Post-COVID Evaluation: Guidelines or criteria developed for TraceTogether, SafeEntry, DORSCON, SMMs

NOTICE PAPER NO. 1130
NOTICE OF QUESTION FOR ORAL ANSWER
 FOR THE SITTING OF PARLIAMENT ON 9 MAY 2022

Name and Constituency of Member of Parliament
Ms Nadia Ahmad Samdin
MP for Ang Mo Kio GRC

Question No. 2882

To ask the Minister for Health (a) whether there will be guidelines or criteria developed for the re-activation of TraceTogether and SafeEntry as contract tracing tools; and (b) what examples of future situations where these tools may be used so that the public can take the necessary steps to retain their tokens where necessary.

NOTICE PAPER NO. 1135
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 9 MAY 2022

Name and Constituency of Member of Parliament
Mr Lim Biow Chuan
MP for Mountbatten

Question No. 2899

To ask the Minister for Health (a) what are the criteria considered by the Ministry in deciding to lower the Dorscon level from Orange to Yellow; and (b) whether the Ministry will relax the rules and allow unvaccinated residents to enter malls and to dine in the food and beverage outlets together with the rest of Singaporeans.

NOTICE PAPER NO. 1135
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 9 MAY 2022

Name and Constituency of Member of Parliament 
Ms Sylvia Lim
MP for Aljunied GRC

Question No. 2902

To ask the Minister for Health (a) in light of the easing of the COVID-19 safe management measures, whether community mask-off events such as temple dinners where food is served will be allowed; and (b) if so, under what conditions.

NOTICE PAPER NO. 1135
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 9 MAY 2022

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

Question No. 2905

To ask the Minister for Health given a 7% increase in the age-standardised death rate in 2021 that bucked the downward trend in previous years (a) what is the Ministry’s analysis of the reasons behind this increase; (b) what is the number of excess deaths due to COVID-19; and (c) what formula is used in the Ministry’s calculation of excess deaths.

NOTICE PAPER NO. 1135
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 9 MAY 2022

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

Question No. 2906

To ask the Minister for Health whether the Ministry will conduct a study on the impact of the COVID-19 pandemic on (i) non-COVID-19 patients facing delayed treatment, especially older ones with chronic conditions and (ii) the public healthcare system, in view of the patient backlog from the periodic suspension of non-essential services.

NOTICE PAPER NO. 1135
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 10 MAY 2022

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

Question No. 2928

To ask the Minister for Health (a) how has the DORSCON level guided decision-making and Government agencies’ preparedness in dealing with COVID-19 over the last two years; and (b) whether the framework will be reviewed.

Answer

Mr Speaker Sir, may I address PQs for oral answer 9 to 13 in the order paper, and also the oral PQ filed by Mr Chua Kheng Wee Loui [1] for the sitting on or after 10 May, please?

With the pandemic situation stabilised, the Multi-Ministry Taskforce took decisive steps to open up social and economic activities, to almost pre-COVID norms.  So, to Ms Sylvia Lim’s question, temples can start to organise dinners, barring any changes in rules later.

Mr Lim Biow Chuan asked if individuals who are not fully vaccinated can be allowed to enter malls and dine in F&B outlets.  I would like to clarify that they can enter malls, as we have significantly removed Vaccinated Differentiated Safe Management Measures (VDS) for non-fully vaccinated persons. 

However, we need to remain cautious because a next infection wave is highly possible.  We also need to watch out for new variants that may threaten us again. Hence, the MTF decided to maintain VDS for the three most risky settings – nightlife outlets with dancing, events with more than 500 participants at any one time, and F&B outlets, where there is a constant flow of diners who are mask-off and interacting. For F&B, we will however not deploy Trace Together (TT) and Safe Entry (SE), and instead put the onus on customers to ensure they are fully vaccinated before visiting an F&B outlet.  We will continue to review our VDS measures as the pandemic situation evolves.

Hence, we are taking a cautious, ‘step down but not dismantle’ posture for our public health measures.  If the situation requires, we will have to step up VDS, and reactivate TT and SE.  Ms Nadia Samdin asked what the criteria are to reactivate these measures.  It is a matter of judgement, depending on the severity of the situation.  We will have to take into account if there is a new variant of concern, whether it is more severe or more infectious than Omicron, whether past infections and current vaccines continue to confer strong protection against the new variant, and how all these affect our hospital capacity.  

I can understand some members of the public want a system with transparent and clear triggering points, but I am afraid that is not possible when we are in a pandemic crisis with fog of war.  But through the MTF’s actions over the years, I hope the public would also appreciate where we are coming from – we will do what is necessary to protect lives when danger is upon us, and we will step down measures when they are no longer necessary, so that people can resume their normal lives.  So, the best step for the public to take, is not to delete your apps or discard your TT tokens!

Members asked about the Disease Outbreak Response System Condition (DORSCON) framework.  It was established after SARS in 2003, then reviewed and progressively improved from the experiences drawn from managing the H1N1 pandemic influenza outbreak in 2009, and the coordination for Middle Eastern Respiratory Syndrome Coronavirus and Ebola Virus Disease.  Post COVID-19, we will certainly review it further, along with our response measures, given all that we have learnt.

The DORSCON Framework was developed as a tool for ministries and agencies to coordinate and execute the government’s response to outbreaks of infectious diseases.   By and large, it has served its purpose well. 

In the initial phase of the pandemic, the MTF decided that for transparency, we would announce the DORSCON level publicly too.  This helped alert the public of the need for personal vigilance and social responsibility.  However, it also led to certain public reactions, such as a rush to the supermarkets.  This is a key issue for review, as DORSCON is meant to bolster preparedness, not to induce public anxiety.

A key factor to consider in our review is that after more than two years of pandemic, the Government and our society have learnt a lot about pandemic response.  We have developed a comprehensive response system, covering health protocols, border controls and safe management of economic and social activities.  It is also tiered and differentiated, catering to different activities and settings, such as schools, offices, public spaces, eating places, nightlife, events etc, at various severity conditions. 

Therefore, from a public communications point of view, the public pay much less attention to DORSCON level, but take care to understand the various public health measures in detail, then respond and do their part accordingly, be it taking vaccination, wearing masks, or abide by the safe management measures.  I am confident that today, we have a much more sophisticated public that understand what they need to do when a pandemic turns for the worse.

The response of the public, and the contribution of everyone in our society is ultimately what gives us resilience during a pandemic outbreak.  So the DORSCON framework is most likely still relevant, but it needs to be part of a larger emergency preparation and public communications framework that we have developed and which people understand.

Members also asked about “excess deaths”.  Let me first explain what it is.  It means comparing death rates across the years, taking into account the changing age profile of the population. If the death rate goes up in a pandemic above that expected in the absence of a pandemic, and over what is expected from population ageing, it means there are “excess deaths”. 

For Singapore, our age-standardised death rate has decreased steadily from 563 per 100,000 residents in 2017 to 519 per 100,000 in 2020. In 2021, the rate increased to 557 per 100,000 residents, almost back to 2017 levels. So there are “excess deaths” in 2021 compared to 2020.

Mr Leon Perera asked why that is so and how we calculate excess deaths.  We used well-established, internationally practiced methods.  There are excess deaths in 2021 because there has been a global pandemic causing millions of deaths.  Singapore suffered loss of lives too.

During a pandemic, excess deaths will be higher than officially reported deaths directly caused by the disease.  To illustrate, a recent WHO analysis of excess deaths found that while the officially reported number of COVID-19 related deaths around the world is slightly over 6 million, “excess deaths” during the pandemic is 15 million – about 2.5 times more. 

There are a few reasons explaining the difference in the two numbers.  One, in some parts of the world, there can be under-reporting of deaths in regions where testing is insufficient, or where data is difficult to collate.  But in Singapore, this is not an issue. Two, there are infected persons who died of other illnesses, but COVID-19 infection might have been a contributory factor but not the main cause.  Three, care-seeking behaviours changed.  For example, individuals with chronic conditions may put off their check-ups and treatments during the pandemic, to their own detriment.  Four, there are many regions where their healthcare systems were overwhelmed.  When that happens, proper care is denied, and the people who suffer are not just the COVID-19 infected patients, but everyone that needs hospital care.

Our excess deaths in 2021 among Singapore residents is about 1,535, after accounting for ageing.  COVID deaths as at end 2021 among residents is 804, or about 52% of excess deaths.  The remainder excess deaths could be due to the factors I explained earlier, except under-reporting is not an issue in an urban environment like Singapore and also the last reason I mentioned – hospitals being overwhelmed.  That’s not a big factor here because we prioritised the protection of our healthcare system, going into a Circuit Breaker when needed. So although our hospitals came under significant pressure at the height of the infection waves, they were not overwhelmed and hospitals could continue to give priority to serious and urgent cases. 

As mentioned in our press statement on 24 March 2022, the Ministry of Health is continuing to collect and analyse the data, to find out more comprehensively the impact of this crisis on Singapore residents, and we will release a special report soon, to estimate the excess deaths over the past two and half years of the pandemic, and the key factors causing the excess deaths. 

I should emphasise that whether it is official COVID-19 death toll or excess deaths, Singapore will have one of the lowest rates in the world, amongst countries that have chosen to live with COVID-19 and resumed normal lives.

[1] To ask the Minister for Health (a) how has the DORSCON level guided decision-making and Government agencies’ preparedness in dealing with COVID-19 over the last two years; and (b) whether the framework will be reviewed.