Hospitals going back to business as usual

As the number of hospitalised Covid-19 patients here continues to fall steadily, hospitals are cautiously turning their Covid-19 wards back into regular ones.

At the peak of the outbreak on April 19, the number of patients in general wards here hit a high of 2,899. But as of yesterday, this figure has fallen by almost 10 times to 303.

The number of patients in intensive care also dropped to four yesterday, down from a high of 32 on April 10.

Professor Teo Yik Ying, dean of the National University of Singapore's Saw Swee Hock School of Public Health, said on Thursday that the drop in patients in the intensive care unit (ICU) reflects the changing demographics of those infected over the past two months.

From January to April, community transmission and outbreaks in nursing homes meant that more people from higher-risk groups, including the elderly, were infected.

"These were the people who were more likely to progress to a severe state of infection that requires ICU (care)," he said.

But from April, the circuit breaker measures significantly reduced the infection rate among such groups. Instead, the vast majority of the cases were young, healthy migrant workers less likely to experience a severe infection, thus leading to lower ICU numbers.

Yesterday, the Ministry of Health told The Straits Times that with fewer Covid-19 cases requiring acute hospitalisation, beds in public hospitals previously set aside for such patients would be disinfected and converted for non-Covid-19 patients where required.

These can be converted back to care for Covid-19 patients if there is another surge in cases.

One such hospital is the National Healthcare Group's Tan Tock Seng Hospital (TTSH).

The chairman of TTSH's medical board, Associate Professor Chin Jing Jih, said that staff who had been retrained for Covid-19 duties are also gradually being rotated back to their original roles.

During the circuit breaker period, non-urgent appointments at clinics and elective surgical procedures had been postponed.

TTSH, which together with the National Centre for Infectious Diseases (NCID) saw the bulk of Singapore's Covid-19 cases, has gradually resumed selected services.

More patients with chronic diseases or acute conditions that require active intervention will now be seen at its outpatient clinics.

Patients with more urgent needs will be prioritised, and patients who are stable but still require specialist care will continue to be looked after through other methods like teleconsultation.

The resumption of services "will be prioritised and phased accordingly in a controlled manner, while still maintaining and managing the outbreak support at NCID and in the community", Prof Chin said.

"This approach will allow us the balance to care for more urgent cases while ensuring our manpower and resources are ready to move back into outbreak mode in the event of a resurgence."

Professor Fong Kok Yong, SingHealth's deputy group chief executive officer (medical and clinical services) and the co-chair of its disease outbreak task force, said its hospitals have been carefully and gradually resuming services as they attend to critical medical needs.

"This is to avoid crowding at our institutions and ensure that we continue to have sufficient capacity, resources and manpower to care for both Covid-19 patients as well as our other patients, while supporting ongoing Covid-19 operations nationally," he said.

The group chairman of the National University Health System's (NUHS) medical board, Professor Aymeric Lim, said that while NUHS is working to resume its hospital services in stages, its institutions need to balance this with their continuing involvement in the foreign worker dormitories.

They will also retain some capacity for Covid-19 cases.

"Those with the greatest needs will continue to be prioritised... The work is not going to slow down for NUHS as a system as we will have to deal with the pent-up demand, and we will continue to take care of the well-being of our staff," he said.

While hospitalisation numbers are now low, one should not drop one's guard, Prof Teo cautioned.

The lifting of the circuit breaker measures will mean more interactions and potential virus spread between family members, especially the elderly, he said. "We should review our own activities and decide which are considered essential and which are not and thus can wait."