Updating Our Healthcare Protocols For A More COVID-19 Resilient Nation

1.     As announced by the Multi-Ministry Taskforce last week, with the rising number of infection cases and as Singapore moves towards COVID-19 resilience, we need to adjust our healthcare protocols. There are two areas. First, we have adjusted our Home Quarantine Protocol so that contact tracers can focus on conducting manual contact tracing for sensitive clusters in settings such as hospitals, schools or markets frequented by seniors. For the other sporadic infection cases, we will quarantine household contacts of infected persons, because these contacts are most at risk of being exposed to the virus. In addition, we will use TraceTogether data to generate Health Risk Warning (HRW) and Health Risk Alert (HRA) based on existing protocols.

2.     Second, given that over 98% of infected individuals have no or mild symptoms, we will expand the Home Recovery scheme, to allow more infected individuals to self-isolate, and take the necessary health precautions at home, with telehealth monitoring support. This will reserve our hospital capacity for those who truly need the medical care, so that we can continue to provide appropriate care for all even with higher infection numbers.

3.     Taken together, these changes will lay the foundation for a more COVID-19 resilient nation.

Adjustments to Home Quarantine

4.     With effect from 11 September 2021, we have reduced the quarantine period from 14 days to 10 days from the date of last exposure to a COVID-19 case, provided the Person-under-Quarantine (PUQ) tests negative for COVID-19 at the end of his or her quarantine. PUQs who received their Quarantine Orders (QO) before 11 September, have completed 10 or more days in quarantine, and have a negative Polymerase Chain Reaction (PCR) test result, will progressively have their QO rescinded earlier. Following rescindment, all PUQs will need to continue to self-administer Antigen Rapid Tests (ART) from Day 11 to Day 14 (from their date of last exposure).

5.     Today, about 7 in 10 close contacts of community cases prefer Home Quarantine. After being notified by MOH, they remain in their home for the duration of the quarantine, except to take PCR tests. We have seen good compliance to the Home Quarantine requirements. Community cases have also been very helpful and cooperative in assisting MOH to identify their close contacts. Given this experience, and with the increasing numbers of infections, we have adjusted the protocol from 14 September 2021.

6.     Our contact tracers will continue to conduct manual contact tracing for sensitive clusters like schools, hospitals, or markets frequented by seniors. For the less sensitive infection cases, an SMS will be sent to all newly confirmed COVID-19 cases, notifying them that they are required under the Infectious Diseases Act to inform their household contacts to register themselves as household close contacts through an online portal (https://go.gov.sg/quarantinereg). The household close contacts must provide the last date of exposure with the COVID-19 case and a contact number.

7.     An electronic Quarantine Order (eQO) will be sent to registrants to indicate the quarantine period and instructions to book PCR tests. PUQs will then be able to go online to schedule their entry and exit PCR tests at a Regional Screening Centre (RSC) near their home. They will be able to travel to the RSCs for the PCR tests and collect free ART kits, administer their own ART daily and upload their results. Should they feel unwell or in need of medical attention, PUQs will also be given instructions to access 24/7 telemedicine services during their quarantine.

8.     As with the current practice, persons with unsuitable home settings for quarantine could still request to be sent to a Government Quarantine Facility.

9.     Related to this are the protocols for HRW and HRA. From 14 September 2021, the HRW has been reduced from 14 to 10 days from the date of last exposure to a COVID-19 case, to align with the shift to a 10-day QO regime. MOH issues HRW to close contacts of COVID-19 cases based on TraceTogether data. These may not be household contacts and have a smaller risk of infection compared to PUQs. Individuals issued HRW are required by law to take one PCR test upon receiving their notice, self-isolate until they receive a negative result, conduct three ART self-tests over the 10-day period of their HRW, and do another PCR test at the end of the HRW.

10.     Besides HRW, individuals can instead be issued an HRA if they had contact of a relatively shorter duration with a COVID-19 case based on TraceTogether data, or their SafeEntry records from the past 14 days overlapped with an area of increased transmission. This group are persons who have had directly or indirectly been exposed to the risk of infection, even if that risk is lower than that of a close contact. Individuals who receive the HRA should monitor their health for the next 10 days, are strongly encouraged to come forward for a free PCR swab test, perform regular ART self-tests throughout the 10 days following their exposure, and minimise interactions with other people.

11.     Some individuals may be notified by confirmed COVID-19 cases to self-register as household close contacts and be issued an eQO, as well as receive a HRW or HRA at the same time. They should note that quarantine takes precedence. Similarly, a health risk assessment will be made after the submission of Home Quarantine registration and individuals may be converted to HRW.

Transition to Home Recovery

12.     From 15 September 2021, Home Recovery will be the default care management model for individuals who are:

a) Fully vaccinated;
b) Aged 12 to 50 years old;
c) Have no or mild symptoms;
d) Have no severe co-morbidities or illnesses; and
e) Have no household members who are more than 80 years old, or are in one of the vulnerable groups (e.g. pregnant individuals; with weakened immune response; or with multiple co-morbidities).

13.     When an individual is tested COVID-19 positive, Home Recovery can start immediately if he or she meets the abovementioned criteria. The individual will need to set aside a room with an attached bathroom.

14.     There is no need to go to a hospital or Community Care Facility. COVID-19 patients on Home Recovery will undergo an initial remote assessment by a telemedicine provider on the first day of their Home Recovery journey to ensure that they are clinically well. These individuals will also be issued with an Isolation Order and may be tagged with an electronic monitoring device to ensure they remain in their designated room at home.

15.     Parents of children who test positive for COVID-19 can also bring their children home to recover, if the child is at least five years old and has no co-morbidities or underlying illnesses. For the child’s safety, a clinical assessment would first have to be done at a hospital before the child can return home to recover.

16.     The individuals undergoing Home Recovery will be provided with access to information, including advisories on the signs and symptoms to look out for. If required, they can request for a care pack which contains a thermometer, pulse oximeter, surgical masks and hand sanitiser. A Home Recovery Buddy will also contact the COVID-19 patient at the start of Home Recovery to check on them and explain how to use the thermometer and oximeter. COVID-19 patients should monitor, measure and record their health signs such as body temperature, pulse rate and blood oxygen saturation (SpO₂) at least once a day using the care diary provided to them. In the event that these individuals require any medical assistance, they will have 24/7 access to their designated telemedicine provider.

17.     During Home Recovery, the entire household should practise good personal hygiene. The patients must avoid any physical or face-to-face contact with the rest of the household, to prevent any onward transmission of the virus. As the household members will most likely all be issued eQO, the household should also arrange for contactless deliveries when ordering essential items such as food or groceries.

18.     COVID-19 patients on Home Recovery may contact the designated telemedicine service provider that they have been assigned to arrange for a PCR swab on Day 6 of illness to end the Home Recovery period sooner. If the COVID-19 patient’s test result meets the discharge criteria (i.e. if their PCR result is negative or has a low viral load), he or she may be discharged from Home Recovery on Day 7 of illness. Otherwise the patient’s Home Recovery period will end on Day 10 of illness without any further tests, so long that the patient is well. After discharge, COVID-19 patients will no longer be subject to any movement restrictions, although they are still advised to minimise social interactions for the next seven days. They may request for a Medical Certificate of up to 7 days from the telemedicine service provider, if they require more time to rest and recuperate. These are in line with the discharge protocols at our medical facilities.

19.     We should point out that in the event that an infected individual is undergoing Home Recovery and household members are on QO, the infected individual may be discharged earlier than the household members on QO. This is not illogical, because for a fully vaccinated infected individual, the viral load will decrease very quickly and typically clears by Day 7. Whereas for someone exposed to the virus and on QO, his or her viral load may take up to 10 days to build up and for the illness to manifest itself.

Everyone Needs to do Their Part

20.     Overall, the more extensive use of Home Quarantine, HRW, HRA and Home Recovery will allow us to ensure appropriate care and self-isolation for our COVID-19 infected individuals, while mitigating the risk of further transmission in a more scalable and sustainable manner. This approach requires a whole-of-society effort as we shift towards greater personal responsibility and self-care. By each doing our part, we will be able to progress together towards becoming a COVID-19 resilient nation.

Annex A - 8 Important Steps: What must you do when you are notified that you are a close contact of a COVID-19 positive case (Infographic)

Annex B - 10 Important Steps: What happens when you test positive for COVID-19 (Infographic) 

MINISTRY OF HEALTH

14 SEPTEMBER 2021