SINGAPORE — The Government will look at the number of community transmissions, the global situation as well as the safety of systems in place as it decides when to lift the circuit breaker measures, Health Minister Gan Kim Yong said on Monday (May 4).

In a ministerial statement in Parliament on the Covid-19 situation, Mr Gan said that first, the Government needs to be assured that community transmission locally is stemmed, or very low.

“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,” he said.

There also needs to be a decrease in Covid-19 infections among migrant workers, which remain high.

“While we have been able to keep local community cases low despite a higher number of cases among migrant workers, it is equally important to reduce the migrant worker cases over time, though it will take a while longer,” Mr Gan said.

“Otherwise, we will continue to be at risk of a spillover from the dormitories into the wider population.”

Secondly, he said the Government will assess the global situation to decide on the extent and approach in reopening Singapore’s borders. The Government will review the rate of transmissions in other countries, as well as what they have done to contain the spread of Covid-19.

“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 a community spread,” Mr Gan said.

Third, he said the Government will put in place a system to allow the country to open up safely. With more business and social activities set to resume, there will be more interactions and a higher risk of virus transmission at the workplace and in the community, he pointed out.

“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 said.

Aljunied Group Representation Constituency (GRC) and Workers’ Party (WP) Member of Parliament Sylvia Lim asked if the Government was using the effective reproduction number when coming to a decision on whether to lift circuit breaker measures.

The effective reproduction number is a measure of the average number of cases that are expected to occur in the population as a result of one infected individual. For example, if a person develops the infection and passes it on to two people, the reproduction number is two.

Responding to her question, Mr Gan said that while the Government was tracking the number closely, it did not want to rely on the numbers alone as the number “means different things in different contexts”.

For instance, during the Covid-19 outbreak in Safra Jurong in March, the number was significantly higher during that period, said Mr Gan. At the time, the cluster was the biggest in Singapore.

“Now, the reproduction number is significantly lower and reflected in the total number of cases that you see,” said Mr Gan who did not specify the latest effective reproduction number for Singapore.

At the same time, the reproduction number is higher in dormitories which have a higher infection rate.

With the numbers depending on the context, Mr Gan said he would prefer not to “peg (the Government’s) metrics to one number alone.

TESTING TO BE EXPANDED

Mr Gan added that Singapore already has one of the highest testing rates in the world and that the Government plans to expand its testing capacity in a manner that will have the greatest impact.

The Government has, to date, conducted over 140,000 tests for Covid-19, or 2,500 tests per hundred thousand people in Singapore, he said.

He added that the Government currently has the capacity to conduct more than 8,000 tests a day in total across the community and migrant workers in dormitories, up from 2,900 in early April, and is working to ramp up testing capacity to 40,000 a day.

Aljunied GRC and WP MP Pritam Singh asked when the Government aims to reach this target.

Mr Gan said the Government hoped to do so in a short period of time but this was subject to several constraints.

The first was the availability of test kits, and the Government will have to look into sourcing for those manufactured locally and globally, he said.

Second, it will also need to ensure that there is sufficient material to conduct tests, such as reagents.

Third, the Government will also have to ensure there is adequate manpower at every stage of the test.

“We can do the swabs, but having swabbed individuals, we will still need to process the swabs, document it, test it and have the results properly recorded. All this requires laboratory capacity, infrastructure and manpower requirements at every stage of the test,” said Mr Gan.

With the increase in testing, the Government will be able to widen the net for diagnostic testing for symptomatic cases, active case finding, as well as screening and surveillance testing in the community and among workers, Mr Gan said in his speech.

“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,” he added.

Currently, tests are done for three reasons, he said: To diagnose suspect cases to provide early treatment and isolate close contacts, to do screening and active case finding of individuals at risk, such as migrant workers decanted from their dormitories before they return to work, and to do surveillance to monitor undetected cases in the community.

WP's Non-Constituency MP Leon Perera had asked about the impediments to testing asymptomatic individuals who may be at risk of Covid-19, and the extent to which testing has been expanded to those who do not exhibit symptoms.

Mr Gan said this is something the Government will study, but he pointed out that the yield will be very low “if asymptomatic testing is done indiscriminately for the whole population”.

“To be effective, it may also need to be done repeatedly as it does not reflect immunity and those tested can be infected after the test. It may not be the best way to use testing resources.”

However, Mr Gan said that the Government has started doing asymptomatic testing selectively for priority groups such as young children living with Covid-19 patients and seniors, particularly nursing home residents.

“Such tests complement existing precautionary measures, such as good infection control practices and close monitoring for symptoms in staff and residents. They will allow us to intervene early where needed to protect the elderly residents,” said Mr Gan.

He added that as more businesses are reopened, the Government may also conduct tests for essential service workers and at borders to reduce the risk of local transmission from imported cases.

Responding to Mr Singh’s query on whether there are plans to test all foreign workers in Singapore, Mr Gan said that there were no such plans at the moment and testing was currently targeted. 

“We do testing on dorms generally to establish a baseline level of infection in each dormitory so that we are able to strategise how we respond to dormitories. And we also do baseline testing of workers in general to have a sense of where we are in terms of the infection rate,” explained Mr Gan.

The Government also conducts aggressive testing in selected dormitories to identify infected workers so that they may be isolated from others, he added.

Mr Gan said that essential workers, including foreign workers, will be tested more than once as part of the Government’s strategy to ensure the safe restoration of business activities.

“For foreign workers who continue to work in essential industries, we will test them, sometimes not once but repeatedly, as they continue to be exposed in the community, in the workplaces...” 

Ms Cheryl Chan, the MP for Fengshan, raised the issue of Covid-19 patients who are recovering well but continue to test positive for the virus despite being housed in community care facilities, in some cases for over a month.

Responding to her, Mr Gan said that the Government was discussing with infectious disease experts on what more could be done for such patients.

He explained that in some cases, patients continued to test positive as tests continue to pick up fragments of the virus even though these fragments are no longer viable and these patients are no longer infectious. 

“And so far, we have been keeping (the patients) in the community care facilities and you’re right that to keep them there is also not very good for them as they are not able to move around freely,” said Mr Gan.

National Development Minister Lawrence Wong said that the Government's decision to begin easing some of the circuit breaker measures from May 12 cannot be taken as a signal that Singaporeans "can now take it easy and start to go out more".

"Remember, the fight is far from over. This battle against the virus is not a sprint; it’s a marathon, and we are not even at the halfway mark," he said. "The virus can flare up again anytime, so we cannot afford to slacken. We must stay vigilant, maintain our discipline, continue to stay home and minimise contacts with others."