IN FOCUS: The long, challenging journey to bring COVID-19 under control in migrant worker dormitories
It took many people and a huge effort to bring the COVID-19 situation under control among Singapore's migrant worker community. CNA spoke to some of those on the frontline of that effort.
SINGAPORE: Singapore reported its first COVID-19 case on Jan 23.
Md Sharif Uddin remembers it well. Even though that first case was an imported infection, he was concerned the coronovirus would spread to the dormitories and light the fuse of a potentially explosive health problem.
“I know our living and working conditions,” said the 41-year-old construction safety coordinator. “If a migrant worker gets infected, then it’ll spread very fast, because our dormitories have a lot of people living together inside a room. It means we will get sick together.”
He was right. About two weeks after Singapore’s first infection, the first migrant worker case was identified. On Feb 8, a 39-year-old who worked at a Seletar Aerospace Heights construction site was confirmed to have the virus.
Before he was hospitalised, the Bangladeshi national visited Mustafa Centre, a department store popular with foreign workers. He lived at The Leo dormitory.
READ:'A new man': Bangladeshi who was critically ill with COVID-19 discharged from hospital after nearly 5 months
The company that manages The Leo said that news that one of its residents had contracted the virus was “surprising and shocking”.
“It was worrying and also shocking because this foreign worker did not actually come back from overseas. Clearly he got it from the community,” CEO of Centurion Group Kong Chee Min told CNA.
This first migrant worker case, otherwise known as Case 42, was “the first sign of trouble”, said infectious diseases expert Dr Leong Hoe Nam.
People were worried when they found out he had travelled to Mustafa, added Dr Leong. “Subsequently, there were no more cases of foreign workers, and there was a huge sigh of relief.”
But that relief was “transient”, he said.
“At that point in time, we didn't know how infective or easily transmissible the agent was. We took reference from SARS-CoV, the nearest cousin, and with the lack of transmission amongst the foreign workers, things looked good.
“I must admit that I was lulled into a false sense of security,” he said.
LULL BEFORE THE SURGE
Early on, even before the first migrant worker case was identified, dormitory operators that CNA spoke to thought they had what was necessary to bring any outbreak under control.
Recalling the first emergency meeting with the Ministry of Manpower (MOM) and the Ministry of Health (MOH) that took place over Chinese New Year, managing director of S11 Dormitories Johnathan Cheah said dormitory managers were told they needed to prepare isolation rooms for suspected or positive COVID-19 cases.
At the point of the meeting - which took place over the weekend of Jan 25 - Singapore had only three confirmed cases of COVID-19.
“Within 24 hours, we set up a small number of isolation rooms and then within the week, we set up a larger number of isolation rooms, all for the purpose of isolating potential suspected or positive cases. That was the plan,” he told CNA.
Centurion Group, which runs five dormitories locally, including Westlite Toh Guan and Westlite Mandai, had its pandemic plan from January, Mr Kong said.
Employees who had travelled overseas were put on a leave of absence, and the firm quickly secured personal protection equipment for its staff working in the dormitories.
Thermometers and thermal cameras were procured to conduct mass temperature screening when the workers left or entered the premises. More isolation rooms were prepared right before Chinese New Year, ahead of workers coming back from China, particularly Wuhan, the epicentre of the outbreak at that time.
Workers were allowed to return to their rooms at the time, but Centurion decided that since the isolation rooms were ready, all workers who returned from China would be isolated in them for 14 days.
They thought this would be the most effective way of preventing an outbreak from imported COVID-19 cases, Mr Kong said.
The situation at the Seletar worksite appeared to be under control by the end of February as well, with five confirmed infections.
But the fuse was continuing to burn. Despite the initial signs that cases among the migrant worker community were being contained, COVID-19 was spreading.
At the end of March, cases linked to dormitories began to surge. Authorities later said they believed that Mustafa Centre, where the first migrant worker case visited, was the starting point for this rise in COVID-19 cases.
By April, Singapore's daily case count hit the hundreds - a trend that continued into August. Most of the new daily cases were migrant workers living in dormitories.
With 300,000 migrant workers - from countries including Bangladesh, India and China who lived in crowded dormitories that housed a dozen or more men in a room - a major health crisis was brewing.
Over the next five months, massive amounts of resources and a range of measures would be directed at bringing the situation under control.
Differing views were put forward on the effectiveness of those initiatives, but there was agreement on what the end result needed to be: Putting a halt to the rapid spread of COVID-19 in foreign worker dormitories. Failure to do so would have huge implications not just for these men, but the entire country.
After finding out about the first cases from The Leo dormitory, Mr Eugene Aw, dormitory business director of RT Group, which runs five factory-converted dormitories, said he sat down with management in February and they decided to do something “pre-emptively”.
By mid- to end-March, they had implemented movement restrictions and staggered timings for the usage of common facilities as well as entry and exit across its five dormitories.
Associate Professor Alex Cook, vice-dean of research at the National University of Singapore’s (NUS) Saw Swee Hock School of Public Health, said it should have been clear that the dormitories were at risk for large outbreaks.
He pointed to the influenza pandemic in 2009, where army camps were affected because of the close living environment. Other countries with COVID-19 outbreaks were seeing multiple cases in similarly closed settings such as nursing homes.
“But there were few voices ... who sounded the alarm, and I will admit to not having the dorms on my radar at all at the start of the outbreak,” Assoc Prof Cook said.
President of the Asia Pacific Society of Clinical Microbiology and Infection Paul Tambyah said that many in the infectious disease community “had raised the concern” about the vulnerability of Singapore’s migrant workers to infectious diseases. Similar concerns were also raised during the Zika outbreak of 2016, he said.
Dr Tambyah said that the Government’s strategy was "more a mitigation and containment strategy” similar to what the Japanese authorities did with the Diamond Princess cruise ship. People on that vessel, where hundreds were infected, were quarantined on board.
“Without the strategies which worked in January and February - isolating infected workers, quarantining close contacts and screening them which worked with the Seletar Aerospace cluster in February - there was no way that the numbers of infected workers could be contained once the multiple dormitory outbreaks began,” he added.
“The Diamond Princess strategy without the benefit of single rooms resulted in a large number of both symptomatic and asymptomatic infections in passengers on the cruise ship as happened in the dorms. The most effective part of both strategies, cruise ship and dormitory, was the identification of sick individuals and treating them promptly.”
Infectious diseases expert Dr Leong said he “honestly didn’t think of” the risk of COVID-19 spreading in the dormitories.
“This is something I am ashamed of,” he said.
A LOCKDOWN WAS IMMINENT
On Apr 5, authorities announced two of Singapore’s 43 purpose-built dormitories - large facilities that house between 3,000 and 25,000 workers each - were gazetted as isolation areas. The residents of S11 Dormitory @ Punggol and Westlite Toh Guan - nearly 20,000 people combined - would not be able to leave their rooms for the next 14 days, and meals would be delivered to them.
READ: COVID-19: Movement in and out of dormitories to stop as all migrant workers to suspend work until May 4
S11 Dormitory @ Punggol was initially identified as a cluster with four linked cases, but reached 63 cases less than a week later on Apr 5.
As one of the first few dorms gazetted for isolation, S11 Dormitory @ Punggol had its first mass swabbing exercise of about 200 workers after the first few cases were discovered.
"When the results came out, I think we were all shocked, very concerned, because they tested positive a very large number of workers. And at that point in time, that was where it struck me that COVID already happened within the dorms, possibly weeks before a ‘circuit breaker’ was even executed,” said Mr Cheah of S11 Dormitories, which manages S11 Dormitory @ Punggol and Changi Lodge II.
Fear began to set in.
“We are not trained health professionals. And we are dealing with a virus that I think the whole world is dealing with and with very little knowledge of how this virus spreads, how it affects the person, and how the person will possibly get well from the virus,” said Mr Cheah.
Westlite Toh Guan got its first case on Mar 26. “We were quite shocked to say, could we have COVID-19 residents that we don’t know about?” said Mr Kong.
“Did we do something wrong in terms of temperature screening and all that – why did the facility not pick up (the case)?”
After investigating the incident, Mr Kong and his team found that the worker had a five-day medical certificate after visiting a doctor, but did not inform the dormitory’s operations team as instructed.
At that point, residents who were well and had not travelled overseas were not isolated in their rooms, and could leave to buy food and mix with other workers. "That's where I feel that is the issue. But again, I think that is too late already,” said Mr Kong. Many other positive cases discovered later were asymptomatic too, which could have contributed to the spread in the dormitories.
Mr Kong recalled receiving a call from MOM informing him of the plans to isolate the dormitory at about 8pm on Apr 3, shortly before it was officially gazetted as an isolation area. “It was quite shocking then, at that time, even with all the measures put in place,” he added.
“The most difficult part is that we are among the first ones who really got isolated, so we are also at a loss as to how that would be done.”
Addressing workers over the public address system, his team relayed a message recorded by an MOM officer to explain the situation.
“We do need to ... tell them what is happening. Suddenly they can't even go out. We need to communicate with the employers as well, so that at least the employers can talk to the employees, and ask them to calm down,” said Mr Kong.
Some of the “most critical” issues the migrant workers had at that time were questions about whether they would be paid, and how food would be provided, he added, as they urged workers to stay in their rooms.
RT Group's Mr Aw recalled finding out that there were two suspected cases at his dormitories on Apr 12. On Apr 17, those cases ballooned to 100.
MOM officers visited the dormitories almost every day, sometimes more than twice. “Two different teams, three different teams will come to the same site, they will come to the dormitory ... ask us to change this change that, implement this, implement that. Hire more people if possible,” he said.
“Every day we were just trying to achieve what we had to ultimately do - to get the dorms to be safe.”
On Apr 14, Manpower Minister Josephine Teo announced a “three-pronged strategy” to curb the spread of the virus: All dormitories, whether they had known clusters or not, were under a lockdown; workers who tested positive and their close contacts would be isolated; healthy and essential workers would be moved to alternative accommodation such as military camps and empty housing blocks.
READ: COVID-19: All foreign worker dormitories to have medical teams of doctors and nurses from hospitals, polyclinics
“We didn’t know what to do (after they announced the lockdown),” said Bangladeshi national Mr Zakir Hossain Khokan, who has been working in Singapore for 17 years and runs a help group for fellow foreign workers called One Bag, One Book. He said he and his bunkmates were “upset and scared”.
Up until that moment, life revolved around going to work. Back at their dormitories, they would cook and perhaps share their meals. Now, they could not do either. And they were surrounded by people who possibly had COVID-19, unable to avoid anyone.
FEEDING THE RESIDENTS
As management teams scrambled to prepare the dormitories and workers leading up to the mass lockdown, food and meal distribution became an issue.
For S11 Dormitory @ Punggol, Mr Cheah initially assembled a team of 10 people to distribute food to the 13,000 migrant workers living in 1,098 rooms. He called bringing meals to the rooms “a mammoth task” along with separating the groups of residents as they came down to collect their food.
“I think we underestimated (it). It was meal distribution, but when you have to distribute meals to 13,000 people, the requirement for manpower is tremendous.
“But it was grossly understaffed. I think it was something that we never really imagined that it would become that way,” he added.
With MOM’s approval, about 300 migrant workers who lived in Mr Cheah's dormitories were allowed to help with the distribution of food and sundries and were paid for their work. This “helped to stabilise the situation”, said Mr Cheah.
Centurion Group's Mr Kong said his team came to know of S11’s experience with food distribution and prepared for possible delays and complications by preparing their own food packages comprising instant noodles, bread, drinks and other dry food, to be given out to workers if the meals arrived late.
Agreeing that manpower was the greatest issue, he added that even with more Centurion staff and migrant worker ambassadors mobilised, it was “still a painful exercise”, ensuring social distancing and accountability in distributing the food.
“ENVIRONMENT … IS TOTALLY UNHEALTHY”
Soon after S11 Dormitory @ Punggol and Westlite Toh Guan were gazetted as isolation areas in April, photos of crowded and dirty living conditions emerged on social media, eliciting a strong reaction from the public with calls for better living standards for migrant workers.
Ambassador-at-large Tommy Koh, who shared a Straits Times article describing a dormitory’s state in a Facebook post, commented that Singapore’s treatment of foreign workers was “third world”.
Dormitory operators CNA spoke to said the picture painted by the photos circulating online deserved clarification.
“That was really unexpected also, because we underestimated the amount of refuse,” said S11 Dormitories' Mr Cheah. More waste was produced because the workers were living in the dormitories round-the-clock and eating food packed in disposable containers, a stark contrast to when they would be out for work most of the day and cooking for themselves.
He described the waste from food containers as “a world of difference”. While waste from meals used to be confined to the central kitchen and dining areas, workers would now bring their trash out to the corridor because they could not go downstairs. The four to six dustbins on every floor were insufficient for the trash from the catered food.
During this period, MOM set up what it called the Forward Assurance and Support Teams, or FAST, that worked with dormitory operators to run the facilities under new COVID-19 rules. Each group, comprising officers from the army, police and MOM, helped with getting food for residents, ensuring an intensified cleaning regime and making sure safe distancing rules were being followed.
READ: ‘Dedicated strategy’ to break COVID-19 spread in dormitories, including housing healthy workers in army camps
But despite these efforts, photos of dirty toilets and rooms continued to spread online, and workers were still complaining about the quality of the food weeks into the lockdown – problems the authorities regularly acknowledged they were aware of and addressing.
“It was very difficult. This actually increased our stress and disturbed our mental health,” Mr Zakir, 41, said. “The environment of the dormitory room is totally unhealthy. One room, 12 people live inside together, one small area. If we maintain 1m by 1m, then (we) actually need (more) space, but we no have space.
“We also don't have much ventilation, only a ceiling fan." He added that being inside the room day and night, with the heat and crowded environment, had an impact on people's mental health. He described it as "very terrible".
Mr Ripon Chowdhury, who was living at a dormitory but has since been moved by his employer to a Housing and Development Board (HDB) unit, said the lockdown was too sudden.
“I knew it was for my own good,” the 32-year-old said. “But the government didn’t take into consideration food, toiletries, before they told us about the lockdown.”
“Admittedly, there were teething issues in the beginning,” Senior Minister of State for Manpower Zaqy Mohamad wrote on Facebook on Apr 29, responding to concerns about the standard of catered food, particularly as it was Ramadan. “But things have gotten better, and are continuing to improve.”
Aside from providing food and necessities to the workers, S11 Dormitories' Mr Cheah said it was not easy to ensure that workers followed safe distancing measures at the start. Doing so took time, he said, just like how Singaporeans had to learn to wear a mask at all times and keep a greater distance from others.
“I think within the dorms is slightly tougher, because they are very used to communal living. More often than not, they spend time with roommates and neighbours because the rooms are adjacent,” he said, adding that friends are used to spending time with one another and they often live in different blocks.
Even as dormitory managers shared information about safe living measures with workers using posters, text messages and videos, the biggest challenge was that many of them did not understand why they had to abide by the rules. “Within the comfort of the room, they are all roommates – why should I be wearing a mask?” said Mr Cheah of how residents viewed the situation.
GETTING THINGS IN PLACE
Dormitory operators said they tried their best to contain the spread.
For S11, this included stepped up cleaning measures, staggering shower times and assigning toilets to each room to prevent intermingling. The management also increased the number of operational and security team members who were on site at any time to ensure that safe living measures were followed.
Centurion Group installed motion-activated cameras to detect when workers left their rooms, and one-way doors that would prevent workers from mixing with those from other rooms and floors, said Mr Kong.
After they found workers propping the one-way doors open, they further invested in smart devices and a QR code system that allowed only workers living on that floor to enter after scanning the QR code.
READ: Situation at larger foreign worker dormitories stable, but COVID-19 picture in smaller dorms ‘mixed’: Josephine Teo
Noting that this ensured “segregation effectiveness” in the dorms, he added that if there is any spread of COVID-19, it would be contained to that floor. “We reduced the bubble to a smaller size.”
As cases continued to skyrocket amid the lockdown, authorities rushed to set up medical outposts at purpose-built dormitories, send out mobile medical teams to factory-converted dormitories and recreation centres, launch teleconsultation services, and develop makeshift quarantine and recovery facilities at large indoor spaces such as the Singapore Expo and Changi Exhibition Centre.
Specific blocks within dormitories were set aside to house recovered workers. But these new setups left some dormitory operators, employers and workers confused.
Mr Sim Kian Eng, the general manager of Kongsberg Technology, a contractor that specialises in industrial flooring and fireproofing works, said that he never knew when his workers would be swabbed, what their test results were, when they would be moved to a different facility, or where they were going. If he wanted the information, he had to ask his dormitory operator or his workers directly after they were tested or shifted out.
“MOM and MOH were liaising directly with the dorm operators, and not with us. I mean perhaps because the workers are staying in the dorm, the dorm operators are responsible for it. But it doesn't make sense to me. Because they are my workers, the employers should be engaged,” he said.
“If I knew what was happening, at least I knew how I could make plans for my business, how long I could pay my workers their full salaries, and assure them about what was happening,” added Mr Sim, who has 35 workers who originally stayed at a factory-converted dormitory.
At times, the workers were themselves unaware of where they had been relocated to by the authorities, or how long they would be there, said Mr Sim. Several workers told him they felt like prisoners who were “locked up indefinitely”, he added.
Mr Zakir was sent to Khoo Teck Puat Hospital where he was diagnosed with COVID-19 on Apr 16 after he showed symptoms of the virus.
After that, it was a string of transfers - from the hospital to Expo, to Tanjong Gul camp, to National University Hospital - after he reported feeling ill again. Then it was on to Holiday Inn Singapore Atrium, before being moved to a dormitory for another week-and-a-half. He returned to his original room on Jul 9.
“One big circle, very terrible,” he said. At times, when he tried to ask the staff members how long he would be at a current location, where he was going to next, or what his swab tests results were, they could not answer him, Mr Zakir said.
On May 27, MOM acknowledged the issue, saying a new Government Facilities Listing feature had been added to the Online Foreign Worker Address Service to keep employers updated on the location of their workers.
“Due to the urgency of the situation, we have not been able to keep employers updated on the latest location of their workers, although employers have been able to stay in touch with their workers via the free data SIM cards provided to them,” the ministry said in a press release then.
But Mr Sim said that the information was usually uploaded only about three to five days after his workers were moved. He wanted to keep close track of his workers so that he would know about their physical condition. So he had to rely on updates from his workers instead.
Executive director and chief operating officer of Straits Construction Kenneth Loo noted that while he knew that some of his workers were being tested, he was not always sure which recovery facility they were at.
Straits Construction runs two temporary living quarters with a capacity for about 750 and 300 workers respectively, and two smaller makeshift outfits that house about 30 to 50 workers.
The workers were moved around and there was no information about where they were, said Mr Loo. "But of course after a while, it improved over time. One thing good was that there was constant communication with the authorities on where the gaps (in the process) were.”
With the FAST teams on the ground, a lot of the information and updates from MOH and MOM were passed to those running the dormitories because “dorm operators were doing the heavy lifting”, said S11 Dormitories' Mr Cheah. Especially in the first month of the circuit breaker, workers were being moved “every other day”.
READ: COVID-19: Construction projects could be delayed months, as contractors fear manpower crunch when clearing backlog
READ: Two weeks and a 70-fold increase: A look into the COVID-19 outbreak in Singapore's foreign worker dormitories
“We had to be the one bringing down the list of workers that they want to be tested. We have to be the one, bringing down the workers they want to decant. Within the first few weeks, there were so many changes because we are dealing with a new thing,” he added.
HICCUPS AS DORMITORIES ‘CLEARED’
On Jun 1, the Government announced that the first batch of 60 dormitories and its 8,000 residents would be “cleared” of COVID-19 that evening, meaning that residents of that dormitory or block within their dormitory would consist only of workers who had either recovered from COVID-19 or tested negative.
Workers in these premises would be able to go back to work, along with another 32,000 COVID-19-cleared workers earlier transferred to alternative lodging sites.
The announcement came four days after the Building and Construction Authority (BCA) said that renovation works for residential units and building works for single dwelling landed properties could resume after the end of Singapore’s two-month circuit breaker on Jun 2.
READ: COVID-19: Construction sites can resume work from Jun 2; priority given to projects that follow new safety measures
But problems occurred as the dormitories were getting cleared. For instance, a Toh Guan dormitory resident was informed by the authorities that he was COVID-19-positive only three weeks after his test on Jun 22, according to news reports. MOH and MOM later apologised for the delay.
Two weeks later, TODAY reported another incident where a worker could not go to work for five days after an administrative lapse by MOH in telling the employer that the worker was cleared of COVID-19.
Mr Sim said there were several times he had trouble getting his workers out, even though they could go back to work once the circuit breaker ended.
Once, in June, a technical glitch on SGWorkPass – the mobile application employers used to check if their foreign employees can leave their residence for work – resulted in his workers’ statuses turning red suddenly, with no explanation. They had been slated to leave for work that morning.
He panicked. Any interruptions to his projects would cost him thousands of dollars each day, he said. Relief set in only after the MOM officers he called up told him the problem would be rectified in a few hours.
Mr Loo said although work was allowed to start from Jun 1, there were many preparations that had to be made before that.
“For example, how to restart the segregation, the safe worksites, safe accommodation, safe transport,” he said, adding that they worked with BCA guidelines to make zonings within the site and make plans to move the workers around safely.
“Of course there was a mad rush to talk about how to build TLQs (temporary living quarters) within the site to decant the workers when they are safe so they can restart.”
Mr Loo also said employers felt the impact of the dormitory situation even more severely when work restarted, as there were some dormitories that were cleared while others were not.
“Theoretically, (we were) supposed to be starting work but practically there’s none because a lot of workers are still isolated. There are some, but construction being construction, a lot of activities are interlinked and interrelated. For example if you do certain things, one trade finishes then you have to continue with the next trade, but the guys in the following trade can’t do it then you would stop,” he added.
READ: Construction workers to be tested regularly when projects gradually resume after circuit breaker
LOCKDOWN TAKES ITS TOLL
Inside the dormitories and recovery facilities, workers were still “mentally suffocating”, said Mr Ripon. At first, he kept himself busy making Facebook videos and talking to friends on the phone. But after getting infected and sent to a community care facility, he was unable to sleep at night.
“What’s happening to me? How many days must I stay here? How to send money?” All these thoughts, he said, started running through his head because he suddenly had nothing to do, adding that the lack of fresh air made him feel worse.
In April, MOM issued an advisory that told all employers they had to continue paying their workers in dormitories their salaries during the lockdown.
Despite this promise, workers’ anxieties about their salaries began to heighten after the circuit breaker, said Mr Sharif, who borrowed S$4,000 to come to Singapore for the fourth time earlier this year, and has a family of five to look after back home.
“We think two months only, maybe after that (we) can go out," he said. But when the workers were unable to go out for longer than that, depression set in, he added. "Because so many migrant workers come here is to earn money. When three months, four months, many workers' family (were) starting (to have) problems,” he said. They were also afraid their companies might close down, or let go of them.
Mr Sharif, who has not gone back to work, said he feels bad for his family. Between April and August, he had received between half and two-thirds of his basic salary.
The distress these men were facing was not unique. In August, MOM released a statement acknowledging that it was aware of the recent spate of suicides and attempted suicides among dormitory residents.
It said that it was monitoring the situation and working with other organisations to improve the mental health support programmes offered to the workers.
There have been three known cases of unnatural deaths since the lockdown, as well as videos circulating online showing workers standing precariously on rooftops and high ledges.
NGOs had said that the workers were vexed over the state of their health, jobs and the prolonged confinement.
Dormitory managers said they were aware of the cabin fever setting in. Centurion formed a team that focused on developing activities for the workers, including online contests or games with prizes to be won.
At S11, free Wi-Fi was provided in all rooms to allow workers to communicate freely with friends and loved ones. Existing pay-to-view TVs were also provided free to the workers for their entertainment.
Subsequently, NGOs provided psychological and emotional support, and the dormitory management provided these channels to workers who could possibly be homesick, Mr Cheah added. More mature workers who have worked in Singapore longer also worked with the dormitory management to support other residents.
“During that period of time I think some of them felt a bit helpless, they wanted to return back to their country. But in a circuit breaker mode, you're not even allowed to leave the room.”
There was a “huge adjustment process” for the workers in lockdown who were used to going out to work for most of the day, said Mr Aw. His team tried to engage workers by finding things for them to do on top of watching shows and playing card games.
“The majority of the workers were handling it quite well. They understood the situation. And given the access to Wi-Fi, most of them could call back home (and) find ways to occupy themselves,” he added. There were even some workers who told him: “Actually I’m not worried about COVID, I’m more worried about money.”
To reassure workers, Mr Aw and his team put up posters to communicate to workers about the severity of the disease, how it spreads and the countermeasures that have been taken. “Them seeing some of their friends catching it but actually being fine actually helped a lot,” he added.
ALL DORMITORIES CLEARED
After months of testing and segregating residents, Singapore announced in late July that it would finish testing all workers by Aug 7.
Save for 28,000 still serving out their quarantine, the rest of the migrant worker population in dormitories would be cleared of COVID-19, co-chair of the multi-ministry taskforce and Minister for Education Lawrence Wong said on Jul 24. Two weeks later, he said most workers would be able to return to work by end-August.
READ: COVID-19: Authorities monitoring migrant worker dorms to manage risk of outbreaks after new cases reported
But just days after the deadline, new dormitory cases were detected. The first one was reported on Aug 12, at an unnamed dormitory which led to 800 migrant workers being newly quarantined.
Since then, new clusters have emerged at the dormitories, including Westlite Toh Guan and Changi Lodge II.
Mr Kong highlighted that with information about the coronavirus constantly being updated and changed, many of the measures that have been put in place – like the lockdown – were unprecedented.
“But again I hope everybody can understand each other's problems in order to solve this together. Hopefully this resurgence doesn't happen like other countries that have to do a second lockdown,” he added.
READ: COVID-19 cases detected again in cleared migrant worker dorms, about 7,000 quarantined due to new infections
READ: New COVID-19 cases at dormitories detected by routine testing is 'part of the plan': Josephine Teo
The new COVID-19 cases found at dormitories were a result of routine testing, Manpower Minister Josephine Teo said on Aug 26.
“We have planned for every single one in the construction, marine and process sector, as well as the people who come into close contact with them, to be regularly tested. So, the findings today are a result of those testing,” Mrs Teo said. “That is what we are doing, it is part of the plan and it is surfacing as part of the plan.”
Infectious diseases experts told CNA that there are several reasons why dormitories “cleared” of COVID-19 would still see new cases and clusters.
“It’s important to be clear what ‘clearing’ means,” said Assoc Prof Cook in an earlier interview with CNA.
“At the point at which the clearing of any particular dorm was done, there were no remaining infections that we had identified. That does not mean that there were no infections.”
For example, a person could have been infected a day or two before the clearance exercise, and still test negative for the virus.
“Even though the vast majority of ‘cleared’ residents were not infected, some infected residents will have been allowed out, where they may have come into contact with workers living in other dorms or in the community,” he said.
“We try to pick these up through report-sick operations and repeat testing of residents but it would be far too expensive to do daily testing, so some will be missed and outbreaks can grow,” said Assoc Prof Cook.
Moving forward, with all the migrant workers having been tested, dormitory operators could return to the strategy of finding cases, identifying contacts and then quarantining them in single rooms to ensure that the rest can continue to work safely, said Dr Tambyah.
“This may be possible now that it seems like some degree of herd immunity has been reached in the dorms,” he added.
“When all the data are collated on recovered patients, those with previous swab tests, survey tests and serology tests, then we will know how many of the workers living in dorms were actually infected and thus how close we are to achieving herd immunity among this part of our community.”
WHAT WENT RIGHT AND WRONG
As of Sep 11, Singapore has seen 57,316 COVID-19 cases - the vast majority of them stemming from the dormitories.
Commenting on the efficacy of the measures implemented in migrant worker dormitories, Assoc Prof Cook said: “Obviously in hindsight there are things we know that we did not know before, and so it’s only fair to judge decisions based on the knowledge that was available at the time.”
MOM’s formation of the joint task force in April to focus on managing the COVID-19 outbreak in the dormitories was important, Assoc Prof Cook noted. “One of the problems at the time was that we had increasing community transmission and ever more imported cases from Europe and America, and so by the time we went into circuit breaker, we had a confluence of three epidemics running at the same time, all of which needed attention.”
Dean of NUS’ Saw Swee Hock School of Public Health Professor Teo Yik Ying said the preventive measures in place now, including mask wearing and safe distancing based on what is known about how the coronavirus is transmitted, were not implemented at the start of the pandemic.
“What is happening right now is also an indication that even with the most stringent measures implemented, we will still see outbreaks happening within the dormitories,” he added.
Prof Teo also noted that trying to social distance 300,000 migrant workers in dormitories was not operationally possible back then, or maybe even now.
Lockdowns are effective in preventing spread in the general community because they lead to a drastic reduction in the number of people one case can infect, said Assoc Prof Cook.
“Can lockdowns prevent spread in a closed community like a dormitory? Only if the arrangement allows for limiting the number of contacts,” said Assoc Prof Cook.
“But in a dormitory where all the men on one floor share communal toilets, and where the 'household' has 15 men in it instead of four, lockdown can only have a limited effect in preventing spread once it has entered the population.”
According to infectious diseases expert Professor Dale Fisher, who chairs the Global Outbreak Alert & Response Network steering committee, placing workers on a lockdown earlier would have been unlikely to help curb the spread of COVID-19 in dormitories.
“There was concern about the real possibility of demand overwhelming our testing capacity. So, protocols that defined the indications for testing were created. This had to be aligned with capacity to act on a positive or negative result,” he said.
“Furthermore there remained competing demands outside the dorm setting so we could not afford to provide all our testing capacity to the dorms but had to ring-fence testing capacity for other settings. Each time the suspect case definitions were expanded, there was a significant increase in testing demand.”
Addressing criticism that the lockdown contributed to creating a source of infections in dormitories, Prof Teo said the lockdown likely helped to protect the rest of the Singapore community from further transmissions. “And from the very start, it was made clear that the circuit breaker was aimed at mitigating transmissions in the community,” he added.
“What this means however, is that the migrant workers ended up spending the entire time within the dormitories, and just like how lockdowns all over the world actually forced most of the transmissions into households, I believe this was also what happened when you have some of these migrant workers infected and were spending most of the time within the dormitories,” said Prof Teo.
“As these migrant workers are young and healthy, a number of them could be infected with no or only mild symptoms, and this likely made detection of those infected a lot harder and contributed to the spread within the dormitories."
Others felt the authorities should have limited the density in the dormitories earlier.
“We missed the opportunity to immediately reduce density at the beginning of the pandemic,” vice-president of Transient Workers Count Too (TWC2) Alex Au said, pointing to a letter the non-profit organisation wrote to the Straits Times on Mar 23 that warned that cramped conditions within the dormitories left residents in a vulnerable position.
Instead of keeping the workers inside their rooms and taking out only essential workers, he said that Singapore could have tried to spread the workers out by moving some of them to public housing blocks or create tent cities in open spaces.
“I think we were very uncreative and conservative in the way we tackled the problem. Yeah, people would look at me and say, 'you're mad. It's never been tried before. What is this nonsense about earthquake tent cities',” he said. “(But) go back to first principles – what is the cause of transmission? It's density. So deal with density.”
Mr Sim said he wondered why the Government did not move the workers out earlier in February to unused HDB blocks, although he acknowledged that information about the virus was still scarce then. Even as the boss, he said he faced resistance from his workers and project managers when he wanted to shift some workers out of the dormitory.
WILL THE NEW DORMITORIES BE GOOD ENOUGH?
In June, the Government announced it was going to build additional dormitories, introduce new living standards and look into a new lease model.
Part of the plans include developing temporary quarters by the end of the year called quick build dormitories, opening new purpose-built dormitories over the next few years, and creating a set of specifications for dormitories that will give each resident more living space and increase the number of shared toilets and bathrooms.
Work under the new system is already under way. On Sep 1, Centurion won a JTC tender to lease and manage four quick build dormitories that will house a total of 6,400 workers. The contract is for three years, with the option by JTC to extend by an additional year.
READ: COVID-19: New migrant worker dorms step in the right direction, say support groups - but could more be done?
Dormitory operators said they are supportive of the new standards, though cost will go up as the number of occupants in each room is reduced. Whether this cost will be borne by industry players or consumers is still up for debate.
“In the past, a single room could house 12. In the future maybe you’re talking about eight or six. What happens is that the unit cost becomes higher. How will they (employers) recover this increase in costs? Naturally they will tender a higher price for the projects," said Mr Cheah.
"(With an) increase in costs for operators we can’t be absorbing the cost because it's a huge cost. So obviously (it) has to (be) passed on somehow," he added.
"I think I'm supportive of the standards because some are much lower compared to some others, in terms of welfare for the workers,” said Centurion Group's Mr Kong, agreeing that consumers are likely to bear the additional costs.
Companies typically pay between S$250 to S$350 a month per worker today, said Mr Cheah, who is also the president of the Dormitory Association of Singapore.
On the flip side, RT Group's Mr Aw said prices might not go up because the dormitory industry is a highly competitive one.
“In the short term, yes, and you are talking about 12 months. But in the long term, when you have more bed spaces than occupants, it baffles me to think that the dorm rates will just go up."
Other industry players agreed that whether the cost is borne by the consumer or the companies, the improved dormitory standards are a necessary sacrifice.
“I treat my workers as working partners – they are not even employees. So they need to be taken care of,” said Mr Sim.
Humanitarian Organisation for Migration Economics’ (HOME) casework executive Desiree Leong said that discussing the issue in light of cost is “regrettable”.
“It is simplistic to frame the issue as a zero-sum game where Singaporeans will feel the pinch if migrant workers are better cared for,” she said. “Singaporeans also lose out when migrant workers are treated as disposable cheap commodities in a regulatory environment that prioritises low cost of business over workers' rights and interests.”
In fact, the new requirements may not go far enough in protecting migrant workers’ lives, said TWC2's Mr Au. He pointed out that the new design still has communal dining and cooking facilities, which means the workers will still mingle.
Apartment-style units with a kitchenette should be developed instead, he said, referring to a proposal TWC2 put up on their website in May. This way, they could just isolate the few men living in an apartment.
It will be more expensive, but the economic cost of disrupting construction work will be even higher, he said.
Mr Zakir said he is glad the authorities are revising the dormitory designs, but hopes that as they continue to study it, they consult a wide range of stakeholders, from psychologists – “now many people talking about migrant workers’ mental health” – to the workers themselves.
“Then we can say this is a really healthy dormitory. Then migrant workers really feel this is home,” he said.
In his response to the President’s Address in Parliament earlier in September, Prime Minister Lee Hsien Loong said that in hindsight, the Government would have done some things differently in its fight against COVID-19.
For example, it would have acted "more aggressively and sooner" on the migrant worker dormitories, said Mr Lee, stressing that it knew communal living in the dormitories posed an infection risk.
“Communal living in any form poses risks – on board ships, in army camps, student hostels, nursing homes,” he said. “We stepped up precautions. For a time, these seemed adequate. But then bigger clusters broke out in the dorms, which threatened to overwhelm us.”
More than just fixing the dormitory layouts, migrant rights need to be tackled as well if the country wants to help this group cope with pandemics like COVID-19, Dr Laavanya Kathiravelu, an assistant professor at the Nanyang Technological University who specialises in migration issues and a HOME board member, wrote in an essay published on academia.sg.
In it, she suggested that one way “is to de-couple migrants’ welfare and visa status from their employers”.
“Workers who visas are tied to specific employers may be reluctant to tell employers if they are sick, for fear of their pay being cut or of being repatriated,” Dr Kathiravelu told CNA.
“They may continue working while sick and thus spread the virus. By decoupling visas from employers, workers know that they cannot be unfairly dismissed for these reasons, and will have no reason to conceal the fact that they may be ill,” she explained.
Hopefully this crisis will help Singapore residents realise how far removed their lives have been from the migrant worker community, and spur both parties to interact more with each other, said Mr Zakir, who has been active in the migrant worker advocacy scene for years.
“Migrant workers and domestic helpers not just they come here earn money, take care your child, take care of your city, and after a few years they will go back,” he said. “They are also part of society (but) the design is that they are not visible in the society.
“We need to make a new design (of society) where we have to interact with each other as a human being," he added.