• Daily Covid-19 cases are set to cross 1,600 soon and double to 3,200 in a week at the current trajectory, MOH said
• If left unchecked, hospital capacity could come under strain 
• Even though most people have mild or have no symptoms, a rise in cases will also mean more patients who need hospital care
• Many patients with mild or no symptoms are also seeking care at hospitals even though it might not be necessary, MOH said

SINGAPORE — Singapore must act now to slow down the unexpectedly rapid pace of increase in Covid-19 cases, which, if left unchecked, will lead to a daily new case count of 3,200 in the next week, the Ministry of Health (MOH) said on Friday (Sept 24). 

Most infected patients now have mild or no symptoms, but if the overall number of cases continues to rise rapidly, there will also likely be a growing number of patients, especially among elders, who do need hospital care, it added.

“Hence, there is a need to slow down community transmission.” 

It also pointed out that even though most of the recent Covid-19 cases have had mild or no symptoms, many are seeking medical attention at hospitals when it might not be necessary, which has put a strain on the overall healthcare and response system and on healthcare workers.

Speaking during a press conference by the national Covid-19 task force, Health Minister Ong Ye Kung said: “As of now, (the daily case count) is still increasing and each daily jump is a big absolute number and adds pressure on our healthcare system.” 

How the trajectory will turn out in the coming weeks is uncertain, he added. 

“Looking at the momentum, it will cross 1,600 cases a day and proceed to the next doubling cycle to 3,200. Whether it completes (this cycle) we don’t know, whether it gallops there or slows down and reaches there slowly, this is something we need to observe.” 

Also speaking at the conference, Finance Minister Lawrence Wong, who co-chairs the task force, noted that the rapid rise in case numbers is due to the high transmissibility of the Delta variant.

“The reproduction rate of the Delta without any safe management measures is easily around five or six,” he said. This means one infected person could potentially spread the disease to up to five or six others.

“With all the safe management measures… the calibrated reopening that we have put in place, we were able to bring down the reproduction rate from a natural rate of five or six, down to about 1.5.” 

Even at this significantly reduced rate, cases will double every eight to 10 days, Mr Wong added. 

“That’s the reality. And to bring it further down, requires a lot more effort.”

And because of the large base of cases, there have been “tremendous pressures” on the healthcare system and healthcare workers, Mr Wong said. 

“So that’s what we are dealing with now, and that’s why we are putting in place these measures to allow us time to settle, stabilise our new home recovery protocols, and also to augment our healthcare capacity.”

Prime Minister Lee Hsien Loong said the new measures announced by the task force will "help us get safely to being a Covid-19 resilient nation" by protecting the capacity of Singapore's healthcare system, ramping operations to support home recovery for patients and supporting businesses affected by the latest restrictions.

The new measures will give Singapore more time to deliver Covid-19 vaccine booster shots to residents and vaccinate those still not vaccinated while expanding hospital capacity, Mr Lee wrote on Facebook on Friday night.

"This will ensure that our healthcare system is not overwhelmed and can continue to take good care of all those who need medical care, whether for Covid-19 or other conditions," he added.

"I know the changes can be confusing and unsettling, but please bear with us. We will work closely with you to protect all our families."

HOW HOSPITALS ARE COPING

A video of patients at Tan Tock Seng Hospital (TTSH) being placed in an area resembling a car park or warehouse has been making the rounds, highlighting the jump in patients that hospitals here are facing. 

In response to a query about the video, a TTSH spokesperson said: “Due to the surge in community cases, the facility is an extension of our emergency department to create more screening space as part of our safe Covid-19 ramp-up efforts.”

In a Facebook post on Sept 19, the hospital also noted: “The last week has been rough. We have been receiving higher than usual Covid-positive and suspect cases via ambulances and walk-ins at our emergency department.”

Besides tending to emergency cases, the department also triages Covid-19 cases and decides whether they should be admitted for treatment, sent home under the home recovery programme, or transferred to the community care facilities.

Speaking at the press conference, Associate Professor Kenneth Mak, director of medical services at MOH, said that the current bed capacity is adequate for all patients who need care in the hospitals. 

“We did make plans, in the past few weeks, to ramp up some of our capacity in anticipation of the rise in cases that we currently are seeing. And we still have the capacity to increase the number of beds dedicated for Covid-19 patients,” he said. 

“However, when we look at the projection in terms of the rise in numbers, we have concerns that in a few weeks, our system may be under pressure.”

He added that the Government has set up programmes to monitor patients where they are, to make sure that they do not fall between the cracks. 

“So, if we pick up a person who shows more symptoms, is getting more sick, whether in the community care facilities or at home, we have a commitment to make sure we can extract them out, and quickly take them to the hospital as soon as possible so that they can receive timely care for their medical condition.”

MOH said in its statement: “While we have been advising individuals with mild Covid-19 symptoms that it is appropriate to recover at home, we understand the anxiety of some individuals in wanting to seek medical attention at hospitals.

“The protocols and processes for home recovery are also new, and we are still improving the system as people are adjusting to them.”

Under current protocols, most Covid-19 cases, especially younger or vaccinated individuals, who have mild or no symptoms, can stay at home to recover.

MOH added that while it irons out teething issues with the home recovery programme, it will also ramp up care facilities to handle more cases.

The number of Covid-19 patients who become severely ill — requiring oxygen support and intensive care — remains within expectations, while the number of individuals with mild symptoms has increased very rapidly, the ministry noted.

EASING STRAIN ON HOSPITALS

Patients who are stable but still require closer monitoring will be admitted to appropriate intermediate care facilities to minimise the strain on hospitals, MOH said.

Patients with comorbidities — the presence of two or more medical conditions — and with a risk of potentially developing severe illness, but who are otherwise asymptomatic or mildly symptomatic, will be closely monitored at community treatment facilities, which are being set up progressively islandwide. 

These facilities will be closely partnered with hospitals so that there will be escalation protocols for such patients to be transferred to an acute hospital quickly for further treatment when necessary. 

This is similar to the existing protocol for community care facilities, but with a higher level of medical care at the community treatment facilities to ensure that these patients who are stable but at higher risk of serious illness are cared for with the appropriate level of medical manning and supporting equipment, MOH said.

Currently, there is one community treatment facility with about 300 beds, and the Government is planning to open another 700 beds at the Singapore Expo in Changi, and another 200 at Sengkang General Hospital in the next couple of weeks, Mr Ong said.

The Government is seeking help from private hospital operators and the Singapore Armed Forces to operate these community treatment facilities, he added.

There are also plans to increase the number of beds at community care facilities from 3,500 to about 4,600 by the end of this week.

UPDATES ON LOCAL SITUATION

Currently, a large majority — 98 per cent — of cases are asymptomatic or have mild symptoms, MOH said.

This is due to Singapore’s high vaccination coverage, with 82 per cent of the population having completed their two-dose full regimen. 

Of the 254 cases with severe illness in the last two weeks, a disproportionate 48 per cent were not vaccinated. The remainder were vaccinated individuals with comorbidities. 

These numbers indicate a vaccine efficacy against severe illnesses that is still around 80 per cent to 90 per cent, MOH said. 

Seniors and people with comorbidities are among the remaining 10 per cent to 20 per cent, who are still susceptible despite vaccination.

The number of patients requiring intensive care is rising at the same rate as overall case numbers, albeit with a lag. There were 21 new cases in intensive care units in the past week, up from nine the week before.