Singapore's Response to Current Global COVID-19 Situation

3.00 pm

The Minister for Health (Mr Ong Ye Kung): Mr Speaker, Sir, since yesterday, 8 January 2023, China has started resuming outbound leisure travel and removed quarantine requirements for returning travellers into China.

Singaporeans are naturally worried that this will lead to more people here, especially the vulnerable, falling severely ill. Further, there are concerns that this will trigger a fresh infection wave that can bring back social restrictions and undo what we have painstakingly achieved over the past three years.

The Government, and certainly, the Multi-Ministry Task Force (MTF) and the Ministry of Health (MOH), are acutely aware of these concerns because protecting Singaporeans and maintaining our freedom and normal lives have been our primary objectives throughout this pandemic journey.

As I have said a few times publicly over the past months, the pandemic is not over and we need to be especially mindful that when China opens up, there will be risks and uncertainties because the virus would be sweeping through a population of 1.4 billion, mostly COVID-19 naive, and that is now happening.

In addition, we have also anticipated that there would be a "winter wave" of infections across countries in the Northern hemisphere. This has also happened in many countries, such as the US, Europe, Japan and South Korea.

Prior to this, many countries have dismantled all their border measures. A few have now reinstated the measures and announced new measures. As for Singapore, we have never dismantled all of our border measures and have kept relevant measures, precisely because we anticipated these risks.

Today, I will explain why we decided on our current measures and why they are appropriate, given our current context and circumstances. But before that, let me report on the outcomes of the measures. After all, the proof of the pudding is in the eating.

Imported infections today account for about 5% to 10% of the total cases reported every day. Cases had fallen, so sometimes, it can be 15% to 20%. By and large, throughout the pandemic, 5% to 10% of the total cases reported every day. The four weeks running up to 1 January 2023 was probably one of the most difficult periods of the epidemic in China.

During that time, that four weeks, there were about 200 travellers from China detected to be COVID-19 positive. That is a low number because every day, our total reported cases is about 1,000. So, for the whole four weeks running up to 1 January 2023, 200 travellers from China were detected to be COVID-19 positive. They accounted for less than 5% of our total imported infections. ASEAN countries accounted for over 50%, rest of Asia around 15%, Europe – 11% and the Middle East – 9%.

Amongst all of our imported cases, in that four weeks, seven developed severe illnesses and had to be hospitalised. Three were from the Middle East, two from ASEAN, one from Europe, one from China. Most were Singaporeans returning from these countries and regions. And these were not large numbers, so the impact on our healthcare system was very small.

Since 1 January 2023 till today, I did a further check. There have also been no severe infection cases coming from China.

Why is it that travellers from China accounted for a very small percentage of imported infections and severe cases, when China is experiencing such a huge infection wave?

And there are two main reasons. It is due to the measures we put in place, and it is backed up by our high vaccination coverage which is being kept up-to-date.

What are the measures? What are the reasons?

First, travel volumes between Singapore and China have been very low throughout the pandemic. As of now, we run 38 weekly flights from China to Singapore, compared to around 400 flights pre-COVID-19. This translates to between 700 to 1,000 arrivals from China every day, less than 10% of pre-COVID-19 volume.

China's opening up to the world is great news and something we are looking forward to, so that we can restore our rich and substantive people-to-people links. As China opens up, the Ministry of Transport (MOT) will carefully calibrate any adjustments from the current low travel volume, at least until the infection wave has clearly subsided in China.

Many scientists believe that the current infection wave in China has already started to subside, especially the major Chinese cities. It will probably take a few more weeks for the trend to be very clear and we can then progressively restore pre-COVID-19 flight volumes between our two countries.

The second reason is that we have been maintaining a test requirement for at-risk travellers. Many Singaporeans have actually forgotten about it. Travellers have to either be fully vaccinated based on World health Organization (WHO) vaccination definitions or produce a negative pre-departure test (PDT) result before heading to Singapore.

That is why when Singaporeans are overseas now, when you go to the airport, you try to check-in with an airline, you have to produce your vaccination certificates at the point of check-in. This is so that the airlines know, and we know, whether you are required to produce a negative PDT result before you are allowed to board the plane.

Over the past months, many Singaporeans have actually written to me and to MOH to feedback that this current rule causes a lot of inconvenience. And they asked, can it be done away with at the check-in counter, where they have to – "kalang kabut" or scrambling – to show their vaccination certificate? Some of them have to log into their HealthHub with their Singpass and so on. We had been explaining to them that it is important to maintain it, to manage the risks that we are currently facing, because unvaccinated and infected travellers coming from anywhere in the world are at risk of severe infection and can add to our healthcare workload.

Spain, one of the most highly vaccinated countries in Europe, has just announced that they are implementing the same test requirement as Singapore. So, in summary, there are three groups of countries with varied responses as a result of China opening up.

First, most of ASEAN, the Middle East, Africa, South America, New Zealand – which are not imposing any border measures.

Second, several countries, namely, Australia, Canada, and several EU countries, such as Belgium, France, Germany, Sweden, India, Japan, UK and the US, they are imposing a 100% PDT requirement on all travellers from China.

And then, the third category, just Singapore and Spain, which have the policy of either you are fully vaccinated or produce a negative PDT result. Thailand, we thought, is putting on some of these requirements; I just read that it is taking them off again. So, we are neither the tightest nor the most liberal, but somewhere in-between. And we do not discriminate because these severe cases can originate from any country, any region in the world, as shown by our data.

Mr Speaker, Sir, our current measures, controlling the number of travellers and requiring PDT for unvaccinated at-risk travellers, have led to low imported infections and even fewer severe cases from China, at the time when the virus is spreading widely in the country.

I cannot speak for other countries, but I will now explain why the measures have worked so far for us and are appropriate in our current context. Minister Iswaran will further elaborate on what MOT is doing with regard to air travel.

But we cannot be complacent. The measures may work now, but not permanently. We will continually assess the situation and, if need be, make adjustments or implement new measures. At all times, our decisions must be based on science, on evidence and on data.

Let me first explain our key concerns at this stage of the pandemic. To do so, it is worthwhile recapitulating how far we have come.

At the early stages of the pandemic, infections were our primary concern, because it was a disease that could lead to many severe episodes and deaths, and there were no vaccines or treatments available. Under those circumstances, we adopted a zero-COVID-19 policy.

That meant tight border measures, testing every passenger and quarantining them before allowing them to move around in our community. The same considerations applied within the community, where we implemented contact tracing, quarantined close contacts, imposed strict safe management measures (SMMs), including a circuit breaker.

Then, effective vaccines were developed, and they changed our considerations fundamentally. With the great majority of our population vaccinated and many recovered safely from relatively mild infections, our population has developed strong hybrid immunity.

Today, the probability of COVID-19 infections leading to severe illnesses or deaths for our population has become very low, comparable to influenza or pneumococcal infections, both of which are endemic diseases that we have been living with for many years and which we have also been encouraging vaccinations for.

To illustrate, in the past 30 days, the number of COVID-19 patients in the Intensive Care Unit (ICU) is in the low single digit, and there were 25 days out of the 30 days where there were no COVID-19 deaths.

Based on the severity rate today, annual deaths caused by COVID-19 infections is similar to that caused by influenza infections. Hence, with extensive vaccination coverage, we can treat COVID-19 as an endemic disease. Like influenza, top line infection numbers should no longer be our pre-occupation.

To illustrate again, at the peak of the year-end XBB variant wave last year, we were registering a seven-day moving average infection of over 8,500 cases a day. Despite the high top line number, we carried on living life normally. We did not impose further social restrictions. We did without masks even.

However, we were watching the situation very carefully in our hospitals because it is the bottom line of number of severe cases and deaths that matter. As it turned out, hospitals were very, very busy, but they were not overwhelmed and we rode through that wave.

Our greater concern goes beyond hospital workload and capacity, to the evolution of the epidemic itself. Today, the infection waves around the world are driven by variants known to us – XBB, BA.2, BA.2.75, BA.5, BA.5.2, BN.1, BF.7, BQ.1, XBB.1.5 now. We know their characteristics and that existing vaccines continue to be effective in preventing severe illnesses of these variants.

What worries us most now, is the emergence of a new, unknown and more dangerous variant of concern. Our main worry is that with the virus continuing to spread throughout the world, there is a higher chance that a new variant of concern may emerge from anywhere in the world.

It may possess worrying characteristics, escape vaccine protection, be more infectious, more likely to lead to severe illnesses, which would be very bad news. A nightmare variant can knock us almost back to square one.

We must then be prepared to hunker down. We may need to reinstate measures, such as strict border controls, quarantine for travellers, social restrictions, including limits on group sizes, until a new and effective vaccine is developed.

So, in short, our key concerns are: first, the emergence of a new and more dangerous variant, and second, even in the absence of a new dangerous variant, to protect our healthcare system against having too many severe cases.

And these set the context of our border measures in response to the infection wave in China and the winter wave in many countries. Let me explain what we are doing to address each of the two concerns.

Let me start with the most important one, which is the emergence of a new and more dangerous variant.

The most common measures that we have read in the papers in response to the opening up of China is COVID-19 tests on travellers. But they do not help detect new variants of concern. The tests tell us if the travellers are infected with COVID-19, but it does not identify the variant.

New variants can emerge from anywhere in the world, not just China. So, to detect new variants, we need an effective global surveillance system where samples from infected persons all around the world are systemically collected, the viral genomes sequenced and then shared on the global platform. This is best done by countries for their own local cases, rather than relying solely on traveller surveillance because they can only provide a delayed snapshot.

Fortunately, such systems exist today. The most commonly used global COVID-19 genome sequencing platform is run by a non-profit organisation and it is called the Global Initiative on Sharing All Influenza Data (GISAID). The data is publicly accessible and protects the ownership rights of the source country.

Today, GISAID hosts all shared genome sequences of the four viral pathogens of global interest currently: namely, COVID-19, influenza, Mpox and Respiratory Syncytial Virus (RSV).

Singapore actively contributes to GISAID, which in turn works with many countries. GISAID has established a base in Singapore in collaboration with the Agency for Science, Technology and Research (A*STAR). And MOH and GISAID have developed a strong working relationship.

Hence, when a major COVID-19 infection wave broke out in China, GISAID collaborated with the various Centres for Disease Controls, or CDCs, in major Chinese cities and provinces to obtain viral sequencing data.

Today, Beijing, Shanghai, Guangzhou, Sichuan, Zhejiang, Jiangsu, Fujian and Inner Mongolia contribute up-to-date viral genome sequences to GISAID on a weekly basis. Just today, you can now find genome sequences also from the province of Anhui, just fresh; it came out today. The data is analysed and processed from their office in Singapore.

There are still gaps in the data, so GISAID is working with the Chinese authorities to expand the data capture. So far, the data shows that the epidemic in China is driven by variants that are well-known and have been circulating in other regions of the world. The dominating ones are BA.5.2, as well as BF.7.

Our local sequencing efforts on infected travellers from China further support this. The majority, as I mentioned, are BA.5.2 and BF.7 strains, which have already been detected in Singapore and other countries for many months. Our assessment is also consistent with that of WHO's Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE), which released its findings on 4 January 2023.

This is a huge relief. What we fear and worry most – a new dangerous variant that evades vaccine protection coming out from China as the virus spreads throughout their population – has not materialised yet. But we will continue to stay vigilant and plug ourselves deeply into the global surveillance system.

Mr Speaker, our second concern is to protect our hospital system.

When China announced that it will start to allow leisure visits in an orderly way, many people around the world is imagining a surge in COVID-19 infections from an increase of tourists from China. Singaporeans, too, are asking if we should implement some of the measures other countries have announced and are implementing. So, let us examine the effectiveness of these measures in protecting our hospitals.

First, some countries conduct polymerase chain reaction (PCR) tests on travellers from China after arrival. But the shortcoming of any on-arrival test is that they are done too late, because the travellers are already within our borders. Further, PCR tests are sensitive and bound to yield a large number of positive cases from countries that are experiencing or have just experienced a big wave. Even recovered travellers will shed dead viral fragments for quite some time, for a few weeks, even though they are no longer infectious. We, therefore, did not consider doing this, as it would merely confirm what we expect, or what we already know.

Then, there are also wastewater tests. For waste-water tests, it is best done on residential premises like dormitories and housing estates, because viral fragments can only be detected from solid wastes. So, the sample capture from plane toilets for a relatively short duration flight from China to Singapore is likely to be very small and of limited use.

The second measure is the PDT. That can be useful because it will sieve out COVID-19 positive passengers, prevent them from boarding the plane, reduce number of imported infections and, hence, severe cases and the burden on our hospitals. So, PDT can be useful.

However, as I explained earlier, there is already low travel volume between Singapore and China, which is currently only less than 10% of pre-COVID-19 norms. This already limits the number of imported infections more so than imposing a blanket PDT requirement on all travellers from China.

I believe China is also acting cautiously and increasing outbound traffic in steps, and not make a sudden full opening.

Minister Iswaran will explain how we will increase the number of flights between Singapore and China in a calibrated fashion, as the infection wave continues to subside in China, while ensuring that the health of Singaporeans and healthcare resources are not compromised.

I reported earlier that over the past four weeks, travellers from China accounted for less than 5% of imported infections, and one out of seven severe cases. If we impose PDT on all travellers from China, the question will also arise: how about travellers from other regions that contributed to more infections and severe cases? How about local community settings which we know are conducive to spreading the disease and can drive infection numbers and severe cases?

Further, by triggering PDT on travellers from one part of the world experiencing high infection numbers, are we contributing to an international precedent of imposing tests on travellers from countries experiencing an infection wave? How will other countries treat travellers from Singapore when we encounter another infection wave?

Instead of imposing a blanket PDT specifically on travellers from one region or one country, we decided very early on that we should encourage adequate vaccination amongst all travellers coming to Singapore, from all parts of the world. This directly reduces the risk of importing severe cases and protecting our hospital system.

That is why we have, until now, maintained the requirement that incoming travellers either are fully vaccinated based on the WHO's definition, or have to undergo a professionally administered or supervised PDT. Mr Speaker, in Mandarin please.

(In Mandarin): [Please refer to Vernacular Speech.] China's opening up to the world is a major milestone in the world's fight against COVID-19. It is great news for many countries, industries, enterprises, families and individuals. To Singapore, this is also an important development because it allows us to restore our rich and substantive people-to-people links.

Although what we yearned for has indeed happened, many people are worried that this could trigger a fresh wave of infection in Singapore and bring back social restrictions, and the freedom we have worked so hard for the past several years might also be lost.

MOH is acutely aware of these concerns and will remain highly vigilant. Therefore, we need to use science, evidence and data to formulate the most effective COVID-19 policies.

Let us look at some figures. Last December was probably one of the most difficult periods of the pandemic in China. During that time, there were about 200 travellers from China detected to be COVID-19 positive. They accounted for less than 5% of our total imported infections, and less than 1% of our total infections.

Currently, most COVID-19 positive cases are mild, especially for those who have been vaccinated. So, what we need to focus on are those severe cases who need to be hospitalised.

Last December, amongst all the imported cases, seven developed severe illnesses and had to be hospitalised – three were from the Middle East, two from ASEAN, and one each from China and Europe. Most of them were Singaporeans returning from these countries and regions. These are not large numbers, so the impact on our healthcare system was very limited.

Why is it that travellers from China account for such a small percentage of our imported infections and severe cases, despite China experiencing a big infection wave?

The main reason is because travel volumes between Singapore and China have been very low throughout the pandemic.

As of now, we run 38 weekly flights from China, compared to around 400 flights pre-COVID-19. This translates to between 700 to 1,000 arrivals from China every day, less than 10% from pre-COVID-19.

In addition, we have been maintaining a test requirement for at-risk travellers. These travellers have to be either fully vaccinated or produce a negative PDT result before heading to Singapore. It is precisely because we have anticipated the situation today that we have kept these two very important border measures. Many scientists believe that the current infection wave has already started to subside in China. During this difficult period, these measures have proved to be effective to keep Singapore's COVID-19 situation stable.

However, it is impossible that measures can work permanently. The MTF will continue to monitor the ever-changing situation and review our measures. If needed, we will change our COVID-19 measures accordingly.

Let me now explain the key concerns that we have at this stage of the pandemic. First, the emergence of a new and more dangerous variant, and second, to protect our healthcare system.

A new variant of concern may emerge from any part of the world. To detect new variants as soon as possible, we need an effective global surveillance system.

This global system is called GISAID. GISAID now collaborates with the various CDCs in major Chinese cities and provinces to obtain viral sequencing data. Today, Beijing, Shanghai, Guangzhou, Sichuan, Zhejiang, Jiangsu, Fujian, Inner Mongolia and Anhui contribute up-to-date viral genome sequences to GISAID on a weekly basis. The data is analysed and processed in their office in Singapore.

The GISAID data so far shows that the pandemic in China is driven by variants that are well-known and have already been circulating in other parts of the world, and current vaccines are effective against these variants. This is a huge relief.

To protect our healthcare system, it is most important to encourage all travellers coming to Singapore from any part of the world to have adequate vaccination. This directly reduces the risk of importing severe cases, and hence, protects our own hospital system.

Ultimately, our best defence is also what everyone can do – to get vaccinated and make sure our vaccination is up to date. Some people ask me: "We keep going for one booster shot after another. When will these vaccinations come to an end? When can we stop vaccination for COVID-19?"

To be honest, COVID-19 vaccination has become part of the new norm. Just like any other endemic diseases like influenza, we encourage people to go for vaccinations every year. This will help prevent many from falling severely ill or even death.

As Prime Minister Lee said in his New Year's Day message, if the situation continues to be stable after the year-end holiday season and the infection wave in China, we can look forward to making final adjustments to our remaining social restrictions to establish a post-pandemic normalcy.

(In English): Mr Speaker, Sir, the latest worry about the outbreak in China is part of the new norm. Today, it is China. Tomorrow, another region may experience a major wave. In fact, many regions in the Northern Hemisphere are experiencing rising infections of both COVID-19 and influenza over the winter season.

New infection waves are bound to start in Singapore from time to time, over and over again, as variants with immune escape emerge, protection from vaccines and previous infections wane, and re-infections increase.

While we step up global surveillance and consider border measures whenever we feel threatened, remember the best defence – and which every one of us can play a part – is to have up-to-date vaccinations.

Some people are asking when the vaccination is going to end. How many shots of booster must we take? To be very honest, COVID-19 vaccinations have become part of the new norm. For an endemic disease like influenza, vaccinations are encouraged every year, which will help avoid many deaths.

COVID-19 is heading the same way. The current situation, where we feel threatened by rising infections around us, is a clear illustration why vaccination needs to be an integral part of our ongoing defence against an endemic COVID-19.

I am heartened that most Singaporeans are responding to this. As of 31 December 2022, about 60% of individuals aged 16 and above are up to date with their vaccinations. Today, about 13,000 individuals are taking the bivalent vaccine on a daily basis. And now, with the introduction of the bivalent formulations for both Moderna and Pfizer – we have two brands to choose from – I hope more will step forward to get better protection.

As we move into this new norm, we will never be complacent, but our responses need to be based on science, evidence and data. We are ready to adjust policies whenever necessary. We will always do our best to maintain our way of life and not go back to the days of lockdowns, unless absolutely necessary.

As the Prime Minister said in his New Year's Day message, if the situation continues to be stable after the year-end travel season and the infection wave in China, we can look forward to making final adjustments to our remaining social restrictions to establish a post-pandemic normalcy. [Applause.]

3.32 pm

Mr Speaker: Minister S Iswaran will be making a related Ministerial Statement. I will allow Members to raise points of clarifications on both Statements after this Statement. Minister S Iswaran.