Primary care doctors get more discretion to assess if their COVID-19 patients can recover in the community
SINGAPORE: Primary care doctors, such as general practitioners, will now have more discretion to assess if their COVID-19 patients can recover in the community or should be referred to care facilities, based on their condition, said the Ministry of Health (MOH) on Wednesday (Jan 5).
This comes under revised health protocols which will kick in “progressively” from Thursday, said Health Minister Ong Ye Kung at a press conference by the multi-ministry task force for COVID-19.
He noted that the move was made to “further empower” primary care partners to look after their patients, by allowing them to “trigger” more protocols.
The existing “Protocols 1-2-3” determine what individuals should do if they are unwell or test positive for COVID-19.
Under Protocol 1, the individual who is not well will be asked to undergo a polymerase chain reaction (PCR) test. If tested positive, the person will undergo home recovery or be conveyed to an isolation facility, depending on their “disposition and risk level”, said Mr Ong.
Under Protocol 2, the patient who is usually asymptomatic or experiencing mild symptoms, will administer an antigen rapid test (ART) and self-isolate for 72 hours if tested positive.
“We will empower primary care doctors to trigger not just Protocol 1, which they are doing now, but also Protocol 2," said Mr Ong.
“We have since engaged our primary care partners and I’m happy to share they welcomed this.”
The move also comes as patients with mild symptoms on home recovery “generally recover quickly” in the comfort of their home without the need for further medical care, said MOH.
At the same time, prevailing evidence indicates that the Omicron variant, while more transmissible, is less severe, it said.
DECIDING ON RECOVERY ROUTE FOR PATIENTS
Associate Professor Kenneth Mak, director of MOH's medical services, said: "The decision-making is based on the clinical severity of the patient's condition and not the type of test that's used to diagnose COVID-19 infection".
The ministry noted that for low-risk individuals with mild symptoms, primary care doctors can make an “immediate diagnosis” via a healthcare-administered ART and continue to care for them under Protocol 2.
The individual will have to self-isolate at home for at least 72 hours. If they feel well after and test negative on a self-administered ART, they can exit self-isolation.
“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 14 for unvaccinated or partially vaccinated individuals, whichever is earlier,” said MOH.
The person will also get a five-day medical certificate, or longer if needed, to cover the period of rest required. But if the individual's symptoms worsen or do not improve, MOH advised returning to the doctor or calling 995 in emergency situations.
On the other hand, those who are assessed by their doctors as being high risk, or with significant symptoms such as chest pain or prolonged fever, will continue to be managed under Protocol 1. They will have to undergo both ART and PCR tests, and if tested positive, will receive an Isolation Order for 10 or 14 days, depending on their vaccination status.
Low-risk individuals who are well, and or asymptomatic, will continue to be managed as per existing Protocol 2 if they test positive on ART, said MOH.
It added that it will monitor the situation in the coming weeks and make further adjustments to gradually allow more to recover under Protocol 2 after seeing a primary care doctor.