Singapore can ramp up ICU capacity but 'not enough people': Janil Puthucheary
SINGAPORE — While Singapore has the resources to increase intensive care unit (ICU) capacity, it lacks the manpower to man the additional units effectively, said Senior Minister of State (SMS) for Health Janil Puthucheary in Parliament on Monday (1 November).
"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 Puthucheary.
"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."
The SMS warned that the nurse-to-patient ratio will also be lower, which means each nurse will have to take care of more patients. He pointed out that in a normal ICU, one nurse looks after one or two patients. "If she has to look after four, she will not have enough hands or time, to provide the same level of care."
Dr Puthucheary added, "There will come a point where even as the healthcare professionals are trying their best, more patients will die."
The SMS was delivering a Ministerial Statement on ICU and hospital capacity, as Singapore reported an additional 3,163 COVID cases and 13 more deaths on Sunday.
'Stretched to their limit'
The past fortnight has seen ICU staff "stretched to their limit", with a peak of 171 COVID cases in ICU, which has since come down to 130. They are occupying around 60 per cent of the 219 ICU beds currently reserved for COVID-19 patients.
Such patients stay for an average of 11- 15 days, and some stay for up to a month.
While only about 0.3 per cent of COVID cases requiring ICU care, it translates to a large absolute number of ICU patients when case numbers are high, and will place a serious strain on ICU capacity, warned Dr Puthucheary.
In addition, there are non-COVID-19 patients with life-threatening medical conditions who require ICU care. Public hospitals currently operate about 163 adult ICU beds for these patients, with an average occupancy of close to 80 per cent. By comparison, in 2019, there were 298 adult ICU beds, and the average occupancy rate was 63 per cent.
"So we have been reducing non-COVID-19 ICU beds, in order to cope with more COVID-19 patients. This is one of the key trade-offs when we increase the number of COVID-19 ICU beds," said Dr Puthucheary.
Increasing ICU capacity not straightforward
The minister revealed that the Ministry of Health (MOH) is currently working with hospitals to ramp up from 219 to 280 ICU beds for COVID-19 patients, which can be ready this week. If needed, the next expansion will be up to 350 beds.
Existing hospital wards, such as single rooms and isolation rooms, have been repurposed into additional ICU beds.
He stressed, "So while we may have plans to step up to a certain number of ICU beds, the real situation on the ground, the operational considerations, are not straightforward. We do not want to go anywhere near the theoretically possible number."
As of Sunday, 1,672 COVID patients have been admitted into the acute public hospitals, taking up about 18 per cent of hospital beds. The occupancy rate of all general ward beds is currently at about 90 per cent, with 85 per cent of isolation beds taken up now.
A total of 284 COVID patients currently need oxygen support in the general wards.
Nevertheless, the SMS stressed that Singapore has had one of the lowest fatality rates in the world, and that while the healthcare system is stressed, it has not been overwhelmed.
"At the beginning it was because we had such tight restrictions, rapid contact tracing, and low total number of cases in the community, but with cases rising fast, the case fatality rate remains low now because we have reached such a high vaccination rate, and because all those who have become sick have been able to receive the care that they need."
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