SINGAPORE: For Singapore to lift COVID-19 "circuit breaker" measures, the number of community cases daily should fall to zero or single digits over a sustained period of time, said Health Minister Gan Kim Yong in Parliament on Monday (May 4).
This is one of three factors being considered when deciding on how to open up again and emerged from strict measures put in place.
AdvertisementAdvertisement[h=3]READ: 66 COVID-19 cases among healthcare workers and support staff: Gan Kim Yong[/h]"Numbers are important. We need to be assured that community transmission locally is stemmed, or very low," said Mr Gan in his ministerial statement.
“Community cases should ideally fall to zero or single-digits daily, with very low numbers of unlinked cases, not just for one day, but sustained over a period of time."
There also needs to be a fall in the number of migrant worker cases, Mr Gan added, noting that this will take "a while longer". The vast majority of Singapore's COVID-19 cases are work permit holders living in dormitories.
AdvertisementAdvertisement[h=3]READ: Singapore to start gradual easing of circuit breaker measures as COVID-19 community cases decline[/h][h=3]READ: COVID-19 circuit breaker extended until Jun 1 as Singapore aims to bring down community cases ‘decisively’: PM Lee[/h]“It is equally important to reduce the migrant worker cases over time, though it will take a while longer. Otherwise we will continue to be at risk of a spillover from the dormitories into the wider population,” Mr Gan said.
START "SMALL AND SELECTIVELY" IN REOPENING BORDERS
Apart from tracking the daily infection numbers, Mr Gan added that the Government needs to make an assessment of the situation globally in order to decide on its approach In reopening Singapore's borders.
“We would review the rate of transmissions in other countries, as well as what they have done to contain spread," he told the House.
"For any reopening of our borders, we are likely to start small and selectively, and to continue to impose a mix of isolation and test requirements, to protect ourselves from new imported cases leading to community spread.
Singapore must also put in place a system to be able to open up safely such as stepping up COVID-19 testing, said Mr Gan, as there will be a higher risk of transmission when businesses are social activities are allowed to resume.
“Therefore we need to step up our capability and capacity to test and detect cases early, contact trace quickly, promptly ringfence close contacts, and establish the original source of the infection to stop other undetected transmission chains, if any," he explained.
“These are the key enablers which give us confidence to reopen.”
TESTING CAPACITY
To date, Singapore has conducted more than 140,000 tests for COVID-19, which works out to 2,500 tests per 100,000 people in Singapore, said Mr Gan.
Responding to Members of Parliament who asked about the different tests available, the Health Minister said Singapore uses mainly the polymerase chain reaction (PCR) test to detect confirmed COVID-19 cases. PCR tests work by detecting the virus RNA from a nose or throat swab, and is the gold standard for detecting current infection, Mr Gan explained.
PCR testing is done to diagnose suspect cases to provide early treatment and isolate close contacts, as well as to do screening and active case finding of individuals at risk, such as migrant workers moved from their dormitories before they return to work.
This kind of testing is also used in conducting surveillance to monitor undetected cases in the community.
Currently, Singapore has the capacity to conduct more than 8,000 PCR tests a day, up from 2,900 a day in early April.
Authorities are working with various private and public sector partners to further increase the testing capacity to up to 40,000 a day by later this year.
"With this increase, we will widen the net that we cast for diagnostic testing for symptomatic cases, active case finding, screening and surveillance testing in our community and among workers, including migrant workers," said Mr Gan.
“We will also do more testing and monitoring to pick out asymptomatic and pre-symptomatic cases among priority groups such as nursing home residents and staff, to prevent clusters from developing. Testing is crucial as risk of infection will increase when we allow more economic and social activities to resume."
ASYMPTOMATIC TESTING
Amid questions about whether asymptomatic testing can be done for the entire population, Mr Gan said his ministry will study this, However, he said the yield will be very low if asymptomatic testing is done indiscriminately, as there is no widespread community transmission.
"It may also need to be done repeatedly as it does not reflect immunity and those tested can be infected after the test," he explained. "It may not be best way to use testing resources."
Instead, the authorities will and have started doing asymptomatic testing selectively, for priority groups.
[h=3]READ: Stretched but coping: How Singapore's healthcare system has cranked up efforts to deal with COVID-19[/h]“For example, we currently test asymptomatic young children, if they are in the same household as COVID-19 patients, since they may not be able to articulate their symptoms well,” Mr Gan said.
“As more businesses reopen, we may also do more tests for essential service workers. At our borders, we can also deploy tests for arrivals to reduce the risk of local transmission from imported cases.”
Mr Gan also pointed to a study by the National Centre of Infectious Diseases (NCID) that showed that while infection rate among the healthcare workers and general population is extremely low, among close contacts, around 2.5 per cent had antibodies, despite not having had symptoms during their quarantine period.
“That means they had been infected earlier but recovered, and remain well without any symptoms. This points to the need to continue our efforts to quickly isolate close contacts of confirmed cases,” he added.
“We will continue to do more of these studies, to help us understand the extent of spread and immunity in the community. I should add that scientific evidence on protective immunity is still under intensive study currently."
Testing more people and for more purposes will be important as Singapore starts to open up, “so that we can pre-emptively detect and break any potential transmission chains,” said the Health Minister.
Mr Gan also gave updates on the capacity in hospitals. The number of isolation beds has increased from around 550 in January to close to 1,500 as of May 2, he said. NCID has also increased their capacity from about 100 to close to more than 500 negative pressure isolation beds in the same period, he said.
A total of 28 COVID-19 patients are in intensive care. Hospitals have almost 150 vacant beds in the intensive care units, and the healthcare system can “quickly bring another 300 online”, Mr Gan said.
Additionally, the public hospitals have put in place plans to ensure that their infrastructure, equipment, medications and manpower are in place to add another 450 ICU beds by mid-May if needed, he added.
“We have also ensured a sufficient supply of ventilators and other ICU accessories to support the care of ICU patients."
IMPORTANCE OF HEALTHCARE WORKERS
Beyond the hardware and technology needed to handle COVID-19, Mr Gan underscored the importance of healthcare workers.
“They are at the centre of our fight against this COVID-19 outbreak. We deeply appreciate their sacrifices, long hours as well as personal and professional commitment to care for each patient. This will be a long campaign, and we need to support our healthcare workers and take care of their needs,” he said.
Responding to MPs who asked about the well-being of healthcare workers, Mr Gan gave assurance that the Government is committed to taking care of them “in every way”.
"The many gifts and words of encouragement from members of the public to our healthcare workers mean a lot to them and have helped to keep up their morale," said the Health Minister, noting that members of the public have been writing thank you messages and buying breakfast for Singapore's healthcare workers.
"As part of the SG United initiative, close to 9,000 messages for our healthcare workers were collected from appreciation zones around Singapore,” he said.
“On behalf of our healthcare workers, let me thank you for your continued support.”
Mr Gan said that the Government recognises the “invaluable contributions of our workers” and will ensure that they receive due recognition for stepping up during this challenging period.
“We recognise that no monetary compensation is ever enough. I want to again acknowledge and thank our healthcare workers for their hard work and dedication,” he said.
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