Prof Teo Eng Kiong, Master of the Academy of Medicine Singapore
A/Prof Matthias Toh, President of the College of Public Health and Occupational Physicians
Dr Brian See, Chairman of the Conference Organising Committee
Ladies and gentlemen,
1. I am happy to join you today at the 15th Public Health and Occupational Medicine Conference. This Conference started as early as 2006, which goes to show the importance placed in these disciplines.
2. When parents think of their young children growing up to be lawyers, they imagine them arguing cases in Court, i.e. litigation lawyers. They forget that there are other legal professionals doing important work such as mediation work, arbitration and corporate work, which may not involve going to the Courts. Engineers are envisaged to build skyscrapers and bridges, but there are also electrical, chemical, environmental and quantum engineers.
3. Likewise, there are doctors like those you see in ER or Grey’s Anatomy, rushing around the Emergency Departments saving lives. But there are doctors in public health and occupational medicine too, doing very important work, especially in preventive care, for communities and workplaces.
4. Hence I learnt that there is an unspoken distinction, however faint, between public health and healthcare. The former focuses on population-level health outcomes and prevention, while healthcare focuses on the clinical aspects of care and individual patient outcomes.
5. I believe that with COVID-19, any distinction between the two has been wiped off. Pre-conceptions are being dispelled. The pandemic demonstrated that prevention, management and treatment are an integrated continuum to keep individuals and society from the harm of diseases. Societal resilience protects the individual patient, while each individual patient’s personal action collectively builds up population and public health resilience.
6. The pandemic is a major inflexion point for those practising public health and occupational medicine, in terms of raising the profile and importance of your work.
7. There is no doubt that at the height of a transmission wave when hospital and intensive care unit (ICU) admissions go up, and the medical personnel in hospitals are under the most stress. We depend on them to hold the fort and minimise casualties due to the pandemic.
8. At the same time, it highlights the importance of upstream work in minimising the number of patients needing hospital care. In that regard, the experience of countries like Singapore, and now Australia and New Zealand, is rather unique.
9. At the start of the crisis, our systemic responses were based on the experience with SARS. Like many countries in Asia, we relied on important public health measures, namely, contact tracing and quarantine to curtail the transmission of the virus.
10. In other countries, especially in the Americas and Europe, they relied on an Influenza-based response – protecting the vulnerable especially the seniors, self-isolation and masking. But COVID-19 was a more infectious and vicious virus than Influenza. Hospitals in those countries were overwhelmed, and death rates were high. Our SARS-like response to COVID-19 helped us avert a major human tragedy.
11. With vaccination, the case mortality rate of COVID-19 has been brought down drastically. From Singapore’s own experience, the case mortality rate of COVID-19 was about half that of Influenza for those who received a full regimen of COVID-19 vaccination. After having the large majority of our population vaccinated, and with the advice of public health professionals, the Government declared a new strategy of transiting to living with COVID-19 as an endemic disease.
12. We had to flip our playbook, from SARS-like to more Influenza-like. The turning point was around National Day this year.
13. We knew this would be a difficult transition period. We are not familiar with an Influenza-like public health response. We fortified our hospitals as much as we can, continue to administer vaccines to the remaining population yet to receive their jabs, maintain key aspects of safe management measures such as masking and limiting group sizes. But progressively and very cautiously, we opened up our borders, allowing events and weddings to continue.
14. There are two big changes in our public health response. First, we had to develop a Home Recovery Programme, which caters to about 70% of patients today. It was a difficult start because we needed to ramp it up very quickly, but with the hard work of the team from the SAF, we have stabilised the operations.
15. Second, we reset our healthcare protocols, from a convoluted web of rules and regulations designed to snuff out the virus, to one that is simple and intuitive to understand so as to limit transmission by relying on individual responsibility.
16. Importantly, we removed quarantine as a public health response. The day after the new rules came into effect, I took a walk around my constituency, and could sense a palpable sense of relief. The uncertainty and fear of being confined and unable to work, unable to bring home an income, unable to look after aged parents and kids, were lifted off the minds of parents and workers.
17. To make home recovery work, and remove the burden of fear of quarantine, these were critical steps in changing the psychology of society in the face of a public health crisis. We moved towards a virus that has become less deadly than Influenza, for the vaccinated.
18. At every step of the way, we guided our decisions on research, data, analytics and simulation. When taking care of patients, we relied on integrated care models, coordination across health settings and community engagement.
19. Our fight continues. It is and will be a delicate balance on three fronts – further opening up our economy and society and regaining our pre-COVID-19 freedoms, continuing to vaccinate and boost our population while protecting those who are vulnerable and unvaccinated, and preserving our healthcare capacity so that when all preventive steps fail, we can still save as many lives as we can at the hospitals.
20. With each passing day, our collective resilience builds up, giving us scope to relax restrictions further, offering reprieve to our hospitals with less crowded wards. We will eventually arrive at our destination of living with COVID-19 as an endemic disease. But it is a very difficult and even painful process of adaptation.
21. Throughout this crisis of a generation, the collaboration between policymakers, healthcare professionals, and other stakeholders across the public and private sectors, was tight and almost seamless. Everyone relied on the other. This was public service at its best.
22. When the pandemic eventually subsides, I think we will develop many new capabilities, and gain valuable perspectives in solving future public health problems. By then, we will have to deal with a far larger challenge, that of the healthcare demands and needs of an ageing population.
23. Public health and occupational medicine will have to influence social determinants of health to keep the population healthy, and work with primary care providers to prevent the onset of serious illnesses. Hospitals will continue to man their posts as the last line of defence, to treat and cure the very sick, in the most effective and affordable way possible. That description is no different from dealing with the pandemic, but we are dealing with a challenge of a generation, one that is ageing rapidly.
24. I wish everyone a successful and fruitful conference. Thank you.