Update on Government Decisions and Measures as Singapore Moves into Endemic Stage of COVID-19 Situation

1 Ms Jessica Tan Soon Neo asked the Minister for Health (a) with the increasing number of COVID-19 cases, whether the current measures are effective in ensuring that Singapore is prepared for COVID-19 to be treated as “endemic”; (b) whether the healthcare system has adequate capacity; and (c) whether new measures are required.

2 Mr Yip Hon Weng asked the Minister for Health as Singapore opens up and moves towards an endemic management model for COVID-19 (a) whether the reporting of COVID-19 cases and the KPIs related to the managing of COVID-19 cases will shift towards availability of COVID-19 management facilities in relation to the number of infections nationally; (b) if so, when will it take place; and (c) what are the plans to effectively communicate this shift to the public.

3 Ms Sylvia Lim asked the Minister for Health whether the Government is reviewing the manner of implementation of COVID-19 Quarantine Orders and Stay-Home Notices so as to improve communication with affected households while safeguarding public health.

4 Dr Wan Rizal asked the Minister for Health regarding the Home Recovery scheme (a) what is the efficacy of the Home Recovery scheme; (b) how many persons have completed the Home Recovery scheme without affecting other family members; (c) what is the average response time for someone who has received a Quarantine Order; (d) whether the current manpower to support the scheme is sufficient; and (e) whether the disbursement of antigen rapid test kits has been timely and sufficient for families under the scheme.

5 Ms Ng Ling Ling asked the Minister for Health with regard to Home Recovery being the default care management model for eligible COVID-19 patients from 15 September 2021 (a) what is the number of Persons under Quarantine (PUQ) who are COVID-19-positive and are under Home Recovery; (b) of these, how many are subsequently found to be ineligible for Home Recovery; and (c) how long is the waiting time for them to be sent to a hospital or dedicated care facilities.

6 Mr Dennis Tan Lip Fong asked the Minister for Health in what circumstances can COVID-19 patients request the Ministry to have their recovery in community care facilities or hospitals after a positive diagnosis, instead of a quarantine at home.

7 Mr Xie Yao Quan asked the Minister for Health (a) how are the younger and fully vaccinated COVID-19 patients being triaged for other home recovery criteria, such as having no severe co-morbidities or vulnerable household members; (b) whether such triaging typically occurs within 24 hours of confirmation of polymerase chain reaction (PCR) test results; and (c) in the longer run, what is the target time to pick these patients up for conveyance to a Government facility from the time they are deemed unsuitable for home recovery.

8 Mr Yip Hon Weng asked the Minister for Health (a) when will the Ministry decide on using viral vector or other combinations of vaccines for the third COVID-19 vaccine booster jab; (b) how will this decision impact the booster jab programme for seniors; (c) whether the definition of "fully vaccinated" will be changed to differentiate those who have taken the third booster jab; and (d) if so, how will this be reflected in the TraceTogether app.

9 Ms He Ting Ru asked the Minister for Health in relation to the Vaccine Injury Financial Assistance Programme (VIFAP) (a) whether the findings of the independent VIFAP Clinical Panel can be released to applicants and, if not, whether this can be done; (b) what avenues are available to applicants to appeal against decisions to reject claims made under the VIFAP; and (c) what are some of the most common grounds for rejecting applications.

The Minister for Health (Mr Ong Ye Kung): Mr Speaker, Sir, may I request that I answer Question Nos 1 to 9 for oral answer and Question Nos 32 to 36 for written answer together? Thereafter, Senior Minister of State Janil Puthucheary will answer Question Nos 10 to 20 for oral answer and Question Nos 27 to 30 for written answer. And both of us will then take supplementary questions together after our respective answers, please?

Mr Speaker: Please proceed.

Mr Ong Ye Kung: Thank you. Mr Speaker, Sir, the recent move to quickly tighten safe management measures was a difficult but necessary decision. We are committed to our plans to opening up and transit to a COVID-19-resilient nation. Hence, lockdowns like circuit breakers are no longer an option. Many workers, families, students and businesses are going to suffer for it, and it will affect our ability to earn ourselves a living in the long term.

With the great majority of our population – over 83% – fully vaccinated, we are one of the most highly vaccinated countries in the world. As a result, during this wave of infections, over 98% of infected individuals experienced mild or no symptoms, 1.7% required oxygen supplementation in hospitals typically for a few days, 0.2% required ICU care and, unfortunately, 0.1% passed away.

Although only a small percentage of infected individuals require hospital or ICU care, we also admit many more others for observation, because they are at risk of developing serious illnesses. So, when the infection number rises, all these translate to a larger number of hospital patients, which put considerable strain on our hospitals and healthcare workers.

Hence, even as we continue our journey to transit to a COVID-19-resilient nation, we should also have a care for our hospitals and healthcare workers, and "tap on the brakes" to slow down the rate of transmission. This is why we had to implement the measures under the Stabilisation Phase last week.

Unfortunately, in this rapidly changing and evolving situation, we have to stay agile, adapt and respond quickly. We will try to give as early a notice as possible to businesses, but there is a practical limit to that, and we seek your understanding.

On the Home Recovery Programme (HRP), this is an important part of our response, given that the vast majority of infected individuals have mild or no symptoms. These individuals do not need special medical care and can, therefore, recover safely at home.

Mr Dennis Tan asked if individuals can request to be sent to an isolation facility instead. We have been considering and accommodating such requests, taking into account the medical conditions of the individuals and their family circumstances. But it is also important to emphasise that individuals and families should make, and have been making, some adjustments to their living arrangements to make HRP safe and possible at home. Because it is only with a high take-up of HRP, that our hospitals can focus resources on those who may require greater medical attention, including non-COVID-19 patients who need acute hospital care. This will enable our healthcare professionals to concentrate on those who need acute hospital care.

In response to Mr Xie Yao Quan, in the initial days of HRP, a fair number of patients without serious symptoms did make their way to the Emergency Departments of hospitals. We did not compile the numbers but it had led to overcrowding of the Departments. We understand the anxiety of these patients. It is, therefore, important for us to iron out all the teething issues of HRP, so that there is a strong sense of assurance as patients undergo HRP. Over the past few days, such incidences have been significantly reduced.

Over the past week, and with the SAF overseeing and operating the programme end-to-end, we have been ironing out the teething issues, resolving service lapses, including those relating to timeliness of notification and conveyancing, and also improving communications with patients and their families. Things are improving day by day.

In response to Miss Cheng Li Hui, currently, there are about 9,800 people on HRP and they are recovering well. Over 2,800 have been discharged as of 3 October 2021. Every day, over half of infected individuals will be onboarded on HRP and we expect the proportion to continue to rise. In recent days, for those eligible for HRP, 93% are contacted promptly and smoothly onboarded. But we still have difficulties contacting the remaining minority because there was either no response or contact details are not accurate. So, this is another teething issue that we are ironing out using IT solutions.

As for those who are illiterate and do not understand the SMS notifications from MOH, we hope family members, neighbours and volunteers can give them a hand. That is why our partnership with the People's Association (PA) is very important. Over the weekend, volunteers have been mobilised to reach out to residents who have been served HRP notifications. I thank the PA and all our volunteers for their hard work on the ground.

As the patients are generally well, we have also kept the involvement of telemedicine providers quite light and have patients call them only when they need medical attention.

In response to Mr Xie Yao Quan, typically, after a person is detected as COVID-19-positive, MOH will contact him within 24 hours, where triaging will be done and a decision made on whether he will be on HRP or needs to be conveyed to a care facility.

In response to Ms Ng Ling Ling, amongst those on HRP, as of 26 September, about 400 are Persons under Quarantine, who subsequently, tested positive for COVID-19. Ninety-five percent of them are eligible for HRP and have recovered or are recovering well at home. Five percent needed to be conveyed to a care facility and this was generally done within 24 hours of the request for conveyance.

I would like to assure the House that MOH and SAF are working hard together, devoting a lot of attention and resources to continue to improve HRP and its processes.

Ms Sylvia Lim also asked about a related issue concerning the procedures of quarantine and Stay-Home Notices (SHN) for travellers. There have been some changes to the SHN procedures, which were announced last week, namely to align SHN duration with the quarantine duration.

As I have explained at the Multi-ministry Task Force (MTF) press conference over the weekend, the healthcare protocols developed over the past months have become complex and confusing to most people. We are undertaking a holistic and comprehensive review to simplify them, so that people understand them and can, therefore, do their part in the fight against COVID-19, and also help others who are in need of assistance and guidance.

Let me now move on to vaccination and boosters. Vaccination remains key to our battle against COVID-19. Those who are fully vaccinated with Pfizer-BioNTech or Moderna vaccines are about 40% protected against infection from the Delta variant. This is protection against infection of the Delta variant. Nevertheless, both vaccines remain very effective in protecting against severe illnesses from COVID-19 infections.

As for the Sinovac vaccine, the number of people who have been administered with the vaccine in Singapore is low, at less than 2% of our population, and we do not yet have meaningful data to gauge its effectiveness – whether against infection or against severe illnesses.

But the Member who asked this question is probably interested to know about the relative effectiveness of the vaccines. There has been some international data available, including a fairly extensive study done earlier this year – it was pre-Delta – that was done in Chile, which uses a mixture of vaccines. Our neighbouring countries, too, have released some data. All these data showed that just like the mRNA vaccines, breakthrough infections are not uncommon amongst individuals vaccinated with the Sinovac vaccine, but the Sinovac vaccine does accord protection against severe illnesses.

For those who are not fully vaccinated due to concerns over medical complications or because they experienced severe side effects after their first dose of mRNA vaccine, they may take the Sinovac vaccine at public hospitals. As of 3 October, under this public health programme, more than 1,900 individuals have taken the first dose of the Sinovac vaccine and around 1,300 individuals have completed their full vaccination regimen.

To Dr Lim Wee Kiak’s question on whether we intend to grant full registration to the Pfizer-BioNTech vaccine, this is something we are looking into, once the longer-term follow-up data is fully available to us and HSA has completed its evaluation.

To Mr Dennis Tan's question, we are also waiting for data from Pfizer-BioNTech with the view to extend the use of the vaccine to include children aged five to 11. These are areas we are proactively working on together with the pharmaceutical companies.

We have also commenced our booster programme. To date, about 550,000 individuals have been invited to take their boosters. Three hundred and fifty thousand of them have taken their jabs or booked an appointment. This is before this weekend. I think, by now, the numbers have gone up. Two hundred and forty thousand of them have completed their jabs. So, we are off to an encouraging start.

To Ms Ng Ling Ling’s question, the Expert Committee has recommended, and MOH has accepted, that individuals eligible for boosters will include those aged 50 and above and all those who are immunocompromised. The Expert Committee continues to review international data to assess the efficacy and safety of booster shots for younger groups, as well as those exposed to high-risk environments, such as healthcare and frontline workers.

In time, we will also be inviting eligible individuals who have taken the Sinovac or SinoPharm vaccine to take their mRNA booster shots. However, most of them are not due yet.

For policy consistency, the Vaccine Injury Financial Assistance Programme (VIFAP) will only apply to the vaccines used under our National Vaccination Programme.

Ms He Ting Ru asked whether VIFAP applicants would have access to the findings by the Panel as well as avenues for appeal if their applications are rejected. The VIFAP Clinical Panel assesses applications based on two considerations. First, whether the patient’s conditions are related to the COVID-19 vaccination. Second, the severity criteria. The reasons for rejected applications are made known to the applicant and unsuccessful applicants may apply for a reassessment if there are new supporting medical information.

At this stage, individuals' vaccination status, as listed on the TraceTogether app, will not change, regardless of their booster dose status. We are administering the booster in good time and, so, this issue of expiring vaccination status has not arisen yet. But, in time, this is an issue that we will need to review.

Mr Yip Hon Weng asked about the possibility of exploring a combination of vaccines to be used for the booster jab. The Expert Committee on COVID-19 vaccination is still studying the heterologous strategy of administering a non-mRNA booster shot that is different from the first two primary series mRNA doses as data emerges. In the meantime, we will administer mRNA vaccines under the booster programme as the best available data utilise these vaccines for boosting with good effect.

Ms Jessica Tan asked if our current measures are effective in ensuring that Singapore is prepared for COVID-19 to be treated as "endemic". Our transition journey to living with COVID-19 is unique in this world, in the sense that we did not allow ourselves to go through big waves of transmission last year, which many countries did and suffered tremendous loss of lives. Today, when we see other countries opening up and living lives almost normally, let us not forget the heavy price that they have paid last year.

We commenced our transition journey only after we have vaccinated the large majority of our population, so that, for the vast majority of infected persons, they now have no or mild symptoms.

I believe our plan is as comprehensive and effective as it can be, given what we know about the virus and the tools we have on hand. But we continue to learn about the virus and improve our responses day by day, week by week. Senior Minister of State Janil Puthucheary will elaborate on other parts of the plan. It is still a long battle ahead, which we will prevail as one Singapore.

It has been a challenging 20 months for all of us, especially our healthcare workers. Although it was posed as a question, I fully agree and thank Mr Xie Yao Quan’s suggestion to recognise healthcare workers. We have enhanced their salaries but I think recognition needs to go beyond that. In good time, when the pandemic has settled down or is over, we must properly express our gratitude to them and make sure that generations of Singaporeans will be inspired by their bravery and dedication during the COVID-19 pandemic.