Some 1,500 medical workers quit in H1 2021 amid severe strain on healthcare system: MOH

SINGAPORE cannot open up and risk having the number of Covid-19 cases "shoot up" and overwhelm the healthcare system.

This is especially so at a time when medical workers are already stretched to their limit alongside a rising number of resignations, Senior Minister of State for Health Janil Puthucheary said on Monday.

"Our hospitals are feeling the manpower crunch. Signs of fatigue can be seen amongst our healthcare workers. It has been over 20 months of continuous daily battle against the pandemic," he said in a ministerial statement in Parliament on an update on the intensive care unit (ICU) and hospital capacity situation.

"A large proportion of our 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."

It is no surprise that resignations have risen this year; about 1,500 healthcare workers have resigned in the first half of 2021, compared with about 2,000 annually before the pandemic, said Dr Janil.

Close to 500 foreign doctors and nurses have quit in the first half of 2021, compared with about 500 in 2020 and 600 in 2019, he added, noting that they have been unable to travel to see their families back home.

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Manpower is also the "most important limit" in increasing ICU bed capacity to cater to a potential rise in severe Covid-19 cases.

Dr Janil said the Ministry of Health (MOH) is working to ramp up from 219 to 280 ICU beds for Covid-19 patients by this week, with the next level of expansion at 350 beds.

Currently, there are 130 critically-ill Covid-19 patients who are occupying 60 per cent of the 219 ICU beds reserved for Covid-19 patients. Non-Covid-19 patients with life-threatening medical conditions occupy about 80 per cent of 163 adult ICU beds.

In comparison, before the pandemic, the average occupancy rate was 63 per cent out of 298 adult ICU beds. MOH has been reducing the number of non-Covid-19 ICU beds to cope with more Covid-19 patients, Dr Janil said.

However, patients in ICU need trained staff who can provide round-the-clock monitoring and continuous care, which is why any increase in ICU bed capacity must be supported by an increase in manpower, he noted.

"Logistically, we can keep stepping up our ICU beds. We have ventilators, equipment, consumables, all the things that are needed. But not enough people," said Dr Janil.

"As a result, when we increase beds, we stretch and stretch our healthcare workers. We will come to the point that they will no longer be able to provide that continuous excellent care."

This will also lead to a lower nurse-to-patient ratio.

"In a normal ICU pre-Covid-19, one nurse will look after 1 or 2 patients. If she has to look after 4, she will not have enough hands or time to provide the same level of care," he said.

"There will come a point where even as the healthcare professionals are trying their best, more patients will die. And this will affect both Covid-19 and non-Covid-19 patients," Dr Janil added.

As more healthcare resources are diverted to support Covid-19 services, hospitals' ability to sustain regular non-Covid-19 services will be reduced, he said.

The Republic has seen 407 Covid-19-related deaths so far, and close to 95 per cent of those who died in the last 6 months were aged 60 and above.

Among these, 72 per cent had not been fully vaccinated, whereas almost all the remaining cases who were fully vaccinated suffered from underlying medical conditions such as high blood pressure, diabetes, cancer and heart, lung or kidney diseases.

Singapore’s high vaccination coverage and booster programme have helped reduce severe illness among vaccinated seniors but the unvaccinated continue to be at risk, he said. Every day, about 60 unvaccinated seniors get infected with 6 likely to end up in ICU.

Compared to the vaccinated, someone who is 60 and above and unvaccinated is 6 times more likely to need oxygen, 8 times more likely to become critically ill and need the ICU, and 17 times more likely to die, said Dr Janil.

He added that Singapore's efforts to keep the absolute number of Covid-19 deaths low have succeeded, with the rate at 0.2 per cent, compared with 3 per cent or more in countries that experienced a surge in cases before vaccination.

"This rate of 0.2 per cent is comparable to catching pneumonia. But it does mean that over time, the absolute number of deaths from Covid-19 will rise despite the best possible medical care, and we could have 2,000 deaths per year," he said.

Pre-pandemic, about 4,000 patients die as a result of influenza, pneumonia and other respiratory diseases, most of whom are elderly and unwell.

"I hope my explanation has helped members understand why although we say we are living with Covid-19, we cannot just open up, and risk having the number of cases shoot up," Dr Janil said.

"More and more cases will translate into more and more ICU beds used, and beyond a certain point, that will force us to accept a lower standard of care, and hence have more deaths that could have been prevented."

In response to questions from Workers Party (WP) MPs on plans to ramp up hiring, Dr Janil said this is already ongoing but the challenge is that new hires, especially those from overseas, tend to be inexperienced with healthcare protocols here.

While the Ministry of Health has been opening up capacity ahead of the curve, it cannot be “so far ahead of the curve that we are having people sit around idle”.

He added that intensive care is a clinical practice that cannot be learnt simply by reading textbooks and doing online courses. All medical staff  have to be mentored and be preceptive when looking after their patients hands-on.

“It’s not something that you could have gone 5 times or 4 times in vacuo, in peacetime and held everything ready and in abeyance. It would have been a waste of resources and also would not have been effective in changing the outcomes currently,” he said.

Leader of the Opposition and Aljunied GRC MP Pritam Singh from WP also asked about the recent pushback against the government’s decision to extend dine-in caps for two people which seemed at odds with the country’s decision to reopen its borders.

In response, Health Minister Ong Ye Kung said the difference is that in the initial stage, Singapore had very low infections while the rest of the world had high rates.

“So when you open up borders at that time, you’re opening up the floodgates. Today, the situation is entirely different. Our infection rates and the outside infection rates are similar and in fact they may be lower than us because they went through huge waves and we are still going through ours,” said Ong.

Travel is also only limited to vaccinated individuals who have to be tested. It is a “similar concept” to bigger events like weddings, he said, where guests can sit in five if they are tested.

“This also presents possibilities for us to think about in future... whether through tests, through vaccination, we can allow gatherings that are a bit more free,” he said.