4 milestone dates in Singapore's approach to tackling Omicron (Jan-Feb 2022)

These include revised healthcare protocols that let primary care doctors diagnose and treat patients according to Protocols 1-2-3, updated testing requirements for non-Vaccinated Travel Lane (non-VTL) travellers, as well as revisions to individuals' fully-vaccinated status.

Over the past week, Singapore's Multi-Ministry Taskforce released a series of updates on Singapore's approach to handling COVID-19, particularly in tackling the Omicron variant.

These updates include revised healthcare protocols which let primary care doctors diagnose and treat patients according to Protocols 1-2-3, updated testing requirements for non-Vaccinated Travel Lane (non-VTL) travellers, as well as revisions to individuals' fully-vaccinated status.

The key dates for these implementations are detailed below.

Thursday, 6 January 2022: Revised healthcare protocols

On Wednesday (5 January), the MTF announced that Singapore will be further enhancing the use of Protocols 1-2-3 to facilitate the streamlined management of COVID-19 cases.

In that vein, effective 6 January (Thursday), individuals will be managed based on the severity of symptoms and health status, per a set of revised protocols, and primary care doctors will play a key role.

The revised protocols are as follows:

For low-risk individuals with mild symptoms, primary care doctors can make an immediate diagnosis via a healthcare-administered antigen rapid test (ART) and continue to care for them under Protocol 2. This means, after seeing the primary care doctor who has ascertained that their symptoms are mild and that they are at low risk of developing severe symptoms, the following will be in place:

• The individual will be required to self-isolate at home for at least 72 hours. Following this, if they feel well, they may exit self-isolation and resume normal activities upon a negative self-administered ART, similar to Protocol 2. Those who continue to test ART positive should continue to self-isolate and self-test daily until they obtain a negative ART result, or until Day 10 for vaccinated individuals, or Day 141 for unvaccinated or partially vaccinated individuals, whichever is earlier.
• The individual will receive a five-day Medical Certificate from the primary care doctor (or longer, depending on clinical discretion) to cover the expected period of rest needed for the symptoms to resolve. If symptoms worsen or do not improve with time, the individual is advised to return to the doctor or call 995 in emergency situations.
• Health Risk Warnings (HRW) will be issued to the individual’s close contacts, including those identified through the TraceTogether app and self-declaration of household members. Persons issued with HRW should follow the prevailing Protocol 3.

On the other hand, individuals who have been assessed by their doctors to be high risk (e.g. elderly, pregnant, immunocompromised) or with significant symptoms (e.g. chest pain, shortness of breath, prolonged fever) will continue to be managed under Protocol 1 where they are required to undergo both ART and polymerase chain reaction (PCR) swabs.

If tested positive, will be issued an Isolation Order for 10 or 14 days, depending on their vaccination status.

Last, individuals deemed as low risk, who are well and/or asymptomatic, will continue to be managed per existing Protocol 2 if they test positive on ART.

The Ministry of Health (MOH) shared that it will "monitor the situation in the coming weeks and make further adjustments to gradually allow more individuals to safely recover under Protocol 2 after seeing a primary care doctor, and support their earlier return to normal activities."

#ICYMI: Friday, 7 January 2022: No more on-arrival PCR test for non-VTL travellers

From Friday (7 January), all non-VTL travellers entering Singapore from Category II (non-VTL), III, and IV countries will no longer have to undergo a COVID-19 PCR test upon arrival.

This was announced by the MTF last week (31 December). According to the Taskforce, this decision was made following assessments on the measures as well as the Omicron variant, given that non-VTL travellers are all required to serve a seven- or 10-day Stay Home Notice and have to test negative on a PCR before exiting their SHN.

In further updates, the MTF announced on the same day that Singapore will be extending the enhanced testing regime for VTL travellers for an additional four weeks from 2 January, and will review it as the situation evolves.

In particular, this enhanced testing regime, first announced in early December, requires all VTL travellers to undergo COVID-19 tests up till Day seven of their arrival, which the MTF noted has since "proven effective in detecting imported Omicron cases amongst VTL travellers and reducing onward transmission."

More details here. 

#ICYMI: Monday, 10 January 2022: Sibling walk-in arrangements for paediatric vaccinations

As shared by the Ministry of Education on Monday (3 January), effective 10 January (Monday), all accompanying siblings of a child with a vaccination appointment on Mondays to Thursdays can walk in for their vaccination without a prior appointment.

This, the Ministry said, aims to provide greater convenience for parents/guardians with more than one child/ward aged five to 11, and to optimise the country's available vaccination capacity on these days.

Parents/guardians who intend to vaccinate their children/wards under the "sibling walk-in" arrangements should arrive at the vaccination centre by 7pm on Mondays to Thursdays.

The Ministry added: "We encourage parents/ guardians who have booked separate appointments for different children/wards to keep only one desired slot and cancel the remaining bookings on NAS. As the children must be accompanied by one parent/guardian, it would suffice for one parent/guardian to be present for children going for the same vaccination appointment.

"However, we will exercise flexibility and allow one parent/guardian per child, should there be requests from the parent/guardian."

Monday, 14 February 2022: Revised requirements to maintain "fully vaccinated" status

In view of data showing that booster shots can increase protection against infection and severe illness from Omicron, the Expert Committee on COVID-19 Vaccination (EC19V) has recommended that persons aged 18 years and above who completed a primary vaccination series should receive a booster dose of an mRNA vaccine no later than 270 days after the last dose in the primary vaccination series.

This will also apply to individuals who received recognised non-mRNA primary vaccination regimens offered under the National Vaccination Programme, such as three doses of the Sinovac-CoronaVac, or three doses of Sinopharm vaccines, as well as regimens of other WHO EUL vaccines. For this group, most will not be due for booster for some time, the MTF stated.

In light of that, effective 14 February (Monday), persons aged 18 years and above who have completed the primary vaccination series of COVID-19 vaccines and are eligible for booster vaccination will be considered as fully vaccinated for 270 days after the last dose in their primary vaccination series.

They should receive their booster vaccination from around five months thereafter as recommended, and no later than 270 days thereafter, to ensure an optimal level of protection. Upon receiving their booster, they will continue to be considered fully vaccinated beyond 270 days.

As an example, the Taskforce shared that if an individual completed his primary vaccination series on 1 June 2021, he would be eligible for a booster vaccination five months later, i.e. from 1 November 2021 onwards, and would have to receive his booster by 26 February 2022 to continue to be considered as fully vaccinated.

Speaking on this at the MTF press conference on Wednesday, Minister for Health Ong Ye Kung said: "We are setting the effective date of the new policy to almost 1.5 months from now, so that everyone whose vaccination status may lapse from 14 February 2022 has a chance to get their booster jabs early and before that deadline. Those who have not reached the ninth-month expiry or who are medically ineligible for boosters will not be affected.

"We have been inviting those who have completed their primary series vaccination regime about five months ago to register for their mRNA booster shots. To facilitate bookings for booster appointments, in the coming weeks, we will send out invitations for booster shots for those aged 60 years and above earlier, around four months. We have consulted the EC19V and they are supportive of this administrative move."

Lead image / 123RF