Mr Chua Kheng Wee Louis asked the Minister for Health (a) what is the number of foreign patient arrivals in Singapore in (i) 2022 year-to-date and (ii) each of the last five years; (b) what are the current utilisation rates of existing capacity by foreign patients in private and public hospitals respectively; and (c) what is the bed capacity in private and public hospitals (i) currently used and (ii) set aside, for COVID-19 hospitalisations in light of the rising number of COVID-19 cases.
Mr Dennis Tan Lip Fong asked the Minister for Health (a) whether the Ministry plans to allow all adults below 50 years old to take their COVID-19 vaccination second booster under the National Vaccination Programme (NVP) and, if so, when is this expected; and (b) will all adults below 50 years old who wish to take their second booster due to travel requirements or concerns arising from travel plans be allowed to do so under the NVP.
Mr Dennis Tan Lip Fong asked the Minister for Health whether the recent deaths of two young children from COVID-19 on 27 June and 17 July 2022 raise any cause for concern regarding the susceptibility of young children to the recent COVID-19 strains, bearing in mind the relatively higher number of daily reported COVID-19 cases in recent weeks and the infectiousness of the recent strains.
Ms He Ting Ru asked the Minister for Health whether he can provide an update on the progress of the Ministry’s evaluation of (i) COVID-19 vaccines for children under five years old and (ii) other types of COVID-19 vaccines that can be administered to children.
7 Ms Joan Pereira asked the Minister for Health (a) whether the Ministry is observing an increasing trend in the COVID-19 re-infection rate given the continued emergence of new Omicron sub-variants; and (b) whether there are any plans to further expand the eligibility for second booster shots for younger age groups, especially when the vaccines are updated to deal with new variants or sub-variants.
8 Ms Joan Pereira asked the Minister for Health in view of the current wave of COVID-19 infections (a) what measures are in place or planned to be put in place to cope with the spike in the number of patients at general practitioner clinics, polyclinics and hospitals’ emergency departments; and (b) whether there are plans to further support the growth of the telemedicine sector in Singapore to provide medical services for mild cases and to reduce the number of infected persons visiting physical clinics.
9 Mr Liang Eng Hwa asked the Minister for Health (a) whether the recent wave of COVID-19 infections has resulted in much longer waiting times for patients at polyclinics and neighbourhood general practitioner clinics; (b) whether the waiting time and services can be improved; and (c) whether the capacity for primary care at the heartlands can be further stepped up.
10 Mr Seah Kian Peng asked the Minister for Health (a) what proportion of the Singapore population does the Ministry estimate has been infected with COVID-19, including unreported cases; and (b) whether Singapore has attained herd immunity with such an infection level.
11 Dr Wan Rizal asked the Minister for Health whether an update can be provided on the study by the Health Sciences Authority and the Expert Committee on COVID-19 Vaccination on the safety and effectiveness of COVID-19 vaccines formulated for young children aged under five years old.
12 Mr Chua Kheng Wee Louis asked the Minister for Health (a) what is the number of foreign patient arrivals in Singapore in (i) 2022 year-to-date and (ii) each of the last five years; (b) what are the current utilisation rates of existing capacity by foreign patients in private and public hospitals respectively; and (c) what is the bed capacity in private and public hospitals (i) currently used and (ii) set aside, for COVID-19 hospitalisations in light of the rising number of COVID-19 cases.
13 Mr Dennis Tan Lip Fong asked the Minister for Health (a) whether the Ministry plans to allow all adults below 50 years old to take their COVID-19 vaccination second booster under the National Vaccination Programme (NVP) and, if so, when is this expected; and (b) will all adults below 50 years old who wish to take their second booster due to travel requirements or concerns arising from travel plans be allowed to do so under the NVP.
14 Mr Dennis Tan Lip Fong asked the Minister for Health whether the recent deaths of two young children from COVID-19 on 27 June and 17 July 2022 raise any cause for concern regarding the susceptibility of young children to the recent COVID-19 strains, bearing in mind the relatively higher number of daily reported COVID-19 cases in recent weeks and the infectiousness of the recent strains.
15 Ms He Ting Ru asked the Minister for Health whether he can provide an update on the progress of the Ministry’s evaluation of (i) COVID-19 vaccines for children under five years old and (ii) other types of COVID-19 vaccines that can be administered to children.
Mr Ong Ye Kung: I will touch on the COVID-19 situation, healthcare capacity and vaccination programme. Thereafter, Senior Minister of State Janil Puthucheary will address PQs for our treatment and vaccination plans for children. And if the Members who filed tomorrow’s questions are satisfied with the answer, they may wish to withdraw their questions.
My Deputy Speaker, we are still in the middle of an infection wave driven by the Omicron variant BA.5. Over the last 10 days, infection numbers have been falling and the week-on-week ratio has dipped below 0.9 over the last week. We should see the wave subsiding further this week.
We did not tighten any social restrictions during the current wave. Everyone went about our lives normally: going to work, visiting families, going out with friends, travelling in and out of Singapore.
However, life is not as normal in our hospitals. Without additional social restrictions, our healthcare system is bearing the brunt of the current wave. Healthcare workers have been very busy. Polyclinics and our General Practitioner clinics also saw higher patient volumes.
To answer Ms Joan Pereira, we are indeed promoting the use of telemedicine for mild COVID-19 cases. It is now a lot more accepted by patients than before. But even so, we need to be realistic that in a big infection wave, the healthcare system will come under stress, notwithstanding the common usage of telemedicine. Waiting times at private clinics, polyclinics and hospitals will inevitably go up and I seek the patience and understanding of all our residents.
In such a situation, the key is to ensure that hospitals are not overwhelmed and that those who need urgent care can be attended to promptly. By and large, we have been able to achieve that.
The first important measure to achieve that is to set aside sufficient bed capacity to cater to COVID-19 patients. So, in response to Mr Louis Chua, based on our worst-case scenario projection for the current wave, we have plans to set aside up to about 1,000 COVID-19 hospital beds for COVID-19 patients.
And this is a dynamic plan, and fortunately, in the course of this infection wave, we did not have to activate all of those beds.
In the same question, Mr Louis Chua asked about foreign patient arrivals for the last five years. I think that this is a non-COVID-19 related question, we will answer it separately and Senior Minister of State Janil Puthucheary will touch on that.
Second, we eased the workload of hospitals by transferring lower-risk patients to COVID-19 Treatment Facilities and discharging long-term stayers back to community care facilities, like nursing homes. Many of these facilities and services are run by private or social sector providers and we are deeply appreciative of them for doing this work.
Compared to the last Omicron wave, the transfer processes are now a lot smoother, and patients and their families have also become a lot more understanding when hospitals say that your loved one needs to be transferred. As a result, for this infection wave, we have been able to make many more transfers than the last and this has made a significant difference to the workload of hospitals.
Finally, hospitals also have to manage their own demand for beds. They have cut down on “business-as-usual” workload, by about 5%, and this comprises of mostly elective surgeries. This is not ideal, because it builds up the backlog of work which eventually have to be attended to eventually. However, the 5% cut today is far less than the 15% cut that we had to implement during the first Omicron wave in the beginning of this year.
Hospitals restricted, but did not suspend visits to patients. We also did not suspend the leave of healthcare workers, so they can still take breaks, including flying to their home countries to see their loved ones and their family members. This is extremely important in maintaining the morale of our healthcare workforce.
Mr Yip Hon Weng asked if hospital-acquired COVID-19 infections is contributing to a bed crunch. The answer is no. Absenteeism in hospitals due to the current COVID-19 wave has been lower this time round, at about 2%. As far as we can determine, while there had been some transmission within hospitals, overall, hospital-acquired COVID-19 infection has been low and, very likely, lower than community-acquired infections. This is because of good infection control measures in hospitals.
We need to recognise that bed crunches are mainly caused by high case numbers because of an infection wave and how those case numbers translate into severe illnesses that need hospitalisation.
There are only two ways to minimize this: one is social restrictions, two is to ensure good coverage of vaccination amongst the population. All of us do not want to bring back social restrictions as far as possible. The rule of five, the rule of two – we try to avoid that. And so, therefore, we need to rely on vaccinations.
In that regard, like many Singaporeans, I am very proud that Singapore has achieved what many countries want to achieve, which is that most people have gotten up-to-date vaccinations. The resilience has been further strengthened as many people recovered safely from COVID-19 infections.
Mr Seah Kian Peng asked what percentage of our population has been infected. On record, we have about 1.7 million reported cases, which is about 30% of our population. MOH also systematically monitors blood samples from routine polyclinic cases and other healthy volunteers for signs of previous infection. From these samples, we estimate about 60% of local residents are likely to have been infected with COVID-19.
Notwithstanding, this does not confer us “herd immunity”. By and large, scientists around the world do not think herd immunity is achievable because the virus will continue to mutate, escape the protection of vaccines and then, infect people.
What is achievable is population protection against severe illness through vaccinations. This is what enables our healthcare system to weather through an infection wave, even with high case numbers, because the translation of case numbers into severe illnesses is very low.
During the last Omicron wave at the beginning of this year, 2.4% of infected persons needed hospitalisation. During this wave, 1.9% ended up in hospitals. The actual percentages are likely to be lower because not all cases are reported.
Notwithstanding our strong resilience due to good vaccination coverage, MOH still has some concerns and we can never be complacent.
First concern, coverage of the vulnerable, especially our seniors. To get good vaccine protection against severe illness from the Omicron variants, we need three doses of mRNA shots. It is no longer a two-dose vaccination; it is three doses.
However, we have more or less hit a plateau – there remains 40,000 seniors, aged 60 and above, who have not received their booster shots, even though they are eligible. Another 40,000 seniors have not completed two doses yet. All of them are vulnerable to severe illness, if infected. We will continue to try to reach out to them through our Mobile Vaccination Teams, through our home vaccination teams.
The second concern – MOH knows that vaccine protection against severe illness will not last forever. So, Mr Shawn Huang has, therefore, filed a very pertinent question on when this will start to wane.
MOH monitors this data closely. Mr Deputy Speaker, Sir, with your permission, may I show some graphs on the screen, please?
Mr Deputy Speaker: Please do. [A slide was shown to hon Members. Please refer to Annex 1.]
Mr Ong Ye Kung: At the top left-hand corner, the line shows “Vaccination Effectiveness Against Severe Illness”; at the top left-hand corner is for the age group above 80, top right hand, 70 to 79, bottom, 60 to 69. And you can see that the graphs are not dipping; in fact, they are staying at a high level. And that is 10 months’ worth of data.
So, our empirical data shows that after 10 months, the protective effect of three doses of mRNA vaccines remains very strong in preventing severe illnesses. That is why as of now, our recommendation is for those who are 80 and above to receive their second booster, or fourth shot, to better protect against severe illness.
Members will notice that at the top left-hand corner is the chart for those above 80. In fact, it has not dipped, but in general, the protection level is lower than younger cohorts, which is why we recommend that they take a fourth shot, or the second booster.
As for those aged 50 to 79, although the protection levels continue to be strong, this is also the age when chronic illnesses start to set in. So, they have been offered the second booster if they want to take it, either because they are travelling, or they are worried about their health because of underlying chronic illnesses.
Our experts are actively studying the benefits of a fourth shot, or a second booster, for the age group of 60 to 79, in further reducing the likelihood of severe illnesses. We will announce their recommendations, once ready and shortly.
As for the younger individuals below 60 years old, they have the protection of both the third shot, as well as age. Currently, they do not require a second booster if they are healthy. MOH will continue to study the emerging data, including the benefits of newer vaccine formulations, weigh against the risk of new variants and update our recommendations, as and when necessary.
Ms Joan Pereira asked about the incidence of reinfections. It does occur in Singapore, but by and large, reinfection rate during the current wave has been low in Singapore and we recorded reinfection rates that are lower than many countries. This is likely because we have very good vaccination coverage and that we just went through a fairly large BA.2 infection wave, just at the beginning of this year.
MOH has been watching the reinfection numbers very closely, because it will inform us of the likely timing of future waves. Our observation is that for those who were infected over the last three months, the chance of getting another infection is very rare. For those infected four to seven months ago, the probability of getting infected again is about 3% that of an uninfected or naïve person. If you have been infected with the Delta variant last year, the probability of getting infected again is about 20% that of an uninfected person, or COVID-19 naïve person.
Of course, this picture will change as time goes by and the protective effect of prior infections wanes. Hence, having been infected by COVID-19 before should not be a reason to let your guard down.
In the meantime, reinfections are taking place, albeit not as frequently in Singapore, compared to other countries, but they are likely to increase as protection of prior infections wanes. We should, therefore, start to include reinfection numbers in our daily reported case counts. In the past, we report the number of patients who had been infected every day. So, a patient who has been infected twice, we count him only once and there are very few of them. With more reinfections, from today, we will report the infection episodes instead of infected persons. This will be a more accurate reflection of the pandemic situation.
Mr Zhulkarnain Abdul Rahim asked about COVID-19 therapeutics. All polyclinics and more than 130 participating PHPCs can prescribe oral antivirals to clinically-eligible patients in the community. To date, more than 3,200 patients have been prescribed such therapeutics across different healthcare settings. It is a small percentage of all infections, reflective of the fact that the vast majority of infected cases are of low risk.
Mr Saktiandi Supaat asked about the Flu Subsidy Scheme. As at end FY2021, the Government has spent about $178 million on the scheme for over 11 million attendances at private clinics and polyclinics for the treatment of acute respiratory infections.
As we progress towards living with COVID-19, Singaporeans have become familiar with exercising social responsibility through self-testing by following Protocol 1-2-3. By keeping ourselves healthy, getting up-to-date vaccinations and, with employers and education institutions not always insisting to see medical certificates, most COVID-19 patients can recover uneventfully by resting at home and seeking care only when needed.
Our policies will, therefore, need to evolve with the state of our preparedness. For safe management measures, we refrain from imposing additional restrictions even as we ride through a wave now. Likewise, healthcare financing policies would also need to start evolving and progressively scale back from subsidy policies that were enacted under exceptional pandemic circumstances.
I want to reassure Members of the House that for residents who see their primary care doctors, they will continue to receive institutionalised, pre-COVID-19 subsidies, such as CHAS, polyclinic subsidies, health screening subsidies and so on. PHPCs and polyclinics will also continue to provide Government-funded swabs to eligible symptomatic individuals at no charge.
Mr Deputy Speaker, Sir, while the current wave is subsiding and I think the worse is over, it is important that we do not be complacent.
As the protection of vaccines and prior infection wanes, the virus will circulate in our society again and cases will rise. We must anticipate when that will happen and take the necessary precautions, including the most important of all, which is to keep our vaccinations up to date.
I have deliberately used the term “up-to-date” vaccinations, rather than a second, third or fourth booster shot. This is because, at some point, just like flu vaccinations, we have to stop counting the number of boosters we have taken. Instead, we must ensure that we get a jab at a suitable interval – maybe nine months or a year. This is something MOH will try to determine in the coming months.
As of now, there is no change to MOH’s guidance and recommendations. It remains what have already been announced.
We need to be alert to the threat of a new variant that is more infectious, leads to more severe illnesses or evades the protection of current vaccines. We hope it will not happen, but many countries in the northern hemisphere are worried about that and what might come up in the coming winter. If we encounter such a variant, I am afraid social restrictions will become necessary again.
Mr Deputy Speaker, Sir, notwithstanding these words of caution, let me underscore the importance of what Singapore just went through.
With each wave, we are coping better. We are riding through this current BA.5 infection wave without imposing further social restrictions or imposing border measures. In our hospitals, we imposed fewer restrictions and hospitals are, generally, able to cope better than the last wave.
That means that the Singapore society has taken another major step forward in living with COVID-19 as an endemic disease and I think this is a big National Day present for all Singaporeans.
Mr Deputy Speaker: Senior Minister of State Janil Puthucheary.
The Senior Minister of State for Health (Dr Janil Puthucheary): Mr Deputy Speaker, Sir, there were several Parliamentary Questions (PQs) on our treatment and vaccination plans for children.
I was saddened by the recent deaths of two young children from COVID-19 and offer my deepest condolences to their families.
Based on local and international data, the BA.4 and BA.5 Omicron subvariants have not been observed to affect children more severely than past variants, and severe COVID-19 infection continues to be rare in children, especially amongst those who are vaccinated. For children aged five to 11, a third mRNA dose may be necessary at some point to keep protection levels high and MOH is making the necessary preparations to roll out vaccination booster doses for this age group in about two months’ time. At present, the Pfizer-BioNTech/Comirnaty COVID-19 vaccine remains the only vaccine authorised for use in children aged five to 17 in Singapore. Children who are not medically eligible for the Pfizer-BioNTech/Comirnaty COVID-19 vaccine may receive the Sinovac-CoronaVac vaccine under a dedicated public health programme, while Moderna’s vaccine for this age group remains under evaluation.
Children under the age of five are, currently, the last group not yet protected by vaccination. MOH is preparing to start vaccination for those under five towards the fourth quarter of this year. The Health Sciences Authority (HSA) is currently reviewing the data submitted by Pfizer/BioNTech and Moderna on their COVID-19 vaccines for this age group. We will provide an update when an assessment of the quality, effectiveness and safety of the vaccines has been completed.
Members asked what could be done to detect, diagnose and treat COVID-19 in children. Currently, children under the age of five remain more vulnerable to COVID-19 infection and have higher rates of severe outcomes, as compared to older children. This is similar to other respiratory diseases. However, the overall incidence of severe outcomes from COVID-19 infection remains much lower amongst children, compared to adults and the elderly.
Children needing medical attention should be seen by a general practitioner (GP) or polyclinic if unwell and the clinical team, the doctors there, will test children with acute respiratory infection (ARI) symptoms using an Antigen Rapid Test (ART) by default or a Polymerase Chain Reaction (PCR) test, if indicated. Children under three months of age are admitted to hospital by default, whereas older children are treated under the Home Recovery Programme (HRP) and reviewed by doctors via telemedicine. This service is available round the clock. Our hospitals continue to prioritise care for children with urgent medical conditions, and those who require further observation and treatment will be admitted. MOH regularly reviews and updates the screening and review criteria with inputs from a panel of specialists.
Oral antivirals are licensed for use under HSA’s Pandemic Special Access Route for patients aged 18 and above only. For children aged between 12 and 18, local and overseas treatment guidelines indicate that Paxlovid may be considered on a case-to-case basis. We will continue to review the evidence for the use of oral antivirals for children under 18 years of age.
We will continue to monitor the incidence of severe illness and deaths due to COVID-19 closely and adjust our processes to protect our healthcare system and patients. We ask everyone to take the necessary precautions and remain socially responsible by self-testing if unwell, getting vaccinated and boosted, and avoiding social interactions if you have a fever or respiratory symptoms.
Lastly, Sir, to address Mr Louis Chua’s question on foreign patients, the number of foreign patients who come to Singapore to specifically seek inpatient treatment or day surgery at our hospitals has, historically, been small. Between 2017 and 2019, our public and private hospitals saw about 32,000 foreign patients annually, or about 3% of all inpatients and day surgery patients. These numbers have since fallen by 80%, compared to pre-COVID-19 levels. In 2021, there were just 6,000 episodes, comprising less than 1% of total cases seen in hospitals.
Mr Leon Perera (Aljunied): Thank you, Mr Deputy Speaker. Just three supplementary questions for the Minister for Health.
Firstly, he shared some data on the mRNA vaccines being effective – three shots against seriously falling ill. Could he give us a sense of that data for the non-mRNA vaccines, the traditional vaccines? Are these less efficacious than the mRNA?
The second supplementary question is: would MOH consider sending mobile vaccination teams to individual homes to vaccinate them even if they are not seniors, if there are strong mitigating factors? For example, if the individual is diagnosed with a mental health condition that makes it hard for them to leave their home.
The third supplementary question is: would the Ministry consider tweaking its systems and processes to encourage people who go for the COVID-19 vaccines to also get the regular flu vaccine at the same time if, indeed, that is scientifically feasible.
Mr Ong Ye Kung: We have a few non-mRNA vaccines. Novavax has shown to be efficacious in preventing severe illnesses. The other two slightly less. I do not have the data. But the data has shown that these are slightly less; not just us, but Chile and Malaysia and other countries have also published similar data and admit similar observations. Having said that, they do have a protective effect. Having those vaccinations is better than not having vaccinations. So, please encourage residents to take them.
As for mobile vaccinations for those who are not seniors, we will do so and we have been doing so. If you come across any residents that need them, you can always raise with MOH and we will assess and try to be as helpful as we can.
Do we administer flu vaccines together? In practice, we can. But unlike many other countries where there are four seasons and there is a winter and a flu season, they find it useful to administer flu vaccines and COVID-19 vaccines concurrently, which is what Australia is doing currently. And towards the fall, many Northern Hemisphere countries intend to do so.
We do not have a flu season. It comes and goes. It could be anytime. So, it is harder for us to combine two vaccinations at the same time because of the lack of a flu season. But theoretically, it is possible. And if someone wants both together, we should think of a way to administer both.
Mr Dennis Tan Lip Fong (Hougang): Thank you, Deputy Speaker. I just want to seek clarification from the Minister regarding my Question No 13, part (b). I am not sure I heard the answer. For Singaporeans under 50, if they wish to take the second booster because of travel requirements or because of concerns arising out of travel, will they be allowed to do so under the National Vaccination Programme?
Mr Ong Ye Kung: Currently, our rules do not provide for that. If you are below 50, you have taken three shots already and you are healthy, our rules do not provide for them and they would not be offered. But if they have underlying conditions and they suspect they are sick, they can let us know and we will offer it to them. The reason is, as I mentioned earlier, protection against severe illness is what is important and it continues to stay very high, especially if you are young. And towards year end, we do not know what is coming our way. In the Northern Hemisphere, many countries are worried about new variants. So, therefore, sometimes, it is also worthwhile to keep our powder dry, especially for the younger group.
Mr Chua Kheng Wee Louis (Sengkang): Thank you, Mr Deputy Speaker. I just have one supplementary question for the Minister.
On 9 May, in a report in The Straits Times, one of the private hospital groups shared that it has stood down its ringfenced general ward capacity. So, I note from the Minister’s response that about 1,000 hospital beds are being set aside for COVID-19 purposes. So, I just wanted to understand – the healthcare system today across both the public and private hospitals, what is the current level of bed utilisation as a whole? And if the need arises, where would these additional 1,000 beds come from and how quickly can they be activated?
Mr Ong Ye Kung: The 1,000 beds I mentioned referred to public hospitals only. If we include private hospital beds that we can acquire, that is another couple hundred more – I cannot remember the number. Today, hospitals are busy, not because of COVID-19 patients, but a lot of business-as-usual patients. Ninety percent occupancy is quite common. And this is after taking into account, setting aside some beds for COVID-19 patients.
As I mentioned, it is a dynamic plan. When we see a curve going down, numbers going down, we may release more beds. When we see the epi curve going up, we may take out more beds and inch towards the 1,000-bed scenario. So, it is a dynamic plan. But what is important, what I mentioned, is that for this wave, we managed to ride through it. I think the worst is over. We managed to go through it better prepared and better response than the last wave.
Ministry of Health
1 August 2022