MP Pritam Singh

Mr Pritam Singh (Aljunied): Thank you, Mr Speaker, and thank you to the Senior Minister of State for the Statement on ICU capacity.

I would like to refer to a report which is found on the SingHealth website. It is carrying a Straits Times article on ICU capacity. This is dated 13 August and I think this number has been quoted by individuals online as well as when the Minister for Health said that up to 1,000 ICU beds can be made available for critically ill COVID-19 patients, if needed.

I think what the numbers suggest, and what the numbers we have now insofar as ICU capacity is concerned, is that there is yet sufficient potential for upscaling the number of ICU beds. Of course, the assumption being that this remark that was made on 13 August refers both to the bed itself, the ancillary equipment needed and the manpower needed to manage 1,000 beds.

Sir, I would just like to ask a question pertaining to this number of 1,000. Is this still the operating parameter or have things changed quite significantly?

The second point is somewhat connected but it is with regard to the measures introduced vis-a-vis the Stabilisation Phase.

I think there has been some pushback in terms of retaining the number of two individuals in a dining capacity. There is significant public feedback that this should be increased to five, especially for vaccinated individuals, particularly since the Government is also opening up more Vaccinated Travel Lanes (VTLs) and lifting travel bans. At least, for the South Asian group of countries, this was lifted very recently.

So, there is a view that cannot quite connect why dining capacity cannot be opened up in view of the number of vaccinated individuals who actually are not imposing on the ICU capacity as much as non-vaccinated individuals. So, I hope there could be some clarity provided insofar as what is holding the Government back on this number, on opening up at least for dining for up to five individuals.

My third question really – and this is the last one, Mr Speaker – follows up on the numbers the Senior Minister of State shared with regard to the resignations in the healthcare system. One thousand five hundred for the first half of 2021 and I believe an additional 500 were foreign healthcare professionals.

Can I just confirm what have been the recruitment numbers over the same period? The Senior Minister of State said in his Statement that the recruitment of healthcare workers from overseas is continuing. So, it will be helpful to have the numbers that are coming on board as well and not just the numbers that are leaving.

Mr Ong Ye Kung: I will take the first two questions and maybe Senior Minister of State Janil Puthucheary can also comment on the first question and answer the third.

I remember quite vividly that we talked about the possibility of ramping up to 1,000 beds. I spoke about it at a press conference illustrating how if cases doubled every week, in five weeks, the beds will actually be exhausted. It is the illustration that even with that kind of capacity, if infections run away from us, it will be of no use. We would just get overwhelmed in a matter of weeks.

I also remember vividly – do not even get near that – not even near the 1,000 limit.

Senior Minister of State Janil Puthucheary is a lot more experienced in this and he knows it inside out. I think he had explained that we have all the logistics and all the consumables to set it up but I think manpower will be a serious constraint. Can they handle 1,000 ICUs? I think not without a major degradation of care.

So, I think it is not a black-and-white kind of situation. With every step up in the number of beds, there is degradation of care and there is a trade-off.

The second question on whether we can increase dining to five for vaccinated diners. We wish to get there too. We were there before. We were even at eight at one point. It is important to the F&B industry, it is important to Singaporeans, it is important for families to get together.

But I think the time is not here yet. I think we will get there. Because when you meet with five, as explained by Senior Minister of State Janil Puthucheary, you do increase the risk of transmission. If it is transmission within vaccinated individuals, it may not be that serious. But we also live with older people, with seniors who may be unvaccinated. And we can inadvertently bring the virus to them.

I have a neighbour, an unvaccinated senior and she has streams of visitors coming to visit her, persuading her to get vaccinated. So, I was persuading their visitors maybe stop coming to persuade her, just give her a call. But this is life in Singapore. So, we do have to pay attention to that.

There is always a comparison with why is it that we can open for travel but not for dine-in. The difference is this, that in the initial stage, Singapore has very low infections and the world around us has very high infection rates. So, when you open up borders at that time, you are opening up the floodgates. Today, the situation is entirely different. Our infection rates and the rates outside are similar. In fact, they may have lower infections than us because they went through huge waves and we are still going through ours. Furthermore, we limit travel or SHN-free travel to only vaccinated individuals and at the border, you are subject to tests.

So, theoretically, if you can have an event, like a wedding, a bigger wedding, everybody is subject to a test, you can sit in fives. So, it is actually a similar concept. This also present possibilities for the MTF to think about in future, whether through testing, through vaccination, we can allow gathering that is a bit less restrictive. These are all possibilities that we will continue to think about.

Dr Janil Puthucheary: Sir, I do not have the specific numbers of recruitment figures for the different clusters and organisations. We can get them.

But I think one of the challenges we have to appreciate is that even if we recruit from overseas, anybody coming into that environment is new, they are inexperienced. By definition, they are inexperienced with the environment, our healthcare protocols, but they may actually be literally new in terms of their training as well. So, their role is going to be quite different. It is going to be augmenting manpower where, perhaps, that level of acuity and that level of complexity does not exist.

So, while we are recruiting – and we have been actively and I will get the numbers – operationally, I cannot see that that is going to make a huge difference in the ICUs. It will make a difference in other parts of our ecosystem. We hope that can displace a little bit of the manpower into some of the higher acuity areas and then release a few people to go and help in the ICU. But I think this is a bit more of a medium-term strategy rather than something that we can rely on as an urgent fix to our current problem.

If I may make a comment on the first part that Minister for Health talked about, some of the uncertainties are about how long we have to carry a certain load or a certain number of patients within the ICU. If you have a terrible disaster, mass casualty, a very bad accident, you may have many times the number of patients that we currently have in the ICU. But as a one-off incident, the patients will not stay as long.

What we have today is the equivalent of a low-intensity conflict and having to be on readiness and high alert for weeks and weeks, and months and months. Your surge capacity at the start of a low-intensity conflict is very, very different after two years or after one month. Even this current surge when it started, there was really no way to know or model how long it was going to last and what the peak of peaks would be.

So, what the Minister talked about is the logistical planning parameter. If you do not have 1,000 bed spaces, you know that you cannot get there. But if you do, that is physically where you can locate people. If you need the equipment and, thankfully, as a system over the last two years – but it started long before the last two years, through emergency planning and resilience preparedness – we actually have the stocks of equipment that we need: the consumables, the little parts to drive the machines as well as the drugs, in order to cater for many, many more patients than we have today. So, as the colleague of mine said, we are not resource-constrained at the moment.

The manpower issue is not something that we can do a simple calculation for. As I said, it depends on how long this goes on for, how long the peak goes on for. Crucially, today, coming to the end of 2021, the amount that we can reduce business-as-usual is really quite different from where we were, let us say, six months ago; in fact, where we were, even three months ago. That is an additional factor that we have to take into account. So, the number is something that we have to think about in a fairly dynamic way.

Ministry of Health
11 January 2022


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