Let me revisit the analogy I used at the last press conference, which is that COVID-19 is like riding a bike downslope. Left on its own, it will go faster and faster, and eventually we lose control of it and crash.
Speed of Bike and SMMs
2. That is why we apply brakes, so that the bike goes down at a controlled speed, and we can arrive safely at our destination. There are three brakes – Safe Management Measures, vaccination and boosters, and border restrictions.
3. How fast is our bike going down the slope now? With everything that we are doing – selected border openings and VTLs, wide coverage of vaccination, active boosting, Safe Management Measures such as masks wearing and group size of two – the bike is actually slowing down.
4. And hence we see the week-on-week infection ratios going below one. Our reproduction rate of infections is now estimated to be about 0.9. The situation in our ICU wards is currently stable, improving slightly, but only slightly.
5. We are watching all these numbers and their trajectory very closely. Many MOH experts or healthcare experts have expressed that while the situation has improved, by no means have we reached an equilibrium with the virus or are we in a steady state situation yet.
6. There is no doubt, if we remove all the Safe Management Measures tomorrow, infections, ICU numbers and deaths will spike rapidly. But the current situation, with all the measures currently in place, gives us some scope to relax the measures that we spoke about at the last press conference.
7. So, on the brake of Safe Management Measures, there can be some relaxation measures as mentioned by Minister Gan, and Minister Lawrence Wong will elaborate on it.
8. As for the brake on border control, the general situation has not changed – which is that the pandemic situation has stabilised in many countries, and in fact for many of them, their infection rates are lower than Singapore’s, which makes this brake not so relevant in today’s circumstances.
9. There has however been a new development since our last press conference, which is a new wave of infections in Europe as they approach winter. The World Health Organization (WHO) has warned that Europe is once again at the epicentre of the pandemic.
10. The new wave in Europe is due to insufficient vaccination take-up. According to the WHO, three-quarters of new cases in Europe were aged over 65 years, and most were unvaccinated.
11. Hence, European countries with lower vaccination rates, such as Germany, France and Switzerland, are seeing higher hospitalisation rates as compared to countries like Denmark, Italy and Spain, with higher vaccination rates, and fewer people getting hospitalised. That is why the COVID-19 pandemic continues to be described as a “pandemic of the unvaccinated”.
12. Overall, despite the rising cases in Europe, infection rates are not out of control in Europe. To illustrate, Singapore’s infection rate, based on the past 7 days average, is about 46 per 100,000 population. Denmark and Germany, despite rising cases are at 28; Spain below 5; Sweden 8; France 10; Switzerland 24; Netherlands 51; UK 55. So, all comparable within a certain range.
13. MOH will continue to closely monitor the situation in Europe and elsewhere in the world too. What is noteworthy is that within Southeast Asia, the pandemic situation is fast stabilising. We will therefore be adjusting the risk classification for several ASEAN countries, including upgrading Cambodia, Indonesia, Malaysia and Vietnam from Category 3 to 2, and Laos, Myanmar, the Philippines and Thailand from Category 4 to 3. And this gives us scope to start opening up our borders with regional countries as well.
14. The next set of brakes, are vaccination and boosters.
15. Including those who have received their first doses, we have covered 95% of our eligible population. This has been a tremendous feat.
16. So when we report every night in our press release that 85% of our total population has completed their full primary series regimen of vaccines, the remaining unvaccinated individuals comprise mainly two groups.
17. First, are the eligible groups who remain unvaccinated. Second, children below 12 who are not yet eligible.
18. For the first group, we are particularly concerned about unvaccinated seniors above the age of 60 years, as they are very likely to fall seriously ill if infected with COVID-19. But with the hard work of all our vaccination teams, we have reduced this group significantly. The size of this group was 175,000 in early August. Today, it is below 64,000.
19. If not for this reduction, our hospitals and ICUs today would have been already overwhelmed. I want to once again thank all our partners who made this possible, and especially those who volunteered their time.
20. The Mobile Vaccination Teams (MVT) and Home Vaccination Teams (HVT) were especially critical in bringing vaccinations closer to the seniors. Since July 2021, the MVTs have reached 70,000 persons, including 27,000 seniors.
21. And now given that the Sinovac vaccine is part of the National Vaccination Programme, from 8 November, our MVTs will also administer the Sinovac vaccine.
22. Since 30 October, we started using the Sinovac vaccine at the Raffles City vaccination centre and approved clinics, and allowed walk-ins for seniors if they are aged above 60. Since then, more than 2,900 individuals have come forward to receive their first dose of the Sinovac vaccine, and amongst these, 500 are seniors.
23. So it is not a huge number, but three doses of the Sinovac vaccine can provide good protection against COVID-19 related severe illnesses and deaths, and it will further reduce the number of vulnerable unvaccinated seniors.
24. Next, our booster programme is also progressing well. As of 4 November, amongst those invited to receive their boosters, 85% of those aged 60 years and above have received their booster dose or booked an appointment, 52% of those aged 50 to 59 years, and 67% of those aged 30 to 49 years have done so.
25. Before the end of the year, we should have 50% of our population who have taken their boosters. We can already see the difference boosters are making to both case numbers and severity of illnesses. In the coming weeks, it will make a huge difference in terms of living with COVID-19.
26. From one end of the age spectrum, let us now move to the other end – which is our children. The incidence of COVID-19 infection in children has been increasing with the local surge in cases.
27. While children have a lower risk of severe disease, with a large number of cases, a small number can still develop life-threatening disease and severe later complications such as MIS-C (Multisystem Inflammatory Syndrome in Children). So far, we have four such cases out of 8,000 children COVID-19 infections, which translates into 0.05%. Vaccination will reduce this risk. Dr Janil Puthucheary and DMS Kenneth Mak will speak more about this later. But I want to say something about the vaccination of children.
28. MOH has been in talks with Pfizer to prepare for the vaccination of children aged 5 to 11 years. We have said and reported that the whole process will likely take us to early next year, before vaccination can start.
29. The major development over the past week had been the authorisation by the United States (US) Food and Drug Administration (FDA) for the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children aged 5 to 11 years. Twitter is now full of pictures of children in the US receiving their COVID-19 vaccines. I was told Sesame Street made a video of one of their muppets, Rosita, taking her vaccination as well. So they are promoting this in the US.
30. The decision was made in the US after a clinical trial conducted by Pfizer for children in this age group, each of whom, as recommended by the drug manufacturer, received one-third of the full adult dosage. So children will still receive two doses, separated. Each dose is one-third that of the adult dosage. And that was done during the clinical trial in the US. The study in the US concluded that vaccination for this group is safe and effective based on this reduced dosage of the adult formulation of the vaccine.
31. Our Expert Committee on COVID-19 Vaccination (EC19V) has studied the data and agreed with the conclusions of the US review. They assessed that in Singapore, it is overall beneficial for children to receive the vaccines, especially in the current setting of community transmission.
32. The EC19V will soon, we expect maybe second half of this month, to make a recommendation on the use of the Pfizer-BioNTech/Comirnaty vaccine for children aged 5 to 11 years in Singapore.
33. At the same time, MOH is embarking on a study involving a few hundred children in this age group who will receive the recommended smaller dosage of the adult formulation. This is partly to see the results for ourselves in a local context, but more importantly, to work out a smooth vaccination process for the children and their parents, before we scale up.
34. Hence, we are pushing ahead with vaccination for children aged 5 to 11 years as soon as we can, and once the EC19V has finalised their recommendation and given the go-ahead. This is so that parents have the added assurance and peace of mind that their children can become protected.
35. Once vaccinations cover children aged 5 to 11 years, we would have left with only a small proportion of our population not covered by vaccines. There are mainly two groups:
36. For the very young, aged 0 to 4 years, we will have to continue to monitor the development of vaccines suitable for them. Fortunately, by and large, the virus tends to affect this group less adversely.
37. As for individuals who do not want to take any of the vaccines, we will need to have Safe Management Measures which differentiate between the vaccinated and unvaccinated. This is in order to protect the unvaccinated, and also to preserve our healthcare capacity. One example is the restrictions on the unvaccinated to participate in higher risk activities and settings, such as dining in restaurants, hawker centres and coffee shops.
38. For hawker centres and coffee shops, we now rely on a light-touch approach of checking to see if they are vaccinated. But it is a high-risk setting, and we will need to move towards a system of more thorough checks at the entrances to ensure that vaccination differentiation is well implemented.
39. As I have mentioned in a recent Parliamentary reply, MOH will also have to impose hospital charges for COVID-19 patients who are eligible but choose not to be vaccinated. This will start from 8 December 2021.
40. Our hospitals really much prefer not to have to bill these patients at all, but we have to send this important signal, to urge everyone to get vaccinated if you are eligible. Billing will still be based on our current subsidy framework, subject to MediSave use and MediShield Life claims. So it will still be highly supported and highly subsidised.
41. Finally, let me just say a few words on healthcare capacity, specifically on the Home Recovery Programme (HRP), and my colleagues will elaborate further on the ICU and condition of our COVID-19 patients.
42. For HRP, operations have been stable and quite smooth. Response time has improved greatly. Currently, over 90% of COVID-19 patients receive their follow-up call from MOH within 24 hours to onboard them.
43. However, there is still the last 10% who are not onboarded on time. The key is for the individuals to fill up the FormSG quickly and properly once you receive the SMS notifying that you have a positive PCR result. That will automatically trigger the response from the HRP operations team and resolve most of the delays and most of the problems.
44. As for those who require telemedicine consultations, the average waiting time had been brought down to around two hours now.
45. I want to specifically address the concerns of one group, which is our seniors who prefer to recover at home, because loved ones are around, and they are familiar with the surroundings.
46. I want to assure our seniors that although our healthcare protocol says that by default, we convey COVID-19 patients above 80 years old to hospitals, this is a default guideline. Where such patients prefer to be cared for at home, we want to support you to do so, including through the home-based care programmes of many of our hospitals.
47. But if we do so, we must also be prepared for the possibility that some patients who are at the end of their lives and who will request to be cared for at home, may pass away at home. And should this happen, we will also make the subsequent process smoother.
48. There was a recent case reported in the media on a senior who tested positive using ART kit and then subsequently passed away at home, and the family had difficulty having the body conveyed out of the residence. I read a follow-up letter from the Association of Funeral Directors, which said that the current MOH rules do not allow them to handle COVID-positive cases in residential premises.
49. So we will take the feedback and revisit the regulations. If they are unclear, we will improve them. We will also work closely with the National Environment Agency and some of the funeral directors to ensure that whatever revised regulations we have can allow them to safely handle COVID-positive cases who pass away at home.
50. We are seeing more and more seniors with advanced medical conditions, who want to undergo palliative care and spend their last precious moments at home, in the presence of loved ones, and we respect these decisions. We think it reflects a positive shift in societal attitude, and MOH will support this shift.