1. Good afternoon. Today, Director of Medical Services (DMS) Associate Professor Kenneth Mak and I will focus our presentation on how we are handling the Omicron variant.
Emergence of Omicron
2. South Africa, which has strong capabilities and know-how to sequence and detect the virus, is detecting rapid spread of the Omicron variant in some parts of the country, particularly in the Gauteng province. But it is also likely to be spreading elsewhere in Africa, just not detected. So the medical community here is very grateful to South Africa for their continued surveillance of COVID-19 and for alerting the world to this emerging variant called Omicron.
3. The World Health Organization (WHO) has classified it as a Variant of Concern (VOC). This is mostly because of the relatively large number of mutations – 32 out of about 5,000, just on the spike protein. There is therefore reason to believe that Omicron may have fairly different characteristics from the previous COVID-19 variants that we know about.
4. For example, is it really more or less infectious compared to Delta? Is it more or less harmful? Do existing vaccines work well against it or less well against it? There are no clear answers to these questions now. Scientists around the world are working hard to provide some answers in the coming weeks.
The Situation we are Facing
5. So the situation we are facing is this: We have our known enemy, called the Delta variant, which we have developed a set of counter measures and honed them over time, and we are making good progress in living with the Delta variant.
6. And then we have an unknown enemy. If this unknown enemy is indeed a lot more transmissible than what Delta is currently, Omicron could spread much more widely than Delta. Whether it would dominate the other variants just like how Delta had done previously, it is a possibility that we need to be alert to and watch out for. It is not definitive. Remember in South Africa, the Delta variant is actually on the wane with fairly few cases, and then Omicron emerges. Nowhere in the world have we noticed a clash between these two variants. We also do not yet know if Omicron infection causes more severe illnesses.
7. In terms of potential timeframes, if indeed Omicron is more transmissible and begins to dominate over Delta, what kind of timeframe are we looking at? We can draw a reference to the Delta variant. Delta took about three to four months to become the predominant variant globally. If Omicron is very infectious, it may be faster than three to four months.
8. However, the spread of Omicron can also be slowed down because countries this time are a lot quicker in introducing border measures. We are seeing US, UK, EU member states, Southeast Asian countries including Singapore, Japan, Australia, Israel, all took swift actions to suspend entries of travellers from affected countries. This did not happen as quickly for Delta.
9. On balance, even if Omicron establishes itself and causes large epidemics around the world, we hope it will take a couple of months. This period of a couple of months will give us valuable time to understand this variant, find out more about it and put in place the appropriate counter measures.
10. During this time, we may see sporadic cases slipping through into our borders, and we want to be able to detect, isolate and contain these cases. What we want to prevent and need to prevent during this discovery period is to prevent Omicron from establishing itself in our community, when we do not know enough about it.
11. When we learn more about it, I am confident we will learn to live with Omicron, just like how we learnt to live with Delta.
Our Responses
12. Given that, our response now will be based on the following two principles:
- First, we will run parallel healthcare protocols – one for the known Delta, and the other for the unknown Omicron. The first to co-exist, the second to contain; and
- Second, buy us time, at least for several weeks, to learn about Omicron.
13. There are a few things we are doing.
14. First, to quickly establish our starting point. So far, indications are that we do not have any Omicron infections in Singapore yet. We are testing travellers and aircrew who arrived in Singapore over the past 10 days who have recent travel histories to the affected regions. There are over 200 of them. We have done 174 tests so far and all are negative.
15. Second, we will freeze all new VTLs and relaxations on social measures. This is a prudent thing to do for now when we are faced with a major uncertainty.
16. Third, we have implemented a new set of healthcare protocols for Omicron. We will continue the current healthcare protocols for Delta. As for the Omicron measures, the healthcare protocols will be a lot stricter and quite similar to the initial protocols we implemented when we first encountered COVID-19. And everyone will be quite familiar with those protocols.
17. But first, we need to differentiate the two kinds of infection – Delta vs Omicron. PCR tests continue to be able to pick up COVID-19 infections of all variants. But there is a particular PCR test supplied by Thermo Fisher, which goes beyond identifying a person as being infected by COVID-19, it can also indicate if the person is likely to be infected by the Omicron variant because this is a particular difference in the S-gene drop out.
18. So we will prioritise this particular PCR test on travellers. It is not fool proof, but the indicative result allows us to act faster and differentiate the healthcare protocols between the two kinds of infections.
19. So if an individual is suspected of being infected by Omicron, he will be admitted to the National Centre for Infectious Diseases (NCID), and if confirmed, will be managed there until we are confident that the person is non-infectious, through repeat testing. There is no option of Home Recovery Programme (HRP).
20. We are also standing up dedicated isolation facilities for Omicron as a further option, if we feel that public health considerations justify this.
21. The swab samples from all these individuals will also be simultaneously sent and prioritised for viral genetic sequencing, so we can ascertain if it is indeed an Omicron variant infection.
22. With every Omicron positive case, we will do what is familiar to everyone, we will conduct full contact tracing. Contacts will then be placed under quarantine and tested with PCR for exit.
23. Fourth, we will continue to push ahead with vaccination. This is absolutely the wrong time to argue that because there are new variants, let’s not vaccinate and wait for a new vaccine. People die because of such arguments and decisions.
24. Remember when we are faced with the unknown, we buy insurance. The insurance is now the existing vaccines. It is not a case where there are mutations and hence existing vaccines will not work, because the human body is much more capable than that, once vaccinated. There is a good chance that existing vaccines will work against Omicron.
25. Doctors from South Africa have observed that amongst Omicron cases with severe symptoms, 65% are unvaccinated and the remaining 35% partially vaccinated. These are very brief early data but it suggests that the vaccine could still be effective and underscores the importance of vaccines. If anything, it is a much more valuable insurance against a big unknown confronting the world now.
26. So please continue to get your vaccination and booster shots. The Ministry of Health (MOH) will also continue to administer vaccines proactively and leveraging our mobile and home vaccination teams to reach out to seniors. We are also making good progress in preparing for paediatric vaccination for those aged five to 11. We will announce details when ready.
27. Fifth, is to learn about Omicron quickly. There are many aspects, but let me list five key aspects:
a) How infectious is it compared to previous variants?
b) What’s the incubation and infectious period?
c) Can ART and other tests detect Omicron at the same level as the other variants?
d) Is it more or less harmful than Delta?
e) How well do existing vaccines work against it?
28. Sixth, border measures. For domestic healthcare protocols, we can use the Thermo Fisher PCR test to preliminarily identify Omicron infections and differentiate the follow-up actions. But for border policies, there is no basis for us to do so. So this is where we need to judge very carefully, and be prepared to adjust our border measures along the way. Minister Lawrence Wong will explain this.
Snakes and Ladders
29. In conclusion, the situation we are facing is like the game of Snakes and Ladders. We don’t know what is the next throw of the dice and which square we will land on.
30. If Omicron is more infectious, more harmful and vaccines do not work well against it, then we have stepped on the snake square, and we will go down, which will set us back a long way.
31. If Omicron is more infectious, but turn out milder, then in time a less harmful virus may dominate over Delta. That is actually a positive development. Then, we would have landed on the ladder square and maybe even take a leap forward in our transition to living with COVID-19. Many scientists believe this is actually one possible natural evolutionary direction of viruses.
32. Or it may be just another variant that makes no great impact, and we continue our current path to transit to living with COVID-19 as a resilient nation.
33. We can only know the answer in the coming weeks. In the meantime, we should take a prudent approach and implement appropriate measures to contain Omicron, not let it establish itself in our community, while we find out more about it.
34. I will now hand the floor to DMS. Thank you.