated persons amongst our daily infection cases. But the proportion of vaccinated persons who become infected remains smaller than the proportion of unvaccinated persons who get infected. The difference in proportions who become severely ill after infection, is even more stark. Importantly, the evidence also clearly shows that vaccination remains highly effective in preventing severe illness if a vaccinated person were to catch the virus.
6. We will have to continue our efforts to encourage vaccination uptake amongst eligible individuals who have not stepped forward for vaccination. As a safety precaution, these individuals will need to continue to be subjected to vaccination-differentiated safe management measures.
7. We will be taking further measures to prepare to move to the Transitionary Stage of opening. This includes expanding our tools for testing and surveillance to keep infections from spiking, and a vaccine booster programme to boost immunity levels of the elderly and immunocompromised to better protect them.
Expanding Testing and Surveillance
8. We will redouble our efforts to make regular testing part of the new normal. Frequent testing remains key for us to identify cases early and avoid huge peaks in cases that could risk straining our healthcare system. For certain higher risk settings, the Government has mandated rostered routine testing. But regular testing should not be confined to persons working in these settings. We strongly encourage everyone, including fully-vaccinated individuals, to self-test regularly with Antigen Rapid Test (ART) kits as a matter of social responsibility, especially if you are participating in higher-risk activities or attending large-scale events. While the unvaccinated are more susceptible to getting infected, vaccinated individuals are also at some risk.
9. Singaporeans can use the ART kits that are being issued to every household between 28 August to 27 September 2021. To date[1], the Health Sciences Authority has approved six ART self-test kits and these are widely available at major retailers and e-commerce platforms. We are actively reviewing new kits for public sale, and will continue to make such self-test kits more readily accessible.
10. Employers can also play their part in making regular testing a new norm. The tripartite partners will discuss further guidelines to promote the more pervasive use of antigen rapid tests at workplaces, and as a key element of business continuity plans. This will go beyond the Regular Rostered Testing (RRT) for higher risk settings and the Vaccinate or Regular Test (VoRT) regime. Such regular testing will enable us to detect cases early, help to reduce workplace transmission and prevent large workplace clusters as more people return to on-site work.
11. To supplement regular self-testing, members of the public can now make an appointment for a self-paid fast and easy test (FET) at the 20 Quick Test Centres (QTCs)[2] from 1 October 2021. This can be to fulfil employment requirements, or for an unvaccinated person to attend a mass event. The QTCs were set up by the Health Promotion Board to support small businesses and freelancers who needed a supervised self-swab ART to meet their testing requirements under the FET RRT regime. We will also study the setting up of more testing sites across the island, so that it will be easier for people to get themselves tested regularly.
12. Individuals who test positive through these FETs or their ART self-tests should visit a Swab-and-Send-Home Clinic for a government-funded confirmatory PCR test to confirm your infection status so that the Ministry of Health (MOH) can follow up with the appropriate public health actions and to extend the appropriate care to you. If you are symptomatic[3], visit a doctor immediately instead of self-testing or booking a test at the QTCs.
Booster Vaccination Strategy
13. Eight months have passed since our first residents were vaccinated under our National Vaccination Programme. MOH with advice from the Expert Committee on COVID-19 Vaccination (EC19V) has reviewed our strategies to achieve protection against COVID-19 through vaccination, especially in light of the more transmissible variants that have emerged globally.
14. With the more transmissible Delta variant, it is not likely that countries can achieve herd protection without a very high population vaccination rate of well over 90%. There has also been emerging data on the waning of vaccine efficacy against infection with time. Although evidence globally and locally continues to show that vaccines are very effective in reducing severe illness and death. Some countries have also decided to proceed with booster doses.
15. Having reviewed the available evidence, as well as scrutinised the safety and efficacy of booster doses administered globally, the EC19V has recommended, and MOH has agreed, to commence a booster programme in Singapore for two subgroups: (a) persons who are moderately to severely immunocompromised and (b) persons aged 60 years and above, as well as residents of aged care facilities.
16. Immunocompromised persons have a blunted immune response to vaccination, and are also at a higher risk of severe illness from COVID-19. These individuals are recommended to receive a third dose of the same mRNA vaccine two months after their second dose as part of their primary course of vaccination to ensure that they start off with an adequate protective immune response to vaccination to.
17. Seniors are also at risk of severe COVID-19 infection and may develop a lower immune response from their two-dose vaccination regimen. This is coupled with the expected decline of their immunity over time, as many were vaccinated earlier. They should receive a booster dose of Pandemic Special Access Route (PSAR) mRNA vaccine six to nine months after having completed their primary course of vaccination regimen, to ensure higher levels of protection from infection and continued high levels of protection against severe disease, and reduce the possibility of spikes in infections and more people falling severely ill.
18. The additional dose recommendations for immunocompromised individuals, and seniors aged above 60 years, as well as residents of aged care facilities are aligned to the vaccination measures adopted in other countries such as Israel and Germany. The US Food and Drug Administration (FDA) has also approved a third dose for immunocompromised individuals and is considering its recommendation for seniors.
19. The first batch of seniors aged above 60 years completed their second doses around March this year. Hence they will be eligible for the third dose within the month of September. More details on the implementation of the booster shot will be announced later.
Towards a COVID-19 Resilient Singapore
20. We have made significant progress in vaccinating our population, adopting safe management measures, and moving towards a COVID-19 resilient nation. The recent rise in cases was not unexpected, and the majority of these only have mild or no symptoms because of the high level of protection conferred by the vaccines against severe illness. As we continue to open and lead our lives as normally as possible, we should expect cases to rise, but we must keep a close watch over the number who fall severely ill.
21. That said, we must continue to keep overall risks under control, by continuing to adhere closely to the safe management measures that have served us very well thus far. Reverting to a tightened posture must be a last resort. We are therefore at a stage where we need all employers, families and individuals to play a part – to exercise civic-consciousness, and to take care of themselves and the people around them.
MINISTRY OF HEALTH
3 SEPTEMBER 2021
[1] The list of ART self-test kits can be found at https://www.hsa.gov.sg/consumer-safety/articles/covid19_ARTselftests.
[2] As of 31 August, there are 20 QTCs at Yishun Bus Interchange, Tekka Facility, Bishan Sports Hall CP, Jurong West Active Sports CP, Pasir Ris Sports Hall CP, 509 MPH Jurong West, 32 New Market Road Lvl 4, 75 Marine Drive, 325A Ang Mo Kio Ave 3 Pavilion, 2 Toa Payoh Lor 7, 528 Ang Mo Kio Ave 10 Badminton Hall, Bedok Town Square, 814 Hougang Ave 10, 506 Tampines Central 1, MOE Heritage Centre, Woodlands Temporary Bus Interchange, 84A Redhill Lane, Punggol Town Square, 321 Clementi Ave 5 and 55 Sims Drive Pavilion.
[3] Mild symptoms: Fever, cough, fatigue, new loss of taste or smell, sore throat, runny nose, muscle aches, diarrhea, nausea or vomiting; Severe symptoms: shortness of breath, chest pain or pressure, loss of speech or movement.