IN FOCUS: How a year of COVID-19 changed Singapore forever

IN FOCUS: How a year of COVID-19 changed Singapore forever

A year after Singapore reported its first COVID-19 case, CNA examines how the pandemic has changed the country.

Marina Bay Sands dusk
People taking in the sights of Marina Bay Sands at dusk, on the first day of Singapore's Phase 1 reopening after the circuit breaker period. (Photo: Jeremy Long)

SINGAPORE: It may seem like a lifetime to some, but it was precisely a year ago that Singapore reported its first COVID-19 case.

On Jan 23, 2020, the Ministry of Health (MOH) said it had confirmed one imported case of "novel coronavirus" infection in Singapore. At that point, the virus didn't have a name.

The case was a 66-year-old man from Wuhan who arrived in Singapore with his family a few days before. 

The ripple effect from that first case has been powerful, with changes to the country’s working lifestyle, economy, social fabric and healthcare sector. Some of those changes will be transient, with things going back to the way they were once the pandemic is over.

But the impact of COVID-19 has been so great that some aspects of Singapore's daily life have been changed forever.

In the days after the first case in Singapore, there was little sign of the impact that was coming. Everyday life went on with little worry. 

But about two weeks later, ministers announced that Singapore would go into Disease Outbreak Response System Condition Orange and restrictions were introduced.

By April, there were many clusters, including the first few in migrant workers’ dormitories. The country went into isolation, with a “circuit breaker” and strict rules on gatherings.

Singapore became quiet: Busy hawker centres were open only for takeaways, non-essential shops were shuttered, and offices were closed as working from home became the new normal. Travelling abroad became a massive challenge, with countries imposing restrictions on visitors to protect themselves from imported cases.

IN PICTURES: Singapore switches off

Arab Street empty 02
The deserted Arab Street, usually popular with tourists, on May 5, 2020, amid Singapore's circuit breaker period. (Photo: Jeremy Long)

Even as Singapore saw community case numbers dip significantly in June, and the country began its reopening, there was still uncertainty about the coronavirus, its mutations and how the relaxing of restrictions would affect the country.

Beyond the day-to-day challenges, conversations about bigger, longer-term issues began to emerge in Singapore. Is working from home the future? Will people keep their job? Will Singapore go into a recession? What about Singapore's migrant workers? Can our healthcare sector cope? What next?

WHO NEEDS AN OFFICE?

Remember when going into the office every day was the norm? Experts have long argued about the benefits of working from home – before COVID-19, it was viewed as a luxury and revolutionary.

That revolution came quickly with the onset of the pandemic, but it was not always luxurious. Arguments can be made for and against telecommuting when it comes to work-life balance, with some celebrating time saved on commuting but others feeling the strain of working in a cramped environment with little separation between work and personal life.

city hall mrt station during singapore's circuit breaker period
The usually bustling City Hall MRT station is almost void of human traffic on Apr 8, 2020, the second day of Singapore's circuit breaker period. (Photo: Jeremy Long) 

Nonetheless, some companies have already said that even when the pandemic is brought under control, they will continue with remote working.

That means deeper changes to working lives as employers work out how to get the best out of their staff when they're sitting at home with associated distractions such as bored kids or noisy neighbours.

Singapore Management University's (SMU) Professor Paulin Straughan said working from home is not just about physical relocation: “It is a whole new transformation of organisational culture, it changes the way we work and the way we account for KPIs (key performance indicators).”

Commentary: Managers should stop treating work-from-home as a luxury

But this is “really dependent” on the employers – some require workers to log in to video chats at regular intervals for “face time”, while others are happy to let their employees take charge of their own time.

One of the biggest changes to the way telecommuting is done is via video chats. Shares of Zoom soared as millions started using the video conferencing platform during lockdowns.

Nanyang Technological University’s (NTU) Associate Professor Andy Ho said: “I think being able to meet on Zoom is actually not a bad thing, in a way that you can make sure that people actually are punctual. It's hard to be late on a Zoom meeting, you're home already, where else can you be?”

But it is “very different” from meeting in person – there is less brainstorming, and it can be more of a hindrance than a help, he added. “When everybody is together physically, it is easy to have a creative, dynamic session, whereas in a Zoom meeting, you really can’t speak over one another.”

zoom video call work from home remote meeting
(File photo: Unsplash/Chris Montgomery)

READ: Most workplaces to close for one month from Apr 7 to curb spread of COVID-19

Working from home might have seemed a dream for some before COVID-19, but once it became a reality, for many it became difficult to separate work life from home life.

For families living in small homes, this became a clear issue in the early days of the pandemic.

“People may find it challenging to unplug from work when there are no physical boundaries to distinguish between home and an office, or become frustrated at having to spend a disproportionate energy and time on work,” explained Ms Michelle Tan, senior clinical psychologist at the Institute of Mental Health (IMH).

Creating those physical and mental boundaries might be key to work-life balance, but for some, it is not as simple as keeping your office space and personal rest separate. 

For these reasons, COVID-19 has “highlighted inequality” in our daily lives, said Prof Straughan. 

“Work from home has benefited those of us with the resources – that luxury of broadband that works very well, that luxury of a private office at home and the luxury of peace and tranquillity in your home area which allows you to focus on work. Not everyone has that.”

READ: Work in office, from home, or both? Hybrid work has potential and pitfalls, say experts

grabfood deliveryperson walks in raffles place during singapore's circuit breaker period
A Grab food delivery person walks in Raffles Place on Apr 7, 2020, the first day of Singapore's circuit breaker period. (Photo: Jeremy Long) 

We have created a work culture that is “one size fits all”, but that cannot be the case going forward, she said, adding that this was because of the nature of work in different industries, employees coming from a wide range of backgrounds and the demands of clients.

There are those who thrive on working from home, especially those who have the ability and discipline to segregate work life and personal life, despite the spatial issues.

For Assoc Prof Ho, who just became a dad, it gave him the opportunity to be at home with his family at a time when he was needed. Working in an office and commuting to and fro every day would have meant spending less time with his newborn.

However, some employers want their workers back in the office “for the sake of making sure we’re using the space”, he said. 

DOMESTIC VIOLENCE AND MENTAL HEALTH

While some enjoy the opportunity to work from home, not everyone relishes it. Those in abusive family relationships struggle to break free, unable to reach out to friends and other family members, and the pandemic further isolated them.

FILE PHOTO: Abuse shot
Photo illustration of abuse. (File photo: Try Sutrisno Foo)

In May last year, the police said reports related to family violence rose by 22 per cent since the circuit breaker started. On average, the number of family violence reports per month rose by about 10 per cent in 2020, police said earlier this week.

Calls to mental health hotlines have also gone up, as people confronted health fears and the impact of the economic fallout from COVID-19, with thoughts of self-harm and suicide.

For families who don’t have a “strong dynamic” or are in “pressure cooker environments”, working from home can exacerbate these issues.

“They’re stuck together, and there’s nowhere else to go, there’s nowhere else to hide, and especially for people facing abusive relationships in the family, those are the people that are in real danger of mental duress,” said Assoc Prof Ho.

The difference the last year has made is that it allowed Singapore to more openly confront these issues, he added.

READ: COVID-19 situation throws into stark relief what victims of domestic abuse face

“Obviously it is a pandemic and it has caused great loss and destruction to our lives, but the silver lining is it did bring our awareness and attention into areas that we would not have talked about in the past,” added the NTU psychologist.

“Domestic violence is not something that we talk about openly, even mental health issues are not talked about openly. But because of COVID-19, because of the social distancing, and the physical distancing that has been set in place, and people are suffering from it, the awareness and understanding become much more pronounced.

“We are much more aware of the mental strain and emotional duress that people are facing because of COVID-19. I think with this greater awareness that in the future, even when COVID-19 is behind us, we can still ride this momentum and continue to do more awareness campaigns … on these issues that we rarely get to talk about.”

FINDING A CLASSROOM ONLINE

The idea of some form of flexible or blended learning has been touted for years, but COVID-19 changed all that. Previously done only a few times a year, home-based learning has become a regular part of the school year at secondary schools, junior colleges and the Millennia Institute.

READ: Home-based learning to be held regularly for secondary schools, JCs and Millennia Institute from Term 3 next year

This came after a month of full-time home-based learning last year amid COVID-19. The Ministry of Education (MOE) said on Mar 27 that home-based learning would take place one day a week. But after a circuit breaker was announced on Apr 3 – and with it, the closure of schools from Apr 8 – home-based learning became the norm. 

In the early stages of this new reality, thousands of tablets and laptops were loaned out to students for home-based learning, as teachers worked quickly to implement class plans. For teacher Zacharoy Dass, doing lessons over Google Meet helped some of his students open up more.

“I was able to hear more from some students who I may not have heard as much from in a normal classroom setting,” he said.

“Being behind a computer screen helped to embolden some of them to speak up more, and just being in the comfort of your room ... I can definitely see how some students benefited from that.”

WIM elearning 6
Children may be spending increasingly more time on devices during the circuit breaker as home-based learning gives them the flexibility of time to do so.

Many students adapted to attending lessons online, even those who live in busy households as the circuit breaker forced parents to work from home.

“Most of them were able to work out an arrangement that allowed them to continue attending lessons and getting the work done in time,” he added.

Moving forward, it is prudent that home-based learning is infused into the curriculum, he said, adding that traditional classroom teaching is still important as it allows students to learn from spontaneous responses in the classroom. Holding classes online can sometimes make it harder for such spontaneity to take place, he said.

The month-long home-based learning also allowed teachers and students to work on teething issues. “If we have to go back to a circuit breaker state, at least we know that we are more prepared than before.”

WILL WE KEEP WORKING FROM HOME?

With COVID-19 still a clear and present danger around the world, working from home might be the default for some companies in the short term. Whether the pandemic changes the approach to a physical office space in the long term is up for debate.

The answer could be a flexible working environment, rather than a rigid one-size-fits-all solution, said the experts.

Commentary: Putting in 50 hours while WFH, it’s a struggle to draw the line between work and home

What is needed is a culture change, said Prof Straughan.

“What I'm hoping is now that we've gone through this period, where we realise that if I can work from home, and protect my family time and my private time, and my business continues to thrive in the midst of the worst recession ever, then surely, this is sustainable.

“That we can continue to respect family time, and even if we work from home, respect the downtime that you must give to your employees, do not use it as an excuse to exploit them.”

But if this cannot be achieved, then you might end up with a whole generation of the labour force who suffer from burnout and disillusionment, she warned.

Raffles Place phase 1 post-CB
Workers at Raffles Place on Jun 2, 2020, the first day after Singapore's circuit breaker period. (Photo: Marcus Ramos)

THE CONVERSATION ABOUT MIGRANT WORKERS

For the 300,000 migrant workers living in Singapore’s dormitories, life was quite different. So used to being out at work or with friends over the weekend, nearly all of them were confined to their rooms as the pandemic took hold.

Some of these rooms accommodated more than 15 people, in double deck beds with little space and not much to do. Each day passed slowly. With communal facilities shut, many had almost no interaction outside those four walls, except when they queued to use the shower or toilet.

With the threat of infection hanging over them, and the worry for their families back home, it became a difficult situation for many workers. As it would turn out, more than 150,000 dormitory residents contracted COVID-19. More than 54,000 dormitory residents have tested positive using the PCR test, while another 98,289 have tested positive using serology tests. The dormitory conditions helped the coronavirus to rip through the migrant population. 

The first cases were in end-March. Weeks later, Singapore was recording hundreds of new cases in the dormitories every day. The authorities kept the workers there, isolated from the community. Thousands were quarantined in their rooms, taken to hospital or shuffled to other dormitories to reduce the density.

Conversations about living conditions, mental health, pay and the country’s reliance on foreign labour came to the fore. From an outpouring of support for those afflicted to racist remarks, it drew a wide range of comments online.

This “huge swell of sympathy”, together with donations in cash and kind during the height of the outbreak may have been short-lived, but it brought the issue of migrant workers and their place in Singapore’s society to the forefront, said NTU’s Assistant Professor in Sociology Laavanya Kathiravelu.

(rp) Westlite foreign dormitory beds
The rooms at Centurion Corporation's Westlite dormitories. (Photo: Centurion Corporation)

READ: Employers, operators and NGOs step up for workers cooped up in factory-converted dormitories

While this awareness may have also generated a “fear of their potential as vectors of infection and disease”, the conversation stretched beyond the living conditions in dormitories to the workers’ importance to Singapore’s economy.

“It is great that such a conversation has become more mainstream, as our reliance on this group has grown without much public awareness about how it has happened,” said Asst Prof Laavanya.

“Most of the discussion is now centred around treating migrant workers better – whether it is improving living conditions in dormitories, or being more kind in everyday interactions, or in discussing mental health issues that they are facing as a result of their continued confinement.”

On-site COVID-19 testing facilities at Avery Key dormitory in Woodlands
On-site COVID-19 testing facilities at Avery Key dormitory in Woodlands. (Photo: Ministry of Manpower)

One of the main reasons COVID-19 spread through the dormitories at such speed was the living conditions many of these men lived in. Migrant workers CNA spoke to talked about the cramped conditions and difficulties during isolation.

READ: Can Singapore rely less on foreign workers? It's not just about dollars and cents, say observers

LIVING CONDITIONS

About two-thirds of Singapore’s 300,000 migrant workers live in 43 purpose-built dormitories, while the rest reside in factory-converted dormitories, temporary quarters at construction sites and public housing or private residential premises.

Over the last three years, foreign worker dormitory operators have flouted dormitory management rules about 80 times a year, the Ministry of Manpower (MOM) said.

Every year, the ministry penalises about 1,200 employers for unacceptable accommodations and about 20 operators for breaching the Foreign Employee Dormitory Act licence conditions. 

For Cassia @ Penjuru dormitory resident Ripon Chowdhury, it was a “terrible year”. After contracting COVID-19 in May, he was taken to the National Centre for Infectious Diseases before being moved temporarily to a new dormitory. Being quarantined in a room with 15 other men was not an easy experience.

“Before COVID-19, I only come to the room to sleep. But nowadays I still have to stay here – I don’t want to stay (in the room),” said Mr Chowdhury. “It’s crowded. I don’t think many workers in Singapore like to stay in dormitories, but we have no choice.”

Cassia @ Penjuru 3
View of Cassia @ Penjuru dormitory. (Screengrab: Google Maps)

READ: Last COVID-19 cluster closes; no active cluster in Singapore for the first time since pandemic began

The Government said last year it will build new dormitories and refit unused state properties as part of plans to reduce the current density in dormitories. These will include quick build dormitories that can last two to three years, while there are longer-term plans to construct more purpose-built dormitories to house 100,000 workers.

This will take time and a “whole industry effort”, said Asst Prof Laavanya, adding that the pandemic has driven home the urgent need for such changes.

Mr Chowdhury said: “If you stay in a 16-person room … we just have a teeny locker and (we are) sharing the bathroom, the shower, the kitchen room with others … infectious diseases spread very fast. We need fewer people in the rooms.”

But even as things look set to improve for migrant workers, the last 12 months have been extremely taxing on them, and not just physically.

MENTAL HEALTH SUPPORT

Living conditions were not the only topic that came to the fore during the last year, with authorities asked about the number of suicides at dormitories over the isolation period.

READ: New task force set up to improve support for migrant workers' mental health

Associate Professor Kenneth Mak, Singapore’s director of medical services, said in August they were concerned about migrant workers who were accommodated in facilities under “very tight regimes” and how the prolonged isolation could have an adverse effect on the workers.

It was in stark contrast with the rest of Singapore. As the country brought community infections under control during the circuit breaker and gradually reopened, dormitories remained isolated for many more months. It took a mental toll on many workers.

Bangladeshi Mohamed Jahid Hassan, who works as a safety coordinator, found the experience “very difficult”.

“Last year for migrant workers was actually not so good. We come here for work, we always get together, we together makan (eat), cook … and weekly or monthly we meet together. But once COVID-19 hit Singapore, we cannot go out with friends,” he said.

Living in a factory-converted dormitory with more than 300 people, he said they were moved into different hotels to isolate them as cases sprung up. While that might sound like a treat for some, the isolation proved difficult for Mr Hassan.

“We stay in the room in quarantine and it’s too much, it’s so difficult for us, but at least we were together. We moved to a hotel, and that was very difficult for us … alone 45 days. That time we faced a lot of problems.”

Tuas View Dormitory 17
Tuas View Dormitory has been gazetted as an isolation area to curb the spread of COVID-19. (Photo: Jeremy Long)

Their mental health took a beating. Some, like Mr Hassan, came up with innovative ways to pass time. He took courses to improve himself, and set up a WhatsApp group with his friends to study English.

But worried for his family back home in Bangladesh – he supports his father, mother, wife and five-year-old daughter – the experience of living alone was not one he cherished as fear took over. Many of his friends told him about the conditions back home, where some of his friends were bedridden by COVID-19.

“So many things come out in the brain (when we’re isolated) and we’re under pressure,” he explained.

Mr Chowdhury said he felt left behind as he watched the country gradually relax restrictions.

He added: “You can see, everyone is moving forward in Singapore, except us, still the same, left behind. Most dormitories are not close to the recreation centres. (They are) very hard to reach … and also even though there are only a few things or special events, we need to get permission from the employer.”

Isolation has “serious psychological effects on some people”, said Mr Alex Au from Transient Workers Count Too (TWC2). Apart from the lack of freedom of movement, many workers are also under pressure due to the hefty loans they took up to work in Singapore, he said.

Cochrane Lodge 01
A resident is seen at Cochrane Lodge dormitory. (Photo: Jeremy Long)

“The psychological distress that they suffered sprang from very real conditions outside their control, which is basically, movement control – the lack of socialising, the lack of contact with others, as well as financial distress.”

But even with the challenges of isolation, living conditions and mental health issues, Mr Hassan said he is grateful he is in Singapore.

“I see a lot of Singaporeans helping out. This is very good for us, and we never forget them helping us, the Government also helping us,” he added.

“REAL, TANGIBLE ISSUES”

While COVID-19 might have changed the dynamics of the conversation around migrant workers, there may still be issues to be discussed. 

Beyond the immediate concerns – housing conditions, isolation, and stress – less attention is given to the “structural conditions”, such as their debt and their reliance on their employers to ensure they are being treated fairly, said Asst Prof Laavanya.

TWC2’s Mr Au said Singapore will have to deal with the “real, tangible issues of money and freedom”.

“I think we really need to do something about giving them a whole lot more freedom to move around, to change jobs, to say goodbye to the bad employer and go to a better employer who provides better,” he added.

IN FOCUS: The long, challenging journey to bring COVID-19 under control in migrant worker dormitories

Asst Prof Laavanya said some people have suggested reducing the nation’s reliance on migrant workers more “holistically”, either through increased automation or replacing them with Singaporean workers. This view may go “hand in hand” with those who want migrant workers to be better integrated into Singapore’s communities, both physically and socially.

WestLite Dormitory quarantine Sep 25, 2020 (2)
A screening tent at WestLite Woodlands Dormitory. (Photo: Ministry of Manpower)

“This is probably a once-in-a-lifetime opportunity for us to do more, because of all these social issues that COVID-19 has exposed,” said NTU’s Assoc Prof Ho.

“On the surface, we may seem like a very harmonious and well-structured, well-managed society – which we are – but there are many hidden issues that are not being brought forward. 

“And because of COVID-19 … there’s no opportunity to hide it anymore, and now, it’s all out in the open. There is the potential to do a lot more.”

UNPRECEDENTED ECONOMIC CHALLENGES

In the early days of COVID-19, nobody quite knew how long it would last – the severe acute respiratory syndrome (SARS) outbreak in Singapore lasted a few months before it was contained. But 12 months on, the country has started recording new unlinked community cases again and new clusters.

The pandemic threw Singapore into a recession, with the Government presenting four Budgets worth nearly S$100 billion to mitigate the impact of COVID-19. 

“The COVID-19 pandemic has brought about unexpected and unprecedented challenges. It has severely disrupted global economic activity and led to both demand and supply-side shocks to the Singapore economy,” said Mr Lam Yi Young, CEO of the Singapore Business Federation.

Even with the financial help, some industries were facing stark losses – none more so than the aviation and tourism sectors. As countries around the world shut their borders and flights grounded to a halt, visitors to Singapore dwindled down to the hundreds monthly. It is a far cry from the more than 1.5 million visitors who visit Singapore every month before COVID-19. 

Monthly visitor arrivals to Singapore
Monthly visitor arrivals to Singapore have dipped since COVID-19. (Graph: STB)

READ: Singapore visitor arrivals edge up to highest since COVID-19 travel restrictions

“The impact of the pandemic was uneven across different sectors. The aviation and tourism sectors were more severely affected as they saw a sudden, massive drop in demand,” said Mr Lam.

Although the Singapore Airlines (SIA) Group reported that in December it carried the largest number of passengers since border restrictions began, it was still a huge 97.1 per cent decline year-on-year. Never has the national carrier seen such loss, with the group cutting about 4,300 positions.

“Without an almost fully recovered global economy it is difficult to predict what or when a recovery will take place,” said Associate Professor Trevor Yu, from NTU’s Nanyang Business School, about the aviation sector.

While the establishment of reciprocal green lanes for travel has been useful in facilitating essential business travel, Singapore saw the launch of its first air bubble with Hong Kong postponed due to a fresh wave of infections in the Chinese city.

The aviation sector has been “very creative” in dealing with the effects of the pandemic, said NUS Business School lecturer Rashimah Rajah.

changi airport during singapore's circuit breaker period (1)
Changi Airport during the COVID-19 circuit breaker. (Photo: Jeremy Long)

Moving duty-free sales online, redirecting cabin crew to social distancing ambassadors and opening up grounded planes for meals have all been welcome distractions for the sector. But it is still facing a long journey back.

“I don't think it will go back to where it was, at least not with the old model of flying and providing excellent service on the plane ... you have to be creative and think about other ways to restructure the organisation, and also the workers themselves,” she explained.

REBOUNDING FROM UNEMPLOYMENT

With Singapore falling into a recession, unemployment rates shot up. In August last year, the overall unemployment rate climbed to 3.4 per cent, past the 3.3 per cent high recorded in September 2009 during the global financial crisis. In September, it went up further to 3.6 per cent.

Although it was still below the highest unemployment rate of 4.8 per cent recorded in September 2003 after the SARS outbreak, it was a worrying picture. 

READ: Singapore will ‘redouble efforts’ to strengthen social compact amid economic challenges: Tharman

While rising unemployment rates in Singapore are not new – the rate has been steadily increasing since the first quarter of 2018 – COVID-19 compounded the situation.

“The overall global economy is still rife with uncertainty and job market is still relatively weak. People would think twice about changing jobs in the face of such prevailing sentiment,” said Assoc Prof Yu.

COVID-19 office workers Raffles Place food takeaway
Office workers carrying takeaway food during lunchtime at Raffles Place. (Photo: Gaya Chandramohan)

But some workers started on new jobs, retraining or taking up traineeships to move into new industries. The idea of staying in the same industry for one’s entire career had gone with COVID-19.

“There has been more and more attention on issues of retraining and career switches across many sectors of the economy. I would say these changes are definitely more acceptable for many individuals,” said Assoc Prof Yu.

The Government introduced the Jobs Support Scheme, the Jobs Growth Initiative and other programmes to help workers, while employers of locals received wage and training support.

Singapore started seeing the earliest shoots of recovery, with the unemployment rate in November falling for the first time in 2020.

READ: Singapore’s unemployment rate in November fell for the first time in 2020

Jobs have been created in industries that do not always require industry-specific experience, and traineeships formed that allow a person to learn on the job. It has opened doorways for people to enter another industry than the one they were in.

“When COVID-19 hit, many workers were quick to realise how obsolete their jobs could be ... and they also realised that there were other sectors that were rising, especially in data science, in big data, artificial intelligence and things like that,” said Dr Rashimah. “People understand that they need to retrain themselves and move to different sectors.”

COVID-19 office workers Raffles Place (9)
Office workers at Raffles Place after the circuit breaker period. (Photo: Gaya Chandramohan)

Those who were furloughed or put on unpaid leave also used their free time to upgrade themselves.

“People quickly realised that the overarching thing that they need to stay relevant ... is resilience. They needed to be resilient, they understood they needed to be adaptable and flexible,” she said.

Those in consumer, food retail and service businesses found themselves having to pivot quickly to new business models and leverage digitalisation to remain viable, said SBF’s Mr Lam. 

Sectors such as biotech, information and communications technology (ICT) and precision engineering sectors found good growth opportunities brought about by the pandemic, he added.

AN UNKNOWN DISEASE

“Am I going to die?”

For National Centre for Infectious Diseases (NCID) ICU senior staff nurse Joel Quek, it was a question he was asked multiple times by COVID-19 patients who were uncertain about the disease and how it would affect them.

Singapore has never seen a pandemic as prolonged and as widespread as the one caused by COVID-19. For the country’s healthcare sector, it is a fight that is ongoing.

When the NCID opened in September 2019, it was in preparation for an outbreak such as this. Staff at the hospital are trained to deal with infectious coronaviruses, but this was different.

The scale and the nature of the pandemic resulted in a fundamental change in work processes and patient care, as well as discussions about the welfare of healthcare workers. 

Joel Quek NCID
NCID senior staff nurse Joel Quek, who takes care of COVID-19 patients. (Photo: NCID)

For patients who suffer from chronic illness, there is “some amount of expectation and preparedness” of what the disease might do to them, and patients might have the time to settle their personal affairs, Mr Quek explained.

The difference is that some COVID-19 patients in ICU do not have this privilege, due to the “sudden and drastic nature” of the disease.

“COVID-19 infections are always sudden and unexpected. Illness severity also varies greatly between patients. In comparison, the usual patients I nurse are suffering from chronic diseases and complications, such as hypertension, diabetes, heart disease and cancer. These diseases usually have an expected progression path and outcome,” said Mr Quek.

“This is a key difference, which makes a huge impact to the patients’ experience of the illness. Multiple times … I had my patients look me in the eye, hold my hand, and ask me directly: ‘Am I going to die?’.

“This was a question that was almost impossible for me to answer and it pained me greatly.”

NCID staff
Employees at Singapore's National Centre for Infectious Diseases putting on protective gear before carrying out testing for the novel coronavirus.

While most patients in ICUs can find support in having their loved ones close by, the infectious nature of COVID-19 also means patients are isolated from the comfort of their family and friends, who themselves might be isolated.

“I vividly remember some patients had to spend their dying moments alone because of this. It was a poignant consequence of the infection,” said Mr Quek.

Using video calls, many of these patients were able to speak to their loved ones before they died. “I did my best to ensure that these patients had someone by their side and a peaceful death,” said Mr Quek.

“Thankfully the majority of patients suffering from COVID-19 infections recover and they have always expressed their heartfelt thanks to us. Working with COVID-19 patients has therefore not only been humbling but also extremely fulfilling.”

READ: NCID nurse becomes first person in Singapore to receive COVID-19 vaccine

During the peak of the pandemic, a second ICU was opened at NCID to accommodate the large number of patients. It was a “morale booster” seeing healthcare workers from different institutions and units working together, he said.

On a personal level, Mr Quek was forced to cut short his studies – he was embarking on an Advanced Diploma in Nursing (Critical Care) – and return to NCID’s ICU in March last year. With his wife also a specialist nurse working in ICU, there was a risk of them contracting COVID-19. Neighbours, friends and family supported them while they isolated themselves and only travelled between work and home, he said.

VERY THANKFUL

Early COVID-19 patients like 28-year-old Celeste Chew said they are grateful for the care they received from healthcare workers when they were facing the unknown.

Celeste Chew
Celeste Chew, 28, who contracted COVID-19, says she is thankful for the care she received. (Photo: Celeste Chew)

“I'm just very thankful that things were all provided for us and we were very well taken care of, especially when you see how the other countries are struggling with it.

“I think that the Government really stepped up to help us … everybody is not perfect. I feel that overall, Singapore has done quite a good job. I know a lot of people have a lot to say about (masks and lockdowns), but I feel that wearing masks is very important.”

The COVID-19 situation has helped foster community spirit among strangers, with people showing more concern for each other and helping when they can.

“I really think that it is quite a beautiful thing. I experienced it with neighbours also. I used to not talk to my neighbours at all, but now the whole floor are friends. That is just amazing, and I cannot understand how that happened. I got COVID-19 and everyone was really nice to us,” said Ms Chew.

Her sentiments were echoed by COVID-19 patient John Bodill, who said the treatment he received was “100 per cent”. With nurses checking on him three times a day and making sure he was fully informed of any developments, it helped ease any anxiety he was feeling.

John Bodill
John Bodill, 63, praises the care he received in a Singapore hospital after contracting COVID-19. (Photo: John Bodill)

NCID executive director Leo Yee Sin said she was thankful for the dedicated team at the hospital and the support from other healthcare institutions.

“In the early stages, when much about the virus was still unknown, we had to adjust rapidly and adapt to the evolving situation as we learnt about the virus on the fly,” she said, adding that staff members took the initiative to seek solutions when challenges arose.

THE NEXT PANDEMIC?

Deputy Prime Minister Heng Swee Keat said on Thursday that the lessons from COVID-19 would help increase Singapore’s preparedness for the next outbreak, because “disease X is not a matter of if, but when”.

After the SARS outbreak in 2003 that led to the deaths of 33 people, Singapore trained healthcare and frontline workers to better deal with infectious disease outbreaks. Medical facilities were also expanded and upgraded.

NCID's Professor Leo said: “We cannot predict which novel pathogen will cause another epidemic or pandemic. Pre-pandemic preparedness, which is to have system readiness to mitigate and lessen any potential impact, is crucial to sustain human health, social stability and economic impact caused by these unknown pathogens.

“No matter what system we have put in place, the most important thing is that the entire system must be flexible and be ready to take on whatever challenge, in whatever form and whatever shape.”

A vaccine is not the only answer to public health intervention, and good hygiene practices “cannot be overemphasised” as part of our day-to-day life, she added.

“COVID-19 has taught us many lessons, yet it may not be the most lethal pathogen to mankind.”

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Source: CNA/mi

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