As we progress towards living with COVID-19, we will encounter new infection waves driven by emerging variants from time to time. Over the past month, COVID-19 cases have been on the rise, mainly due to the Omicron XBB subvariant. The Ministry of Health (MOH) has been closely tracking the trajectory of this wave, and has taken steps to ensure that our healthcare capacity remains protected.
2. The Omicron XBB subvariant was first detected in August 2022 in India, and has since been detected in more than 17 countries, including Australia, Bangladesh, Denmark, India, Japan and the US. While observations from countries where XBB has been reported suggest that it is at least as transmissible as currently circulating variants, there is no evidence that XBB causes more severe illness.
3. In Singapore, XBB is now the predominant subvariant circulating in the community, accounting for 54% of local cases during the week of 3 to 9 October, from 22% the previous week (Figure 1). The previously dominant subvariant, BA.5, is now estimated to account for 21% of local cases, while the subvariant BA.2.75 is estimated to account for 24% of cases.
4. There is evidence that XBB may be driving an increase in reinfections. The proportion of reinfections among total COVID-19 cases in Singapore has been increasing over the past month, with reinfections currently making up about 17% of total new cases (Figure 2). Given that immunity from natural infection in the population is likely waning over time, this underscores the importance of ensuring minimum protection from vaccination and keeping our vaccinations up to date to protect us against severe infections.
Healthcare Capacity Remains Protected
5. To date, the increase in hospitalised cases remains proportionate to the rise in overall local cases. More importantly, the number of severe cases has remained low. As of 14 October 2022, the number of cases hospitalised, requiring oxygen supplementation and in the intensive care unit (ICU) are at 562, 44 and 9 respectively, compared to 365, 37 and 13 a week ago. This is despite the 7-day Moving Average of Local Cases rising from 4,714 to 7,716 cases over the same period (Figure 3).
6. Based on current information, MOH expects that this XBB infection wave will peak by around mid-November 2022. Using the BA.5 wave as an indication, hospitalised cases then peaked at 800 in July 2022, and our hospitals, while stretched, were able to cope with the numbers. Given that we are able to quickly ramp up to the same capacity and beyond, our projections on healthcare utilisation show that we have adequate ICU, hospital and COVID-19 Treatment Facility (CTF) beds to cope with the upcoming wave.
7. In response to the surge over the past two weeks, public hospitals have rapidly activated various measures to operate about additional 200 beds to care for hospitalised COVID-19 patients. These include deferring non-urgent admissions, discharging stable patients home or to nursing homes, and transferring recovering patients to transitional care facilities and community hospitals. In the coming two weeks, public hospitals will operate a total of more than 800 beds for COVID-19 patients. We are also ramping up CTF capacity in stages, to provide over 800 beds by early November.
8. Members of public are encouraged to only go to the Emergency Department (ED) for emergency conditions as our hospitals’ EDs continue to see a high number of patients daily, mostly for non-COVID related conditions. Patients who are triaged to be non-serious may be requested by the EDs to be diverted to Urgent Care Centres or nearby primary care clinics for management.
9. To relieve the load on General Practitioner (GP) clinics and polyclinics, we urge employers not to require medical certificates (MC) from employees who have either self-tested positive for COVID-19 or have Acute Respiratory Infection (ARI) symptoms. This is to avoid patients with mild or no symptoms making unnecessary visits to GP clinics, which would compromise the standard of care for other patients who require medical attention. Those who are well should be allowed to work from home if they are able to do so. We also encourage those with mild flu-like symptoms to consider teleconsultation with their doctor. They may visit flu.gowhere.gov.sg for a list of telemedicine providers.
Revised Healthcare Protocols for Paediatric Patients and Pregnant Patients
10. Our healthcare protocols are regularly reviewed and updated based on the latest COVID-19 situation. Currently, COVID-19 positive paediatric patients (3 to <12 months old) and pregnant patients (gestational age below 36 weeks) are triaged as Protocol 1 and placed under the Home Recovery Programme (HRP). In monitoring the COVID-19 trend from Omicron subvariants in Singapore, the risk of severe COVID-19 disease in these two groups is low.
11. In view of the low risk, patients from these two groups can be managed as Protocol 2 by default, for self-recovery at home or under the care of their own primary doctors, with effect from 25 October 2022. These patients should continue to monitor themselves closely for signs and symptoms of concern (e.g. shortness of breath, chest pain, persistent fever >38°C) while recovering at home. If signs and symptoms worsen, they should seek medical attention.
Keeping up to date with COVID-19 Vaccination
12. Vaccination is our primary defence against COVID-19 and given that immunity in the population is likely waning over time, we urge the public to get vaccinated or boosted when they are eligible to do so.
13. As of 14 October, the bivalent Moderna/Spikevax vaccine has been made available to persons who have yet to achieve minimum protection, as well as those aged 50 years and above who received their last vaccine dose more than five months ago. We have seen good response to this, with over 4,000 people coming forward on 14 October to get their dose.
14. We encourage those who are eligible to step forward for vaccination. They may walk into any Joint Testing and Vaccination Centre (JTVC) offering the Moderna/Spikevax vaccines to receive their bivalent vaccine dose. Please refer to www.gowhere.gov.sg/vaccine to locate the nearest JTVC.
Important for Everyone to Exercise Personal and Social Responsibility
15. Our society will continue to build up even more resilience with each infection wave. As we ride through this wave, it remains important to protect our most vulnerable. Members of the public are encouraged to wear masks when in crowded places, or when visiting or interacting with vulnerable persons. In particular, experts have advised that the elderly and immuno-compromised should continue to wear masks in crowded indoor settings to reduce their risk of catching any respiratory infections.
16. We urge everyone to continue to exercise personal and social responsibility by maintaining good hygiene, testing and minimising social interactions when unwell, and keeping up to date with vaccinations.
Please refer to the Annex for the figures.
MINISTRY OF HEALTH
15 OCTOBER 2022