SINGAPORE: Clinics in Singapore are seeing a greater number of COVID-19 positive patients as coronavirus cases here start climbing again.
Dr John Cheng, the head of primary care at Healthway Medical Group, said there was a gradual increase of about 10 per cent in patients with acute respiratory infections at their clinics in the past two weeks. Healthway has more than 50 general practitioner clinics.
But he added: “It is different from the last wave where there was a sudden surge that made it difficult for clinics to cope. Having said that, it may be too early to comment as the peak is projected to be in July or August.”
Health Minister Ong Ye Kung said last month that Singapore could expect a new Omicron wave in July or August, likely to be driven by subvariants BA.4 and BA.5.
Fullerton Health clinics and affiliates, which number more than 800, have also seen an increase in patients with acute respiratory illness (ARI) from May through June, said a spokesperson.
“We will be closely monitoring the ARI rate in July as more individuals have returned from overseas travel following the June holidays and it is also the tail end of the southern hemisphere influenza season,” said the spokesperson.
Dr Lee Joon Loong from Paddington Medical Clinic said that in the last week, he saw more COVID-19 patients on average than during the earlier Omicron wave, which peaked in March.
Dr Zhang Hao Tian from 1 Bishan Medical Clinic said he has seen an uptick of about 20 to 30 per cent in coronavirus cases, but the increase is “still quite manageable” compared to earlier waves.
On Tuesday, Singapore reported 11,504 new COVID-19 cases – the highest daily number of infections in more than three months. There were more than 9,000 daily cases on Wednesday and Thursday.
This is a marked increase from May and earlier in June when the number of infections ranged from 1,000 to more than 6,000 a day. At the peak of the last Omicron wave, daily cases topped 25,000.
Then, the primary healthcare system comprising general practitioners, polyclinics and hospital emergency departments was stretched, although the number of patients with severe disease or in intensive care was lower than during the Delta wave.
Dr Lee said that he recommends patients who have symptoms consult a doctor for an assessment, as he has seen more people with “increased severity” and complications from the infection, he said.
He added that he has treated symptomatic patients who tested negative with an antigen rapid test kit at home, but was positive when tested at the clinic.
“We do a proper test and we also assess for the complications of COVID-19. That's why it's very important to see your doctor,” he advised.
Dr Cheng said that people who test positive but are asymptomatic or have very mild symptoms can recover at home, according to Ministry of Health (MOH) guidelines.
“If they are unwell, they are advised to see a doctor,” he said.
While studies and data overseas have reported more breakthrough infections due to BA.4 and BA.5, clinics here have not seen a clear trend of this happening in Singapore.
“But do keep in mind that we have not reached the peak of the BA.4 and BA.5 subvariant wave yet,” said Dr Cheng.
Professor Paul Tambyah, deputy director of the Infectious Diseases Translational Research Programme at the NUS Yong Loo Lin School of Medicine, said that the rate of reinfection with BA.4 and BA.5 is still low.
“The problem with BA.4 and BA.5 is that they are more transmissible but not necessarily more virulent. This happens with all pandemic viruses. They become more transmissible and less virulent over time,” said Prof Tambyah.
Associate Professor Natasha Howard from the Saw Swee Hock School of Public Health at NUS said that people who have been fully vaccinated and boosted or recently had COVID-19 can still get infected.
“Unless you can avoid people entirely, and most of us wouldn’t want to, it will be almost impossible to avoid any COVID infection (or reinfection) as we adjust to endemicity,” she said.
“This is why we so strongly recommend being fully vaccinated and getting boosted once you’re eligible. If you are fully vaccinated you are less likely to experience severe disease.”
Dr Zhang, whose Bishan clinic offers vaccinations, has also noticed more people enquiring about and taking booster jabs.
"We do see quite a lot of people asking and walking in for vaccinations, which is quite heartening and which we strongly encourage," he said.
For those who are concerned about reinfection, they should still get their booster vaccination 90 days following recovery, said the Fullerton Health spokesperson.
Assoc Prof Howard said that most seniors should take an mRNA vaccine as a booster, unless they are medically ineligible, in which case they can take Novavax's Nuvaxovid.
“While these don’t specifically target BA.4/5 subvariants they still provide good protection against severe infection,” she said.
Booster vaccine candidates in the pipeline, such as Moderna's bivalent booster candidate (mRNA-1273.214) that showed a good response against BA.4 and BA.5, are not yet approved for use.
Assoc Prof Howard expects the BA.4 and BA.5 subvariants to “soon overtake” the currently dominant BA.2 Omicron subvariant in Singapore.
In May, 97 per cent of local COVID-19 cases sequenced were all Omicron, with the majority being subvariant BA.2 and its lineages. While there were cases of BA.4 and BA.5, they made up 1 to 2 per cent of the cases.
The new subvariants do not appear to cause more severe disease than earlier mutations.
But she warned: “People should remember that more cases means more hospitalisations and deaths due to basic maths, even if the total proportions of these to cases remain unchanged.”
Besides getting a booster shot, Dr Cheng encouraged people to practise basic hygiene and wear a mask, avoid crowded places and practise social responsibility by staying home if feeling unwell.
Prof Tambyah added that the virus will continue to adapt to evade the immune system and “infect the last few people who remain uninfected”.
“In practical terms, this means that we need to continue with the approach we have taken of ‘living with the virus’,” he said.
“We know that most people will eventually get infected but as long as we concentrate on treating those who are vulnerable and at risk, we will be fine.”
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