[BREAKING] Something funny is happening with the Hospitalisation numbers

zwHrebmeM

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Despite the recent increase in case nos.in the past 3 days, the increase in hospitalisation numbers are MUCH, MUCH lesser! 😲
MtVO9iy.png

Yesterday alone, 321 Completed isolation and 24 Discharged from hospital (full discharged, not transferred to CCF)! 😲
Figure 4.1: Summary of Confirmed Cases by Status in the Past 14 Days
BXMFayd.png

Typically, those completed isolation are those that were infected 10 days ago (low viral loads) or 14 days ago (high viral loads).
However, 10/14 days ago, there weren't so many that got infected. :unsure:

A likely explanation is the start of the pilot Home isolation model (self-monitoring at home).
But that means already a lot of infected people are selected for this model daily. 😲 (I thought it's still a piloting phase!)

If this goes ahead:
  • Hospitalisation numbers will continue to reduce in the next few weeks
  • MTF will use this as basis to justify SG being able to take larger community cases and pushing ahead with opening up. This means more people will get infected. (This is not necessary good because Long Covid cases will go up)
BUT
  • The reduction in hospitalisation nos. will only be short-term. Once the full effects of Home isolation model is felt, the hospitalisation nos. will then increase if daily community cases continues at a high no.
  • If the pilot is not successful, there'll be a sudden surge in hospitalisation (our acute hospitals may not be able to handle)
We need to pay attention to this in the next few weeks.

_________________________________________________________

Edit on 13 Sep:

Since I started this thread on last Thu 9 Sep, what has changed to the Hospitalisation nos.?

(Images deleted as only 10 pics allowed per post. Refer to full post on 13 Sep below for data)
QQqbyxm.png


Acute hospitalization increased 72 beds on 12 Sep!

Biggest daily increase this year.
(In fact, before CB announcement last year, the increase wasn't even that much.)

This is mainly due to the increased in those >60 yo (probably due to Chinatown cluster)

fig3(12sep21).png

The increased in O2 (35 -> 54) is also worrying.

Also CCF increased by 1,000 in just 4 days!

This sharp increase is not sustainable.
SG still has buffer now but needs time to ramp up in case the figures continue to rise.
Although it may be manageable now, but if the increase continues for another 2 weeks, there's bound to be stress to the healthcare system.

I predict that if there's another 50+ increase in Acute hospitalization nos. today, MTF would have to take additional measures to stop the spread.

TTSH, CGH, Bt Merah View, JFP and now Chinatown has already proven that any cluster involving high % of elderlies/vulnerable groups will be serious.
MTF needs to learn from mistakes and prevent any more of these clusters from happening.
Don't just rely on vaccination/boosters but also pay attention to preventing transmission at places with more seniors/vulnerable groups.

Also, home transmission from household members to elderlies/vulnerable groups should be look at more seriously. MOH should continue to provide more advice, so that those families with these group of people can do better to prevent unintended transmission to them.

As said previously, we'll need to pay attention to the Hospitalization Nos. in the next few weeks.

_________________________________________________________

Edit on 19 Sep:

Since OYK mentioned about General Wards coming under pressure, I thought I should do an update.

BXMFayd.png

Qy2N8De.png

OPi98RU.png


For the past 14 days, General Ward has just increased by 242 beds (i.e. +17 beds/day)

So why is OYK so concern?
It's because this low rate was achieved thru MOH implementing several schemes to reduce the load on Hospitalization:
  • Shortened Isolation period
  • Home Recovery
But these are short term (what I call "kick the can down the road") strategies.

Whoever needs Hospitalization, O2, ICU, in the end will still need it.
Shortening Isolation period or putting them in Home Recovery will not change anything.
It fact, it may increase the risks that they'll need it more if their conditions are not well managed during Home Recovery.

So what is the concern?
  • Yesterday's increase of 46 beds in the General Ward is a concern
    • As I mentioned previously, the rate of increase is a big concern. If it is gradual increase, there is time to ramp up capacity. However, if the increase is > 50 beds for a few consecutive days, then there's not sufficient time to ramp up capacity.
  • Reaching over 800 beds in General Ward is a concern
    • Previous high last year during dorm cases explosion was 1,741 (at that time, the healthcare system was stretched). MOH has to implement tightened measures when it reaches half of this i.e. 870. This is because measures when implemented need time to show effect.
  • Not many non-tightening measures left to implement
    • Isolation period can't possibly be shortened further or it'll be too risky
    • Home Recovery can't be relaxed further to allow those above 70 yo
    • Next on the cards is to 'discharge' those non-life threatening patients from the General Wards. But this take time. If the increase in General Ward is gradual, this method will work. But if the increase is big (eg. > 50 beds/day), then this method alone is not sufficient.
MOH is probably hoping to see those measures implemented on 6 Sep to start showing effect to slow down the rate of increase.
If this does not happen in the next few days, it is likely MOH will be "forced" to implement certain tightened measures.

Watch the Hospitalization numbers in the next few days.
It will provide clue to the way ahead.

_________________________________________________________

Edit on 22 Sep:

Since I started this thread on 9 Sep, what measures have MOH implemented?
Let's recap.

  1. 10 Sep
    1. Expand Home Recovery progressively for vax 19~50 yo; 5~18 voluntarily
    2. Shorten Isolation period for vax from 14 to 7 days
    3. Rely more on TT and less on interviews for Contact Tracing
    4. Shorten Quarantine period from 14 to 10 days
    5. Increase frequency and sectors for FET RRT
    6. Regular testing for onsite staff
  2. 12 Sep
    1. Suspend visits to Residential care homes temporarily
    2. Use ART more frequently for staff & residents of Aged care facilities
  3. 14 Sep
    1. Expand Home Recovery as default for vax 19~50 yo
    2. Shorten HRW and HRA self-monitor period from 14 to 10 days.
  4. 17 Sep
    1. Extend Home Recovery as default for vax 51~69 yo
  5. 19 Sep
    1. Set up Stepped-Up CCF
(I have excluded measures that have no/little bearing on hospitalisation nos. eg. self registration of household close contacts, deployment of ART venting machines etc.)

5 days, 12 measures in a period of 13 days.
Are they effective?

Only those measures that increase testing will help to reduce the rate of increase in infection (by picking up infected persons early to prevent further transmission).
8 days (2 infection cycles) have passed since implementation, and the effect seems limited at best.

The other measures are short term and just "kick the can down the road".

Hospitalisation Nos.
BXMFayd.png

ko0tZnw.png


CTTkQf8.png


Increase in Acute Hospitalisation > 50 for 2 days already.
New SUCCF will start tomorrow on 23 Sep with 250 beds (5 days worth?)
Increase in Acute Hospitalisation needs > Speed of setting up SUCCF
This is not sustainable.

As I've mentioned previously, MTF will have to implement tightened measures when General Wards reach more than 870.
This level has been crossed for 2 days already.
MTF cannot delay any longer or our Healthcare system will be stressed, if not already so.
Measures when implemented need time to show effect.
And history has showed us in these 20 months that for countries (including SG) that act late to bring infection numbers down, there will be severe consequences.

KM mentioned that 10~15% of infected will need hospital care.
10% of 1,000 infected daily = 100 will need hospital care daily.
Assuming 14 days hospital stay -> 1,400 beds needed constantly if infection maintains at 1,000/day.
This is just unsustainable without stress on our Healthcare system.
MTF needs to act NOW to bring the infection numbers lower, not to mention also the benefits of having lower infection numbers.

Implementing tightened measures is easy.
Spinning the story is not.
But let's do the RIGHT thing.
 
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laopokcar_g

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People will qualify for the home isolation scheme if they have mild or no symptoms and can be isolated from the rest of the household, said the Ministry of Health (MOH) on Thursday (Aug 19).

However, such patients and their household members must meet certain stringent conditions.

For instance, everyone in the home must be fully vaccinated and must not belong to any vulnerable groups, such as pregnant women, the elderly or the immunocompromised. This is in line with the World Health Organisation's recommendations and the best practices of other developed countries, MOH said.
 

Broadwalk

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Despite the recent increase in case nos.in the past 3 days, the increase in hospitalisation numbers are MUCH, MUCH lesser! 😲
MtVO9iy.png

Yesterday alone, 321 Completed isolation and 24 Discharged from hospital (full discharged, not transferred to CCF)! 😲
Figure 4.1: Summary of Confirmed Cases by Status in the Past 14 Days
BXMFayd.png

Typically, those completed isolation are those that were infected 10 days ago (low viral loads) or 14 days ago (high viral loads).
However, 10/14 days ago, there weren't so many that got infected. :unsure:

A likely explanation is the start of the pilot Home isolation model (self-monitoring at home).
But that means already a lot of infected people are selected for this model daily. 😲 (I thought it's still a piloting phase!)

If this goes ahead:
  • Hospitalisation numbers will continue to reduce in the next few weeks
  • MTF will use this as basis to justify SG being able to take larger community cases and pushing ahead with opening up. This means more people will get infected. (This is not necessary good because Long Covid cases will go up)
BUT
  • The reduction in hospitalisation nos. will only be short-term. Once the full effects of Home isolation model is felt, the hospitalisation nos. will then increase if daily community cases continues at a high no.
  • If the pilot is not successful, there'll be a sudden surge in hospitalisation (our acute hospitals may not be able to handle)
We need to pay attention to this in the next few weeks.
Good observation and thanks for heads up. :o
 

smellyfish

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this is an important step in our progress towards endemic. we are really trying to show the world the middle ground between opening up irresponsibly of the west and closing up irresponsibly of the east. Frankly the PAP is the only government in the world with the means to even attempt this
 
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zwHrebmeM

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People will qualify for the home isolation scheme if they have mild or no symptoms and can be isolated from the rest of the household, said the Ministry of Health (MOH) on Thursday (Aug 19).

However, such patients and their household members must meet certain stringent conditions.

For instance, everyone in the home must be fully vaccinated and must not belong to any vulnerable groups, such as pregnant women, the elderly or the immunocompromised. This is in line with the World Health Organisation's recommendations and the best practices of other developed countries, MOH said.
That's why I'm surprised that if the recent increase in Completed Isolation is due to sending them for Home Isolation, then the numbers are really a lot considering the criteria! 😲
 

herzberg

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Correct mah, pak zam liao then mild symptoms, stay at home no need kia lao kun chu, ownself poke nose, ownself recover will do
 
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