Mr Pritam Singh asked the Minister for Health (a) how many Singaporeans and Permanent Residents (PRs) respectively are deemed to be medically ineligible for COVID-19 vaccination; and (b) excluding these persons, how many Singaporeans and PRs respectively remain unvaccinated as of December 2021.
Mr Chua Kheng Wee Louis asked the Minister for Health in view of the emergence of the COVID-19 Omicron variant globally and subsequent tightening of border measures, what are the key quantitative or qualitative metrics and thresholds that the Government will consider before making a decision for domestic reopening plans to be rolled back and safe management measures tightened.
Mr Dennis Tan Lip Fong asked the Minister for Health (a) what is the Ministry’s strategy in containing the spread of the Omicron variant of COVID-19; (b) what measures should Singaporeans expect to be taken; and (c) how will these measures differ from previous measures implemented to contain the spread of the Delta variant or COVID-19 virus generally.
Mr Leon Perera asked the Minister for Health (a) what is the expected impact on ICU utilisation based on the Ministry’s modelling for the COVID-19 Omicron variant; (b) at what ICU utilisation rate will hospitals begin to defer non-urgent clinical services; (c) what is the number of healthcare workers working in ICUs currently as compared to December 2020; and (d) what permanent changes have been made to increase healthcare capacity and in particular ICU capacity and scalability since (i) the start of the pandemic and (ii) the start of 2021.
Ms He Ting Ru asked the Minister for Health (a) whether there are plans to offer non-mRNA COVID-19 vaccines to children in the age groups of five to 11, and 12 to 18; and (b) if so, when can these vaccines be expected.
Ms He Ting Ru asked the Minister for Health whether the Ministry has plans to apply vaccination differentiated measures to children aged between five and 11.
Mr Gerald Giam Yean Song asked the Minister for Health what is the impact from the emergence of the COVID-19 Omicron variant on the plans for Singapore to live with COVID-19 as an endemic disease, in terms of the timelines for reopening the economy and permitting more social and cultural activities involving the gatherings of people.
The Minister for Health (Mr Ong Ye Kung): Thank you. Mr Speaker, Sir, Singapore just weathered a significant COVID-19 transmission wave, caused by the Delta variant, which is still active in many parts of the world.
By working together, making collective sacrifices to restrain our social interactions, watching out for each other and implementing sound policies, we have overcome perhaps the most difficult part of the pandemic.
As of now, our hospital situation is stable, with 11 COVID-19-related ICU cases. Most activities have resumed, and we are meeting up with friends and loved ones. Our society has become much more resilient to COVID-19 than before. This is an important milestone.
But a new Omicron wave is upon us. If we work together, we can ride through the wave. Once we have done so, we will be even more resilient than now, and even more prepared to live with COVID-19.
When Omicron first burst onto the global scene, we immediately introduced measures such as restricting travel from affected countries in Africa, enhancing testing for all travelers, isolating cases in hospitals and reinstating stringent contact tracing and quarantine for Omicron infections.
These measures will not stop Omicron from taking root and spreading in Singapore, given its high transmissibility. However, they have helped to delay its emergence, giving us precious time to understand it better and to prepare ourselves.
The characteristics of Omicron have now become clearer. This is what we know today. There are three key points.
First, local and overseas evidence show that it is far more transmissible than the Delta variant, so we must expect a wave that could be a few times larger than the Delta wave. So, if Delta infections reached a sustained incidence of about 3,000 cases a day, Omicron could perhaps reach 10,000 to 15,000 cases a day, or even more. Cases are likely to double every two to three days. So, once cases start to rise steeply, within a couple of weeks, we may see 3,000 Omicron cases a day.
Second, there has been consistent international evidence showing that Omicron infections are less severe than Delta. The incidence of hospitalisation and severe illness is lower and there are also indications that any hospital stays are also shorter. Indeed, the clinical outcomes, particularly the number of people who become severely ill or die, are much more important than the topline number of infection cases.
Mr Speaker, Sir, may I show a couple of slides on screen, just to illustrate this clearly?
Mr Speaker: Yes, please. [A slide was shown to hon Members. Please refer to Annex 1.]
Mr Ong Ye Kung: Thank you. This graph describes the situation in South Africa. The blue line shows number of infections. Members can see three humps, reflecting the three waves that they have gone through: the first is Beta, then Delta in the middle, and the latest, the tallest is Omicron. And it is plotted against the scale on the left axis. The grey part for the top graph shows hospitalisations, plotted against the scale on the right axis. And so, Members can see that in the latest wave, the number of hospitalisations is proportionately lower than the previous two waves.
The bottom graph is even more stark. The red area shows number of deaths, plotted against a separate scale on the right axis. Members can see that during the Omicron wave, the red area is actually very small; number of deaths is proportionately much lower than the previous two waves.
The next slide is a similar analysis but now, it is for the UK. Members can see a similar pattern: proportionately fewer hospitalisations and fewer deaths.
A study by health authorities in South Africa showed that 4.9% of cases were admitted to hospitals during the Omicron wave, compared to 13.7% during the Delta wave. Amongst the patients admitted to hospital during the Omicron wave, they were 73% less likely to have severe disease.
In the UK, the risk of being admitted to hospital or emergency care with Omicron was about half that of Delta.
Data from Denmark also showed that about 0.8% of Omicron cases were hospitalised, lower than the 1.2% rate of hospitalisation among cases infected with other variants.
This has also been borne out by our own local experience. In Singapore, we have recorded 4,322 Omicron infections so far, including 308 seniors aged 60 and above. Eight of them out of the 4,322 needed oxygen supplementation, and all of them have been taken off oxygen after a short few days. None required ICU care as yet.
In comparison, if these 4,322 infections had instead been caused by Delta, we would expect 50 to 60 patients needing oxygen supplementation, ICU care or to die.
However, we should be careful in interpreting these observations. It is early days and the circumstances of each country are different. South Africa, for example, has a young population and a high level of natural immunity, even though their vaccination coverage is low.
The UK has both high levels of vaccination and natural immunity, and this current Omicron outbreak is riding on the back of a protracted Delta outbreak, which worsens clinical outcomes.
Further, Omicron transmits much faster and infects more people. So, even if a small percentage of infected individuals falls very sick, because of the large base of infections, it can still lead to many people needing ICU care, or die.
The third thing we have found out about Omicron is that vaccines, especially boosters, retain substantial protection against severe disease. Indeed, the most recent studies in the UK found that for vaccinated individuals, the risk of hospitalisation for Omicron is reduced by 72% compared to the unvaccinated. With a booster shot, vaccine effectiveness against hospitalisation is estimated to be 88%.
Currently, Omicron has spread to over 130 countries and has become the dominant strain in many places. Hence, we lifted the suspension of flights from affected African countries and aligned the healthcare protocols between Omicron and other COVID-19 variants.
Members would like to know our strategy in responding to the Omicron wave.
Given that it is less severe than the Delta variant and vaccines still work against it, our key objective remains: which is to live with COVID-19 as an endemic disease. Then, we can lead life as normally as possible and continue to build a bright future for Singapore and our children.
That includes not locking down our borders, which will inflict tremendous pain on families, workers, businesses and also the mental well-being of many people. In any case, a severe lock down strategy will likely delay but not prevent the inevitability of Omicron finding its way into our community.
There are two factors working in our favour.
First, a high percentage of our population is vaccinated and more are getting their boosters every day.
Second, unlike many European countries which have to contend with a double whammy of a concurrent Delta and Omicron wave, we have only recently gone through a Delta wave. We are not likely to have to ride through two rapidly rising infection waves.
In recent days, our overall local infection number is creeping up, to a few hundred a day, with Omicron accounting for about 40% of all cases. Given the transmissibility of Omicron, we expect the numbers to rise steeply in the coming weeks and Omicron will become the dominant variant within a few weeks.
The responses that we have developed against Delta will continue to be relevant against Omicron, with some adjustments. And there are three responses, essentially.
First, vaccination and boosters remain key. In countries where Omicron has spread, the unvaccinated and under-vaccinated are still the most prone to falling seriously ill when infected.
Mr Dennis Tan asked for a breakdown of COVID-19 deaths. There were 802 such deaths in 2021, of whom 555 were not fully vaccinated. Although the unvaccinated is a small proportion of our population, they contributed to 70% of the deaths in 2021.
The remaining 247 were vaccinated with a range of locally available vaccines. I am going to read out some crude incidence rates but be mindful we are calculating these based on quite a small of sample of 247 deaths of individuals who are vaccinated. They are as follows: 79 deaths per 100,000 for non-fully vaccinated persons overall; 11 deaths per 100,000 for those vaccinated with Sinovac; 7.8 per 100,000 for Sinopharm; 6.2 per 100,000 for Pfizer-BioNTech and one per 100,000 for Moderna.
These rates are only indicative – as I mentioned, the sample size is small and they also do not account for other factors which may affect mortality such as the age and timing of vaccination.
Around 132,000 individuals aged 18 and above remain unvaccinated, while around 300 persons are medically ineligible. We will continue to try to convince those who are medically eligible to get vaccinated, through their primary care physicians, public messaging and the media. But as Members would appreciate, as the number gets smaller, it is also harder and harder to convince them.
For those who are homebound, our Mobile Vaccination Teams can visit their homes to vaccinate them.
Over the past months, we have managed to vaccinate well over 90% of every eligible age group. it is quite an achievement. We are especially happy to see that amongst seniors aged 60 to 69, and 70 and above, 96% and 95% have been fully vaccinated respectively.
As for those aged 12 to 19 years, 95% are fully vaccinated. For the even younger ones aged five to 11, we have just started vaccinating them. The response has been good and operations smooth.
At this time, only the Pfizer-BioNTech/Comirnaty vaccine is authorised for use in ages below 18 years. We will continue to closely monitor the availability of other non-mRNA vaccines that are approved for use in children.
At the same time, our vaccine booster programme is gathering pace. About 46% of our population has received their boosters. We have recently brought some 900,000 individuals aged 18 to 29 into the booster programme, of whom 700,000 are already eligible to receive their boosters today. Our booster coverage will continue to expand over the month of January.
We have also set a validity period for full vaccination status of 270 days, as a strong signal to our population, “Please get your boosters promptly”.
As to whether there is a need for further booster shots – fourth shot, fifth shot – it is too early to tell. Today, Israel is the only country that has authorised a fourth dose for non-immunocompromised individuals.
For an endemic infectious disease like Influenza, we can draw some inference from there. This virus mutates frequently, so people receive vaccinations every year to protect themselves against it, without many problems, or the need for disruptive border closures and social restrictions each time there is an Influenza infection wave. It is a possible future scenario when we live with COVID-19 as an endemic disease.
MOH and the Expert Committee on COVID-19 Vaccination (EC19V) will continue to monitor local and international data on the durability of protection from vaccine boosters and the evolution of the virus to assess the need for further vaccinations.
The second response: we continue to enhance our healthcare capacity. We have made preparations to ramp up capacity and manpower of the Home Recovery Programme, Community Treatment Facilities (CTFs) and public hospitals. We stand ready to provide up to 350 ICU beds, 2,000 isolation beds and 4,000 CTF beds for COVID-19 cases with a couple of weeks’ notice.
Particularly, for hospital ICU capacity, existing single rooms and isolation rooms can be repurposed into additional ICU beds when required. Medical equipment and consumables are ready. Manpower is always a limiting factor, but ICU staff has increased by 12% over the past year to about 1,800 now and we have trained or are training about 500 more staff to assist with ICU operations.
Anti-viral medications for COVID-19 have been used to treat vulnerable patients who are at high risk of falling severely ill. When authorised for use and made available in Singapore, these oral anti-viral medications will be important additions to the range of COVID-19 therapeutic agents already in use locally. We have signed or are negotiating supply agreements for these medications, but unfortunately, I am not at liberty to release details due to confidentiality obligations in these contracts.
Outside of the hospitals, we will be enhancing our health protocols to right site patients, so that hospital resources go to those who need them most. The MTF has recently announced our partnership with primary care doctors to care for patients who are recovering at home after being tested positive with Antigen Rapid Tests, under what we termed Protocol 2. This will help them safely recover and return to normal activities as soon as possible.
I should caution Members against thinking that coping with a transmission wave successfully is a matter of recruiting more healthcare workers and building more ICU facilities. Our objective is not to have more people falling very sick and admitted to ICU, but in fact to avoid it.
Hence, we size our emergency healthcare capacity based on what is sustainable and practical, bearing in mind this is a crisis of a generation, the capacity needed cannot be provided within our redundancy provision and ICU-trained staff do not just increase multi-fold overnight or even over a few months. Hence, we have tried to temper the infection numbers through safe management measures and exercising self-restraint in our social interactions.
So, vaccinations, expansion of healthcare capacity, and safe management measures – the three must work in tandem and we must strike a balance between the three factors.
We cannot, for example, over-liberalise, remove all social restrictions, let infections rise uncontrollably and leave the healthcare system to bear the consequences. Neither do we swing to the other extreme: protect the healthcare system at all cost, go for a zero-COVID-19 strategy, and lock down our borders and society which will cause tremendous suffering to our people.
How the three factors balance off each other, is a matter of judgement depending on the pandemic situation. It will be too rigid to set metrics and parameters to trigger social restrictions, as we need to respond flexibly and appropriately to the twists and turns that the pandemic situation may take.
This brings us to the third response, which is safe management measures. In recent months, instead of imposing across-the-board social restrictions, we introduced more Vaccination-differentiated Safe Management Measures (VDS).
This is because unvaccinated individuals are at far higher risk of falling severely ill. This group has consistently taken up two-thirds of our ICU beds, throughout the pandemic. By restricting their social interactions, we protect them against infections and serious illnesses and taking up hospital resources. The rest of society who have been vaccinated can also then live life more normally.
However, there are presently no plans to introduce VDS for children aged 12 and below in community, public, preschool and school settings. This is due to a combination of reasons, namely, children are less likely to develop severe illnesses when infected and we want to preserve as much as possible universal access to holistic education for children. Minister Chan will explain further.
For now, children aged 12 and below who are Singapore Citizens, Permanent Residents or Long-Term Pass Holders and did not travel recently will continue to have their COVID-19 medical bills fully covered by the Government. This is regardless of their vaccination status.
So, in general, while we have a strict VDS system in place, to enable society to carry on normal lives as much as possible while protecting the unvaccinated, the rules are much less strict on children, based on the reasons I explained earlier.
Members asked if we are likely to tighten up social activities because of the Omicron wave. When the Delta wave subsided late last year, we refrained from being too jubilant and over relaxing restrictions. That would have been a mistake. We kept our masking requirements, we did not allow back night entertainment, we kept group sizes at five.
So, it is the MTF’s hope that we can ride through the Omicron wave with the current safe management measures posture. If we have to tighten the restrictions, it will be as a last resort and when our healthcare system is under severe pressure.
In conclusion, Mr Speaker, Sir, I believe that just as we have ridden through the Delta wave with unity and resolve, we will be able to do so again with the Omicron wave. Omicron is a different enemy, but we are much better prepared and much more resilient than before. And after the Omicron wave passes, which it will, we would have taken another huge step towards living with COVID-19. Singapore will be one of the best and safest places to live in on Earth.
Ministry of Health
10 January 2022