Genesis, evolution and effectiveness of Singapore's national sorting logic and home recovery policies in handling the COVID-19 Delta and Omicron waves

Yau, Joachim Wen Kien; Lee, Martin Yong Kwong; Lim, Eda Qiao Yan; Tan, Janice Yu Jin; Tan, Kelvin Bryan; Chua, Raymond Swee Boon

doi:10.1016/j.lanwpc.2023.100719

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…This proportion increased to 98% during the Omicron wave (January to June 2022), with more patients fully recovering at home under the HRP and primary care. ( 17 ) During the period when the HRP was implemented (October 2021 to June 2022), there were 1318 deaths out of 1 617 535 cases, for an overall mortality rate of 0.08%.…”

Section: Resultsmentioning

confidence: 99%

“…The implementation of the HRP encountered several challenges, including the definition of comorbidities of concern in the screening checklist, ( 17 ) along with operational issues in coordination during the surge in COVID-19 cases during the initial roll-out period. ( 18 ) To accurately describe “comorbidities of concern” in the screening questionnaire, the list of comorbidities that health ministry’s Expert Committee on COVID-19 vaccinations had earlier defined was referenced, while also formulating distinct risk categories for certain conditions.…”

Section: Discussionmentioning

confidence: 99%

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Coronavirus disease and home recovery: a Singapore perspective

Tan,

Yau,

Toh

et al. 2023

WPSAR

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Objective: At the beginning of the coronavirus disease (COVID-19) pandemic in Singapore, the strategy initially involved aggressive ring-fencing of infections, before pivoting towards managing recurrent local interspersed outbreaks of COVID-19. A key feature of Singapore’s efforts to preserve health-care capacity was the implementation of the nationwide Home Recovery Programme (HRP), whereby patients were allowed to recover at home as long as they met certain criteria. The programme was centrally coordinated by Singapore’s Ministry of Health and was supported by telemedicine providers, primary care physicians and government agencies. This report aims to highlight Singapore’s experience in coordinating and implementing the HRP, the challenges faced and the outcomes. Methods: Published and internal data from the Ministry of Health in Singapore, along with policy documents, were reviewed together with a brief literature review of similar programmes conducted globally. Results: Implementation of the HRP led to the majority of patients (98%) recovering from COVID-19 in the outpatient setting, with similar mortality rates to inpatient settings. Hospitalization rates for COVID-19 cases were reduced as compared to previously, alleviating strain on the health-care system. Discussion: The HRP was largely successful at preventing health-care capacities from being overwhelmed, while keeping fatalities to a minimum. Nonetheless, the risks of emergent variants of concern remain present, and heightened vigilance and potential modification of existing protocols based on fluctuations in virulence and infectivity are still needed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coronavirus disease and home recovery: a Singapore perspective

Tan,

Yau,

Toh

et al. 2023

WPSAR

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“…This may have affected the personal risk-benefit assessment of COVID-19 vaccination in some individual. In contrast, for example, health officials in Singapore made it clear by June 2021 that the successful containment of COVID-19 with non-pharmaceutical interventions was only temporary, and vaccination was essential for older adults in advance of the planned transition away from containment towards the end of 2021 (32, 33).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the impact of the Vaccine Pass Policy on COVID-19 vaccine hesitancy and uptake among Chinese adults in Hong Kong

Wong,

Mak

et al. 2023

Preprint

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SummaryBackgroundRecognising the importance of attaining high vaccine coverage to mitigate the COVID-19 impact, a Vaccine Pass scheme was implemented during and after the first large Omicron wave in Hong Kong in early 2022 requiring three doses by June 2022. We evaluated the impact of the Vaccine Pass policy on vaccine uptake in adults.MethodsWe analyzed patterns in vaccine uptake and hesitancy using local data from the population vaccine registry and 32 cross-sectional surveys conducted from October 2021 to December 2022. We examined the association of Vaccine Pass phases with vaccine uptake, taking into account covariables including self-risk perception, perceived self-efficacy in preventing COVID-19 and trust in government in pandemic control as well as physical distancing measures and demographics.FindingsThe uptake of primary series and third doses was significantly associated with stages of Vaccine Pass implementation, and other statistically significant drivers included age group, chronic condition, higher perceived personal susceptibility to COVID-19, higher trust in government, and higher educational attainment. Older adults (≥65y) were less likely to be vaccinated against COVID-19, compared to adults aged 18-44 years.InterpretationVaccine uptake in older adults was observed to have increased by a greater extent after the policy announcement and implementation, which occurred during and after a large Omicron wave with high mortality in older ages in early 2022. Since the policy withdrawal the uptake of further booster doses has been very low in all ages. Improving voluntary booster uptake in older adults should be prioritized.FundingHealth and Medical Research Fund, Hong Kong.

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“…Swab collection site for RT-PCR (nasopharyngeal, nasal, oropharyngeal and mid-turbinate, or throat) was recorded by healthcare staff and collected, but anatomical collection site of RAT was not known. Completion of the primary vaccination series was defined as two doses of Pfizer-BioNTech/Comirnaty or Moderna-Spikevax, three doses of Sinovac-CoronaVac or Sinopharm BBIBP-CorV, or two doses of non-mRNA vaccines approved under the World Health Organization (WHO) Emergency Use Listing besides Sinovac-CoronaVac and Sinopharm BBIBP-CorV [ 15 ]. Individuals who received additional vaccine doses after the primary vaccination series were considered boosted.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic performance of rapid antigen tests (RAT) for COVID-19 and factors associated with RAT-negative results among RT-PCR-positive individuals during Omicron BA.2, BA.5 and XBB.1 predominance

Tan,

Zeng,

Cui

et al. 2024

BMC Infect Dis

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Background While numerous studies have evaluated the real-world performance of rapid antigen tests (RATs), data on the effect of Omicron sublineages such as XBB and reinfections on RAT performance is limited. We assessed the performance of RATs and factors associated with RAT-negative results among individuals who tested SARS-CoV-2-positive by reverse transcription-polymerase chain reaction (RT-PCR). Methods We conducted a retrospective study among Singapore residents who underwent testing for SARS-CoV-2 with RAT (Acon Flowflex or SD Biosensor) and RT-PCR in the same clinical encounter between 9 May 2022 and 21 November 2022. RT-PCR served as a reference standard for RAT performance. Logistic regression was used to estimate the odds ratios (OR) of factors associated with negative RAT results among RT-PCR-positive cases. Results Of 8,620 clinical encounters analysed, 3,519 (40.8%) were SARS-CoV-2-positive on RT-PCR. Overall sensitivity and specificity of RAT was 84.6% (95% CI 83.3–85.7%) and 99.4% (95% CI 99.1–99.6%) respectively. Acon Flowflex consistently achieved higher sensitivity and specificity than SD Biosensor test kit. Among RT-PCR-positive cases, individuals who had a previous documented SARS-CoV-2 infection, coinfection with another respiratory pathogen or tested ≥ 6 days from symptom onset had higher odds of testing RAT-negative, but the associations were attenuated after adjustment for cycle threshold values (proxy for viral load). There was no significant difference in RAT performance between Omicron sublineages BA.2, BA.5 and XBB.1. Conclusion Diagnostic performance of RAT was not affected by changes in predominant circulating Omicron sublineages. However, reinfection cases may be under ascertained by RAT. In individuals with a previous SARS-CoV-2 infection episode or symptom onset ≥ 6 days prior to testing, a confirmatory RT-PCR may be considered if there is high clinical suspicion.

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Genesis, evolution and effectiveness of Singapore's national sorting logic and home recovery policies in handling the COVID-19 Delta and Omicron waves

Cited by 8 publications

References 9 publications

Coronavirus disease and home recovery: a Singapore perspective

Coronavirus disease and home recovery: a Singapore perspective

Assessment of the impact of the Vaccine Pass Policy on COVID-19 vaccine hesitancy and uptake among Chinese adults in Hong Kong

Diagnostic performance of rapid antigen tests (RAT) for COVID-19 and factors associated with RAT-negative results among RT-PCR-positive individuals during Omicron BA.2, BA.5 and XBB.1 predominance

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