Genesis, evolution and effectiveness of Singapore's national sorting logic and home recovery policies in handling the COVID-19 Delta and Omicron waves

Joachim Wen Kien Yau; Martin Yong Kwong Lee; Eda Qiao Yan Lim; Janice Yu Jin Tan; Kelvin Bryan Jek Chen Tan; Raymond Swee Boon Chua

doi:10.1016/j.lanwpc.2023.100719

Genesis, evolution and effectiveness of Singapore's national sorting logic and home recovery policies in handling the COVID-19 Delta and Omicron waves

Lancet Reg Health West Pac. 2023 Jun:35:100719. doi: 10.1016/j.lanwpc.2023.100719. Epub 2023 Mar 2.

Authors

Joachim Wen Kien Yau¹, Martin Yong Kwong Lee², Eda Qiao Yan Lim³, Janice Yu Jin Tan², Kelvin Bryan Jek Chen Tan², Raymond Swee Boon Chua²

Affiliations

¹ Headquarters Medical Corps, Singapore Armed Forces, Ministry of Defence, Singapore.
² Ministry of Health, Singapore.
³ National University Hospital, Ministry of Health Holdings, Singapore.

Abstract

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.

Keywords: COVID-19; Delta; Home recovery; Mortality; Omicron; Primary care; Severity rates; Sorting logic; Technology; Telemedicine; Triage criteria.

Publication types

Review