Updates To Healthcare Protocols And Implementation Of Vaccine Booster Strategy

1.   The Multi-Ministry Taskforce (MTF) had earlier announced some measures to slow the spread of new cases, in response to the current infection wave that began on 23 August 2021. These give us time to encourage more unvaccinated seniors to get vaccinated, and roll out our vaccine booster programme.

2.   This is the first time we are experiencing such an exponentially rising wave of infection in the community. Despite our high vaccination coverage, there is still a risk that the exponential cases can lead to more severe illnesses and deaths. The coming weeks will be a critical period as cases will continue to rise, and we will observe if infections translate to requirements for Intensive Care Unit (ICU) beds and deaths. We will also be rolling out the vaccine booster programme from 14 September to persons who are immunocompromised and seniors aged 60 years and above, to maintain the high level of vaccine protection. These are necessary steps to take as we continue our journey to re-open our society and community. We seek Singaporeans’ understanding and support during this period so that we can ensure as safe a re-opening as possible.

3.   The most immediate task ahead is to reconfigure our healthcare protocols so that we can cope with the current level of infections. The large majority of infection amongst fully vaccinated persons have been mild or asymptomatic. The evidence also shows that fully vaccinated individuals recover faster and are well protected against serious illness. The Delta variant has also been shown to have a shorter incubation period than previous variants.  

4.   Given this evidence, we will expand our home recovery pilot to allow more vaccinated individuals to recover at home, bring forward the discharge timeline for fully-vaccinated infection cases, and shorten the length of quarantine. This will allow us to better prioritise our healthcare capacity for treating serious cases, as well as for other healthcare needs.

Updates on Local Situation

5.   With the increase in community transmissions, we have intensified our testing programme to pick up cases early. With most residents respecting safe management measures (SMMs) in place, around 0.5% of the tests return positive, but nevertheless, the number of daily cases has been rising over the past fortnight, from an average of 76 cases per day a fortnight ago, to 288 cases per day in the past week. At the current trajectory, it is likely that we will soon reach more than 1,000 daily cases, detected early through intensified testing.

6.   For now, the number of serious cases remains low – as of 9 September, there are 26 cases of serious illness requiring oxygen supplementation, and 7 in critical condition in the ICU. This is likely due to both our high vaccination rates, which stand at 81% fully vaccinated today, and the younger age profile of the infected. There continues to be strong evidence that vaccination is protective against severe illness. Among fully vaccinated cases in the past 28 days, 99.2% were asymptomatic or had mild symptoms. Among unvaccinated and partially vaccinated individuals, 95.1% were asymptomatic or had mild symptoms. Nevertheless, we are still early in this new wave of transmission and we need to continue to monitor the situation and remain vigilant.

Updates to Healthcare Protocols

7.   In line with the evidence that fully vaccinated individuals are mostly showing mild symptoms or are asymptomatic if infected, we started the Home Recovery Pilot on 30 August 2021, for fully vaccinated COVID-19 individuals infected with COVID-19 to recover from home, provided that they have a suitable home setting where they can be isolated from the rest of their household. Under the pilot, their household members must also be fully vaccinated and not belong to any vulnerable groups (such as the elderly or immunocompromised). These individuals will be equipped with care packs to monitor their symptoms and given access to 24/7 telemedicine support if they require any medical assistance.

8.   21 individuals have been enrolled onto the pilot thus far and the results have been positive. Nine individuals have since been discharged as of 9 September, and the rest remain clinically well.

9.   Given the encouraging pilot results, we will expand home recovery as the default care management protocol for more fully vaccinated individuals from 15 September 2021[1]. We will extend the scheme progressively to individuals up to 50 years-old who have no significant co-morbidities or underlying illnesses. This is because these individuals are generally well with no or mild symptoms and are able to self-care at home. Once notified of their COVID-19 positive results, these individuals should immediately self-isolate at home.

10.   There have been a number of requests from parents to bring their infected children home as they are often well with no symptoms, and parents prefer to be able to take care of them at home. We have been careful and admitting children to hospitals to provide them with dedicated medical care. However, we will now allow and encourage parents to bring their infected children home, if they are at least 5 years-old and do not have co-morbidities or underlying illnesses. For these children, they will first be assessed by the hospital to be clinically fit for home recovery, before sending them back home for their recovery journey.

11.   There is also evidence that vaccinated COVID-19 cases recover faster than unvaccinated cases. As such, since 7 September 2021, we have also shortened the length of isolation for fully vaccinated COVID-19 cases. These cases may be discharged as early as seven days into their illness if they have undetectable or very low viral loads, showing that they are non-infectious. Unvaccinated persons will continue to be discharged from 14 days into their illness.

Updates to Quarantine Protocol

12.   As the number of infection cases build up, we will prioritise our contact tracing resources on preventing large clusters at high-risk and vulnerable settings. We will rely more on TraceTogether data to identify close contacts of COVID-19 cases. Close contacts of a COVID-19 will be issued Health Risk Warnings (HRW) or Health Risk Alerts (HRA) and should get tested to minimise the risk of spread of disease. Household members of confirmed COVID-19 cases will also be required to quarantine themselves to further prevent risk of spread of disease. More information on the self-quarantine arrangement and the support which will be provided to these persons will be released later.

13.   We will also adjust the quarantine period. The quarantine period is currently set at 14 days to account for the maximum COVID-19 incubation period. However, the Delta variant has a shorter incubation period – an average of under four days compared to an average of six days for the original strain. This means that it will take an average of four days after exposure to the virus, for the virus to be detectable in the individual. As such, we will reduce the quarantine period from 14 days to 10 days from the date of last exposure, provided the person under quarantine tests negative for COVID-19 at the end of his quarantine. He/she will need to continue to conduct daily ART after the quarantine period to Day 14 to mitigate any remaining risk of infection. This will be implemented from next week[2].

14.   Overall, the shifts in our approach, including the use of HRW and HRA and self-quarantine, allow us to mitigate the risk of further transmission in a more sustainable manner. It requires more personal responsibility, and each of us to do our part.

Commencing Vaccine Booster Programme

15.   As announced on 3 September 2021, the Ministry of Health (MOH) will be commencing the vaccine booster programme for two subgroups: (a) persons aged 60 years and above, as well as residents of aged care facilities and (b) persons who are moderately to severely immunocompromised.

Seniors and Residents of Aged Care Facilities

16.   From 14 September 2021, we will progressively invite seniors 60 years and above, and residents of aged-care facilities who have completed their vaccination regimen with two doses at least six months ago to receive their booster dose of a Pandemic Special Access Route (PSAR) mRNA vaccine. An SMS with a personalised booking link will be sent to the mobile number that they had registered with earlier for their first two doses, for them to book a new appointment on www.vaccine.gov.sg. Eligible residents of aged care facilities can also look forward to receiving their booster dose in the coming weeks.

Immunocompromised Individuals

17.   Individuals who are moderately to severely immunocompromised and have completed their two doses of the PSAR mRNA vaccines are encouraged to receive a third dose of the same PSAR mRNA vaccine two months after their second dose. However, they should consult their treating specialist, who would have the best understanding of their medical condition, prior to receiving their third dose. Eligible individuals may thereafter receive the vaccination in a hospital or Specialist Outpatient Clinic of their treating specialist, if these are offering vaccinations. Alternatively, they may obtain a referral form duly completed by their treating specialist, and subsequently walk into any Vaccination Centre for their third dose.

Regular Testing

18.  As announced on 6 September 2021, sectors currently on mandatory 14-day Fast and Easy Test (FET) Rostered Routine Testing (RRT) will need to increase their frequency of testing to every 7 days starting from 13 September 2021. New sectors with frequent interactions with the community would also be progressively onboarded onto 7-day FET RRT. Together, this intensified testing will improve our sentinel surveillance, allowing us to detect cases early and slow down the spread of the virus.

19.   We also announced earlier that workplaces not on mandatory RRT should carry out regular testing for their onsite staff over a two-month period. We will begin to distribute the ART kits from next week onwards for companies to undertake this regular testing. More details on the application process, the coverage, and delivery of kits etc. will be provided soon. Beyond workplace testing, we encourage Singaporeans to use the ART kits that are currently being distributed to all households by 27 September 2021, to self-test yourselves before visiting crowded places, attending events or visiting vulnerable seniors. This will help us keep our community safe.

Towards a COVID-19 Resilient Singapore

20.   We urge everyone who has not been vaccinated to step forward now for your vaccination, and for those who are eligible for the booster programme to come forward when you are invited. This will allow us to maintain our high vaccination coverage and reduce the risk of serious illnesses or deaths. As we shift towards a COVID-19 resilient state, we will need everyone to play their part to see a doctor or stay home if feeling unwell, to self-test regularly and get a confirmatory polymerase chain reaction (PCR) test if self-tested to be positive, and to abide by the safe management measures. Together, we will be able to progress along our journey towards being a COVID-19 resilient nation.

MINISTRY OF HEALTH
10 SEPTEMBER 2021

[1] These changes will not apply to dorm residents for now due to the larger risk of transmission given their cohorted living arrangements.

[2] These changes will also not apply to dormitory residents for now due to the larger risk of transmission given their cohorted living arrangements. Sectors may also have additional requirements due to their unique needs.