Medical staff prepare pre screening procedure at the National Centre for Infectious Diseases building at Tan Tock Seng Hospital in Singapore on January 31, 2020. – Patients infected with the virus similar to the SARS pathogen are warded in isolation rooms at the National Centre for Infectious Diseases according to the health ministry as Singapore bans January 28 new arrivals with recent travel to virus-hit Chinese province ramping up government measures against the spread of a deadly virus. (Photo by Roslan RAHMAN / AFP)

On 9 April, a user on the HardwareZone forum started a thread which pointed out the capacity of Singapore’s healthcare system, specifically in terms of the number of hospitals beds available, and the date is staggering.
According to data from the Ministry of Health (MOH), the country has a maximum of 11,321 beds in acute hospitals which comprises both general hospitals and speciality centres (excluding Psychiatric Hospitals) with acute care inpatient facilities.

Now, looking at the case status as of 21 April by MOH, there are 3,566 COVID-19 patients in general wards in hospitals and 27 in intensive care. That’s a total of 3,593 patients in hospitals, or about 31.7% of inpatient hospital beds being used for COVID-19 patients.
These of course do not include patients who are already warded at these hospitals for other illnesses. Even before the pandemic struck, hospitals in the country were challenged by overcrowding. A Value Champion article in 2018 illustrated consistently high occupancy rates in hospitals, especially on weekdays, and long wait-times which are another indicator of overcapacity. The Singapore Business Review in 2018 quoted research firm ValuePenguin saying that the country’s the average daily bed occupancy rates for public hospitals in Singapore is at 85%.
Back to the current situation, if we look at MOH’s data from 11 April (the latest available data) on the bed occupancy rate (BOR) at different hospitals, excluding KK Women’s and Children’s Hospital and the National University Hospital (Children), we can see that nearly all the hospitals are at over 70% occupancy rate. Khoo Teck Puat is at 85.5% occupancy:

Based on this, we can estimate the available number of beds as of 11 April, which are only at 2227.
On 11 April, there were 943 COVID-19 cases hospitalised in the country (out of a total of 2,532 cases). By 21 April, that number skyrocketed to 3,593 cases hospitalised out of 9,125 cases in total.
That’s an increase in 2,650 cases of COVID-19 hospitalised. But the number of bed available as of 11 April were only 2,227.
The table by MOH on the summary of cases status for the past 14 days also shows that more and more cases are being “decanted” into isolation facilities such as the ones at D’Resort and the Singapore EXPO as well as private hospitals and community hospitals.
On 20 April, 3,782 cases were in these isolation facilities. That number rose sharply to 4,682 on 21 April.
We don’t have more recent data on bed occupancy rates as MOH seems to have stopped updating that particular information.
But looking at MOH’s latest situation report on 21 April, we can see that the number of patients being discharged each day is far lower than those being admitted into hospitals.
Looking at the number of cases that have completed isolation between 20 and 21 April, that’s only 20 cases. And that’s the same number of cases listed in the discharge column.
Given that we know these isolation facilities are specifically for cases who are clinically well but still test positive for COVID-19, it’s safe to assume that the 20 who were discharged were discharged from isolation facilities and not hospitals.

That then leaves us with the question of the 1,111 new cases MOH reported on 21 April.
Looking at the table above, there are 4 more cases in ICU, 169 more cases in general wards and 900 more cases in isolation facilities. That only adds up to 1,073. If we take away the 20 cases that have been discharged, that’s 1,053 cases.
So where are the other 58 cases?
On top of that, when we look at the MOH press release on the daily update of new cases on 19 April which reported 596 new cases, many those, over 200 cases, were still classified as “pending” on which hospitals they would be admitted to.

The following days, on 20 and 21 April, the MOH no longer provided a detailed breakdown of new cases as they did before in terms of where these cases are admitted, or whether they are linked to clusters or not. Instead, only a summary of cases is provided. Why is there no breakdown?
Since the sharp increase in new cases over the last few days has made Singapore the country with the highest number of COVID-19 cases in Southeast Asia, could it be that public hospitals in the country at now at maximum occupancy and can’t take on anymore patients?
Just today, Professor Dale Fisher from Department of Medicine at the NUS Yong Loo Lin School of Medicine, appearing in Straits Times’ Big Story interview, agreed that the hospital systems are strained when asked on whether can the healthcare system cope with the huge numbers of COVID-19 infection cases from the dormitories.
“there is no doubt about that”, said Prof Fisher and noted that many of the hospital staff are now providing medical services at the dormitories.
Prof Fisher. who is also Senior Consultant in the Division of Infectious Disease at the National University Hospital and Chair of the Global Outbreak Alert and Response Network (GOARN) steering committee for the World Health Organization, also shared that elective hospital work, surgery or clinical appointments at the hospitals have been cut or postponed.
And with the likely possibility of even more confirmed cases coming up in the days to come, will it come to a point where Singapore’s healthcare system is unable to cope?

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