A Critical Path
1 When the Multi-Ministry Taskforce (MTF) presented our transition plan to a COVID-resilient nation, we explained that we must be prepared to see infections rise, and also increased intensive care unit (ICU) cases and deaths. The rapid rise in infections over the last 18 days is therefore not unexpected. Except it is happening sooner than what we had anticipated.
2 We had hoped for a controlled Preparatory Phase, where we can get more people vaccinated, adjust our healthcare protocols, try out several pilot projects to open up the social and economic activities, and travel, while keeping infection numbers at a manageable level, maybe 100, 200.
3 Then we would enter the Transition Phases, where we open up further, and expect cases to start rising along a steep curve, but we would be well-prepared to manage it. Unfortunately, the Delta variant did not follow our plan, which is also not surprising.
4 This rapid and exponential rise in daily infections that we are experiencing now, is what every country that seeks to live with COVID-19 has to go through at some point. We want to go through it differently from other countries, in two major ways:
5 First, we want as few deaths as possible. Practically every country that has gone through this transmission wave, has suffered hospital collapses and high death tolls. We want to avoid that.
6 If we can achieve the first objective, then we can also achieve our second objective – which is to avoid a long hard lockdown, a repeat Circuit Breaker. That is, in fact, what New South Wales in Australia and Vietnam are going through now.
Vaccination is still key
7 The key is vaccination. As DMS explained, vaccines are very effective in protecting us against severe illnesses, ICU cases and deaths. Are we achieving the two objectives we set for ourselves?
8 Our cases started rising sharply 18 days ago on 23 August, when daily cases shot up to almost 100 and has been rising rapidly since. Through the 18 days, ICU numbers were kept at five to seven. There were two new ICU admissions and one death, due to recent clusters.
9 The MTF will be distributing a chart to illustrate this. We are seeing a high number of infection cases, but so far over the last 18 days, ICU admissions and deaths have been kept low, but we should expect it to rise. Therefore, there is strong evidence to show that vaccination has weakened the relationship between the number of infections and number of patients with severe illnesses and deaths. But it is early days yet, as there is a time lag between infections and the onset of severe illnesses.
10 As far as possible, we do not want to reverse course in our transition. We need to monitor the incidences of severe illnesses and deaths closely in the coming few weeks.
11 Let us navigate this wave first before we embark on further steps to re-open. So for now, we are not reversing; we still want to progress on our transition journey. But we are not racing ahead, but we are actively responding, watching, monitoring. I will repeat this in a few Chinese words: 冷静观察、稳住阵脚、沉着应对。
12 The imperative now is to quickly adjust our healthcare protocols and that is a very urgent task. We are no longer dealing with 50 or 100 cases a day but multiple times of that. The old ways do not work anymore.
13 So what numbers are we potentially dealing with?
14 Based on the experiences of other countries, mainly in Europe, which are also highly vaccinated, a transmission wave does not last forever. It typically takes four weeks, if not eight weeks; or we can assume around 30 to 40 days to peak before it comes down, and then stabilise. During that rise, daily cases can double every 10 days. This means we need to be prepared for four to five doubling cycles.
15 We are 18 days into the wave and it has doubled twice and on its third doubling cycle – from 100 on 23 August to 200 on 3 September, and now 200 to 400, and now 400 to 800. Beyond that, it may go on for another two cycles, meaning daily cases may double from 800 to 1,600 and 1,600 to 3,200, hitting a peak before starting to come down and stabilise.
16 What I have just said is what is possible, having observed what happened in other countries. How it will actually unfold will depend on what we do collectively: to test extensively, reduce interactions where possible, wear our masks properly and diligently, get ourselves tested when required, isolate ourselves when ill or tested positive through an antigen rapid kit. If we do that, we may be able to avoid five doubling cycles.
17 Let me cite some numbers in other countries, which have settled down and living life quite normally. If you look at the infection rate, in terms of number of infections per 100,000 population per day: South Korea – 3 to 4; Italy, Denmark, Sweden – 9 to 10; Germany – 11, Netherlands -15, France – 18, Switzerland – 30; USA – 45; UK – 55. Currently, we are at 7, at the lower end of all these countries that have been living with COVID-19. Our numbers are rising and it may surpass many and peak before it comes down, but that is how other countries have dealt with it. Going through a wave in order to live with COVID-19.
18 The key imperative is to get our healthcare protocols readjusted and reconfigured. Our public health responses need to shift decisively to cope with much large number of infections. Based on the characteristics of Delta variant, which DMS has presented, we will make the following four major changes:
19 First, quarantine. At these numbers, our contact tracers can no longer interview every infected individual and map out their whereabouts and contacts; link them and identify clusters.
20 Instead, we will focus on dealing with vulnerable settings and large clusters. We will also rely on simpler and scalable methods, such as automatically requiring household members to be quarantined at home.
21 We will also generate a list of close contacts using TT data. For very close contacts, we can send out Health Risk Warnings, so that they are required by law to get themselves tested and self-isolate till they receive negative results. We will also send Health Risk Alerts to other contacts, for them to monitor their health.
22 Second, as the incubation period for Delta is shorter, with a median of under four days, we will shorten the quarantine period from 14 days now to ten days. This will be less disruptive to people, and yet capture a significant majority of infected cases.
23 Third, based on the finding that infected individuals with CT>25 are no longer infectious during the recovery phase, we can also bring forward discharge.
24 Today, an individual is discharged on Day 10 if he is tested negative or CT>30. We will now allow discharge at Day 7 if he is tested negative or CT>25. If not, he will be discharged at Day 10. We will continue to review the data and tweak the discharge policy accordingly.
25 Fourth, we will move decisively to home recovery. This is very important, so that hospital beds are allocated to those who truly need medical attention. Today, the large majority of infected patients are in hospital for observation, and most are discharged uneventfully.
26 We have started a home recovery pilot for 21 individuals, with nine already discharged. It has worked well, the individuals are relieved they can recover from home, and neighbours have been very supportive and understanding, and I thank them for that.
27 We would have wished for more time to expand the pilot but we need to make a bigger move. We will implement in the next few days a default home recovery for one group of individuals, and strongly encourage home recovery for another group of individuals.
28 First, those who are young, fully vaccinated, who do not have comorbidities or underlying illnesses. They must not live with any vulnerable persons, e.g. pregnant, immunocompromised or anyone above 80 years old. Their homes must have a room with an ensuite toilet. We will start with younger persons and expand up to individuals who are around 50 years old. This will account for about 50 percent of infected cases.
29 Second, for infected children between 5 and 11 years old. Many parents have been requesting for them to recover and to be cared for at home, especially when the children are generally well with no or minimal symptoms. But hospitals have been cautious and have been admitting them to the wards. We will change this policy, and encourage parents to bring children infected with COVID-19 home, for recovery.
30 At the same time, we will ramp up our Community Care Facilities (CCFs), isolation beds and ICU beds. With all these changes, we can handle about 1,000 infections a day. And we have drawer plans to make further changes to the protocols and ramp up more facilities, to handle beyond 1,000 daily cases.
31 I should point out that the protocols I just described are similar to those practiced in the US, Japan, UK or in Europe. Their starting point is Influenza protocols, while ours is the SARS protocols. In terms of severity and transmissibility, COVID-19 is somewhere in between SARS and Influenza, and so we find our practices converging over time.
32 While we have a very high vaccination coverage, we will continue to administer vaccines. Our mobile and home vaccination teams, including many volunteers, continue to work hard to get vulnerable seniors vaccinated.
33 We have announced the start of a booster programme. Our Specialist Outpatient Centres will offer booster vaccinations to fully vaccinated immunocompromised persons from 15 September 2021.
34 In addition, there are about 900,000 seniors aged 60 and above eligible for the booster shots. From 14 September 2021, we will be sending out some 200,000 SMSes to those who took their second shots in March this year or earlier, to make an appointment for their booster shots.
35 The booster shot can be either Pfizer or Moderna, as recommended by Expert Committee on COVID-19 Vaccination (EC19V). The Ministry of Health (MOH) recommends that you take the shots, so please come forward.
36 We will begin administering the third shot to seniors aged 60 and above in nursing homes around the same time.
37 About 1.5 percent of our population has taken the Sinovac vaccine, administered through the SAR route by private clinics. MOH has also administered the Sinovac vaccine to those who are allergic to the mRNA vaccines.
38 The private clinics had suspended vaccination as their stock has been depleted. MOH has facilitated the ordering of new stock. Barring unforeseen circumstances, they should arrive around 20 September, and be available at some of these clinics a few days after that.
39 I mentioned earlier that to live with COVID-19, no country is spared from going through a wave of transmission like what we are experiencing now.
40 But we have done whatever we can to prepare for this – Circuit Breaker, Heightened Alert, TraceTogether (TT), Safe Management Measures, and very importantly, vaccinating the large majority of our population.
41 I have consulted widely when preparing these talking points. After hearing from so many experts and doctors, I would like to convey an important advice to the following groups.
42 If you are a senior, minimise your social interactions for the next one month. Just go out for the essentials, like buy food, or see the doctor. This is especially if you are still unvaccinated. If you pull down your mask, and chat with friends for an hour, you put yourself at a very high risk of infection.
43 If you are a young person living with seniors who are parents or grandparents, please help to protect them. Also minimise your social interactions, cut back on eating out, or do not bring home too many friends home. These activities can easily bring the virus to the seniors.
44 If you are pregnant, please understand that the scientific data internationally is very clear – that vaccines are safe for you and your baby, but a COVID-19 infection is not. Please get yourself vaccinated.
45 If you are somehow still not vaccinated, or have been persuading your parents, grandparents or pregnant wife not to get vaccinated, it is perhaps time to reconsider. The risks between vaccinating and not vaccinating have significantly shifted.
46 More than ever, we need to all work together, exercise civic consciousness and personal responsibility, and do our part. Take care of ourselves, and everyone around us.