If you’ve ever wondered what being confined within four walls for 14 days feels like, this Singaporean has given the low-down on her experience.
On the contrary, it’s nowhere near as dreary as it sounds.
Having just returned to Singapore from where she was based in Berlin, Germany on Friday (March 27), Winifred Wong, 28, decided to document her experience on Instagram.
Having made a transition in Heathrow Airport, Wong, too, was required to serve her notice in a hotel. After receiving her SHN along with plenty of instruction sheets, she and several others were escorted towards their assigned hotel — Village Hotel Singapore.
Uncooperative patients, long hours and a lack of protective equipment are hampering health care workers across the world as they take the fight to the coronavirus, leading many to fall sick themselves.
In Malaysia, a pregnant woman who did not disclose that her father was infected tested positive after giving birth, leading to the shutdown of the entire hospital for cleaning. In the Philippines, nine doctors have died, two of whom had dealt with a patient who lied about her travel history.
In Spain, where more than 5,400 health care workers have been infected, accounting for about 14 per cent of the country’s patients, there are no longer enough workers to care for patients.
In Italy, which has more than 69,000 patients, the virus killed a doctor who had no choice but to work without gloves.
In the United States, which has surpassed China to become the world’s most infected nation with more than 83,000 people testing positive for Covid-19, hospitals are being overrun with patients.
Quarantining infected people, workplace distancing and school closures are most effective in combating the spread of the new coronavirus, when implemented all at once, according to new research looking at Singapore’s response to the disease.
Researchers from the National University of Singapore saw a dramatic drop in projected cases when all three physical distancing measures were taken together.
But they warned that if a large number of people in the community had no symptoms, or if infection rates were very high, the policies had a much reduced effect.
Singapore has used a policy of testing and tracing of Covid-19 patients to limit the virus spread, without ordering a widespread lockdown of society, as many cities and countries around the world have done.
But the city state on Tuesday announced new measures to shut down bars and other entertainment venues and cancel religious services and after-school activities, a day after reporting 54 new infections, bringing the total number of cases to 509.
SINGAPORE – An e-mail purportedly sent by Prime Minister Lee Hsien Loong has been circulating online, and he has reported this to the police.
The e-mail, claiming to be sent on behalf of the Government, provides an update on the Covid-19 outbreak and encourages readers to respond with their thoughts about the situation.
In a Facebook post on Monday (March 30), PM Lee wrote: “If you receive such an e-mail, do not respond to it. Also do not provide any personal information. And please do not forward it to your friends and family.”
He added: “These are unscrupulous characters trying to exploit the current crisis to dupe you. Be extra careful, and stay safe online.”
SINGAPORE: Retractable laundry racks, laminated timber doors and modern bathroom walls and floor tiles – these are some of the fittings owners of ageing Housing & Development Board (HDB) flats that are eligible for upgrading works can look forward to.
About 230,000 HDB flats built between 1987 and 1997 are set to be upgraded under the extended Home Improvement Programme (HIP) announced in August 2018. The Government is expected to spend more than S$2 billion to upgrade these flats.
The first batch of flats, comprising 55,000 units, will be offered the extended HIP starting from this year.
The package for the extended HIP will be refreshed to include more contemporary and better quality items, said HDB in a press release on Monday (Mar 30).
Besides featuring more updated designs, these new fittings also help to enhance residents’ safety and comfort at home, it added.
The HIP – which addresses common maintenance problems related to ageing flats – was previously offered to HDB flats built up to 1986. About 320,000 flats were eligible for the HIP under this 1986 age-band.
There are two main components of work under the HIP – essential and optional.
Essential improvements are fully paid for by the Government and include the repair of spalling concrete and the replacement of pipe sockets with a new laundry drying racks.
Optional improvements include items such as upgrading of the toilets and new decorative doors and metal grille gate.
Depending on their flat type, Singaporean households pay between 5 per cent and 12.5 per cent, or between S$550 and S$1,375, of the cost for the optional improvements.
The HIP only proceeds when at least 75 per cent of a block’s eligible households have voted in favour of it.
For the upcoming HIP upgrading works, HDB has developed a new retractable laundry rack that was designed with the elderly in mind, it said.
The new rack comes with six stainless steel poles installed externally. The poles can be extended and retracted within the frame of the rack.
The retractable laundry rack with poles extended within the frame to dry laundry (left) and with poles retracted when hanging or retrieving laundry (right). (Photo: HDB)
“Besides requiring less effort to use, the new retractable laundry rack is also safer as residents no longer need to lift and manoeuvre bamboo poles loaded with laundry out of the window to dry,” said HDB.
Laminated timber doors will be included as an option under the extended HIP, in place of veneer doors.
The new laminated timber doors are more scratch-resistant and durable compared to veneer doors, said HDB. The decorative timber door will continue to be offered as an option.
The new laminated timber door (left) will be offered as an option alongside the current timber door (right). (Photo: HDB)
A modern steel grille entrance gate with an interior thumb-turn knob – which allows residents to unlock the gate from inside without using a key – will also be offered as an option, replacing the current mild steel gate.
The wrought iron gate will continue to be offered as an option.
The new steel entrance gate with thumb-turn knob (left) will be offered as an option alongside the current iron wrought gate (right). (Photo: HDB)
Larger wall and floor tiles, which provide a more “modern look and feel, and allow for better visual continuity” will also be offered.
Additionally, a new range of dual flush low capacity WCs, along with tap and sanitary fittings with better quality finishes will also be introduced.
Bathrooms will be upgraded with larger tiles and better quality sanitary fittings that come in a range of more modern designs. (Photo: HDB)
Patients visiting hospitals, polyclinics and most national speciality centres under SingHealth will receive digital medical certificates (MCs) instead of hard-copy versions from tomorrow.
The new DigiMC system developed by the Government Technology Agency (GovTech) will also be used at private institutions such as Raffles Medical and Mount Alvernia Hospital.
“Digital MCs offer patients greater convenience, streamlines clinical and administrative workflows and is environmentally-friendly,” said Dr Goh Min Liong, SingHealth’s group chief medical informatics officer.
Raffles Medical launched a DigiMC pilot this month and aims to roll the system out fully by June, barring delays arising from the coronavirus situation, a spokesman told The Straits Times.
Mount Alvernia also plans to roll the system out in a few months.
But the system will not be implemented at the National Neuroscience Institute, which is also under SingHealth, by tomorrow, ST understands. This is because it is located at the Tan Tock Seng Hospital campus under the National Healthcare Group (NHG), another public healthcare cluster.
If you are looking to pick up a Nintendo Switch to beat the quarantine blues in light of Covid-19, you may want to brace yourself for disappointment. Global stock for the official, US$300 (S$430) console has become impossibly low, even on the usual platforms of Amazon, Best Buy, and eBay.
In a statement to GameSpot, Nintendo acknowledged the situation, and expressed that the supply will be renewed in the near future, “Nintendo Switch hardware is selling out at various retail locations in the US, but more systems are on the way. We apologise for any inconvenience.”
Of course, there are ways to go about the problem, but they do not come cheap. Third-party sellers are selling the Switch at ridiculously premium prices, with the cheapest on Amazon being US$439 (standard two-week shipping) and US$480 (immediate shipping).
SINGAPORE – It could take several years for the coronavirus to go around the world and run its course unless something happens to abort that process, says Prime Minister Lee Hsien Loong, adding that the world will have to brace itself for a long battle ahead.
In an interview on Sunday (March 29) with CNN’s Fareed Zakaria about Singapore’s much-lauded response to the Covid-19 pandemic, Mr Lee said he hesitates to call the Republic a “success story”.
In response to the suggestion that Singapore has contained the virus outbreak, he said: “I hesitate to talk about success because we are right in the midst of a battle, which is intensifying.”
He does not see the pandemic going away in a couple of months and expects it to spread to other parts of the world such as India, Africa, South-east Asia and Latin America.
“By the time it goes around the world, and then finally runs its course, I think that is several years, unless something happens to abort that process.”
Mr Fareed also asked about the role of the United States in the pandemic, noting that President Donald Trump did not seem interested in taking the lead.
No matter how often he checked the clock on the opposite wall, its hands never moved.
Worse, he could not lift his own.
To prevent him from pulling out the tubes in his nose, mouth and hands in his delirium, Mr Raymond Koh was tied down to his hospital bed. That week in March, when he lay seriously ill with Covid-19, was the scariest of his life, he told The Straits Times.
A day after the 47-year-old bank IT manager found out on March 10 that he had been infected with the coronavirus, his oxygen levels started to drop. X-rays showed patches in his lungs. His temperature was fluctuating.
Doctors at Sengkang General Hospital told the father of a teenager he would be taken to the intensive care unit (ICU) immediately.
“My mind went totally blank,” recalled Mr Koh. “I was nervous and fearful. I thought to myself, it’s only when a person is in critical condition that he has to go to ICU.
“What will happen to me? Will I see my wife again?”
He feared the worst, as his own father had become critically ill and died in intensive care eight years ago.
SINGAPORE: There has been much talk recently of the “herd immunity strategy”.
Herd immunity is the indirect protection and subsequent reduction in cases brought about because a specified proportion of the population is immune to that disease.
Herd immunity can be the outcome of a strategy or action, most sensibly, of vaccination. In the UK, however, herd immunity for COVID-19 has been discussed as the outcome of taking minimal action and letting many in the population get infected.
The UK’s COVID-19 response has gained renewed attention after UK Prime Minister Boris Johnson and Health Minister Matt Hancock tested positive for the virus this week.
A key issue in the discussion around the “herd immunity strategy” is one that has been seen more broadly in the COVID-19 response: Confusion around what a strategy is, versus what an action is and even what an outcome is.
This may sound like semantics, but confusion between these terms has had a serious impact on policy-making around the world.
Here are other words that have been much used recently: Containment, suppression, mitigation. Are these actions, responses or outcomes?
These words have each been used to mean all of the above, which has led to some confusion. For example, suppression is the outcome of having few cases in the population and keeping transmission under control. However, it has also been used to describe the strategy, even the actions taken to achieve this.
For some clarity, let’s group things into four groups: outcomes, actions, constraints on these actions, and other consequences of these actions. Being clear-minded on these is critical in determining and communicating an effective coronavirus strategy.
1. UNDERSTANDING WHAT OUTCOMES WILL ARISE IF NOTHING IS DONE
Firstly let’s consider the action of inaction, where we do nothing differently and continue going about daily life, with no public health response.
People are seen wearing protective face masks at Orchard Road, Singapore on Mar 11. (Photo: Gaya Chandramohan)
We have two, non-mutually exclusive ways of predicting this outcome – first, using mathematical models to bring together what we know about the disease and the healthcare system and how it spreads, to get predictions of infection, case numbers and the impact on the healthcare system.
Second, using mental models to extrapolate from what we have observed in other places. Initially we had the first few months of cases in Wuhan, then Italy, to assess what would happen if we did nothing.
Unfortunately we may soon have other examples of what doing nothing, or doing something too late, looks like.
The first approach can produce useful insight, but there are currently many uncertainties. The second approach seems sensible, but there is room for people to say, the conditions here are vastly different from China, Italy or New York.
Drawing conclusions from my work and those of my colleagues around the world, using both mathematical and mental models, it is clear the outcome of inaction will be devastating both in terms of health outcomes and for the economy.
2. IDENTIFYING SPECIFIC OUTCOMES TO ALTER
Since we agree taking no action is not a viable strategy, we should next start crystalising what outcomes we desire.
A health worker in protective gear peers from a tent which was constructed to test people for COVID-19 outside the Brooklyn Hospital Center in Brooklyn, New York City, U.S., Mar 27, 2020. (Photo: REUTERS/Andrew Kelly)
The preferable outcomes we should be aiming for, broadly speaking, are reductions in the number of infections, cases or deaths, but there are some subtleties within that.
Countries may want to develop a focus, whether reducing onward spread from imported cases, keeping case numbers low for a period of time (until vaccine available, for example), or ensuring that the number of cases needing hospitalisation, ventilators and ICU beds at any time is not higher than what is available at that time (essentially, flattening the curve).
3. LAYING OUT ACTIONS AND IDENTIFYING CONSTRAINTS
In order to achieve each outcome, there are a range of actions that can be taken. Some examples from around the world include physical distancing, movement restrictions (local, national and international), closing schools, testing and isolation of cases, contact tracing and isolation of individuals with underlying health conditions.
The decision on which actions to take lies with respective governments, but as members of society, some of these are actions we have to take.
We need to be clear about how each action is helping achieve the outcome. The actions listed above will limit the numbers of infections and cases.
Other actions will alter the outcome in a slightly different way, by changing the healthcare capacity to deal with cases, for example, increasing numbers of beds or ventilators available, or by reducing burden of other diseases.
There are of course constraints on what actions can be taken, for example current testing capabilities, current contact tracing systems, social norms and what a population will follow, and authorities’ ability to enforce restrictions.
Each country’s action have been taken within their own unique constraints and what has been deemed possible.
Healthcare workers hand off a biohazard bag at a coronavirus testing site outside International Community Health Services in the Chinatown-International District during the coronavirus outbreak in Seattle, Washington, on Mar 26, 2020. (Photo: REUTERS/Lindsey Wasson)
For example, the UK government argued it couldn’t bring in strict measures early as people would tire of them.
Singapore has been carrying out rigorous testing and aggressive contact tracing, but this was not deemed possible in other countries, due to constraints of the contact tracing systems.
These constraints may be real, but they may be moveable, either by the mobilisation of resources, or by updating the mental model about what is possible. This has already been clearly demonstrated, as actions that seemed impossible only four months ago, such as keeping vast amounts of people under lockdown, are now happening around the world.
Constraints also must be viewed in the context of the outcome of inaction.
4. MAPPING OUT THE CONSEQUENCES OF ACTIONS
The actions taken to improve the outcome will also have other consequences. For physical distancing or movement restrictions, consequences will include isolation and loneliness, loss of income, more people needing to do online shopping and those with unstable home environments left at increased risk.
For school closures, the consequences may include key workers staying home to look after children, or children spending more time with vulnerable grandparents. For both of these actions, there will also be wider economic impacts, particularly on smaller businesses.
Some of these consequences feed directly back into the disease outcomes, for instance, if healthcare workers must stay at home to look after children, which has lead the UK to keep schools available only for children of key workers.
High school English teacher, Fabiano da Silva Silveira from the Brazilian Israeli High School leads an online class after regular classes were suspended due to coronavirus disease (COVID-19) outbreak. (Photo: Reuters)
Other consequences do not impact the disease outcomes, but also must be responded to, for example the consequence of loss of income can be managed by government action of subsidies or universal basic income.
5. WEIGHING UP OUTCOMES AND CONSEQUENCES OF DIFFERENT ACTIONS GIVEN UNCERTAINTIES
All around the world, governments and individuals are weighing up the outcomes and consequences of different actions, and making very tough decisions.
It has been argued that the initial actions by governments in resource-limited places have been more extreme as the outcomes of inaction, given current healthcare systems and economy, were perceived as being too costly.
In contrast, the UK may have believed that it could deal with the outcome of inaction or minimal action. It is clear this is not the case.
Globally, but particularly in the US, the discussion is being framed by some as the health outcomes of inaction versus the economic consequences of actions. We can clearly see the economic consequences of the actions taken to manage the coronavirus spread, however, the economic consequences of inaction are perhaps less clear.
It seems obvious, but perhaps researchers and policymakers need to do a better job of quantifying and communicating the impact on the economy when large numbers of people are seriously ill, deaths mount, and hospitals are overwhelmed.
As we deal with a completely new disease and a completely new situation, there is much uncertainty.
Executive Director of the World Health Organization’s (WHO) emergencies program Mike Ryan speaks at a news conference on the novel coronavirus in Geneva, Switzerland on Feb 6, 2020. (Photo: REUTERS/Denis Balibouse)
These uncertainties must be weighed up and research done to fill these knowledge gaps and inform a stronger response, but as the World Health Organisation Health Emergencies Programme head Dr Mike Ryan has said, we cannot let this uncertainty stop us from taking action now.
THE SINGAPOREAN RESPONSE
The Singapore government’s response, which has been praised around the world, has been aiming for the outcome of keeping cases as low as possible for as long as possible, and not overwhelming the healthcare system.
Up until now most of the actions here have been taken by the government agencies, such as intensive testing, contact tracing and quarantine, with consequences only for targeted individuals.
We are all now being asked to take actions in the form of physical distancing. All the small physical distancing actions we each take now will lead to the outcome of fewer cases and a non-overwhelmed healthcare system.
At some point we may have herd-immunity, be that due to the spread of the disease, or use of an as of yet non-available vaccine, but in the absence of a vaccine the goal of achieving herd-immunity should not be the driver of actions.
As for the consequences of these actions, the Singaporean Government appears to be bringing in decisive policies to support those who are impacted and individuals are acting to support their communities.
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Hannah Clapham is an assistant professor at the Saw Swee Hock School of Public Health at the National University of Singapore and was previously the head of modelling at the Oxford University Clinical Research Unit in Ho Chi Minh City.
