Combined Reply On Developments In Singapore's Transition to A Covid-resilient Nation (Part 2)

Name and Constituency of Member of Parliament
Ms Ng Ling Ling
MP for Ang Mo Kio GRC

Question No. 1137

To ask the Minister for Health of the positive COVID-19 cases that are confirmed with a polymerase chain test at a Swab and Send Home clinic, how many of these cases have been initially detected through the antigen rapid self-test kits.

Name and Constituency of Member of Parliament
Mr Xie Yao Quan
MP for Jurong GRC

Question No. 1177

To ask the Minister for Health (a) to date, what are the respective numbers of healthcare workers who have been (i) confirmed as COVID-19 positive (ii) placed on quarantine (iii) placed on health risk warning and (iv) placed on health risk alert; and (b) whether the Ministry is considering any strategies to ensure sufficient manning in the public healthcare sector while managing the risks.

Name and Constituency of Member of Parliament
Ms He Ting Ru
MP for Sengkang GRC

Question No. 1178

To ask the Minister for Health (a) how many individuals are currently hired for COVID-19 contact tracing operations; (b) whether manpower numbers will be adjusted given the recent huge spike in cases and as Singapore moves towards an endemic COVID-19 situation; and (c) what are the principles behind how manpower adjustments in contact tracing operations will be made.

Name and Constituency of Member of Parliament
Mr Gerald Giam Yean Song
MP for Aljunied GRC

Question No. 1180

To ask the Minister for Health (a) since 18 August 2021, how many patients who tested positive for COVID-19 waited (i) between 24 and 72 hours or (ii) more than 72 hours, after the receipt of their test results before being issued Quarantine Orders; and (b) whether more staff and resources will be provided to operate the Ministry hotline and convey COVID-19 patients to Government quarantine facilities.

Name and Constituency of Member of Parliament
Ms Denise Phua Lay Peng
MP for Jalan Besar GRC

Question No. 1534

To ask the Minister for Health what support measures will be granted to persons with disabilities, the young and elderly, who are served with SHN/Quarantine Orders and are deemed to be unable to do so on their own or in unfamiliar physical settings.

Name and Constituency of Member of Parliament
Mr Yip Hon Weng
MP for Yio Chu Kang

Question No. 1548

To ask the Minister for Health (a) what is the stipulated time limit to address public queries on their quarantine orders (QOs); (b) in August 2021, what is the number of feedback that the Ministry has received concerning belated issuances of QOs or problematic communications and how are they addressed; and (c) whether the Ministry has a backup plan to deploy additional manpower in case of a surge in COVID-19 infections.

Name and Constituency of Member of Parliament
Mr Liang Eng Hwa
MP for Bukit Panjang

Question No. 1817

To ask the Minister for Health (a) what is the current number of personnel involved in administering the Quarantine Order (QO) and Stay-Home Notice (SHN) process; (b) whether the service providers are able to cope with the increased numbers of people on QO and SHN; (c) whether the overall experience can be improved; and (d) how many cases of adverse feedback have been received to date.

Name and Constituency of Member of Parliament
Mr Xie Yao Quan
MP for Jurong GRC

Question No. 1824

To ask the Minister for Health (a) what is the number of confirmed or suspected COVID-19 cases with mild symptoms who sought medical attention at the Emergency Department of a public hospital in the last 28 days; and (b) what are the strategies that the Ministry is considering to direct more of such cases to primary care.

Name and Constituency of Member of Parliament
Mr Ang Wei Neng
MP for West Coast GRC

Question No. 1828

To ask the Minister for Health whether the Government will (i) consider providing more Antigen Rapid Test (ART) kits to each Singaporean household beyond the three provided by Temasek Foundation and (ii) work with distributors of ART to lower the retail price ART given the sharp rise in COVID-19 cases in the community.

Name and Constituency of Member of Parliament
Assoc Prof Jamus Jerome Lim 
MP for Sengkang GRC

Question No. 1840

To ask the Minister for Health given how individuals exposed to COVID-19 positive cases serve their Stay-Home Notices (SHN) at their place of residence, but those arriving from abroad serve SHN in a dedicated SHN facility (regardless of whether they have access to an isolated place of residence) (a) what are the material differences between these two cases for this differentiated treatment; and (b) whether the Ministry will consider allowing those with isolated residences to serve their SHN at home rather than a dedicated facility, should they opt to do so.

Name and Constituency of Member of Parliament
Assoc Prof Jamus Jerome Lim
MP for Sengkang GRC

Question No. 1841

To ask the Minister for Health what is the current procedure and reason for isolating minors issued with a Quarantine Order especially with regard to (i) the other members of their household and (ii) their legal guardian.

Name and Constituency of Member of Parliament
Ms Joan Pereira
MP for Tanjong Pagar GRC

Question No. 1848

To ask the Minister for Health in view of the number of patients hospitalised for COVID-19 (a) what has been the impact on the resources, particularly manpower, allocation within hospitals and the consequent impact on care quality; and (b) how will the Ministry ensure that resources are allocated adequately to those who are ill, including those in critical conditions not related to COVID-19.

Name and Constituency of Member of Parliament
Mr Gerald Giam Yean Song
MP for Aljunied GRC

Question No. 1876

To ask the Minister for Health for COVID-19 patients serving their quarantine order at home, whether it is reasonable to expect that, despite their best efforts, they will not spread the virus to members of their household, particularly if they live in smaller flats which lack rooms with attached bathrooms.

Name and Constituency of Member of Parliament
Mr Xie Yao Quan
MP for Jurong GRC

Question No. 1881

To ask the Minister for Health (a) for the last 14 days, what is (i) the average time taken to pick up COVID-19 patients aged 70 years and above for conveyance to a hospital, from the time they are confirmed positive by the polymerase chain reaction (PCR) test and (ii) the number of COVID-19 patients in home recovery and community care facilities who turned ill and required hospitalisation; and (b) in the longer run what is the capacity of general wards in public hospitals and SCDF ambulances that the Ministry expects to set aside for COVID-19 patients.

Name and Constituency of Member of Parliament
Mr Leon Perera
MP for Aljunied GRC

Question No. 1886

To ask the Minister for Health regarding COVID-19 patients (a) for the past three months, what is the weekly capacity and utilisation rates of (i) ICU beds (ii) isolation beds in hospitals and (iii) community care facilities; (b) what are the plans and associated lead time to increase ICU capacity if required; (c) what are the criteria used to determine the need to increase ICU capacity; (d) whether the recent spike in COVID-19 infections has led to a congruent spike in ICU and oxygen supplementation patients; (e) if so, why; and (f) if not, why.

Name and Constituency of Member of Parliament
Ms Yeo Wan Ling
MP for Parsi-Ris Punggol GRC

Question No. 1908

To ask the Minister for Health (a) to date, what is the number of point-to-point (P2P) drivers and riders who have been placed on (i) Quarantine Order (QO) (ii) Health Risk Alert and (iii) Health Risk Warning (HRW) respectively; (b) of these P2P drivers and riders, how many have successfully been provided with QO allowance; and (c) as self-employed persons placed on HRW are asked to be self-isolated, whether the Ministry will consider extending the provision of QO allowance to them.

Name and Constituency of Member of Parliament
Dr Lim Wee Kiak
MP for Sembawang GRC

Question No. 1914

Dr Lim Wee Kiak: To ask the Minister for Health as we make the transition from managing COVID-19 as a pandemic to an endemic (a) what is the relevance of contact tracing in light of the large number of unlinked cases; and (b) what is the expected timeline for TraceTogether to be ceased and its contact tracing data deleted.

Name and Constituency of Member of Parliament
Dr Lim Wee Kiak
MP for Sembawang GRC

Question No. 1915

Dr Lim Wee Kiak: To ask the Minister for Health whether Singaporeans who are fully vaccinated with COVID-19 vaccines under the World Health Organisation’s Emergency Use Listing can fulfil their Stay-Home Notice (SHN) at home instead of a designated SHN facility regardless of the countries or regions they are returning from.

Oral Answer

1. Mr Speaker, I will address Members’ questions about our healthcare capacity to deal with the on-going surge in cases, protocols for quarantine orders (QO) and stay home notices (SHN), and testing as a means of reducing transmission.

Healthcare Capacity 

2. Mr Speaker, the recent exponential rise in cases has impacted our healthcare capacities. Currently, about 15% of hospital beds in the acute public hospitals are used for around 10% of all COVID-19 cases. Those requiring oxygen supplementation or ICU care account for 2% of total cases, most of whom are unvaccinated or elderly. 

3. In the last three months, ICU bed occupancy has increased from 26% to 53%. Occupancy of isolation beds has risen from 58% to 86%, while the occupancy of community care facility (CCF) beds has gone from 10% to 35%. Public hospital emergency departments have seen up to an 8-fold increase in the number of patients with ART or PCR positive results seeking medical attention. Prior to the last 14 days, we conveyed COVID-19 patients above 70 years old to the hospital within 12 hours from the time they have a positive PCR test. With the current high case loads, we are now taking on average 48 – 72 hours to do so. SCDF ambulances are reserved for patients with emergency conditions, hence MOH has set up a dedicated fleet of 95 additional ambulances to convey COVID-19 patients to the different healthcare facilities.

4. We are taking steps to expand our hospital and treatment resources to ensure that everyone who requires medical care, whether for COVID-19 or other conditions, will receive it. 

5. We have asked hospitals to prioritise resources for COVID-19 patients by reducing non-essential elective appointments. We have been shifting asymptomatic and lower risk COVID-19 patients from hospital to COVID-19 treatment facilities (CTF), CCFs and the Home Recovery Programme. This allows acute hospital resources to be focused on managing patients who need urgent or essential care.  

6. We are closely monitoring ICU trends. We have increased the ICU bed capacity by 74 beds, for a total of 187 beds dedicated to COVID-19 patients with severe conditions. More ICU beds can be opened at short notice, if needed.

7. We are also closely monitoring the hospital manpower situation,  given that close to 400 healthcare workers have tested COVID-19 positive. Our hospitals will continue to dynamically cross-deploy their resources to ensure that manpower needs are met. We are also working with private healthcare providers to augment our manpower.

8. To further preserve our healthcare capacity in the face of future waves of infections, we must also adopt more sustainable healthcare protocols based on the medical care required. The vast majority – over 98% – of infected individuals have mild or no symptoms, and only 0.3% needed ICU care or have died. This is a result of having vaccinated most of our population, who will only experience mild illness if they suffer a breakthrough infection. We are thus making home recovery the default protocol for infected individuals, unless they have severe symptoms, are elderly, or have underlying co-morbidities that make them more susceptible to severe disease outcomes.
 
Operations Capacity

9. Besides focusing our hospital and medical treatment resources on those who need it most, we are also ensuring that our COVID-19 response systems are directed appropriately. 

10. We will continue to use technology, such as TraceTogether and SafeEntry, to automatically and quickly identify the majority of close contacts, and to prompt them to self-monitor and take precautions against unknowingly infecting others. This process augments our efforts, and allows us to focus the work of the 350 full-time contact tracers we have today. 

11. We must optimise the deployment of these officers. As cases have increased multiple fold in the community, it is not always useful to comprehensively contact trace around every case detected, by conducting extra interviews and manual case detection. Instead, we are focusing these intensive contact tracing efforts on cases and clusters detected in vulnerable settings like hospitals, nursing homes and schools. These are areas where contact mapping and comprehensive identification of close contacts have the greatest public health benefit today. Individuals who are tested positive have also been asked to self-declare their household members so that they can be placed under quarantine. We are calling on the self-responsibility of our people to aid in our efforts. 

12. Next, our quarantine and isolation operations. The QO and SHN processes are administered by around 300 officers from MOH and the Immigration & Checkpoints Authority (ICA). These officers handle around 6,700 daily queries on average, on issues such as quarantine status, quarantine conveyance and testing, as well as QO rescindment requests. While such queries should be resolved within three working days, the current surge has resulted in some, especially the complex ones, taking longer to resolve. This also increases the waiting time for others before their calls can be connected, even if their queries are not as complex. We will continue to enhance resourcing to manage surges and seek the public’s understanding for longer response times during this period. We have put out more public communications materials, in print media and on our websites, so that individuals affected by COVID-19 can potentially self-help.

13. We will continue to scale up the Home Recovery Programme. This ensures that our hospital and medical treatment resources are prioritised for those who are, or could be, severely ill. We have also adjusted our QO regime to allow individuals who are less likely to fall severely ill with COVID-19, and whose homes are suitable for home recovery, to quarantine at home. This regime places the responsibility on the confirmed COVID-19 cases and their household members, including minors and their caregivers, to self-register. After the original quarantined individual is confirmed to have COVID-19 and has been served an Isolation Order, the other household members should self-register for quarantine as well, in order for the whole family to recover and be quarantined together at home.

14. We will also increasingly allow fully vaccinated travellers who need to serve a SHN, to do so at home. Currently, such travellers from Category II and III countries may already apply to serve their SHN at their place of residence or other suitable accommodation that they have secured. Almost all travellers from Category II countries, and around half the travellers from Category III countries fulfill the criteria and have opted-out of the SHN dedicated facility. We will progressively review and adjust our border measures, but for now, fully vaccinated travellers from Category IV countries must still serve their SHN in SHN dedicated facilities.  

15. Those serving home quarantine or home SHN are also given information on transmission prevention, including isolation protocols and good personal hygiene practices. ART kits are provided to household members for them to monitor their own health. Those on home isolation requiring dedicated care arrangements may also apply for assistance ahead of, or during, the SHN. Vulnerable persons serving SHN or QO who need support for their activities of daily living, such as minors and the disabled, may also be accompanied by a caregiver. We will continue to review our protocols and measures.

16. There is a financial impact to businesses or individuals whose livelihoods are affected by QOs. Between January and September this year, around 3,300 point-to-point (P2P) drivers and riders have been placed on a QO. These individuals, along with others whose livelihoods have been affected by QOs, can apply for a QO Allowance to help cushion the financial impact.

Testing

17. Mr Speaker, the public health actions that are triggered upon confirmation of COVID-19 infection for an individual are disruptive. But, it remains important that we detect possible COVID-19 infections early, so as to minimise the impact of transmission to their loved ones at home, or to their friends or colleagues. 

18. There are some who have a misconception that we are testing widely to attempt to eliminate the virus. This is not so. We have many community cases around us. Our widespread testing aims to reduce the overall rate of transmission from each COVID-19 infection, slowing the spread in the community. ART also enable individuals to perform self-test, and do our part to slow down transmission of the virus. This will allow us to ride the wave of infections without overwhelming our healthcare and public health response resources. 

19. To this end, regular testing in the workplace and at home remains key. We have made ART test kits widely available, through sale at major retailers, free nationwide household distributions, and supplying kits to companies for mandatory routine testing regimes or voluntary regular testing. Individuals who are exposed to the virus and issued health warnings or alerts may also collect ART kits for regular self-testing from our vending machines island-wide. 

20. To make the test kits on sale more competitively priced, we are actively reviewing new brands of equally effective kits to bring into the market. We will also evaluate if there is a need to conduct another round of nationwide household distribution of kits to support regular self-testing. These Fast and Easy tests have been effective in augmenting our case identification efforts. Of the total COVID cases identified in the last eight weeks via the PCR test at Swab and Send Home (SASH) clinics, 7% had initially tested positive using the self-test ART kits before coming forward for their confirmatory PCR test. 

Conclusion

21. As we move towards living with COVID-19, each of us must play our part to lower transmission risks and slow the pace of community infections. While the government will continue to make adjustments to augment our healthcare and public health response capacity, all of us need to be socially responsible to take care of ourselves and others around us through regular testing and adherence to isolation protocols if we have been exposed to positive cases. Continued adherence to our Safe Management Measures will also help to dampen the rate of transmission. This is what it means for us to work together to be a COVID-19 resilient nation.