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Minister for Health Ong Ye Kung provided his assessment on the Ministry of Health's (MOH) handling of the Covid-19 pandemic in Singapore in parliament on Mar. 21, 2023.

The MOH will undergo a restructuring, such as retaining a crisis strategy and operations team, setting up of a new Communicable Diseases Agency and a Healthcare Reserve Force, Ong said during the parliamentary debate on the White Paper that reviewed Singapore's response to the pandemic.

Ong also said that the prevailing Infectious Diseases Act (IDA) was "too blunt and heavy" and that it will be updated to prepare Singapore for a future crisis.

Ong explained the three important judgements calls - protect hospital capacity, support from people for vaccination, and the decision to open up.

Three important judgment calls during the pandemic

Ong felt that while every county and region took its own path — whether by choice or forced by circumstances — how each country or region faired during the pandemic essentially boiled down to three judgment calls.

One: Protect hospital capacity

Firstly, whether countries' decisions in the early stages of the pandemic had caused hospitals to become the only defence against the virus .

He explained that the "Influenza playbook" was quickly proven inadequate for Covid-19 for many countries in the West, and the hospitals, which was their only defence against the virus, quickly became overwhelmed.

Ong said that places like Singapore, South Korea and China had experienced SARS or MERS and thus moved quickly to contain initial outbreaks with stringent measures — and Singapore succeeded in preventing its hospitals from being overwhelmed.

He said,

"If there was one thing the Prime Minister constantly reminded the MTF (Multi-Ministry Taskforce) Chairs, it was this golden instruction – protect our hospital capacity — and we took it all very seriously. Because when the entire weight of a country's health rests on hospitals, even if that was not the intention, it will not just be Covid-19 patients that die, but everyone who needs urgent medical attention can die."

Two: Trust & support for vaccination from the people

The second important judgment call was on the countries' vaccination coverage.

"Those were, if you remember, confusing times because the vaccines were new and anti-vaxxers were out in full force, spreading falsehoods and half-truths to persuade people to avoid vaccinations," Ong said.

"Fortunately, the great majority of Singaporeans and the public trusted our recommendations to take the vaccines," he said.

He said Singapore achieved over 90 per cent vaccine coverage and thanked the Workers' Party (WP) for supporting the pivotal national vaccination effort.

Three: Decision to open up after high population immunity

Ong said the third judgment call was to decide whether Singapore should open up after achieving high population immunity.

He said that countries in Europe and America could afford to open up early, as they had high population immunity after the virus spread widely in their countries, but after many people were infected and with many deaths.

Many people also urged Singapore to open up quickly, just like these countries. "The desire is understandable," Ong pointed out. "But they overlooked the key difference between us and them – they had paid the price in human lives, which we refused to pay."

Looking back on all three decisive moments of judgment, Ong thinks Singapore had collectively made the right calls.

Six areas for improvement

Having gone through the "trials and tribulations of the pandemic", the government has identified six areas for improvement in Singapore's healthcare system to better prepare the country for the next pandemic, Ong said.

This includes boosting Singapore's preparedness and response to a pandemic, strengthening the capacity of local hospitals,  restructuring MOH, updating legislation, securing vaccines and medical supplies for the future, and recognising the advances Singapore has made during the crisis.

Transitional care facilities to strengthen local hospitals' capacity

Ong noted that Singapore's healthcare system is currently "less resilient than ideal" due to the delays in infrastructure development caused by Covid-19 and the increased hospital workload after the pandemic crisis.

Separately, public hospital bed occupancy has risen from the pre-Covid level of 87.6 per cent in 2019 to 93.1 per cent in 2022.

This is largely driven by patients staying longer in hospitals, with the duration increasing from an average of 6.1 days in 2019 to 7 days in 2022.

Most of these patients are older and have complex conditions which require them to remain in the hospital for a longer period of time.

To help this group of patients – medically stable individuals in public hospitals who are waiting for long-term care arrangements – and at the same time free up hospital resources for other patients, Ong announced that transitional care facilities (TCFs) will be continued even after the Covid-19 pandemic.

TCFs were first rolled out in August 2022, as Mothership reported previously, as a "dual-care facility" to treat chronic patients and/ or Covid-19 patients in the event of a surge in local cases.

Ong said in Parliament on Mar. 21, 2023 that a total of 500 TCF beds were set up in five sites, run by private operators, during the Covid-19 pandemic.

"The TCFs have proven to be very useful. It is as good as adding 500 more beds to our acute hospitals."

As such, the government has decided to retain the existing TCFs, making them a medium or even long-term feature of Singapore's healthcare system.

A new TCF in the West, located close to Ng Teng Fong General Hospital, will be added to the list of current TCFs, including the one at Changi Expo Hall 9 which holds around 200 beds, in the next few months, Ong said.

He added, "We will also continue to expand the community and step-down care sectors, such as community hospitals and nursing homes."

Restructuring MOH

Next, Ong announced that MOH will undergo a restructuring.

Referring to the severe acute respiratory syndrome (SARS) disease in 2003, Ong said MOH had similarly undergone a restructuring after the outbreak and launched a slew of "organisational enhancements" that came in handy during the Covid-19 pandemic.

This includes the pandemic preparedness plan, which evolved into the Public Health Preparedness Clinics (PHPC) Scheme, the National Public Health Laboratory (NPHL), and the National Centre for Infectious Diseases (NCID).

Ong said it is time to review MOH's structure to be better prepared for the next pandemic.

Developing a wide repertoire of responses

He said one "big lesson" is the "need to rely on a wide repertoire of responses" as "each pathogen has unique characteristics needing different responses".

For instance, a severe but less transmissible disease like SARS requires an individual-centric approach comprising testing, isolation, tracing, and quarantining that is precise, accurate, and error-free as possible.

However, this approach may not work for less severe but highly transmissible pathogens, such as the Delta or Omicron Covid-19 variant, making it almost impossible to contact trace and isolate, especially when the virus becomes increasingly widespread.

This scenario requires population-based interventions, such as wearing masks, ART tests in the community, self-testing, self-quarantine of those exposed, and home recovery for those with milder symptoms, to manage the exponential growth of infected persons, Ong said.

Communicable Diseases Agency

Ong emphasised that the individual-centric, clinical approach and population-based, public health approach are not mutually exclusive.

Instead, both approaches complement the other, and were jointly employed during different phases of the Covid-19 pandemic, Ong added.

As such, there is a need to institutionalise both sets of capabilities for the long term.

Ong announced that MOH will do so through its new Communicable Diseases Agency (CDA).

He said the CDA will oversee disease preparedness, prevention and control, surveillance, risk assessment and outbreak response.

It will also consolidate the relevant public health functions in MOH, NCID and Health Promotion Board.

Separately, the NPHL will be transferred to the CDA, while the latter will maintain oversight of the clinical facilities in NCID.

Crisis Strategy and Operations Group

MOH will retain the Crisis Strategy and Operations Group (CSOG) established during the Covid-19 pandemic.

Ong described CSOG as, "the machinery behind all the pandemic-related operations that we are familiar with – contact tracing, home quarantine, conveyancing to isolation facilities, testing, vaccinations, and home recovery."

Many of CSOG's staff – officers from various ministries, contract staff, and individuals from industries affected by the pandemic – have since returned to their respective posts and industries and the operation has "scaled down greatly".

Despite this, MOH will retain the CSOG to maintain surge readiness for a mid-sized outbreak and other health emergencies, including preparing healthcare institutions to be crisis ready.

During "peacetime", when there is no emergencies, the CSOG will operationalize Healthier SG, Ong said.

Healthcare reserve forces

Additionally, MOH will set up a Healthcare Reserve Force, which comprises ex-healthcare workers and volunteers.

This group of individuals will be trained and equipped so that they can reinforce MOH's operations teams during larger surges, as well as complement the existing pool of SG Healthcare Corps volunteers.

Kenneth Mak to be Director General of Health

Lastly, as part of MOH's restructuring, Ong announced that Kenneth Mak will be called the Director General of Health.

Mak's former title was the Director of Medical Services.

Ong explained Mak's new title, saying it "more accurately describes his role as the main overseer of both clinical and public health of Singaporeans".

He added that Mak's new title will come into effect later in the year after the changes to the Healthcare Services Act.

"With these changes, MOH will be organized to place greater emphasis on both clinical services and public health. They require different instincts, considerations, capabilities and skillsets. Both are important and critical and will be institutionalised and built up within MOH."

Updates to legislation

Ong also emphasised the importance of updating our legislation to be prepared for a future crisis.

IDA was too "blunt and heavy"

He said the prevailing IDA allows the Minister for Health to declare a public health emergency in grave public health situations, which will activate extensive powers for the minister, such as controlling the movement and gathering of people and imposing curfews.

However, the Government had chosen not to activate it during the pandemic.

"While COVID-19 was a crisis and a serious threat, we did not declare a public health emergency. We wanted to restrict group sizes but not to control the movements of people. "Ong explained.

"In other words, the emergency powers under the IDA were too blunt and heavy compared to the public health measures and SMMs (Safe Management Measures) that were needed at that time."

He said the Government had instead chosen to enact ad-hoc legislation, Part 7 of the COVID-19 (Temporary Measures) Act, to provide the Ministry with temporary, complementary powers to the IDA without declaring a public health emergency.

"Ideally, we should review and amend the IDA. As it stands now, the IDA envisages only two worlds of public health - peacetime or public health emergency, with no gradations in between." Ong added. "It needs to be more future-proof."

DORSCON colours to be changed to situational tiers that are more intuitive

While the full proposal will be put to parliament later this year, Ong raised a few examples of the amendments that are being worked on, including replacing DORSCON colour coding with four situational tiers — Baseline (peacetime state), Outbreak Management, Public Health Threat, and Public Health Emergency.

"I think it is more intuitive to tell the public that there is an outbreak, a threat, or an emergency, as opposed to colours. And the law spells out what measures could take place under each situation." Ong explained.

Ong mentioned that while the replacement descriptors might not be able to make the public's anxiety disappear, the type of information available to the public will play a part in how people react.

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Top image from Ong Ye Kung/Facebook