Statement by Mr Gan Kim Yong, Minister for Health, at Parliament, on the Update on Whole-of-Government Response to COVID-19

Introduction

1.     Mr Speaker, Members. Minister Lawrence Wong and I first spoke about COVID-19 in Parliament in January, and I updated Members again during the COS debate earlier this month. The situation continues to evolve rapidly, and we would like to take this opportunity to provide a further update on the latest situation and our strategy going forward. As the Taskforce involves multiple ministries, may I have your permission, Mr Speaker, to invite the relevant Ministers to respond to clarifications on their respective responsibilities?

Global Situation

2.      As of yesterday, there are more than 370,000 COVID-19 cases and over 16,500 fatalities from the disease worldwide, and the epicentre has shifted to Europe, and perhaps the United States (US). The number of deaths in Italy alone has exceeded that in China. The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March.

3.       How the outbreak develops globally will depend on the strategies and efforts of countries around the world. WHO has advised that we can still change the course of the pandemic if all countries take the necessary actions to contain the outbreak. Otherwise, we will continue to see the number of affected countries and cases rise rapidly. Regions such as China, Hong Kong and Taiwan, had experienced a reduction in the number of cases a few weeks ago, but have started to see increases in new cases in the past few days, driven by imported cases, arising mainly from residents returning from abroad. We face similar challenges.

Local Situation and Current Measures

4.     Currently, in Singapore, we have 558 confirmed cases, of which 2 have passed away, 155 have been discharged, and most of the rest remain stable or are improving. From late-January to February, Singapore saw an initial wave of imported cases from China. Some of these resulted in several local transmission chains, such as The Life Church and Missions Singapore and Grace Assembly of God combined cluster which resulted in 31 cases. However, in recent weeks, we are seeing a second wave of imported cases. In the past week alone, the number of cases in Singapore more than doubled, from 266 to 558 cases. Almost 80% of these new cases were imported, all from countries other than China even though we continued to see around 1,000 residents and long-term pass holders return from China in the past week. The top three sources of importation to Singapore are the United Kingdom (UK), US, and Indonesia. And over the coming weeks, the number of cases will continue to rise, as some of our around 200,000 overseas Singaporeans return home from all over the world.

5.    We have slowed the local spread thus far through a three-pronged approach: first, reducing importation; second, detecting and isolating cases early; and third, emphasising social responsibility and good personal hygiene habits.

6.    To reduce the risk of importation, we have stemmed the inflow of travellers by imposing border controls, and issued travel advisories to advise Singaporeans to defer their travel plans until the situation around the world is under control. Minister Lawrence Wong will elaborate on this later in his speech.

7.    We have also strengthened the checks at our borders to detect and isolate cases before they come into contact with the Singapore community. For example, since January, we have progressively put in place temperature screening, health checks and swabbing at all our checkpoints. All who meet the suspect case definition are conveyed directly to the hospital, while all symptomatic travellers as well as some selected travellers are swabbed as a precautionary measure.

8.    Beyond our checkpoints, we have also put in place a system to detect cases early, through surveillance at hospitals, polyclinics as well as Public Health Preparedness Clinics.

9.    We have re-activated Public Health Preparedness Clinics just over a month ago, and today, we have more than 900 clinics offering subsidised consultation and treatment for Singaporeans and Permanent Residents with respiratory illnesses. Singapore residents have benefited from more than 267,000 subsidised attendances at these clinics thus far, on top of that at our polyclinics.

10.    To date, we have done around 39,000 tests for COVID-19. This translates to about 6,800 tests per million people in Singapore, compared with around 6,500 in South Korea, and about 1,000 in Taiwan. These tests are important in helping us to detect as many cases as possible and as early as possible.

11.    The moment a case is confirmed, we activate contact tracing to identify close contacts and quarantine them as soon as possible, so as to reduce further spread of the disease.

12.    The Government has put in place many measures to reduce imported cases, trace, and isolate any such cases as soon as possible to prevent spread. But every one of us needs to play our part in practising good personal hygiene, social responsibility, and safe distancing to further reduce the risk of local transmission. We announced several safe distancing measures yesterday. Minister Lawrence Wong will elaborate on these later. I hope that Singaporeans will support these measures and keep up the good hygiene habits which will play an increasingly important role in our fight against COVID-19. 

Research Efforts

13.    During the COS debate I mentioned Singapore’s efforts in developing research and knowledge on COVID-19 and sharing these with other countries. There is an article in today’s paper about an innovative rapid test kit being developed by A*STAR’s researchers. We hope it will go to trial soon and give us that additional weaponry against COVID-19. For treatment, a COVID-19 therapeutic workgroup comprising members from the various hospitals across different disciplines as well as the Health Sciences Authority (HSA) has been set up to work on guidelines for repurposed drugs with antiviral activity (such as Lopinavir-ritonavir, Interferon Beta-1B and hydroxychloroquine) to treat infected patients in Singapore.

14.    The National Centre for Infectious Diseases (NCID) and Tan Tock Seng Hospital (TTSH), together with the Singapore Blood Blank, have initiated donor recruitment to collect convalescent blood plasma from recovered patients to treat other COVID-19 patients. Our doctors have also been participating in international clinical trials, with collaborators such as the US National Institute of Health. 

15.    For vaccines, scientists all over the world have successfully isolated and cultured the virus, which will aid the development of a vaccine. The international community is also working together to identify vaccine candidates and conduct clinical trials. For example, some institutes such as Moderna Inc have already started human trials as of last week. In Singapore, Duke-NUS Medical School is working with Coalition for Epidemic Preparedness Innovations (CEPI) and international partners to develop a clinical trial for a vaccine, with plans to start testing sometime this year. With all these ongoing efforts, WHO estimates that the earliest a vaccine will be ready would likely be sometime next year. 

16.    We do not know how long the pandemic will last, but we have to plan on the basis that COVID-19 will be with us for a long while, maybe till the end of the year or longer, and ensure that we have the resources and capabilities to see us through. COVID-19 has also taken a toll on our economy The impact will extend way beyond the pandemic. Many Singaporeans and businesses will need to make adjustments as this is not something that will be over quickly. The measures we announced yesterday will impact many businesses and workers. The Government will introduce greater support for the economy and workers in response to this situation.

Managing Healthcare Capacity

17.    MPs have asked about healthcare capacity. We will ensure that we have sufficient capacity to meet our healthcare needs not only for COVID-19 patients but also for other patients. 

18.    We had invested significantly in the past to ensure that we have sufficient healthcare capacity to manage infectious outbreaks. The 330-bed NCID was purpose-built with spare capacity, and can be further increased to over 500 beds if need be.

19.    To preserve capacity and resources for those who most need it, clinicians at our public hospitals had earlier reviewed their patients and deferred non-urgent appointments and elective procedures where clinically appropriate to do so. They have continued to see patients with higher needs to ensure that they receive timely care. When appointments had to be deferred, the public hospitals have worked to ensure that patients received sufficient supportive care. 

20.    We are exploring collaborations with private hospitals for some non-COVID-19 patients to be cared for there instead. We already have ongoing collaborations with some of them and we can step up so that we can preserve capacity in our public hospitals to manage the outbreak. Patients transferred to private hospitals through such collaborations will continue to pay similar rates they would have paid at our public hospitals.

21.    The most important resource actually is our healthcare staff. They have been working tirelessly to make sure that our patients, COVID-19 or otherwise, are well taken care of. I want to once again take this opportunity to thank healthcare workers for their dedication.

22.    We recognise the heavy workload and stress that our healthcare workers face every day. The surge in patient load due to COVID-19 means that some are taking on longer shifts, while others are required to take on additional roles. To ensure the well-being of our healthcare workers, institutions will make sure that their staff are well-rested and have put in place a series of measures to reduce staff burnout, such as counselling services and peer support programmes. 

23.    Most importantly, every case we can avoid will help to lighten their load. Hence each one of us can help by doing the right thing to reduce the risk of transmission.

24.    I want to thank Singaporeans also for your resilience, your understanding and support, in adapting to these new measures and changes quickly and putting up with inconveniences and disruptions to your daily lives for the sake of other Singaporeans and our community. With the global situation still evolving, and the number of cases rising rapidly worldwide, we must prepare to see more cases here too in time to come. Yesterday, we had 17 local cases in addition to 32 imported ones. We must work together and do what we can to keep the number of local cases down.

Shifts in How We Manage Healthcare Capacity

25.    With a significant number of imported cases from returning residents and visitors, we have progressively put in place travel restrictions and placed returning residents on the Stay-Home Notice (SHN) and quarantine, but there is still a risk of them leading to more localised transmissions.

26.    As more clusters emerge, our contact tracing, quarantine and healthcare resources will be stretched. If the clusters grow too large, such as those we see in the Life Church and Missions Singapore and Grace Assembly of God or SAFRA Jurong, if we have a few of them at the same time, it will be very difficult to contain them effectively, and the pressure on our healthcare system will increase. While we still have sufficient capacity in our healthcare system today, we cannot be complacent and we need to preserve our buffer capacity.

27.    Previously, all confirmed COVID-19 cases, regardless of severity, were admitted to our hospitals, and remained there until they were tested negative for the virus twice, over a period of 24 hours, and this takes up our capacity. We took this conservative approach early on in this epidemic, as there was little knowledge about the severity of the disease, and we wanted to find out more. However, we now know that about 80% of COVID-19 cases are mild to moderate. That means many of the COVID-19 cases in our hospitals experience mild symptoms, no more than that of flu. They only require limited medical care, and what we need really are isolation facilities to prevent them from infecting others, until they are free of the virus.

28.    Therefore, MOH is tapping on private capacity and setting up community care facilities, such as the collaboration with Concord International Hospital which started accepting well and stable COVID-19 patients last Friday and Mount Elizabeth Hospital which saw its first patient on Monday. We are also converting some Government Quarantine Facilities, starting with D’Resort with a maximum capacity of about 500, for this purpose. As per public hospitals, Singaporean residents and long-term pass holders transferred to these facilities will continue to receive free-of-charge testing and treatment, except for those who have travelled overseas despite the travel advisory and contracted the infection while overseas. 

29.    Patients at these facilities will continue to be quarantined and closely monitored, so there is no risk of the general public in the community being exposed to these cases while they are at these facilities. Similar to cases admitted to the hospital, patients will be closely monitored for symptoms and repeatedly tested for the virus. Only when they have fully recovered and tested negative for the virus twice over a period of 24 hours, will they be discharged back into the community. At this point, they no longer have any risk of transmitting the virus to others as they have fully recovered. We will continue to explore the use of such isolation facilities for our well and stable COVID-19 patients. This way, we can focus our critical hospital resources on the seriously ill, to minimise the number of fatalities. 

30.    But rest assured that any Singaporean who requires medical care, whether for COVID-19 or other illnesses, will receive the necessary treatment and care. 
Slowing Down the Infection Rate 

31.    Let me take this opportunity to explain our strategy going forward and share what we can expect. While we implement plans to ensure sufficient healthcare capacity, it is equally important to prevent new local clusters in the first place. This way, we can try to avoid an exponential growth in the number of infections, which could quickly overwhelm the healthcare system, as we saw in Hubei and Italy, and increasingly so in many other countries.

32.    Singapore’s strategy is to slow down the infection rate and maintain it at as low a level for as long as possible. A lower infection rate will help us to better conduct epidemiological investigations, contact tracing and quarantining of close contacts, so as to prevent further spread of the disease in the community. It will also preserve healthcare capacity to care for the more severe cases. 

33.    If we do nothing, the number of cases will shoot up, like what happened in several cities and countries recently. Then our only hope is that most of the population get infected and become immune quickly, and the rate of infection will start to slow down as more become immune, or a vaccine or a cure is found. This scenario may seem attractive – you get over with it very quickly – but there are unfortunately two major risks. Firstly, an uncontrolled spike in the number of cases in a short period of time will overwhelm the healthcare system, easily resulting in high mortality rates, and there is no turning back once we are on this track. The second risk is that it is not certain yet that this immunity will be effective or sustained. 

34.    One alternative is to introduce stringent safe distancing and other measures to slow down the infection rate. The number will still grow but if we do it right, we will end up with a lower peak. This is commonly known as flattening the curve. But by flattening the curve, we may actually stretch out the pandemic, meaning it will take longer for the pandemic to be over. For Singapore, we are still at the start of the curve today, and we have a chance, to do neither. We hope that if we do it right, we can significantly slow down the growth as much as we can, until the pandemic is over, without either a sharp peak or long tail. This may sound impossible, because these are the two curves that are established by academics. But as impossible as it may sound, we have to try our best to do so.

Detection and Contact Tracing

35.    To achieve this, we are strengthening our efforts to detect cases early to initiate the contact tracing process as soon as possible to reduce the risk of the infection spreading. In preparation for the expected surge in cases in the coming weeks, we have expanded our contact tracing capacity, from 3 teams when we started out to 20 teams today, thanks to manpower support from colleagues from the Public Service agencies, including the SAF. We can now trace up to 4,000 contacts each day, and will continue to scale up our contact tracing capacity as needed.

36.    We are also leveraging technology to supplement our contact tracing efforts. For example, last week, MOH and GovTech launched the TraceTogether app, which will capture data on whom you have come into contact with for some time. This will be useful if you have come into close contact with a confirmed case whom you do not know. By downloading and activating the app, the contact tracers will be able to inform you early so that you can isolate yourself and protect your family, or receive early treatment if you are already unwell. For those who are concerned about privacy, I would like to assure you that the app does not track your location, it does not matter where you go, but uses Bluetooth to detect if you have been in close proximity for more than 30 minutes with someone else with the app switched on. I urge Members and all Singaporeans to download the app to protect yourselves and your families. 

Social Responsibility and Safe Distancing

37.    I have spoken multiple times about the importance of social responsibility, here in Parliament as well as publicly. The Government will continue to put in place measures to protect Singaporeans as I have shared earlier, but the daily actions of each one of us will go a long way in winning this war. If you have been issued with a quarantine order or Stay-Home Notice, please stay at home and abide by the requirements of the order or notice. If you violate them, there will be penalties, and the heaviest penalty is that you may infect others, including those you love. If you are unwell, please wear a mask and see a doctor immediately. If you have been given a medical certificate, please stay home for the whole duration covered by the medical certificate. Wash your hands with soap regularly and do not touch your face. It is literally in our hands to contain this outbreak.

38.    In Singapore, we saw a few local clusters emerge where individuals who were feeling unwell or had Medical Certificate but did not minimise social contact, and continued to attend work or social activities. We have encouraged employers to support employees to spend the necessary time away from the office, so that they can recover. 

39.    Studies on COVID-19 have shown that for each ill person who behaves responsibly, we can protect two to three others from being infected. It’s not just about ourselves, but those around us too, including our loved ones. For the young and healthy amongst us, we may get away with a mild cold or cough, but for our vulnerable loved ones around us, the disease may prove to be more serious. So we must not take social responsibility lightly. 

40.    We have been progressively putting in place safe distancing measures, especially for the vulnerable groups. For example, after the SAFRA Jurong cluster arose, we suspended all senior-activities at CCs, RCs, Senior Activity Centres, and others. When some MPs  asked me at the last sitting whether we can resume some of these activities, I was very happy to say yes, then. Now I am afraid it will be a while longer before we do that, to protect the seniors.

41.    Seniors are of particular concern to us. MOH introduced an enhanced set of measures last week together with a set of guidelines to protect our seniors. We encourage seniors to maintain good personal and environmental hygiene like everyone else, and engage in more home-based activities rather than joining group activities. For example, they can exercise at home with TV and online exercise programmes, as well as enjoy broadcast programmes covering singing, cooking, and other programmes by celebrities and PA trainers.

42.    Don’t go out except for essential activities such as work or to buy food and supplies. Family members and caregivers of seniors should also take precautions such as washing hands with soap and water before interacting with seniors, and refraining from visiting seniors if one is unwell. Each of us needs to play our part to take care of our seniors. With these added precautions in place, seniors can continue staying active and healthy. 

43.    The measures we have put in place are extra “brakes” to slow down the transmission of the virus, prevent our healthcare system from being overwhelmed, help bring the number of cases back down over time, and protect, particularly, our seniors. 

Conclusion 

44.    Sir, let me conclude. While we should keep a wider physical distance between ourselves and others, we need to close the emotional distance between us. As PM pointed out, this is as much a psychological battle as it is a medical one. To win this battle, we must close ranks while keeping a safe physical distance. We should not stop caring about fellow Singaporeans or build walls between ourselves. On the contrary, we need to be more united than ever so that we can ride through this crisis together. We can show our appreciation to our frontline workers who are working very hard to keep Singapore clean and Singaporeans safe, and show our support to colleagues and friends who have acted responsibly and isolated themselves when they feel unwell.

45.    The months ahead will be challenging. We need to be prepared for disruptions to our daily lives, and changes to how we do things. But I am confident that if we stay united, with a whole-of-society effort, we can get through this together as a nation, SG United.