Haze

8 July 2013

Question No. 1260

Name of Person: Dr Lam Pin Min

Question

To ask the Minister for Health (a) what is the short and long term effects of air pollution from the haze on the health of Singaporeans; and (b) what contingency plans are being considered to safeguard the health of Singaporeans should the haze continue for the next 2 to 3 months.

Question No. 1277

Name of Person: Ms Lee Li Lian

Question

To ask the Minister for Health (a) what effort has been made to make parents more aware of the advice that N95 masks are not designed for children; and (b) whether the Government intends to make available masks that are certified for children in public health emergencies.

Question No. 1295

Name of Person: Mr Gerald Giam Yean Song

Question

To ask the Minister for Health (a) what is the increase in the weekly number of respiratory, heart, eye and skin problems reported at polyclinics, private clinics and hospitals since the onset of the current haze situation compared to the weekly average in the month before; (b) how many private clinics have signed up for the Government scheme which offers subsidised treatment for haze-related illnesses; (c) what is the Ministry doing to ensure that more private clinics participate in this scheme so that more Singaporeans can benefit from it; and (d) what are the details of the Ministry's contingency plans to cope with the expected surge of patients with illnesses caused by the haze.

Answer

Short- and long-term effects of air pollution

1.       For healthy individuals, short-term exposure to haze may cause temporary minor irritation of the eyes, nose, throat and skin. However, such irritation typically resolves on its own in most cases.

2.       However, the haze particles can aggravate lung disease, cause asthma attacks and acute bronchitis^[1] in people who already have chronic lung diseases, and trigger off heart attacks and irregular heartbeat (arrhythmias) in people with heart problems.  Thus far, there has been no clear evidence of long term health effects of short-term haze, like that we have experienced.^[2]

3.      So far the impact of the haze on healthcare services is manageable. When the haze was more severe in the week of 17 to 23 June, we saw a 16% increase in polyclinic attendances for relevant conditions³ compared to the week before, but attendances at hospital accident and emergency department did not show any significant increase. The air quality improved in the last week of June and polyclinic attendances correspondingly decreased to only 4% higher as compared to before the onset of haze. In contrast, attendance at A&E departments for the relevant conditions⁴ decreased by 23% in the last week of June, possibly due to the public taking our advice to remain indoors unless required otherwise.

N95 Masks for Children

4.       N95 masks are not specifically designed for use in children, nor have they been certified for effectiveness for such use.  To be effective, N95 masks need to maintain a well-fitted seal at all times, which may be difficult to achieve in young children who are smaller and of varying sizes. It is possible that older children may be able to fit the smaller sized N95 masks for adults.  Parents who wish to buy these masks for their children should ensure proper fit and usage of the mask. 

5.       When haze reaches unhealthy levels, children should be kept indoors as much as possible. This has been communicated to the public through various platforms including the mass media and online media. Since schools reopened last week (on 1st July), MOH has been working with MOE and schools on various mitigation measures, based on the health advisory for the day.

Long term measures to protect the health of Singaporeans

6.       MOH has worked with our healthcare institutions to put in place plans in three areas, to ensure that we are “haze ready”.

Managing surges in attendance at the hospitals and polyclinics

7.     First, managing the expected surge of patients at our polyclinics and hospitals for haze-related conditions. The Ministry has already implemented a special scheme where those who suffer from respiratory problems or conjunctivitis because of the haze need only pay $10 when they seek treatment at participating GPs. The scheme applies to Singaporeans aged 18 years and below, or 65 years and above, and those in low income groups. The scheme can enhance the accessibility and affordability of primary care for haze-related conditions.

8.      As of 27 Jun 2013, there are more than 600 GP clinics participating in this scheme. Information on the participating GP clinics is on the MOH website, and also shared through community organisations. Much effort has been put in to bring GPs on board. The Agency of Integrated Care (AIC) has been actively reaching out to individual GP clinics to encourage them to join. To increase awareness amongst members of public, posters have been distributed to GPs so that the participating clinics can be easily identified.

9.      MOH had also earlier worked with hospitals to retrofit suitable spaces within the hospital campuses to ready additional bed capacity in the event of a demand surge due to an increase in dengue cases. We have stepped up efforts to transfer stable patients from the hospitals into community hospitals and nursing homes to free up acute bed capacity.

10.       Should the haze worsen and there is a need to free up bed capacity, non-urgent services and elective cases at hospitals may be scaled back.

Ensuring Patient Safety and Care

11.    Second, we will work hard to care for the patients in our public sector hospitals and healthcare institutions so that they are not adversely affected by the haze. If the haze situation is bad, they will close windows and doors to reduce the inflow of dust particles. If necessary, air coolers and fans will also be used to improve the ventilation for patients in non-air conditioned wards. For especially vulnerable patients, we will put in air purifiers to help reduce the impact of the haze on these patients during significant haze. We will also facilitate home delivery of medication for chronic patients if necessary, so that they can get their needed medication without having to visit our clinics.

Ensuring Continuity of Critical Services

12.     Third, our hospitals and polyclinics have adequate equipment and supplies, including ample medication stocks, on standby to support the continuation of critical services.  

13.     Our hospitals also have plans in place to ensure adequate manpower to staff critical services such as A&E, Intensive Care Unit and operating theatres.

14.     At the national level, we are re-building our stockpile of N95 masks so that they are available for use should there be a disease outbreak during this period.

[1] Inflammation of the lining of the upper airways

[2] Studies available are of those examining the impact of long-term exposure over several years to high levels of air pollution in cities. This is not applicable to the context of haze, which is a short-term event

[3] Asthma, Bronchitis, Emphysema, Upper Respiratory Tract Infections (URTI), Acute Conjunctivitis, Acute Myocardial Infarction and Ischaemic Heart Disease (AMI & IHD)

[4] Asthma, Bronchitis, Emphysema, Upper Respiratory Tract Infections (URTI), Pneumonia, Acute Conjunctivitis, Acute Myocardial Infarction and Ischaemic Heart Disease (AMI & IHD)