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SINGAPORE: Hundreds of general practitioner (GP) clinics will be reactivated as Public Health Preparedness Clinics (PHPCs) as part of efforts to better detect and manage COVID-19 infections, said the Ministry of Health (MOH) on Friday (Feb 14).

The ministry added that this is a "proactive step" to reduce the risk of further community spread.



Many local confirmed cases had continued to "circulate in the community" or gone to work when they were already ill, the health ministry noted.

"This is why MOH had earlier given guidance to doctors to provide medical certificates (MCs) of five days for patients with respiratory symptoms so they could stay home to recover," said the ministry in a press release.

The National Centre for Infectious Diseases (NCID) has also observed that a "significant number" of Singapore's COVID-19 cases had mild symptoms in the initial phase of infection.

"Similar to influenza, these patients typically experience mild flu-like symptoms such as fever and cough. And similar to influenza, they can be infectious during this initial period of mild symptoms," said MOH.



"The risk of their infecting others can be reduced with appropriate measures."



SUBSIDIES AT PHPCS, POLYCLINICS

There are currently about 900 GP clinics designated as PHPCs.



From Feb 18, the PHPCs will be "progressively activated" to care for patients with respiratory symptoms such as fever, cough, sore throat and runny nose, said MOH.



Patients suspected to have pneumonia will be referred to hospitals for further tests and care.



These clinics, which provide subsidised treatment, investigations and medication during public health outbreaks, were previously activated to deal with haze and the H1N1 influenza pandemic.

"These preparedness clinics are an important line of defence during our public health outbreaks," said Health Minister Gan Kim Yong.



"The activation of these preparedness clinics is not new."

The PHPCs will provide "special subsidies" for Singapore citizens and Permanent Residents (PRs) diagnosed with respiratory illnesses, said MOH.

Patients with respiratory symptoms can also go to polyclinics, where the subsidies will also apply.

Singapore citizens and PRs diagnosed with respiratory illnesses at the PHPCs and polyclinics will pay a flat subsidised rate of S$10 for their consultation and treatment. Pioneer Generation and Merdeka Generation seniors will pay S$5.

"The activation of PHPCs and polyclinics will allow us to enhance and tighten disease surveillance. We would be able to detect the virus earlier, and reduce the risk of further transmission," MOH added.



The clinics can be identified by a PHPC decal. Members of the public can also visit https://www.flugowhere.gov.sg/, where a list of PHPCs will be updated from Feb 18.



(Image: Ministry of Health)

MOH's director of medical services Kenneth Mak told reporters that GPs undergo a "process of enrolment" when they apply to join the scheme.

This includes teaching them the importance of infection control and training them to use personal protective equipment, Associate Professor Mak said.

"So, there is a little bit more work done in order to make sure they are better prepared to deal with patients that have infectious diseases," he added.



"It is not that ordinary GPs cannot manage such conditions, but these GPs (PHPCs) have been given additional training, additional preparation that they've done such that in times like this, we have a ready group of doctors and their clinics who are able to stand up and then further support as we then manage an outbreak in a crisis."



These PHPCs will help refer patients to hospital if they are suspected to have pneumonia

FOLLOW 5-DAY MC

Most patients with respiratory symptoms are not infected with COVID-19, said the health ministry.

"But we must take extra precautions," MOH added. "It is therefore important that anyone with respiratory symptoms (such as fever, cough, sore throat and runny nose) seek medical treatment early, and stay home throughout their illness.



"We urge all individuals and employers to cooperate and follow strictly the five-day MC regime that has been put in place."

Healthcare professionals have been advised to provide MCs of five days for patients with respiratory symptoms.

Patients will be referred for further medical assessment and tests if they do not recover within five days.

National Development Minister Lawrence Wong, Health Minister Gan Kim Yong and Ministry of Health's director of medical services Kenneth Mak speak at a press conference, Feb 14, 2020. (Photo: Try Sutrisno Foo)

When asked how MOH decided on the five-day period, Assoc Prof Mak said the ministry looked at the normal duration which patients with respiratory problems recover from their illness.

"The majority of people will recover within three to four days," he added. "Having therefore a little bit of extra period to allow them to properly recover, setting that duration of about five days allows us to reduce the noise factor.

"Most people with minor conditions would have recovered by then, and it (five days) allows us to look and determine whether there are other patients who are still not getting better, who might be getting worse, and we then want them to come back to the GP ... to reassess - these are the patients that might be referred to the hospital for further testing."

The ministry also advised patients to return to the same doctor to seek further treatment if their symptoms persist or deteriorate.



"Patients must recognise the importance of staying home when unwell," it added.

"Mixing in large crowds, or continuing to go to work or school when ill, even with mild symptoms, will put others at risk."



The ministry added it would be taking further pre-emptive measures to reduce the risk of community transmission.

With enhanced detection and surveillance, it expects to see more confirmed COVID-19 cases in the coming days, it said.

"Activating the PHPCs is a proactive step to reduce the risk of further community spread of the virus," MOH added.

"I hope we can work together to fight this disease. If each of us play our role and be socially responsible, we can minimise the risk, reduce the risk of further community transmission," Mr Gan said.



On Friday, Singapore confirmed nine new cases of COVID-19, taking the total number of people infected to 67.

The coronavirus started in the Chinese city of Wuhan but has since spread to more than 25 countries.

More than 1,300 people have died from the coronavirus and more than 63,000 people have been infected, the vast majority in China.

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