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Singapore's ICU capacity has come under immense strain, but the government is doing all it can to expand healthcare capacity and support workers, Senior Minister of State for Health Janil Puthucheary said on Monday (Nov. 1).

Puthucheary was delivering a ministerial statement in Parliament, giving an update on the capacity of hospitals and the intensive care units (ICUs) in Singapore.

Increasing occupancy rate in ICU

During his speech, Puthucheary gave an update on the current situation within Singapore's ICUs and hospitals.

He said that as of Oct. 31, there were 1,672 Covid patients admitted into Singapore's acute hospitals, taking up about 18 per cent of hospital beds there. The occupancy rate of all general ward beds was at about 90 per cent, while the occupancy rate for isolation beds was slightly lower, at 85 per cent.

284 cases need oxygen supplementation, and currently require oxygen support in the general wards.

Only the most serious cases need ICU care, and about 0.3 per cent of all Covid cases require it. Although this is a small proportion, Puthucheary emphasised that this translates to a large number of ICU patients when case numbers are high, and that this places a serious strain on Singapore's ICU capacity.

Critically ill ICU patients

There are currently 130 patients who are critically ill in the ICU, all of whom require the continuous care of an ICU team.

They occupy around 60 per cent of the 219 ICU beds currently reserved for Covid-19 patients.

In addition, there are also non-Covid patients with life-threatening medical conditions who require ICU care.

Puthucheary said that public hospitals in Singapore currently operate about 163 adult ICU beds for these patients, with an average occupancy of close to 80 per cent.

In comparison, in 2019, there were 298 adult ICU beds, with an average occupancy rate of 63 per cent.

Puthucheary explained that MOH has been reducing non-Covid ICU beds to cope with more Covid patients, and that this is one of the key trade-offs when increasing the number of Covid ICU beds.

Overall, the total number of ICU beds for both Covid and non-Covid patients have been increased to 382 over the past two months.

Puthucheary further elaborated:

"Our ICU staff have been stretched to their limit in the last two weeks. At its peak, we had 171 Covid-19 cases in the ICU, but the situation has eased a little. Today this has come down to 130."

He credited the booster doses with helping in reducing severe illness among unvaccinated seniors.

Healthcare workers facing drastic fatigue

According to Puthucheary, a large proportion of Singapore's healthcare workers have not had the opportunity to take leave since 2020, and over 90 per cent of them will not be able to clear their accumulated leave for 2021.

This is a higher proportion compared to the past two years.

Puthucheary said that healthcare workers have gone "way beyond the call of duty" to care for patients, with nurses working for an average of 160 to 175 hours for the month of September.

He said that he received a message from a senior member of the clinical teams, who told him that they were "increasingly stretched, overworked and fatigued", and that morale was slipping among the healthcare workers.

Another message he received described the situation quite aptly.

"It feels like what started as a 2.4k run became a marathon, and just as we are reaching the finishing line, we have to run a second marathon. Our people are exhausted physically, mentally, emotionally – whether they will admit it or not.”

As a result of the fatigue faced by the healthcare workers, resignation rates among healthcare workers have been on the rise, with about 1,500 healthcare workers having resigned in the first half of 2021 alone, compared to about 2,000 annually prior to the pandemic.

Puthucheary added that foreign healthcare workers have resigned in a bigger number, especially when they are unable to travel to see their families back home.

Close to 500 foreign doctors and nurses have resigned in the first half 2021, compared to about 500 in the whole of 2020 and around 600 in 2019, according to Puthucheary, and most of these resignations were tendered for personal reasons, migration or moving back to their home countries.

MOH will give more support to healthcare workers

During his speech, Puthucheary acknowledged that the pandemic has taken a toll on healthcare workers, and that they are carrying a "burden of care that is sometimes unimaginable".

"Having to hold a phone for a patient so their family can say their last goodbyes. Holding their patient's hand, keep them company, on behalf of the patient’s relatives. They need all the support we can give them."

In order to give more support to these healthcare workers, the Ministry of Health (MOH) is actively redeploying manpower to serve as healthcare or patient care assistants at healthcare institutions, and is stepping up the recruitment of healthcare workers from overseas.

MOH is also reaching out to more volunteers to join the SG Healthcare Corps, and is collaborating with private hospitals to help ease some of the load on healthcare workers in public hospitals.

Expanding ICU capacity means further stretching healthcare workers

Apart from addressing manpower issues, MOH has also been trying to set aside more beds for Covid patients.

MOH has set up Covid-19 Treatment Facilities (CTFs), which now have close to 2,000 beds with an occupancy of less than 50 per cent, and is continuing to add further capacity to CTFs, with an aim to reach around 4,000 beds in November.

MOH is also seeking to expand ICU capacity further, up to 350 beds, to prepare for a potential rise in severe Covid cases. 280 ICU beds will be ready by the end of the week.

They have also been augmenting ICU manpower by deploying previously trained ICU staff to help with patient care, and bringing in non-ICU staff to work under the supervision of ICU trained staff.

However, Puthucheary warned that ramping up ICU capacity may not be as straightforward as some may imagine, as there are certain operational considerations that makes it unwise for MOH to expand to anywhere near to this "theoretical number" of ICU beds.

For example, while MOH can keep increasing the number of beds, they may not have enough people to care for the patients in the bed, stretching the healthcare workers as a result.

Current situation will not last forever

According to Puthucheary, Singapore has one of the lowest fatality rates in the world during the Covid-19 pandemic, due to high vaccination rates.

Although he emphasised that every death is a tragedy, he also pointed out that some deaths are unavoidable, despite Singapore's best efforts to prevent them.

"By keeping restrictions tight last year when our population was vulnerable to the disease, and then cautiously opening up after we vaccinated the vast majority of our population. Even then, we have to accept there will be some deaths.

Our goal is to make sure that there are no significant excess deaths, as a result of an inability to provide adequate medical care. So far that is something that we have been able to do, and that we want to keep doing."

According to Puthucheary, "now that we have to live with Covid-19", large numbers will get infected, but the government will continue to make sure that those who are infected will get good treatment and care, in order to keep the death rate low.

While Singapore's death rate, which stands at 0.2 per cent, is low compared to other countries that experienced a surge in cases before vaccination, Puthucheary said that over time, the absolute number of deaths from Covid-19 will rise despite the best medical care.

He said that Singapore could have 2,000 deaths per year, and that most of these will be the elderly, or those who are already unwell.

Puthucheary said that in comparison, about 4,000 patients pass on as a result of influenza, viral pneumonias and other respiratory diseases during pre-Covid-19 years, and that these are also mostly the elderly and the unwell.

"What we are trying to do has not yet been done by any other country. We are trying to get to the point where the combination of high vaccination rates, booster jabs and even more boosting from mild infections means that Covid-19 will no longer spread as an epidemic in Singapore. And we are trying to get there without excess mortality. What no other country has done before.

In other words, though we will have fatalities as a result of Covid-19, we will not see more overall deaths than we would in a normal non-Covid year. Nearly every other country that has arrived at that destination has paid a high price, in lives."

Puthucheary said that the fact that Singaporeans maintained of the lowest case fatality rates in the world is a "small miracle" that did not materialise because of chance, but because Singaporeans stood together, did their duty and put the interest of others ahead of their own.

He also credited the healthcare workers for their achievement, and emphasised that the current situation will not last forever, and that eventually the case numbers will come down, and the situation will stabilise.

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