10-15% of Covid-19 patients in S'pore likely to need hospital care once situation stabilises

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SINGAPORE - Only 10 to 15 per cent of Covid-19 patients in Singapore are expected to need hospital care when the current rise in cases has stabilised, while one in every two patients will likely recover safely at home and the remaining 30 per cent in community care facilities (CCFs).

Essentially, the current situation - where emergency departments are seeing more Covid-19 cases and hospitals here have scaled back non-urgent procedures as they approach capacity - is temporary, said Singapore's director of medical services, Associate Professor Kenneth Mak.

Prof Mak sketched this picture of an evolved Covid-19 care landscape to The Straits Times on Monday (Sept 20) on the sidelines of the 2021 Singaporean Researchers Global Summit, a gathering of Singaporean researchers here and abroad, at the Nanyang Technological University.

He emphasised the importance of a spectrum of recovery options to suit different Covid-19 patients' needs in order for there to be good recovery outcomes without overtaxing Singapore's medical system.

For instance, patients with certain risk factors and who require monitoring to ensure that they do not deteriorate but who are assessed to not need a hospital bed will be placed in enhanced or stepped-up CCFs.

On the other hand, those who are infected and healthy but are unable to safely isolate at home will be cared for in the current CCFs, said Prof Mak.

For the majority of patients who are vaccinated and have mild or no symptoms, home recovery will be the default route to recovery.

"Eventually, we can match the likelihood of (viral) mutation, the course of illness with the type of care we can provide them, so we are never going to shortchange people.

"We want to make sure that we also have enough resources for those who truly are more seriously ill," he added.

The Ministry of Health (MOH) said on Sunday (Sept 19) that a new category of stepped-up CCFs will be set up for Covid-19 patients who are generally well, but have underlying health conditions that require close monitoring.

The first such facility will open this Thursday at the NTUC Health nursing home in Tampines, which currently has 250 beds.

The NTUC Health Nursing Home (Tampines) at Tampines Street 22. ST PHOTO: ALPHONSUS CHERN

Several CCFs will also have a proportion of their beds converted to the stepped-up type, including the CCF at the Singapore Expo's Connect@Changi, which aims to provide 50 such beds by Friday.

Asked if MOH will be looking into converting more CCFs into enhanced ones, Prof Mak said that the situation is dynamic as it remains important to ensure that there are enough CCFs for the group of people who are well.

As for setting up more enhanced CCFs, he stressed that it is not just about providing more beds, but also provisioning additional monitoring equipment and oxygen support equipment at such facilities.

"But over time, we will see a shift such that more people get looked after in the community setting than in the hospitals... But we are in a process of transition," he said.

"We have some facilities (and are) trying to expand some capabilities and so I think over the next month we will see some shifts, some transitions in terms of the proportions of people in the hospital versus in the CCF."

The home recovery scheme will allow fully vaccinated Covid-19 patients aged between 12 and 69 years old to recover safely at home so that hospital resources can be deployed to those who need more intensive care.

To be eligible, the individual must not have any severe co-morbidities or illnesses, and should not live with household members who are above 80 years old or are considered vulnerable, such as pregnant women.

Co-morbidity refers to the presence of two or more diseases or medical conditions in a patient.

One group of patients that will mostly be cared for in the stepped-up CCFs are nursing home residents with Covid-19, said Prof Mak. They will be transferred to these enhanced facilities as they tend to be frail and have multiple other medical problems.

At the event, Prof Mak also fielded a question on whether preventing infection spread is no longer a priority for the Government, given the introduction of self-isolation and home recovery.

He stressed that the basic tenets of wanting to prevent the spread have not gone away.

"It's still an emphasis on trying to detect cases, encouraging people to isolate as much as possible to disrupt future transmissions that will just spread... because there are still people who are not vaccinated, who can get seriously ill, require the intensive care unit, and can still die."

But the emphasis of responsibility has now shifted away from the state and towards the individual, Prof Mak said.

MOH will take charge of contact tracing, but a lot more social and personal responsibility will be needed such as for individuals to come forward, get tested, and to self-isolate so as to disrupt the chains of transmission, he said.

"We are beginning to, in a way, increasingly emphasise the role of the individual citizen, people in the community, society, in helping us to manage this and this is perhaps what will allow us to be more resilient."

The Singaporean Researchers Global Summit, which is in its second edition, is a platform that brings together local institutes of higher learning and connects Singaporean researchers at home and abroad to exchange ideas and knowledge.

At the summit, Deputy Prime Minister Heng Swee Keat said the key ingredient Singapore has going for it as a global research and innovation hub "is in the depth of our collaboration and our openness to new ideas".

He noted that the amount of resources Singapore has committed to research, innovation and enterprise for the next five years - $25 billion - is significant in terms of its national budget, but small relative to global investments in research and development.

Yet, the Republic has been able to punch above its weight because of the strengths of its partnerships, which stretch across academia, the private sector and the Government, both here and abroad.

"This spirit of collaboration is a strength of our system, and a quality that we must continue to nurture," he added.

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