Singapore's monkeypox protocols: Patients may recover at home effective 22 Aug 2022

To qualify for the Home Recovery Programme, patients must be medically assessed to be clinically stable, and must have a place of residence deemed suitable for home recovery.

Singapore has allowed monkeypox patients to recover at their place of residence under the Home Recovery Programme (HRP) starting 22 August 2022, if:

• they are medically assessed to be clinically stable; and
• their place of residence is deemed suitable for home recovery.

Meanwhile, patients assessed to be at higher risk of complications will continue to be managed in hospitals.

Patients who are confirmed to have the disease will be issued with an Isolation Order and are required under the Infectious Diseases Act to remain isolated until they are medically assessed to be non-infectious.

According to a statement by the Ministry of Health (MOH), currently, all confirmed cases assessed by public hospitals to be clinically stable are recovering with telemedicine support at a Monkeypox Isolation Facility (MIF). However, from today, confirmed cases may recover at home with telemedicine support.

To be deemed suitable for HRP, the patient's place of residence must fulfil the following conditions: 

• The patient can self-isolate in a bedroom with an attached bathroom, and there is an additional bathroom for other household members’ use.
• None of the other household members are:
  • pregnant;
  • children aged below 12 years;
  • seniors aged 80 years and above;
  • individuals undergoing dialysis, are immunocompromised or on immunosuppressants; or
  • individuals at higher risk of being infected (e.g. with caregiving needs)
• There are no pets at home. This is to avoid any animal-to-human transmission which may occur when an animal contracts monkeypox from an infected person and then spreads to other persons through bites, scratches, or through direct contract with skin, mucosa, blood, and bodily fluids.

Patients who are not suitable for home recovery may continue to recover in the MIF.

MOH added that patients on HRP will receive regular telemedical consultations to assess their state of recovery, and may be conveyed to the National Centre for Infectious Diseases (NCID) for additional reviews if necessary. There is also a dedicated MOH hotline to call if they require any assistance during the period of recovery.

In the event that patients experience any shortness of breath, chest pains, severe headaches, stiff neck, changes in mental state (e.g. mood, behaviour), or unusual symptoms with their nerves (e.g. numbness, weakness, changes in speech or vision, abnormal movement of the arms or legs), they should call 995 immediately and inform the operator that they are monkeypox patients.

At the end of the isolation period, patients will be conveyed to NCID to undergo a discharge review. If they are medically assessed to have fully recovered, they will be able to exit isolation. If they have not recovered, they will continue to be isolated until the next appointed discharge review.

In addition to the above, MOH stated that suspected monkeypox patients who are assessed to be clinically well will no longer be required to isolate in the hospital while awaiting their test results. Instead, they may isolate themselves at home if they are able to do so. Those who are unable to self-isolate in their home will be isolated at an isolation facility while awaiting their test results. Suspected cases who are assessed to require admission for clinical care will continue to be managed in hospitals.

Ending the statement, the Ministry said: "MOH will continue to monitor the monkeypox situation closely and calibrate our preparedness and response measures as needed. Members of the public are encouraged to exercise personal responsibility by monitoring their personal health, maintaining good hygiene, and avoiding high-risk sexual activity, such as having multiple sex partners or casual sex, especially during travel. They should also avoid close contact with individuals known or suspected to have monkeypox infection."

Photo / Shutterstock

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