Yau Joachim Wen Kien, Lee Martin Yong Kwong, Lim Eda Qiao Yan, Tan Janice Yu Jin, Tan Kelvin Bryan Jek Chen, Chua Raymond Swee Boon
Headquarters Medical Corps, Singapore Armed Forces, Ministry of Defence, Singapore.
Ministry of Health, Singapore.
Lancet Reg Health West Pac. 2023 Jun;35:100719. doi: 10.1016/j.lanwpc.2023.100719. Epub 2023 Mar 2.
Singapore developed several novel strategies to transition towards "living with COVID-19", while protecting hospital capacity. The Home Recovery Programme (HRP) was a national, centrally-administered programme that leveraged technology and telemedicine to allow low-risk individuals to safely recover at home. The HRP was subsequently expanded by partnering primary care doctors in caring for more cases in the community. A key enabler was the National Sorting Logic (NSL), a multi-step triage algorithm allowing risk-stratification of large numbers of COVID-19 patients at a national-level. At the core of the NSL was a risk assessment criterion, comprising of Comorbidities-of-concern, Age, Vaccination status, Examination/clinical findings and Symptoms (CAVES). The NSL sorted all COVID-19 cases into the various levels of care - Primary Care, HRP, COVID-19 Treatment Facility and Hospital. By adopting a national approach towards managing healthcare capacities and triaging COVID-19 patients, Singapore was able to prioritize healthcare resources for high-risk individuals and prevent hospital capacities from being overwhelmed. As part of the national response strategy to tackle COVID-19, Singapore set up and integrated key national databases to enable responsive data analysis and support evidence-based policy decisions. Using data collected between 30 August 2021 to 8 June 2022, we conducted a retrospective cohort study to evaluate the outcomes and effectiveness of vaccination policies, NSL and home-based recovery. A total of 1,240,183 COVID-19 cases were diagnosed during this period, spanning both Delta and Omicron waves, Overall, Singapore experienced very low severity (0.51%) and mortality (0.11%) rates. Vaccinations significantly lowered severity and mortality risks across all age groups. The NSL was effective in predicting risk of severe outcomes and was able to right-site >93% of cases into home-based recovery. By leveraging high vaccination rates, technology and telemedicine, Singapore was able to safely navigate through two COVID-19 waves without impacting severity/mortality rates nor overwhelming hospital capacities.
新加坡制定了多项新策略，在保护医院收治能力的同时向“与新冠病毒共存”过渡。居家康复计划（HRP）是一项由国家集中管理的计划，该计划利用技术和远程医疗，让低风险个体能够在家中安全康复。随后，通过与基层医疗医生合作，以便在社区护理更多病例，居家康复计划得到了扩展。一个关键推动因素是国家分类逻辑（NSL），这是一种多步骤分诊算法，可在国家层面上对大量新冠病毒患者进行风险分层。国家分类逻辑的核心是一个风险评估标准，包括关注的合并症、年龄、疫苗接种状况、检查/临床发现和症状（CAVES）。国家分类逻辑将所有新冠病毒病例分为不同级别的护理——基层医疗、居家康复计划、新冠病毒治疗机构和医院。通过采取全国性方法来管理医疗保健能力和对新冠病毒患者进行分诊，新加坡能够为高风险个体优先分配医疗资源，并防止医院收治能力不堪重负。作为应对新冠病毒的国家应对策略的一部分，新加坡建立并整合了关键的国家数据库，以实现快速数据分析并支持基于证据的政策决策。利用2021年8月30日至2022年6月8日期间收集的数据，我们进行了一项回顾性队列研究，以评估疫苗接种政策、国家分类逻辑和居家康复的结果及有效性。在此期间共诊断出1,240,183例新冠病毒病例，涵盖德尔塔和奥密克戎毒株流行期。总体而言，新加坡的严重程度（0.51%）和死亡率（0.11%）非常低。疫苗接种在所有年龄组中均显著降低了严重程度和死亡风险。国家分类逻辑有效地预测了严重后果的风险，并能够将超过93%的病例正确安排到居家康复。通过利用高疫苗接种率、技术和远程医疗，新加坡得以安全度过两波新冠病毒疫情，而不会影响严重程度/死亡率，也不会使医院收治能力不堪重负。
