On COVID-19 Situation, Healthcare Capacity and Vaccination

NOTICE PAPER NO. 1237
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022

Name and Constituency of Member of Parliament

Ms Joan Pereira
MP for Tanjong Pagar GRC

Question No. 3127

To ask the Minister for Health (a) whether the Ministry is observing an increasing trend in the COVID-19 re-infection rate given the continued emergence of new Omicron sub-variants; and (b) whether there are any plans to further expand the eligibility for second booster shots for younger age groups, especially when the vaccines are updated to deal with new variants or sub-variants.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

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

Question No. 3132

To ask the Minister for Health in view of the current wave of COVID-19 infections (a) what measures are in place or planned to be put in place to cope with the spike in the number of patients at general practitioner clinics, polyclinics and hospitals’ emergency departments; and (b) whether there are plans to further support the growth of the telemedicine sector in Singapore to provide medical services for mild cases and to reduce the number of infected persons visiting physical clinics.

NOTICE PAPER NO. 1241
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

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

Question No. 3139 

To ask the Minister for Health (a) whether the recent wave of COVID-19 infections has resulted in much longer waiting times for patients at polyclinics and neighbourhood general practitioner clinics; (b) whether the waiting time and services can be improved; and (c) whether the capacity for primary care at the heartlands can be further stepped up.

NOTICE PAPER NO. 1243
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Seah Kian Peng, 
MP for Marine Parade GRC

Question No. 3143

To ask the Minister for Health (a) what proportion of the Singapore population does the Ministry estimate has been infected with COVID-19, including unreported cases; and (b) whether Singapore has attained herd immunity with such an infection level.

NOTICE PAPER NO. 1243
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Dr Wan Rizal 
MP for Jalan Besar GRC

Question No. 3144 

To ask the Minister for Health whether an update can be provided on the study by the Health Sciences Authority and the Expert Committee on COVID-19 Vaccination on the safety and effectiveness of COVID-19 vaccines formulated for young children aged under five years old.

NOTICE PAPER NO. 1246
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 2 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Saktiandi Supaat
MP for Bishan-Toa Payoh GRC

Question No. 3148 

To ask the Minister for Health (a) what is the net Government expenditure on the Flu Subsidy Scheme during the COVID-19 outbreak up to the de-activation of the scheme on 1 July 2022; (b) whether the Flu Subsidy Scheme has encouraged more eligible Singapore residents to seek medical treatment for respiratory infections; and (c) whether the de-activation of the Scheme will hamper early detection efforts as COVID-19 community infections are spiking again.

NOTICE PAPER NO. 1248
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Chua Kheng Wee Louis
MP for Sengkang GRC

Question No. 3161

To ask the Minister for Health (a) what is the number of foreign patient arrivals in Singapore in (i) 2022 year-to-date and (ii) each of the last five years; (b) what are the current utilisation rates of existing capacity by foreign patients in private and public hospitals respectively; and (c) what is the bed capacity in private and public hospitals (i) currently used and (ii) set aside, for COVID-19 hospitalisations in light of the rising number of COVID-19 cases.

NOTICE PAPER NO. 1251
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Dr Dennis Tan Lip Fong
MP for Hougang

Question No. 3177

To ask the Minister for Health (a) whether the Ministry plans to allow all adults below 50 years old to take their COVID-19 vaccination second booster under the National Vaccination Programme (NVP) and, if so, when is this expected; and (b) will all adults below 50 years old who wish to take their second booster due to travel requirements or concerns arising from travel plans be allowed to do so under the NVP.

NOTICE PAPER NO. 1251
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 2 AUGUST 2022 

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

Question No. 3197

To ask the Minister for Health following the major easing of COVID-19 rules in end-April 2022 (a) what is the infection rate for hospital-acquired COVID-19 infections; (b) how many transmissions have been from visitors and how many from healthcare workers; (c) whether hospital-acquired COVID-19 infections affect discharge dates; and (d) whether this has led to a bed crunch situation.

NOTICE PAPER NO. 1252
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Dennis Tan Lip Fong
MP for Hougang

Question No. 3203 

To ask the Minister for Health whether the recent deaths of two young children from COVID-19 on 27 June and 17 July 2022 raise any cause for concern regarding the susceptibility of young children to the recent COVID-19 strains, bearing in mind the relatively higher number of daily reported COVID-19 cases in recent weeks and the infectiousness of the recent strains.

NOTICE PAPER NO. 1252
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

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

Question No. 3209 

To ask the Minister for Health whether he can provide an update on the progress of the Ministry's evaluation of (i) COVID-19 vaccines for children under five years old and (ii) other types of COVID-19 vaccines that can be administered to children.

NOTICE PAPER NO. 1243
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Zhulkarnain Abdul Rahim
MP for Chua Chu Kang GRC

Question No. 1941

To ask the Minister for Health (a) what is the current percentage of COVID-19 patients who have been treated with oral antiviral drugs; and (b) whether the Ministry will consider approving the use of such drugs for the treatment of toddlers or young children who are infected with COVID-19 and are unvaccinated.

NOTICE PAPER NO. 1248
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Shawn Huang Wei Zhong
MP for Jurong GRC

Question No. 1959 

To ask the Minister for Health (a) whether he can provide an update on the longitudinal studies thus far on effects of the mRNA COVID-19 vaccinations; and (b) whether there are any new observations on the efficacy of vaccinations after subsequent boosters.

NOTICE PAPER NO. 1251
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Mr Zhulkarnain Abdul Rahim
MP for Chua Chu Kang GRC

Question No. 1982 

To ask the Minister for Health what steps can be done to accurately detect, diagnose and treat COVID-19 among symptomatic children under the age of 12 years in an efficient and expeditious manner, such as making PCR test and hospitalisation mandatory especially for children who are vulnerable, unvaccinated or under the age of 5 years.

NOTICE PAPER NO. 1251
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022 

Name and Constituency of Member of Parliament
Dr Shahira Abdullah
Nominated MP

Question No. 1986 

To ask the Minister for Health whether the Government will consider changing the current protocol to one advising all children under 12 years old who are infected by COVID-19 to be seen by a doctor even if they feel well.

Answer

1.     Mr Speaker Sir, with your permission, may I address the COVID-19 related PQs for oral answer filed by Ms Joan Pereira, Mr Liang Eng Hwa, Mr Seah Kian Peng, Mr Louis Chua, Mr Wan Rizalt, Mr Dennis Tan, filed for 1 August, those filed by Mr Saktiandi Supaat and Mr Yip Hon Weng, filed for 2 Aug, and PQs for written replies filed by Mr Zhulkarnain, Dr Shahira Abdullah and Mr Shawn Huang.

2.     I will touch on the COVID-19 situation, healthcare capacity, and vaccination programme. Thereafter, SMS Janil will address PQs for our treatment and vaccination plans for children. And for members who filed tomorrow’s questions, if you are satisfied with the answers, you may wish to withdraw your questions.

COVID-19 Situation and Healthcare Capacity

3.     We are still in the middle of an infection wave driven by the Omicron variant BA.5. But, over the last 10 days, infection numbers have been falling and the week-on-week ratio has dipped below 0.9 over the last week. We should see the wave subsiding further this week.

4.     We did not tighten any social restrictions during this current wave. Everyone went about their lives normally – going to work, visiting family members, going out with friends, and travelling in and out of Singapore.

5.     However, life is not as normal in our hospitals. Without additional social restrictions, our healthcare system is bearing the brunt of the current infection wave. Healthcare workers have been very busy. Polyclinics and our General Practitioner clinics also saw higher patient volumes.

6.     To answer Ms Joan Pereira, we are indeed promoting the use of telemedicine for mild COVID-19 cases. It is now a lot more accepted by patients than before. But even so, we need to be realistic that in a big infection wave, the healthcare system will come under stress, notwithstanding the common usage of telemedicine. Waiting times at private clinics, polyclinics and hospitals will inevitably go up, and I seek the understanding of patients and all our residents.

7.     In such a situation, the key is to ensure hospitals are not overwhelmed, and that those who need urgent care can be attended to promptly. By and large, we have been able to achieve that.

8.     The first important measure we took is to set aside sufficient bed capacity to cater to COVID-19 patients. So, in response to Mr Louis Chua, based on our worst-case scenario projection for the current wave, we have plans to set aside up to about 1,000 COVID-19 hospital beds for COVID-19 patients.

9.     This is a dynamic plan, and fortunately, in the course of this infection wave, we did not have to activate all of those beds.

10.     In the same question, Mr Louis Chua asked about foreign patient arrivals for the last five years. I think this is a non-COVID-19 related question and SMS Janil will touch on that.

11.     Second, we eased the workload of hospitals by transferring lower-risk patients to COVID-19 Treatment Facilities, and discharging long-term stayers back to community care facilities like nursing homes. Many of these facilities and services are run by private or social sector providers, and we are deeply appreciate of them for doing this work.

12.     Compared to the last Omicron wave, the transfer processes are now smoother, and patients and their families have also become a lot more understanding when hospitals say your loved ones need to be transferred. As a result, for this infection wave, we have been able to make more transfers than the last, and this has made a significant difference to the workload of hospitals.

13.     Finally, hospitals also have to manage their own demand for beds. They have cut down on ‘business-as-usual’ workload, by about 5%, and it comprises mostly elective surgeries. This is not ideal, because it builds up the backlog of work, which have to be attended to eventually. However, the 5% cut today is far less than the 15% cut that we had to implement during the first Omicron wave in the beginning of this year.

14.     Hospitals restricted but did not suspend visits to patients. We also did not suspend the leave of healthcare workers, so they can still take breaks, including flying to their home countries to see their loved ones and their family members. This is extremely important in maintaining the morale of our healthcare workers.

15.     Mr Yip Hon Weng asked if hospital-acquired COVID-19 infections is contributing to a bed crunch. The answer is no. Absenteeism in hospitals due to the current COVID-19 wave has been lower this time, at around 2%. As far as we can determine, while there had been some transmission within hospitals, overall hospital-acquired COVID-19 infection has been low, and very likely lower than community-acquired infections, and this is because of good infection control measures in hospitals.

Vaccinations

16.     We need to recognise that bed crunches are mainly caused by high case numbers because of an infection wave, and how those case numbers translate into severe illnesses that need hospitalisation.

17.     There are only two ways to minimise this – one is social restrictions, and two is to ensure good coverage of vaccination amongst the population. All of us do not want to bring back social restrictions as far as possible, so we need to rely on vaccinations. In this regard, like many Singaporeans, I am very proud that Singapore has achieved what many countries want to achieve – which is that most people have gotten up-to-date vaccinations. The resilience has been further strengthened as many people recovered safely from COVID-19 infections.

18.     Mr Seah Kian Peng asked what percentage of our population has been infected. On record, we have about 1.7 million reported cases, which is about 30% of our population. The Ministry of Health (MOH) also systematically monitors blood samples from routine polyclinic cases and other healthy volunteers for signs of previous infection. From these samples, we estimate about 60% of local residents are likely to have been infected with COVID-19.

19.     Notwithstanding, this does not confer us ‘herd immunity’. By and large, scientists around the world do not think herd immunity is achievable because the virus will continue to mutate, escape the protection of vaccines, and then infect people.

20.     What is achievable is “population protection against severe illness”, through vaccinations. This is what enables our healthcare system to weather through an infection wave, even with high case numbers, because the translation of case numbers into severe illnesses is very low.

21.     During the last Omicron wave at the beginning of this year, 2.4% of infected persons needed hospitalisation. During this wave, 1.9% ended up in hospitals. The actual percentages are likely to be lower because of not all cases are reported.

22.     Notwithstanding our strong resilience due to good vaccination coverage, MOH still has some concerns and we can never be complacent.

23.     First, coverage of the vulnerable, especially our seniors. To get good vaccine protection against severe illness from the Omicron variants, we need three mRNA shots. It is no longer a two-dose vaccination.

24.     However, we have hit a plateau. There remains 40,000 seniors aged 60 and above who have not received their booster shots, even though they are eligible. Another 40,000 seniors have not completed two doses yet. So, all of them are vulnerable to severe illness if infected, and we will continue to try to reach out to them through our Mobile Vaccination Teams, through our Home Vaccination Teams.

25.     Second, we know vaccine protection against severe illness will not last forever. Mr Shawn Huang has therefore filed a very pertinent question on when this will start to wane.

26.     MOH monitors this data closely. Mr Deputy Speaker Sir, with your permission, may I show some graphs on the screen please?

27.     Our empirical data shows that after 10 months, the protective effect of three doses of mRNA vaccines remains very strong – in preventing severe illnesses. That is why as of now, our recommendation is for those who are 80 and above, to receive their second booster or the fourth shot to better protect against severe disease. Members would notice that the top left-hand corner is the chart for those 80 and above, it has not dipped but in general, while the protection for this age group is not waning, it is generally lower than young age groups, which is why we recommend that they take a fourth shot or the second booster.

28.     For those 50 to 79, although the protection level continues to be strong, this is also the age when chronic illnesses start to set in. So, they have been offered the second booster if they want to take it either because they are travelling, or worried about their health because of underlying illness.

29.     Our experts are actively studying the benefits of a fourth shot or a second booster for the 60-79 year-olds in further reducing the likelihood of severe illness. We will announce their recommendations shortly, and once ready.

30.     As for younger individuals below 60 years old, they have the protection of both the third shot as well as age, and they currently do not require a second booster if they are healthy.

31.     MOH will continue to study the emerging data, including the benefits of newer vaccine formulations, weigh against the risk of new variants, and update our recommendations as and when necessary.

Re-Infections

32.     Ms Joan Pereira asked about the incidence of reinfections. It does occur, but by and large, reinfection rate during the current wave has been low in Singapore, and we recorded reinfection rates that are lower than many other countries. This is likely because we have very good vaccination coverage, and we just went through a major BA.2 infection wave just the beginning of this year.

33.     MOH has been watching the reinfection numbers very closely, because it will inform us of the likely timing of future waves. Our observation is that for those who were infected over the last three months, the chance of getting another infection is very rare. For those infected four to seven months ago, the probability of getting infected again is about 3% that of an uninfected or naïve person. If you have been infected with Delta variant last year, the probability of getting infected again is about 20% that of an uninfected or COVID-naive person.

34.     Of course, this picture will change as time goes by, and the protective effect of prior infections will wane. Hence, having been infected by COVID-19 before should not be a reason to let your guard down.

35.     In the meantime, reinfections are taking place, albeit not so frequently in Singapore compared to other countries, and likely to increase as protection of prior infections wanes. We should therefore start to include reinfection numbers in our daily reported case counts. In the past, we report the number of patients who have been infected every day. So, a patient who has been infected twice, we count them only once, and there are very few of them. With more reinfections, from today, we will report the infection episodes instead of infected persons. And this will be a more accurate reflection of the pandemic situation.

36.     Mr Zhulkarnain asked about COVID-19 therapeutics. All polyclinics and more than 130 participating Public Health Preparedness Clinics (PHPCs) can prescribe oral antivirals to clinically eligible patients in the community. To date, more than 3,200 patients have been prescribed such therapeutics across different healthcare settings. It is a small percentage of all infections, reflective of the fact that the vast majority of infected cases are of low risk.

Flu Subsidy Scheme

37.     Mr Saktiandi Supaat asked about the Flu Subsidy Scheme. As at end FY2021, the Government has spent about $178 million on the scheme for over 11 million attendances at private clinics and polyclinics for the treatment of acute respiratory infections.

38.     As we progress towards living with COVID-19, Singaporeans have become familiar with exercising social responsibility through self-testing and by following Protocol 1-2-3. By keeping ourselves healthy, getting up-to-date vaccinations, and then with employers and education institutions not always insisting to see medical certificates, most COVID-19 patients can recover uneventfully by resting at home, and seeking care only when needed.

39.     Our policies will therefore need to evolve with our state of preparedness. For safe management measures, we refrain from imposing additional restrictions even as we ride through a wave now. Likewise, healthcare financing policies also need to start evolving, and progressively scale back from subsidy policies that were enacted under exceptional pandemic circumstances.

40.     I want to reassure the House that for residents who see their primary care doctors, they will continue to receive institutionalised pre-COVID-19 subsidies such as Community Health Assist Scheme (CHAS), polyclinic subsidies, health screening subsidies etc. PHPCs and polyclinics will also continue to provide government-funded swabs to eligible symptomatic individuals at no charge.

Conclusion

41.     Mr Deputy Speaker Sir, while the current wave is subsiding and I think the worse is over, it is important that we do not be complacent.

42.     As the protection of vaccines and prior infection wanes, the virus will circulate in our society again, and cases will rise. We must anticipate when that will happen and take the necessary precautions, including the most important of all, which is to keep our vaccinations up-to-date.

43.     I have deliberately used the term ‘up-to-date’ vaccinations, rather than a second, third or fourth booster shot. This is because at some point, just like flu vaccinations, we will have to stop counting the number of jabs, or boosters we take. Instead, we must ensure that we get a jab at a suitable interval – may be nine months or a year. This is something MOH will try to determine in the coming months.

44.     As of now, there is no change to MOH’s guidance and recommendations. It remains what have already been announced.

45.     We need to be alert to the threat of a new variant that is more infectious, lead to more severe illnesses, or evade the protection of current vaccines. We hope it will not happen, but many countries in the Northern Hemisphere are wary of what may emerge in the coming winter. If we encounter such a variant, social restrictions will become necessary again.

46.     Mr Deputy Speaker Sir, notwithstanding these words of caution, let me underscore the importance of what Singapore just went through.

47.     With each wave, we are coping better. We are riding through this current BA.5 infection wave without imposing further social restrictions or imposing border measures. In our hospitals, we imposed fewer restrictions, and hospitals are generally able to cope better than the last wave.

48.     That means that the Singapore society, we have taken another major step forward in living with COVID-19 as an endemic disease. I think this is a big National Day present for all Singaporeans.

Treatment and Vaccination for Children Under Five

49.     Mr Deputy Speaker Sir, there were several PQs on our treatment and vaccination plans for children.

50.     Sir, I was saddened by the recent deaths of two young children from COVID-19, and offer my deepest condolences to their families. Based on local and international data, the BA.4 and BA.5 Omicron subvariants have not been observed to affect children more severely than past variants, and severe COVID-19 infection continues to be rare in children, especially amongst those who are vaccinated. For children aged five to 11 years of age, a third mRNA dose may be necessary at some point to keep protection levels high, and MOH is making the necessary preparations to roll out vaccination booster doses for this age group, in about two months’ time. At present, the Pfizer-BioNTech/Comirnaty COVID-19 vaccine remains the only vaccine authorised for use in children aged five to 17 years in Singapore. Children who are not medically eligible for the Pfizer-BioNTech/Comirnaty COVID-19 vaccine may receive the Sinovac-CoronaVac vaccine under a dedicated public health programme, while Moderna’s vaccine for this age group remains under evaluation.

51.     Children under the age of five are currently the last group not yet protected by vaccination. MOH is preparing to start vaccination for those under five towards the fourth quarter of this year. The Health Sciences Authority (HSA) is currently reviewing the data submitted by Pfizer/BioNTech and Moderna on their COVID-19 vaccines for this age group. We will provide an update when an assessment of the quality, effectiveness and safety of the vaccines has been completed.

52.     Members asked what could be done to detect, diagnose and treat COVID-19 in children. Currently, children under the age of five remain more vulnerable to COVID-19 infection, and have higher rates of severe outcomes as compared to older children; this is similar to other respiratory diseases. However, the overall incidence of severe outcomes from COVID-19 infection remains much lower amongst children compared to adults and the elderly. Children needing medical attention should be seen by a GP or polyclinic if unwell.

53.     The clinical teams, the doctors there will test children with acute respiratory infection (ARI) symptoms using an Antigen Rapid Test (ART) by default, or Polymerase Chain Reaction (PCR) test if indicated. Children under three months are admitted to hospital by default, whereas older children are treated under the Home Recovery Programme (HRP) and reviewed by doctors via telemedicine. This service is available round the clock. Our hospitals continue to prioritise care for children with urgent medical conditions, and those who require further observation and treatment will be admitted. MOH regularly reviews and updates the screening and review criteria with inputs from a panel of specialists.

54.     Oral antivirals are licensed for use under the HSA’s Pandemic Special Access Route for patients aged 18 and above only. For children aged between 12 to 18 years, local and overseas treatment guidelines indicate that Paxlovid may be considered on a case-by-case basis. We will continue to review the evidence for the use of oral antivirals for children under 18 years of age.

Conclusion

55.     We will continue to monitor the incidence of severe illness and deaths due to COVID-19 closely, and adjust our processes to protect our healthcare system and our patients. We ask everyone to take the necessary precautions, and remain socially responsible by self-testing if unwell, get vaccinated and boosted, and avoiding social interactions if you have a fever or respiratory symptoms.

56.     Earlier we have mentioned we would address Mr Louis Chua’s question on foreign patients. The number of foreign patients who come to Singapore to specifically seek inpatient treatment or day surgery at our hospitals has historically been small. Between 2017 and 2019, our public and private hospitals saw about 32,000 foreign patients annually, or about 3% of all inpatients and day surgery patients. These numbers have since fallen by 80% compared to pre-COVID levels. In 2021, there were just 6,000 episodes comprising less than 1% of the total cases seen in hospitals.