Singapore: On the rest day after night shift in ward 9D of Tan Tock Seng Hospital (TTSH), senior nurse Jennilyn Angeles (Jennilyn Angeles) felt something was wrong.
“I think it was my body giving up because I was too tired of the workload in the ward,” she recalled. “(I think) it’s just fatigue.”
But the situation is worse.
She had a high fever, a runny nose and physical discomfort-these are typical symptoms of a virus that she is very familiar with.
She explained: “I feel scared because I already have two or three (COVID-19) symptoms.”
After seeking treatment and receiving a swab in the emergency room of the hospital, Ms. Angelis returned home to self-isolate in her room while waiting for the swab result.
At midnight, she was told that she had tested positive for COVID-19.
“I was terrified and couldn’t help crying. I couldn’t believe that despite the vaccine, my test result was positive,” she said.
“I don’t know what to do next, because I never thought that the virus would infect me. I prayed and calmed down, and immediately called my roommate to inform them.”
She took precautions, such as always wearing a mask at work and restricting her activities during vacations.
“You can’t imagine how I felt that day,” she told CNA.
“A SENSE OF FOREBODING”
The next morning, Ms. Angelis was taken to the National Center for Infectious Diseases (NCID). Prior to this, the staff of TTSH had already begun to act. One of the persons involved is Laura Ho, deputy director of the nursing department.
“(My immediate reaction) was to huddle with their respective head nurses and head nurses to (jointly) formulate measures to contain, control and spread the net,” she said.
This means implementing an immediate response strategy, which involves a series of measures.
Ward 9D was sealed off on April 28, after which the hospital’s infection group was discovered. The patients and staff who were in the ward were wiped.
It has also identified individuals and close contacts who may have been to the ward for testing and isolation if necessary. Instructions have been issued to reduce the flow of personnel between the various teams in the hospital.
On April 30, TTSH announced that no visitors were allowed to enter and blocked the other three wards.
Dr. Habeeb Rahman Sahul Hameed, chairman of the hospital’s 3S (employee support staff) executive committee, said that at the same time, it is necessary to ensure that hospital staff can continue to take care of patients around the clock.
“In order to do this, we need to isolate staff and also need to start planning weeks or even months in advance to keep patients away while the cluster continues to grow and plan their care outside the hospital,” he explained road.
“The staff were taken away by the quarantine order and need to be taken care of. Tighter infection control measures have been formulated to restrict activities in the hospital… Other ways of seeing a doctor need to be increased. Fortunately, we have developed telemedicine to help us do To this point.”
The head nurse Ng Shu Hua told the Central News Agency that she was most worried about her colleagues who worked in the inpatient ward after hearing the news.
“There are many uncertain factors, such as how this cluster will affect me, my family, work operations, and the public’s perception of TTSH employees,” said Ms. Ng from the hospital’s outpatient management department.
For Liu Liwei, a senior nurse who works on the same floor as the 9D ward, the news is “close to home”.
“It was too close to home, and overnight, the 9th floor became the epicenter. I racked my brains to think about whether I had been to 9D in the past few days,” she said.
Dr. Habeeb added that there is also an ominous feeling.
“People are worried because TTSH and NCID meet the country’s greatest need to respond to COVID-19, and if (they) shut down due to an internal outbreak, it will have a significant impact on the overall response to a pandemic,” he said.
“The most important thing is that when our TTSH employees are affected, the situation is closest to what happened during SARS, and there is an ominous premonition that the worst may happen.”
“PATIENCE AND A DASH OF SYMPATHY”
As the hospital stepped up measures, Ms. Angelis continued to fight COVID-19 at NCID.
Angelis was worried that her mother in the Philippines was worried, and only notified her that she was infected with COVID-19 a few days later.
“On the night I received the news, the first person I called home was my eldest sister, because I didn’t want to tell my family the news, especially (because) my mother was old,” she explained.
“I waited two days to tell my mother the news, but then I made sure that my two siblings were with my mother when they broke the news so they could support my mother.”
There is also speculation that Ms. Angelis is the index case of the cluster, which has an impact on her spirit.
“My colleague has warned me not to open the news (website) in advance. Do not read anything on social media,” she said.
“Although I know (that) is not mine, of course, you will feel sad.”
In a ministerial statement in May, the then Minister of Health Gan Kim Yong stated in Parliament that Ms. Angelis “due diligently” to report her symptoms and that her “responsible” behavior made it possible to detect clusters.
“I should point out that this does not mean that she is the first infected case and brought COVID-19 into the ward. The investigation is still ongoing. But her responsible behavior has allowed us to receive the infected group at Tan Tock Seng Hospital. “He said.
The results of the investigation have not been publicly announced.
At a media briefing later that month, the multi-ministerial working group stated that since the infection is concentrated in Ward 9D, they are studying the possibility of airflow problems and other factors. They also do not rule out the possibility of infection by patients and visitors who do not wear masks.
Ms. Angelis spent 11 days in NCID and was eventually discharged from the hospital and continued to recover in a community care facility.
A RACE AGAINST TIME
To curb the spread of the epidemic, the hospital stopped admitting patients and transferred emergency cases to other public hospitals.
There is also an urgent need to implement temporary mitigation measures in the ward. Helping to resolve this issue is Goh Mia Siang, Director of Facilities Development and Management at TTSH.
“I’m shocked by the appearance of COVID-19 variants in our general wards. Since general wards are not designed and built to accommodate patients with infectious diseases, they do not have the required engineering controls, such as directional airflow and high-rise buildings for dilution. Air ventilation rate or HEPA filtration for airflow purification,” he told CNA.
“In addition, in non-isolated wards, patients can move freely, wear masks with other people close to each other (when eating and sleeping), share toilets, cubicles and other convenience facilities. In view of the above situation, I am very worried if We have more fake’clean’ patients (based on negative swab results) that subsequently prove positive for COVID-19, and we may get more clusters.”
Mr. Goh immediately sought approval to install exhaust fans and portable air purifiers with HEPA filters in each patient compartment.
“Our greatest enemy is time,” he recalled.
Mr. Goh said that some contractors and suppliers are unwilling to come to the hospital to provide the required manpower and materials.
He added: “We must purchase and use any available materials and think creatively.”
Mr. Goh said that although these measures usually take about a month to complete, they will be implemented in eight days and completed in mid-May.
Dr. Habeeb said: “At one time, about 1,000 employees (members) were quarantined. The impact of quarantine on their emotional and mental health and their families is huge.”
“As there are fewer and fewer staff (members) staying in the hospital to take care of patients, a lot of extra time is spent, and infection control measures mean strict isolation.
“The manpower of some departments has been significantly reduced, so that other hospitals urgently need reinforcements to maintain patient care.
“The staff of other departments have been deployed to the places where the hospital needs them, and the work has become lonely, long and heavy.”
Even as the cluster grows, TTSH staff continue to work hard. Nurses working in the affected ward learned to adapt to wearing a full set of personal protective equipment (PPE), which they would wear when entering the affected ward.
Ms. Liu said: “Wearing personal protective equipment is like being in a greenhouse-protective clothing is impervious to water, so my colleagues and I always sweat profusely. In the end, the mind is more important than the body, and we have adapted to treat PPE as ours. Second skin.”
Ms. Liu added that the patients in her ward were also “nervous.”
“My colleagues and I must continue to provide updates/guarantees to facilitate video calls between patients and close relatives. During this period, these patients often undergo RRT (Routine Shift Testing), so I find it very useful to approach them with a swab kit. Challenging, especially when I see them resigned to their fate,” she said.
“Patience and a little compassion help.”
Ms. Ng participated in the routine inspection of the management roster and also served as the lottery officer. This means that sacrifices must be made.
“I try to minimize contact with my family and spend most of the time in my own room. My life revolves around work and family,” she recalled.
“Mentally, this is very challenging for me, because we are used to saying ‘Hi, good morning’ all these things every day, eating together, and then suddenly communication is interrupted… impersonal.
“It’s really a mental burden. Then you go to work and see all your colleagues-they also have their own struggles at home.”
Although she was at home, Ms. Wu did not feel this way.
“Most of the time, I feel lonely, even when I am at home with my family. There is not much face-to-face human interaction. I haven’t seen my fiance for a few weeks, and mainly communicate with him through video calls,” she said.
“I don’t think I have contributed to the family.”
She remembers being evaded publicly during the hospital cluster.
Ms. Wu said: “I clearly remember one time when a lady saw me boarding a train wearing a nurse’s uniform, and she immediately walked away to the adjacent carriage.”
“I was affected because it was as if we were working hard to contribute to the healthcare (system), but that’s what we got…I feel demoralized.”
But she added that she had the support of her relatives and colleagues.
“My family is deeply concerned about the cluster outbreak of TTSH. They have provided me with the fullest support by ensuring that my meals and other basic necessities are taken care of.
Ms. Wu explained: “They check me frequently to make sure that my body and emotions are all right, and they give me words of encouragement to affirm my dedication to work.”
She recalled an example where a member of the public posted a banner in front of the Medical Innovation Center building to encourage employees not to give up.
“Many words of encouragement and affirmation from family, friends, colleagues and supervisors helped me through this difficult time. I am satisfied to know that we help each other when we need it,” Ms. Wu added.
Dr. Habeeb said that what is impressive is the adaptability of hospital staff in solving problems together and adapting to new roles.
He added: “Employees gather through Zoom, WhatsApp and FB@workplace to cheer each other up, and organize virtual events to keep another company in touch.”
“During this period, employee support was (a) the main point of intervention, and many different departments worked together to support welfare work.”
These efforts include mindfulness classes that all employees can call, a COVID-19 chatbot to respond to employee inquiries, and a team to respond to requests from quarantined employees.
“Doctors and nurses in the quarantine area made tool kits for their colleagues to help them through the days of quarantine. We launched an employee welfare survey to understand the performance of our employees, and our employee support hotline continued to respond to calls to classify and Provide emotional/psychological intervention,” said Dr. Habeeb.
“Welfare staff in the clinical department are responsible for the well-being of their colleagues.”
PALPABLE RELIEF
The hospital began accepting new patients on May 18, and the 9D Ward began accepting new patients on May 22. Before the hospital called for reopening, all hospitalized patients and 12,000 staff had passed a series of swab tests.
The TTSH cluster-Singapore’s first hospital COVID-19 cluster-finally closed on June 6. There were no new cases associated with it in the previous 28 days. According to the Ministry of Health, the cluster has 48 cases, of which 3 deaths are related.
The measures taken by the hospital are still effective today. Nurses must now wear personal protective equipment such as goggles and N95 masks before entering any hospital ward. This also applies to clinics in hospitals.
In the past, they only needed to wear surgical masks when seeing a doctor in the general ward.
There is now a separate strip station for nurses to safely remove contaminated equipment after leaving the ward.
All wards are equipped with portable air purifiers with HEPA filters and exhaust fans to enhance ventilation and airflow. The hospital also has long-term plans to build more isolation rooms and renovate existing wards.
For the paramedics, it was obvious to breathe a sigh of relief after the cluster was closed.
“(I feel) TTSH can’pause’ from the media spotlight, which makes me relieved. Another great relief is that we no longer need to wear a full set of personal protective equipment, except for N95, because we continue to provide patients with Nursing,” Ms. Ng said.
“When the’quarantined’ patients were allowed to visit and… gradually discharged from the hospital, there was (there) joy of celebration.”
At the same time, they know very well that the fight against COVID-19 is far from over.
“I think we should gradually learn to accept and adapt to the new normal. We have all made sacrifices in some way to protect the safety of our loved ones and communities,” Ms. Wu said.
“We should not relax our vigilance and continue to take safety precautions, such as washing hands frequently, wearing masks and keeping a safe distance.”
Dr. Habeeb said that as the hospital continues to serve the public, it has learned lessons from its era as a cluster.
He added: “The journey of the pandemic has taught us a lot, and it is sometimes much more difficult than we prepared.”
“I think the most important thing is to be prepared, but more important is to be flexible in responding to changes. In the past two years since the outbreak, we can hardly predict with certainty.
“In addition, we have learned the importance of communication so that employees can help each other on the ground, and hopefully look forward to getting out of trouble.
“During this period, management and employees communicated through various platforms, from emails to hospital social media updates, to employee announcements and virtual city halls. These platforms are very popular.”
Now back to work at TTSH, Ms. Angelis is ready to continue her work on the front line.
She said: “My motivation is to get better so that I can quickly return to work, fight this epidemic with everyone in the hospital, and (re)recover healthy.”
“I am very happy that many people have expressed their love and care through their prayers, thoughts and simple wishes for my recovery.
“COVID-19 is real, and the virus is really cunning, hidden in the community; it is invisible and intangible. Unfortunately, some of us may be infected with it.
“However, after having survived this battle, although we were unable to do anything when we were sick, I believe that as long as we maintain a firm belief, it will help us heal.”
Nurse colleague Ms. Ng added: “With COVID-19 everywhere in Singapore – if we don’t care about our patients, who will take care of our patients there?”
