Updated Protocols for Serving Quarantine Orders at Home and Support Measures for Persons with Disabilities, the Young and the Elderly

10 Ms Denise Phua Lay Peng asked the Minister for Health what support measures will be granted to persons with disabilities, the young and elderly, who are served with Stay-Home Notice (SHN)/Quarantine Orders (QOs) and are deemed to be unable to do so on their own or in unfamiliar physical settings.

11 Mr Liang Eng Hwa asked the Minister for Health (a) what is the current number of personnel involved in administering QO and SHN process; (b) whether the service providers are able to cope with the increased numbers of people on QO and SHN; (c) whether the overall experience can be improved; and (d) how many cases of adverse feedback have been received to date.

12 Mr Yip Hon Weng asked the Minister for Health (a) what is the stipulated time limit to address public queries on their QOs; (b) in August 2021, what is the number of feedback that the Ministry has received concerning belated issuances of QOs or problematic communications and how are they addressed; and (c) whether the Ministry has a backup plan to deploy additional manpower in case of a surge in COVID-19 infections.

13 Assoc Prof Jamus Jerome Lim asked the Minister for Health given how individuals exposed to COVID-19 positive cases serve their SHNs at their place of residence, but those arriving from abroad serve SHN in a dedicated SHN facility, regardless of whether they have access to an isolated place of residence, (a) what are the material differences between these two cases for this differentiated treatment; and (b) whether the Ministry will consider allowing those with isolated residences to serve their SHN at home rather than a dedicated facility, should they opt to do so.

14 Mr Xie Yao Quan asked the Minister for Health (a) what is the number of confirmed or suspected COVID-19 cases with mild symptoms who sought medical attention at the Emergency Department of a public hospital in the last 28 days; and (b) what are the strategies that the Ministry is considering to direct more of such cases to primary care.

15 Assoc Prof Jamus Jerome Lim asked the Minister for Health what are the current procedure and reason for isolating minors issued with a QO, especially with regard to (i) the other members of their household and (ii) their legal guardian.

16 Ms Joan Pereira asked the Minister for Health in view of the number of patients hospitalised for COVID-19 (a) what has been the impact on the resources, particularly manpower, allocation within hospitals and the consequent impact on care quality; and (b) how will the Ministry ensure that resources are allocated adequately to those who are ill, including those in critical conditions not related to COVID-19.

17 Mr Gerald Giam Yean Song asked the Minister for Health for COVID-19 patients serving their quarantine order at home, whether it is reasonable to expect that, despite their best efforts, they will not spread the virus to members of their household, particularly if they live in smaller flats which lack rooms with attached bathrooms.

18 Mr Xie Yao Quan asked the Minister for Health (a) for the last 14 days, what is (i) the average time taken to pick up COVID-19 patients aged 70 and above for conveyance to a hospital, from the time they are confirmed positive by the polymerase chain reaction (PCR) test and (ii) the number of COVID-19 patients in home recovery and community care facilities who turned ill and required hospitalisation; and (b) in the longer run what is the capacity of general wards in public hospitals and SCDF ambulances that the Ministry expects to set aside for COVID-19 patients.

19 Mr Leon Perera asked the Minister for Health regarding COVID-19 patients (a) for the past three months, what are the weekly capacity and utilisation rates of (i) ICU beds (ii) isolation beds in hospitals and (iii) community care facilities; (b) what are the plans and associated lead time to increase ICU capacity if required; (c) what are the criteria used to determine the need to increase ICU capacity; (d) whether the recent spike in COVID-19 infections has led to a congruent spike in ICU and oxygen supplementation patients; (e) if so, why; and (f) if not, why.

20 Mr Ang Wei Neng asked the Minister for Health whether the Government will (i) consider providing more Antigen Rapid Test (ART) kits to each Singaporean household beyond the three provided by Temasek Foundation and (ii) work with distributors of ART kits to lower the retail price, given the sharp rise in COVID-19 cases in the community.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, the recent exponential rise in cases has impacted our healthcare capacities. Currently, about 15% of hospital beds in the acute public hospitals are used for around 10% of all COVID-19 cases. Those requiring oxygen supplementation or ICU care account for 2% of total cases, most of whom are unvaccinated or the elderly.

In the last three months, ICU bed occupancy has increased from 26% to 53%. Occupancy of isolation beds has risen from 58% to 86%, while the occupancy of community care facility (CCF) beds has gone up from 10% to 35%.

Public hospital emergency departments have seen up to an eight-fold increase in the number of patients with ART or PCR positive results seeking medical attention.

Prior to the last 14 days, we conveyed COVID-19 patients above 70 years old to a hospital within 12 hours from the time they had a PCR positive test.

With the current high caseloads, we are now taking, on average, between 48 and 72 hours to do so. SCDF ambulances are reserved for patients with emergency conditions, hence, MOH has set up a dedicated fleet of 95 additional ambulances to convey COVID-19 patients to the different healthcare facilities.

We are taking steps to expand our hospital and treatment resources to ensure that everyone who requires medical care, whether for COVID-19 or other conditions, will receive it. We have asked hospitals to prioritise resources for COVID-19 patients by reducing non-essential elective appointments.

We have been shifting asymptomatic and lower-risk COVID-19 patients from hospital to COVID-19 treatment facilities (CTF), as well as the Community Care Facilities (CCFs) and the Home Recovery Programme. This allows acute hospital resources to be focused on managing patients who need urgent or essential care.

We are closely monitoring ICU trends, in particular. We have increased the ICU bed capacity by 74 beds, for a total of 187 beds dedicated to COVID-19 patients with severe conditions. More ICU beds can be opened on short notice, if needed.

We are also closely monitoring the hospital manpower situation, given that close to 400 healthcare workers have tested positive for COVID-19. Our hospitals will continue to dynamically cross-deploy their resources to ensure that our manpower needs are met. We are also working with private healthcare providers to augment our manpower.

To further preserve our healthcare capacity in the face of future waves of infections, we must also adopt more sustainable healthcare protocols based on the medical care required. The vast majority – over 98% – of infected individuals have mild or no symptoms and only 0.3% have needed ICU care or have, sadly, passed on. This is a result of having vaccinated most of our population, who will only experience mild illness if they suffer a breakthrough infection. Thus, we are making home recovery the default protocol for infected individuals, unless they have severe symptoms, are elderly, or have underlying co-morbidities that make them more susceptible to severe disease outcomes.

Besides focusing our hospital and medical treatment resources on those who need it most, we are also ensuring that our COVID-19 response systems are directed appropriately.

We will continue to use technology, such as TraceTogether and SafeEntry systems, to automatically and quickly identify the majority of close contacts and to prompt these contacts to self-monitor and take precautions against unknowingly infecting others. This process augments our efforts and allows us to focus the work of the 350 full-time contact tracers that we have today. We must optimise the deployment of these officers. As cases have increased multiple fold in the community, it is not always useful to comprehensively contact trace around every case detected by conducting extra interviews and manual case detection.

Instead, we are focusing these intensive contact tracing efforts on cases and clusters detected in vulnerable settings like hospitals, nursing homes and schools. These are areas where contact mapping and comprehensive identification of close contacts have the greatest public health benefits today. Individuals who are tested positive have also been asked to self-declare their household members so that they can be placed under quarantine. What we are doing is calling on the self-responsibility of our people to aid our officers and our efforts.

Next, if I may speak on our quarantine and isolation operations. The Quarantine Order (QO) and Stay-Home Notice (SHN) processes are administered by around 300 officers from MOH and the Immigration and Checkpoints Authority (ICA). These officers handle around 6,700 daily queries, on average, on issues, such as quarantine status, quarantine conveyance and testing, as well as QO rescindment requests.

While such queries should be resolved within three working days, the current surge has resulted in some, especially the complex ones, taking longer to resolve. This also increases the waiting time for others before their calls can be connected, even if their queries are not as complex. We will continue to enhance the resourcing to manage surges and seek the public's understanding of the longer response times during this period. We have put out more public communications materials, in print media and on our websites, so that individuals affected by COVID-19 can potentially self-help themselves as well as their families and friends.

We will continue to scale up the Home Recovery Programme (HRP). This ensures that our hospital and medical treatment resources are prioritised for those who are, or could be, severely ill. We have also adjusted our QO regime to allow individuals who are less likely to fall severely ill with COVID-19 and whose homes are suitable for home recovery, to quarantine at home. This regime places the responsibility on the confirmed COVID-19 cases and their household members, including minors and caregivers to self-register. After the original quarantined individual is confirmed to have COVID-19 and has been served an Isolation Order, the other household members should self-register for quarantine as well, in order for the whole family to recover and be quarantined together at home.

We will also increasingly allow fully vaccinated travellers who need to serve an SHN to do so at home. Currently, such travellers from Categories II and III countries may already apply to serve their SHN at their place of residence or other suitable accommodation that they have secured. Almost all travellers from Category II countries and around half the travellers from Category III countries fulfill the criteria and have optedout of the dedicated SHN facility. We will, progressively, review and adjust our border measures, but, for now, fully vaccinated travellers from Category IV countries must still serve their SHN at the SHN dedicated facilities.

Those serving home quarantine or home SHN are also given information on transmission prevention, including isolation protocols and good personal hygiene practices. ART kits are provided to household members for them to monitor their own health. Those on home isolation requiring dedicated care arrangements may also apply for assistance ahead of, or during the SHN. Vulnerable persons serving SHN or QO who need support for their activities of daily living, such as minors and the disabled, may also be accompanied by a caregiver. We will continue to review our protocols and measures.

There is a financial impact on businesses or individuals whose livelihoods are affected by QOs. Between January and September this year, around 3,300 point-to-point (P2P) drivers and riders have been placed on QOs. These individuals, along with others whose livelihoods have been affected by QOs, can apply for a QO Allowance to help cushion the financial impact.

Mr Speaker, the public health actions that are triggered upon confirmation of COVID-19 infection for an individual are disruptive. But it remains important that we detect possible COVID-19 infections early, so as to minimise the impact of transmission to their loved ones at home, or to their friends or colleagues.

There are some who have a misconception that we are testing widely to attempt to eliminate the virus. This is not so. We have many community cases around us. Our widespread testing aims to reduce the overall rate of transmission from each COVID-19 infection, slowing the spread in the community. ART testing also enables individuals to perform self-testing and do our own part to slow down transmission of the virus. These strategies will allow us to ride the wave of infections without overwhelming our healthcare and public health response resources.

To this end, regular testing in the workplace and at home remains key. We have made ART kits widely available, through sale at major retailers, free through nationwide household distributions and supplying kits to companies for mandatory routine testing regimes or voluntary regular testing. Individuals who are exposed to the virus and issued health warnings or alerts may also collect ART kits for regular self-testing from our vending machines island-wide.

To make the test kits on sale more competitively priced, we are actively reviewing new brands of equally effective kits to bring into the market. We will also evaluate if there is a need to conduct another round of nationwide household distribution of kits to support regular self-testing. These fast and easy tests have been effective in augmenting our case identification efforts. Of the total COVID-19 cases identified in the last eight weeks via the PCR test at Swab and Send Home (SASH) clinics, 7% had, initially, tested positive using the self-test ART kits before coming forward for their confirmatory PCR test.

Sir, as we move towards living with COVID-19, each of us must play our part to lower transmission risks and slow the pace of community infections. While the Government will continue to make adjustments to augment our healthcare and public health response capacity, all of us need to be socially responsible to take care of ourselves and others around us through regular testing and adherence to isolation protocols if we have been exposed to positive cases. Continued adherence to our safe management measures will also help to dampen the rate of transmission. This is what it means for us to work together to be a COVID-19 resilient nation.

Mr Speaker: Ms Jessica Tan.

Ms Jessica Tan Soon Neo (East Coast): Thank you, Mr Speaker. I thank the Minister as well as the Senior Minister of State for their comprehensive replies as well as the reassurance that we will continue to improve the processes and measures. I would like to ask two supplementary questions.

With the increase in cases and home recovery as the default care management measure for COVID-19 positive cases, there is no discharge memo that will be given after they have recovered, after the 10 days. What help can individuals get in terms of getting TraceTogether status cleared? I have got quite a few requests for help because many have got their TraceTogether still indicating that they are not cleared and they cannot proceed on to even just do necessary daily activities.

The second supplementary question is, for seniors who are sent to the CCF, what is the support given, especially to those who are not so digitally savvy and they need help at the centre? They are alone and are not able to be accompanied and several of them may be over 80. I also had several requests for help because some of the seniors did not know what to do and even how to ask for help or use some of the simple facilities.

Mr Ong Ye Kung: I thank the Member for raising this issue. Indeed, I have received a lot of feedback, too, where a person, after his discharge, does not have his TraceTogether indication lifted. So, we are fixing that. It is, essentially, an IT issue. The reason why there is now a fixed day of discharge is because, once a person is vaccinated, the viral load drops very quickly, especially after day 5. And by day 10, NCID finds that they cannot culture the virus anymore because the viral load becomes quite low. Which is why we can safely discharge patients who are vaccinated on day 10.

The IT system needs to keep up with that policy. So, in the next few days, the TraceTogether issue will be resolved as we will also synchronise the removal of the alert in line with the discharge day. So, once you are infected, the TraceTogether app would know and it will count that 10 days from then, if you are vaccinated, you will be automatically removed. If you are not vaccinated, it will be, removed after 14 days. So, I expect this problem to be resolved.

As for CCF, I thank the Member for raising that issue. There are nurses and workers available at the CCF. So, if we come across such cases where the senior is alone or illiterate, let us know and we will alert the CCFs. There are people on hand, medical workers, who can help out and help the senior navigate and understand the messages that we are sending to them.

Mr Speaker: Ms Denise Phua. Please limit it to two supplementary questions if possible and keep the questions short. This applies to everyone.

Ms Denise Phua Lay Peng (Jalan Besar): I thank the Minister and the Senior Minister of State for the answers. I know it is really a very difficult time for everyone. We also want to support as much as possible, but I cannot help asking these two supplementary questions.

Number one is, thank you for letting us know that Home Recovery now is a default option for COVID-19 positive residents. My questions are specifically for those who are vulnerable. What if home recovery is the default option but a resident is just not suitable for recovery at home? For example, in the Central district, we have a lot of rental flats where there is a lot of sharing of facilities like toilets and living rooms, with just one door for everybody to get through. What if the homes are just not suitable for home recovery? Or what if there are just very large families in some of these homes?

The second supplementary question is this. Thank you to Senior Minister of State Janil Puthucheary for making it very clear that caregivers are allowed to accompany those who are vulnerable like the elderly who are not independent, the disabled young or old and so forth. As Members of Parliament, we often get questions that come fast and furious from residents. If the questions come directly to us, we always get responsive replies, especially when we write to MOH officeholders (POHs). But, in general, how does the public get to know that the caregivers can accompany the more vulnerable, especially if the MOH hotline is very stretched at the moment? So, what if quick responses are required —

Mr Speaker: If the Member could keep her questions short, please.

Ms Denise Phua Lay Peng: — and they just do not know where to get the answers. Thank you.

Mr Ong Ye Kung: I will keep my answers short.

Mr Speaker: Thank you.

Mr Ong Ye Kung: HRP is the default, provided you meet certain criteria, such as you are younger, you are vaccinated, some not vaccinated but younger. But within this default, while it is the default, it is not rigid. It is important that once the person is notified that he is on HRP, he is also given a phone number to call to reach what we call an HRP Buddy. If he is not comfortable because of living conditions or he is living with vulnerable seniors or unvaccinated children, they can then make the request to say, "While I am asked to go on HRP, can I be taken out to a CCF?"

And we will try our best to accommodate those requests. So, your residents can certainly, request by calling the HRP Buddy.

As for how would the public know, mass media is one way. We put out FAQs as simply as we can. But even so, it is hard to understand for many members of the public.

Another layer will be our community volunteers, our Community Centres (CCs). Many do call up our CCs to ask questions. So, we also need to arm PA and our CCs with answers for all these questions. Most, or 80% of the questions, are related to those few things. Our volunteers should be also equipped with the information and they can reach out and explain to them.

Finally, it will be the hotline. It has been difficult to call through in the past few days. But we have been beefing up the resources day by day and, with SAF's help, it has really improved a lot. As of yesterday, when I checked, we are able to attend to almost 70% of the callers. So, it is improving and we continue to improve it. Once that happens, as more people can call through, get the answers, they will also tell their friends, and I think the situation will change.

Mr Speaker: Assoc Prof Jamus Lim.

Assoc Prof Jamus Jerome Lim (Sengkang): Thank you, Mr Speaker, and thank you to Senior Minister of State Janil Puthucheary for his responses. Both my supplementary questions have to do with whether we are following a protocol that may look good on the surface but actually seems to make less sense when you dig into the policy.

The first has to do with my question on what are the material differences between importing cases and quarantine. If I may develop this, is the concern the risk of importing new variants? If so, does MOH actually have a view on the risks of the new variants' fitness, given that Delta is fairly endemic? Does it make sense to apply such a strict protocol that could discourage business travel with long stay-at-home requirements for imported cases?

My second question has to do with how the Senior Minister of State indicated that, currently, those issued with a QO should self-isolate, but it actually does not require all family members to do. So, I wonder what is the Senior Minister of State's view on how this procedure could, potentially, be a loophole, since, surely, there is no appreciable difference between the legal guardian who has to accompany a minor in the case of an SHN versus the other household members, insofar as virus exposure is concerned.

Dr Janil Puthucheary: Sir, I thank the Member for his questions. For the first question, I think he is, essentially, asking why does it appear as if there are different standards for someone who is travelling, versus someone who is given a Home Quarantine Order or a Health Risk Alert here in Singapore.

Partly, this is a result of the changing situation and, actually, today, an increasing number of travellers are allowed to do an SHN and you will see that we will have further and further streamlining, optimising and alignment of our various measures. The situation is moving quite fast. We will review and align these measures.

But if I could go into the specifics of the Member's question or, at least, what I think are the specifics of his question, the risk associated with travellers is partly to do with variants; it is partly to do with the robustness of the information that we are receiving, depending on where they are coming from, what we understand about the situation they have in their home country as well as the particulars of that individual's likely location if they are not in a dedicated facility here, in the stay-at-home facility.

So, we do take all these factors into account when dealing with the appeals, with respect to travellers.

For the Member's second question, I did not quite understand what he was asking. The call is for all of us to be responsible and for the household members of a contact, indeed, to register. We are not asking for only some of them to register. We are asking for all of them to register. And, indeed, the risk to the whole household is pretty much the same as a caregiver that accompanies someone who is vulnerable. Hence, our request for all of them to register.

In truth, much of the exposure and the risk will happen before the COVID-19 index case is detected. Hence, that is why we are requiring the whole household to limit their movement and their exposure to people outside of the household.

Mr Speaker: Mr Yip Hon Weng.

Mr Yip Hon Weng (Yio Chu Kang): Thank you, Mr Speaker. And I thank the Minister and the Senior Minister of State for their replies.

I have two supplementary questions. The first pertains to Question No 2. The COVIDsitrep website is a good initiative in terms of communications. I wish to ask whether the Ministry is prepared to consider a benchmark such as the probability and death rate of getting the seasonal flu and dengue fever versus getting COVID-19, in our public communications. This will help allay fears and contextualise the likelihood of getting COVID-19.

My next supplementary question pertains to Question No 12. In monitoring the COVID-19 situation in Singapore, I wish to ask the Ministry what the next trigger points that MOH is worried about. And given the R-naught (R₀) indicator, we can roughly predict when they will occur. As such, how does MOH intend to communicate both the trigger points as well as the time horizon to the public? This will give the public and industries sufficient lead time and early warning to adjust to new measures.

Dr Janil Puthucheary: Sir, I will address the Member's first question. Indeed, we do need to communicate. The relative risks of COVID-19 infection and getting the infection and then perhaps risks of complications and severe disease and put these in context relative to other common diseases, such as influenza, or even not so common diseases, such as dengue, for the public to understand how they should go about their business when we reach some sort of equilibrium.

We will be putting more information out to the public. But, at the moment, we have not reached that equilibrium yet. We are in the middle of quite a large wave and there are very real anxieties around COVID-19 and, especially for the elderly, the vulnerable, the under-vaccinated.

So, I thank the Member for his suggestion that we do need to put some of these numbers in the context of a lot of other diseases that we are used to dealing with. We will do so when we are approaching an equilibrium and we have plans to do so.

But, at the moment, the anxieties are around the large number of cases, the wave that we are experiencing. It is very real and we should not underplay it.

I understand that Minister Ong Ye Kung will address the second question.

Mr Ong Ye Kung: Thank you. As for the Member's second question on trigger points before we loosen our safe management measures further, we are aware and we are all well aware that certain countries have declared certain dates or certain vaccination levels, and then, they will open up. We have not adopted that approach. Because we recognise that in battling COVID-19, this is a live, evolving, fast-changing situation and it is not wise for us to tie our hands and limit our options as we adapt and stay agile in battling the COVID-19 virus.

Therefore, we will have to take into account of the situation in hospitals, our case numbers, how people are reacting, what is our social preparedness to live with the virus and how businesses are doing, and we adjust our measures from time to time. But our direction is very clear: we have to live with COVID-19, we have to become a COVID-19-resilient nation. The direction is clear, but, from time to time, we may take a longer route, we may take a detour, but we will stay on course.

Mr Speaker: Mr Gerald Giam.

Mr Gerald Giam Yean Song (Aljunied): Sir, my first supplementary question is for Minister Ong Ye Kung and my second supplementary question is for Senior Minister of State Janil Puthucheary.

Sir, many Singaporeans and businesses are very frustrated with the repeated open-shut of our economy and our lives. Minister Ong Ye Kung said on 21 September that during the preparatory period, MOH projected handling 100 to 200 cases a day. This is far lower than the actual caseload since 19 August. Why were these projections so far off? Delta has been with us for almost six months and there is plenty of data on Delta infections from countries like India and Israel, which were hit by the Delta wave before us. Why was the Government not better prepared for the caseload after reopening?

And for Senior Minister of State Janil Puthucheary, what is the rationale for children under 12 being ineligible for home recovery, given that children, even those unvaccinated, usually have mild or no symptoms when infected? Because allowing them to recover at home, by default, allows their parents to care for them and will also reduce the load on hospitals.

Mr Ong Ye Kung: I will answer both questions. I do not think we characterised our safe management posture as opening and shutting. But depending on the situation, we have to make adjustments and, over time, we have made progress in the sense that I think we have put the circuit breaker behind us. If we remember, in April last year, almost all businesses were shut. And then, we had Heightened Alert, which is a far more moderate form of slowing transmission, slowing economic activities. This time round, we try not to go back to Heightened Alert, but, instead, it is mainly restaurants and F&B that are affected. We want to keep them open, try not to affect businesses so much. MOF provided financial assistance, but they can operate with table of two.

So, we are making progress and I think we should also feel encouraged that, because of vaccinations, we are able to move forward.

As for the numbers, if I remember correctly, in late August, when we started seeing a wave, I mentioned 3,200 as a possible daily number, if the doubling cycle goes on five times. We were at 100 cases then; if it goes on five times, we would have reached 3,200.

The "100 and 200" number, I am not sure where it comes from. A lot of things were said during the MTF press conferences, but I did refer to it, as, during the preparatory phase, we were hoping to maintain around that number. Because we were still preparing ourselves.

And when the whole thing is over, in the endemic stage, perhaps, we will see 200 cases, maybe more.

But I hope we take all these numbers in that spirit. I speak to epidemiologists, doctors all the time. They explain things to me, they cite numbers. I then try to explain things to the public. And so, some numbers may be picked on, but let us take it in the right spirit. I am not making any projections or predictions, but these are things that I learn from MOH, and I am trying to explain honestly to the public to the best of my abilities.

As for children under 12, actually, they can serve home recovery. We do encourage them to serve home recovery. And many parents, in fact, like to serve home recovery.

I am not sure if it is made the default, but, certainly, it has great potential to be made a default. And a great majority of children can recover very well at home and they are happier that way.

Mr Speaker: Ms Joan Pereira.

Ms Joan Pereira (Tanjong Pagar): Thank you, Speaker. The Senior Minister of State mentioned that MOH has tapped on private hospitals to alleviate the load on public hospitals. I have one supplementary question. May I know how has this helped alleviate any shortage of resources in the public hospitals?

I have had residents who have been hospitalised with non-COVID-19 related illnesses and shared that the care was inadequate. So, I hope the Senior Minister of State can answer that.

Dr Janil Puthucheary: Sir, I thank the Member for the question. The whole of our healthcare system has been mobilised for this effort: public and private. And they are different institutions, but they are working as a team. It is a bit hard to quantify because the private sector is looking after COVID-19 patients under their roof, but they are also looking after other patients with other conditions. Their doctors and nurses have been deployed elsewhere into other sites. So, has it helped? The answer is yes, because manpower, beds and resources are available.

But to put a specific quantification on it, I do not think I am able to adequately answer the Member's question.

The way I would look at it is this. We have a healthcare system here in Singapore that is made up of public and private providers, volunteers as well. And the healthcare is not just about the bed, doctor or nurse. It is the entire system working together and everyone is mobilised to try to do their best to deal with this crisis in front of us. So, I suppose the shortest answer to the Member's question is yes.

Mr Speaker: Mr Liang Eng Hwa.

Mr Liang Eng Hwa (Bukit Panjang): Thank you, Sir. I would like to ask either the Minister or the Senior Minister of State on individuals who need to do the seven-day or 14-day mandatory PCR tests. MOH, currently, publicly, runs regional PCR screening centres. They are not quite located at the convenient locations for those who need to do those tests on a weekly basis or bi-weekly basis. So, can I ask MOH if there are plans to build more of such centres?

Secondly, in some estates, where there are hawker centres, they do have their own PCR testing facilities set-up. But only the stallholders are allowed to use those testing facilities. So, in such situations, can MOH allow, support or facilitate these PCR testing facilities to be used by other workers who need to do their regular seven-day, 14-day tests, so that the community resources can be shared and to ensure better convenience for those frontline workers, as well as building that community spirit?

Dr Janil Puthucheary: Sir, I thank the Member for his question. He has identified the direction in which we are moving with these strategies. We have opened up more centres. We have 22 Regional Screening Centres, 20 Quick Test Centres and five private Quick Test Centres. We are already working on opening up these areas to other users and working with the employers as well, just to make sure these resources are made available to as wide a base as possible, to speed up the processes that he talks about.

The sector leads among the employers are encouraged to move towards the fast and easy testing RRT, primarily with the employer supervised self-swab model, so that people could self-test at their own location, at their own convenience. Some sectors will still keep going with the Quick Test Centres. And the ones, particularly in the hawker centres, that the Member talked about, are available, but they are prioritised on the basis of how they were set up for the employees that they are meant to serve.

But in the medium term, we are working with other parts of the Government to incentivise private vendors; perhaps, through a grant scheme, and our intent is to then set up more centres which can be more convenient in other locations for the community and larger groups of workers. This is an important part of our strategy going forward for COVID-19 resilience.

Mr Speaker: Ms He Ting Ru.

Ms He Ting Ru (Sengkang): Thank you, Mr Speaker. I have two supplementary questions. The first is, I take the Minister for Health's earlier explanation about the numbers that were quoted earlier. But my question relates to what were the previous planning parameters when we first announced that we are moving into the endemic phase. This is very key because we need to know that we are properly resourced; that we do not have a situation like what we saw in the last couple of weeks where people were waiting for days, or up to a week, before they were actually responded to.

So, my question would be, how many cases were we planning for back then, before this current surge? Was it 1,000, 2,000, 3,000 or 5,000? And how can we actually put measures in place to make sure that it does not occur, especially when we are planning to loosen the restrictions again in three weeks. So, I think everybody wants to avoid a situation where we actually end up where, every time we loosen some restrictions, we see a massive surge, and then people cannot actually get any answers, or they cannot get through the hotlines.

The second point is whether anything can be done for better communications and messaging for residents and people who are actually affected. We have things like Heightened Alert, Stabilisation, preparatory stages. People are getting very confused about what each of these actually refer to. Same goes for the acronyms like HRP, QOs. And I am sure many Members have actually seen the many, many different flowcharts and spreadsheets. It is just very, very confusing.

What else can be done to make sure that our communications to a very complicated situation, are communicated to residents so that they do not end up having to jam the hotlines as well?

Mr Ong Ye Kung: I thank the Member for acknowledging that it is a complicated situation. Over 20 months, we have developed many responses, many protocols, in order to handle the situation, which is why there is now a plethora of different protocols.

But as I mentioned during our press conference over the weekend, now, we are in a different phase. Many of the protocols were designed at a time when the public wants to see us snuffing out every single cluster. And so, we have all these tight protocols.

But, now, we are in a phase of trying to live with COVID-19 and there are protocols.

So, we announced last weekend that we are in the process of holistically reviewing all the protocols with a view to streamline them. I do not think we can get away with some abbreviations and some alphabet soup. That will still be around. It is after all, a very complicated situation. But we will try our best to streamline as much as possible, so that people would understand it, able to do their part to fight against COVID-19 and also, to help others.

Back to the numbers and planning criteria, the Member seems to have a narrative that we totally did not plan for all these. On the contrary, we have always planned for a big surge. You would hear from Saw Swee Hock School of Public Health, and these are partners that we work very closely with, they have projected 5,000 and 10,000 cases a day, as high as that. You speak to different epidemiologists, they may have different views, but these are the numbers, if we fully open.

You have seen it in other countries happening that kind of peak. And that is why, through our communication with the public, you would hear us – whether myself, Minister Gan Kim Yong or Minister Lawrence Wong – always saying, cases will rise; and when cases rise, the number of people with severe illnesses and deaths will rise. And we have been saying that.

I also mentioned at end August, when we started seeing this wave, we said, that doubling cycle, if it happens five times, we will reach 3,200. Therefore, we have always sized ourselves up for that kind of number. We hope that we can do so progressively, and not suddenly, which is why we also announced a four-stage opening process: preparatory stage, where we try out home recovery, build up, our CTFs, CCFs and so on. And then transitions – we call it transition stage one, if people still remember – and stage two, and then, finally, endemicity. We gave no deadline or timeline, for reasons I have explained earlier, that we need to watch the situation.

But we were just in the preparatory stage. The Delta variant came in and then cases started to shoot up.

But, fortunately, we have always been planning ahead, which is why, at that point in time, we were already ready to handle 1,500 cases a day, in terms of Community Care Facilities (CCFs), hospital beds, ICU beds, and then also thinking already about setting up the Community Treatment Facility (CTF) beds and we are also starting with HRP.

By now, we have capacity to handle 3,000 cases and ramping up in one to two weeks to handle 5,000 cases – but we do not know whether we will reach there. And then, already thinking about the next step on how to handle 10,000 cases.

So, in terms of planning capacity, manpower, we are always one, two bounds ahead.

What I think did not go well, and I fully acknowledge that, was the HRP. And all the complaints about conveyancing, calling, not getting in, people not getting responses. It is not because the beds were not catered for, but processes with regard to HRP were not totally ready. We were caught by the sudden increase. We are still implementing the pilot programme when all these happened.

But the team swung into action, the call of public duty kicked in and everybody was putting in their heart and soul to solve the problem. So, day by day, we are seeing improvements and we will continue to do so. We have to make HRP work, then the great majority of patients who are well, no symptoms, mild symptoms can recover at home. Then, the hospital capacity that we plan for can focus on the 2% that really need help. Things are improving.

Mr Speaker: Mr Xie Yao Quan.

Mr Xie Yao Quan (Jurong): Thank you, Mr Speaker. My question pertains to my original Parliamentary Question 18, part (b), which I believe has not been quite answered.

The question really is this: as we learn to live with COVID-19 and settle into a new equilibrium of elevated daily number of cases, in the longer run, what is the capacity of general wards in public hospitals that the Ministry expects to set aside for COVID-19 patients? The concern is the more beds we set aside for COVID-19 patients, the less beds we will have for non-COVID-19-related conditions. Are there enough hospital beds to go around in our public healthcare system?

The other side of this question is in terms of wait time to a hospital bed for a COVID-19 patient. In the longer run, at steady state, does the Ministry have an expectation and what might that be?

Dr Janil Puthucheary: Sir, I thank the Member for the questions. For the first part, we set aside COVID-19 beds currently because our approach is to isolate them and separate them from the rest of the patients in the healthcare facilities.

But as you go towards endemic COVID-19, COVID-19 will have to be treated like any other infectious disease. In peacetime, in the endemic situation, we do not have influenza beds, dengue beds or chickenpox beds – and all of these are infectious diseases. What we have are beds on the basis of the patients' needs. Increasingly, the COVID-19 patients in hospitals will have other types of diseases. They will have kidney problems, heart problems and neurological problems. So, it is a bit hard to then delineate, in the steady state, once we are done with the surge, once we are done with this current strategy, as we move towards endemic COVID-19, I do not think we will be in a position to then say, these are the COVID-19 beds and these are the non-COVID-19 beds. We will have to treat COVID-19 like other infectious diseases.

Nevertheless, in the middle of the surge now, we are ramping up our capacity, mobilising resources, as we have described in our answers to Parliamentary Questions and supplementary questions, but also trying to improve the flow of patients through our system, so that these resources are made available.

But the most important strategy is to focus the resources that we do have on those who need it the most. Vaccination is part of reducing the number of people who need those resources. The well, who are asymptomatic, being able to stay home, or go to CCFs or CTFs, is part of that strategy as well, as are our attempts to then slow down the transmission in the community.

All of these, then, feeds into the issue of wait time. Whether it is about bed space or having your call answered, making sure that those resources that we have, and those officers, are deployed to deal with the people who need help most, will also help in reducing the wait time. But, ultimately, we do need the manpower and we are working on ramping up that capacity as well.