With a week-on-week decline in ICU bed utilisation, Singapore is in a good place. Truth is, it is not yet out of the woods. As a public service, we republish a 19 Nov 2021 article by Ho Ching from her Facebook page. She explains why the ICU rate needs to come down further and why more of our seniors need to get vaccinated.

We have been watching our ICU utilisation rate.
Ideally, we should have on average a 50% utilisation. This is bcos we need a buffer in case of a sudden disaster or emergency.
Before Covid, we track between 1/3 utilisation abd 2/3 utilisation of our ICU beds.
So it’s good to know our ICU bed utilisation has come down to below 70%.
But is that really good?
Not really!
Eh? How come?
Ah! That is bcos we have increased the number of ICU beds by converting normal or high dependency hospital beds into emergency ICU beds.
Our hospitals have also postponed some less urgent surgeries.
 
But such postponements may end up with serious conditions later. That was why the surgeries were scheduled in the first place, even if it is not an emergency as yet.
So this 60+% utilisation is based off an expanded number of beds.

HoC quote11.21 

We now have about 400 ICU beds, an increase of over 100 ICU beds to meet covid needs.
Including the serious cases which need close 24 hour monitoring in ICU, we still have about 140 covid cases in ICU.
So we are not quite back to business as usual, or BAU in management jargon.
And what is our planning norm for ICU beds.
Like Britain, we have a planning norm of about 5 ICU beds per 100,000 population.
This works out to be around 280-290 ICU beds in total in Sg.

Germany: Runs out of ICU beds
Germany tips the scale at the other end. They have 10 times more ICU beds per 100,000 people than Sg.
That means 50 ICU beds per 100,000 population.
Even then, Germany is running out of ICU beds.
Border towns in Germany have had to airlift their Covid patients across the border to hospitals in Italy etc. This is the opposite flow from last year, when countries like Holland have had to airlift Covid patients to German hospitals across their border.
One key reason for the ICU shortages in Germany is their record numbers of Covid cases sweeping through Germany due to the Delta.
Germany still has large pockets of the unvaccinated, both in the former East German states, and even in wealthier West German states like Bavaria. 
 
True, with the Delta, the 2-shot vaccination is less able to prevent infection, compared to having a 3rd shot booster.
So vaccinated folks can still be infected, and infect others.
And the starting viral loads for both vaccinated and unvaxxed folks are equally high, 1000 times higher than the viral load from the old variants. This is 3 orders of magnitude higher.
Hence, the much higher viral loads of the Delta are so much more infectious. Epidemiology modelling and calculations show the average number of cases infected by one case to be around 5-8, sometimes even higher at 9. More recent estimates are leaning towards 8.
However, data show that with vaccination, viral loads in patients drop faster, and patients recover faster.
This means there is a shorter window for infected but vaccinated folks to infect others.
Without vaccination, the risk of ICU or death from a Covid infection is 10 times more than for the fully vaccinated. This data is consistent across the world, with slightly lower protection for those on less effective vaccines, and with time.
Thus, the large pockets of the unvaccinated are putting enormous pressure on the ICU beds, in Germany as well as Sg and elsewhere.
The Germans are also seeing shortages of trained medical and nursing staff to run the ICUs. The toll on the healthcare workers have been relentless the last 20 months.
Sg is beginning to see the pressure ease, but we are not out of the woods yet.
The pressure has eased partly bcos we have boosted our seniors, and partly bcos, everyday, we are also seeing 100-200 seniors come forward for their 1st shot.
So we still have about 1,000+ of seniors having their 1st shots every week. And they could be fully vaccinated a month or so later. 

Singapore: Help our seniors get vaccinated
So do help our seniors be vaccinated.
Do also help our pregnant mums to be vaccinated as soon as possible.
An unvaccinated mum has high risks both to herself and to her baby.
Women planning to have babies should also vaccinate.
A vaccinated mother either passes her antibodies to her baby in the womb, or to her baby via her breast milk.
The antibodies passed to the baby in the womb may protect the baby for as long as 6 months after birth. This happens wth other vaccines, and will likely also happen with the Covid prevention vaccinations.
Ho Ching was CEO of Temasek Holdings for 17 years and is the spouse of Prime Minister Lee Hsien Loong. She posts frequently on her Facebook page here.


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