Ms Sylvia Lim asked the Minister for Health (a) in light of the easing of the COVID-19 safe management measures,whether community mask-off events such as temple dinners where food is served will be allowed; and (b) if so, under what conditions.
Mr Leon Perera asked the Minister for Health given a 7% increase in the age-standardised death rate in 2021 that bucked the downward trend in previous years (a) what is the Ministry’s analysis of the reasons behind this increase; (b) what is the number of excess deaths due to COVID-19; and (c) what formula is used in the Ministry’s calculation of excess deaths.
Mr Leon Perera asked the Minister for Health whether the Ministry will conduct a study on the impact of the COVID-19pandemic on (i) non-COVID-19 patients facing delayed treatment, especially older ones with chronic conditions and (ii) thepublic healthcare system, in view of the patient backlog from the periodic suspension of non-essential services.
Mr Ong Ye Kung: With the pandemic situation stabilised, the Multi-Ministry Taskforce, or MTF, took decisive steps to open up social and economic activities to almost pre-COVID-19 norms. So, to Ms Sylvia Lim’s question, temples can start to organise dinners, barring any changes in rules later.
Mr Lim Biow Chuan asked if individuals who are not fully vaccinated can be allowed to enter malls and dine in F&B outlets. I would like to clarify that they can enter malls, as we have significantly removed Vaccinated-differentiated safe management measures, or VDS, for non-fully vaccinated persons.
However, we still need to remain cautious because the next infection wave is highly possible. We also need to watch out for new variants that may threaten us again. Hence, the MTF decided to maintain VDS for the three most risky settings: nightlife outlets with dancing, events with more than 500 participants at any point in time and then, F&B outlets where there is a constant flow of diners who are mask-off and interacting. But for F&B outlets, we will, however, not deploy TraceTogether and SafeEntry, and instead put the onus on customers to ensure that they are fully vaccinated before visiting an F&B outlet. We will continue to review our VDS measures as the pandemic situation evolves.
Hence, we are taking a cautious “step down but not dismantle” posture for our public health measures. If the situation requires, we will have to step up VDS, and reactivate TraceTogether and SafeEntry. Ms Nadia Samdin asked what the criteria are to reactivate these measures. It is a matter of judgement, depending on the severity of the situation. We will have to take into account if there is a new variant of concern, whether it is more severe or more infectious than the Omicron variant, whether past infections and current vaccines continue to confer strong protection against the new variant and how all these affect our hospital capacity.
I can understand that some members of the public and Members of the House want a system with transparent and clear triggering points, but I am afraid this is not possible when we are in a pandemic crisis with fog of war. But through the MTF’s actions over the years, I hope the public would also appreciate where we are coming from. We do what is necessary to protect lives when danger is upon us, and we will step down measures when they are no longer needed, no longer necessary, so that people can resume their normal lives.
So, the best step for the public to take is not to delete your TraceTogether app and not to throw away your TraceTogether tokens. Please keep them.
Members asked about the Disease Outbreak Response System Condition (DORSCON) framework. DORSCON was established after SARS in 2003, then reviewed and progressively improved from the experiences drawn from managing the H1N1 pandemic in 2009, and the coordination for Middle Eastern Respiratory Syndrome Coronavirus and Ebola Virus Disease. Post COVID-19, we will certainly review it further, along with our response measures, given all that we have learnt during this pandemic crisis.
The DORSCON framework was developed as a tool for Ministries and agencies to coordinate and execute the Government’s response to outbreaks of infectious diseases. By and large, it has served this purpose well in this pandemic.
In the initial phase of the pandemic, the MTF decided that for transparency, we would announce the DORSCON level and colour code publicly too. This would help alert the public of the need for personal vigilance and social responsibility. However, it had also led to certain public reactions, such as a rush to the supermarkets. This is one key issue for review, as DORSCON is meant to bolster preparedness, not to induce public anxiety.
A key factor to consider in our review of the DORSCON framework is that after more than two years of pandemic, the Government and our society have learnt a lot about pandemic response. We have developed a comprehensive response system, covering health protocols, border controls and safe management of social and economic activities. It is also tiered and differentiated, catering to different activities and settings, such as schools, offices, public spaces, eating places, nightlife, events and so on, with various severity conditions.
Therefore, from a public communications point of view, we believe that the public now pay much less attention to the DORSCON colour code and take care to understand the various public health measures in detail, and then respond and do their part accordingly, be it taking vaccination, wearing masks, or abide by the safe management measures. So, I am confident that today, we have a much more sophisticated public that understands what they need to do when a pandemic turns for the worse.
The response of the public, and the contribution of everyone in our society, is ultimately what gives us resilience during a pandemic outbreak. So, the DORSCON framework is most likely still relevant, but it needs to be part of a larger emergency preparation and public communications framework that we have already developed and now people understand.
Members also asked about “excess deaths”. Let me first explain what it is. It means comparing death rates across the years, taking into account the changing age profile of the population. If the death rate goes up in a pandemic, above that expected in the absence of a pandemic and over what is expected from population ageing, it means there are excess deaths.
For Singapore, our age-standardised death rate has decreased from 2017 to 2020, from 563 per 100,000 residents to 519 per 100,000 residents. In 2021, the rate increased to 557 per 100,000 residents, almost back to 2017 levels. So, 2021 is about the same as 2017, just a notch lower. So, there are excess deaths in 2021, compared to 2020.
Mr Leon Perera asked, why that is so and how we calculate excess deaths. We used well-established, internationally practiced methods including age adjustments. There are excess deaths in 2021 because there has been a global pandemic causing millions of deaths around the world and Singapore is not exempted.
During a pandemic, excess deaths will be higher than officially reported deaths directly caused by the disease. To illustrate, a recent WHO analysis of excess deaths found that while the officially reported number of COVID-19 related deaths around the world is slightly over 6 million, “excess deaths” during this pandemic is 15 million – about 2.5 times more.
There are a few reasons explaining the difference in the two numbers. One, in some parts of the world, there can be under-reporting in regions where testing is insufficient, or where data is difficult to collate. But, in Singapore, this is not an issue. Two, there are infected persons who died of other illnesses, but COVID-19 infection might have been a contributory factor but not the main cause. Three, care-seeking behaviours changed. For example, individuals with chronic conditions may put off their check-ups, treatments and medications during the pandemic, to their own detriment. Four, there are many regions where their healthcare systems were overwhelmed. When that happens, proper care is denied and the people who suffer are not just the COVID-19 infected patients, but everyone that needs hospital care.
Our excess deaths in 2021 among Singapore residents is about 1,535, that is for 2021, when we had a Delta wave, after accounting for ageing. COVID-19 deaths as at end 2021 among residents is 804, or about 52% of excess deaths. The remainder excess deaths could be due to some of the factors I explained earlier, except under-reporting, it is not an issue in an urban environment like Singapore; and also, the last reason I mentioned, hospitals being overwhelmed. That is not a big factor here, because we prioritised the protection of our healthcare system, going into a circuit breaker when necessary. So, although our hospitals came under significant pressure at the height of the infection waves, they were not overwhelmed and hospitals could continue to give priority to serious and urgent cases.
As mentioned in the MOH press release on 24 March 2022, MOH is continuing to collect and analyse the data, particularly the recent Omicron data, to find out more comprehensively the impact of this crisis on Singapore residents and we will release a special report soon, to estimate the excess deaths over the past two and half years of the pandemic, and the key factors causing the excess deaths.
I should emphasise that whether it is official COVID-19 death toll or excess deaths, Singapore will have one of the lowest rates in the world, amongst countries that have chosen to live with COVID-19 and resumed normal lives, and that is because of the cooperation of everyone in Singapore and the effectiveness of protecting our healthcare system.
Ms Sylvia Lim (Aljunied): Thank you, Mr Speaker. I have two supplementary questions for the Minister for Health. He mentioned earlier that Vaccine-differentiated Safe Management Measures (VDS) will still be needed for events of more than 500 participants. Can he clarify that this also applies to the community dinners that I asked for? Meaning that, if the number of participants is expected to be more than 500, then the organisers would have to check that the participants are vaccinated? So, that is the first question.
The second question, he mentioned that these dinners can proceed. What about events or activities that are associated with the dinners like auctions and stage performances like “getai”, are all these also allowed?
Mr Ong Ye Kung: The answer to both questions is yes. So, if the temple dinner has more than 500 people, they ought to install a SafeEntry check-in counter; and auction, performance can proceed.
Mr Leon Perera (Aljunied): I thank the Minister for his comprehensive answers and just a procedural clarification. If I heard correctly, the Minister said he would answer all questions until Question No 13, I am just wondering has he answered Question No 13 as well, which is about the impact of restraints placed on non-urgent treatments and testing during COVID-19 and what backlog there has been for such treatments and testing, and what has that impact been.
Mr Ong Ye Kung: Thank you. I intend to answer Question No 13. So, whether the Ministry will conduct a study on the impact of COVID-19 pandemic on various aspects, as I mentioned, we have issued a Press Statement earlier on in March, on 24 March, we have issued a Press Statement that we will collate all the data, we will do a proper study, it is a special report on the impact of the entire pandemic and we will answer some of the questions including the data required.
Ministry of Health
9 May 2022