SINGAPORE: Jane*, a stay-home mum to two school-going kids, came to see me at my clinic recently complaining of increasing hair loss since the start of the circuit breaker period.

She said she was shedding in excess of 200 strands of hair a day.

She had been feeling stressed during that period where she had to care for her children, parents and tend to household chores while being cooped up at home. She felt fine otherwise, not exhibiting any symptoms of illness.

THE HIDDEN VICTIMS OF COVID-19

Stories like Jane’s complaining of more hair loss since COVID-19 morphed into a pandemic have been more commonplace in Singapore. 

Women more than men tend to seek medical attention for hair loss in our experience, perhaps because they are more conscious about the impact to their physical appearance.

The Cleveland Clinic, one of the top hospitals in the US, has similarly reported seeing more patients for stress-related hair loss.

This pandemic has impacted the lives of many people all over the world, economically, physically and mentally. You could be a victim of the infection, a breadwinner who lost your job or just the average Joe forced to stay home due to lockdown measures.

LISTEN: Unfair firing and hiring practices under scrutiny during Singapore’s worst recession

READ: Commentary: Will COVID-19 spell the end of strata malls?

But even people who have managed not to catch the infection so far have had their lives disrupted in unimaginable ways.

The mental stress associated with the socioeconomic fall-out and stringent public health measures, coupled with the challenge of getting through each day, can cause hair loss.

Doctors around the world are reporting a rise in stress-related hair loss. Chronic stress might be at the heart of these conditions.

Sungkyunkwan University School of Medicine in Seoul did a study involving 13,000 men showed that men who worked more than 52 hours a week lost twice as much hair as men who worked less than 40 hours a week.

WHY DOES INCREASED HAIR LOSS HAPPEN?

Telogen Effluvium is the most common form of hair loss. The hairs on our scalp go through a normal cycle of growth, rest and then shedding.

When one suffers from an acute or chronic illness, this cycle is disrupted and more hairs are shunted into the shedding phase, resulting in increased hair loss.

The same occurs when a person is stressed. Telogen effluvium can also be caused by certain medications, major surgery, nutritional deficiencies, child birth and major organ dysfunction such as the kidney or liver.

Alopecia Areata, an autoimmune condition where the body’s own immune cells damage the hair cells, causing them to fall off, is another culprit of hair loss.

The hair fall can be diffusely over the entire scalp, or more commonly over a localized area, giving rise to a focal bald patch. An acute illness or stress can be the trigger that causes this immune mediated self-damage of our hair.

We often tend to think of older adults who may suffer from these afflictions but even youths may not be spared.

READ: Commentary: Overweight yet undernourished? The hidden effects of junk food consumption

READ: Commentary: Our coronavirus diets and what’s behind the urge to eat like kids

Another patient I met was a teenager, Sarah, who was brought by her mother for enlarging bald patches on her scalp. Her mother said that her daughter could not concentrate during her home-based school lessons and was struggling with her homework.

She had started pulling at her hair and these actions got more frequent and excessive the more stressed she was, resulting in these enlarging bald patches.

Trichotillomania, the condition Sarah has, is a third and least common form of hair loss where people start pulling out their hair as a stress response. People react and respond to stress in different ways. Some people listen to music to relieve stress. Some people binge eat, while others participate in exercise.

The cause is often an underlying psychological disorder or stress. The individual develops an irresistible compulsion to pull hair from their scalp.

READ: Commentary: Here’s what months of food deliveries and takeaways have taught us

These patients often present with irregular bald patches on the scalp and broken hair strands of varying lengths.

HOW MUCH IS TOO MUCH HAIR LOSS?

Someone affected indirectly by COVID-19 may experience hair loss. Hair fall in excess of 80 to 100 strands a day is considered abnormal.

There are obviously many other causes of hair loss. Hair loss can be rapid or gradual, focal or diffuse. Fortunately, in the three types of cases above, the hair loss is often self-limiting once the initial illness or stress is over, and the hair usually grows back.

People tend to underestimate the impact of hair loss and forget the change in physical appearance can be a blow to one’s self esteem, especially if it happens rapidly. An unwanted vicious cycle may occur when the stress of dealing with hair loss aggravates the situation.

People often think hair loss can be attributed to high MSG intake but in my experience, it’s not a specific diet, but an imbalanced diet lacking in nutrients important for healthy hair, including iron, zinc and vitamin D.

READ: Commentary: Brands need to stop advertising junk food to kids on social media

READ: Commentary: You can enjoy jogging even by yourself

Extreme situations such as those seen in patients with anorexia nervosa, resulting in rapid and drastic loss in weight, is also a shock to the body that can lead to hair loss, often compounded by nutritional deficiencies as a result of extreme dieting habits.

This pandemic does not seem to be one that will pass soon. We will likely see more cases of people suffering from hair loss, related to COVID-19 or not.

GET HELP

What can you do if you are suffering from hair loss during this period?

My advice is to consult a healthcare professional, such as a dermatologist, who is trained to manage hair loss.

READ: Commentary: Immobility during COVID-19 and its effects on our sleep, physical activity and well-being

The doctor would ask more questions during the consult to see if further investigations, including blood tests and a scalp biopsy, may be required to uncover any scalp disorders. 

A scalp biopsy is the sampling of scalp tissue via a scalpel. This is done under local anesthesia and the wound is stitched up, leaving you with a small scar.

The doctor would then recommend various treatments depending on the most likely cause. People should note that treatment responses, including those involving lotions, oral supplements or steroid injections for autoimmune conditions, will take time, even these are successful, as hair takes time to regrow.

Sarah has since gone back to school and now enjoys her time with her friends. She is coping better with lessons and her school work.

Her mother has noticed that she no longer pulls at her hair and new hair has regrown. 

Jane has also seen a reduction in the rate of her hair fall after her stress levels came down when the circuit breaker measures were lifted.

READ: Commentary: Please don’t end work from home. It’s not that bad

BOOKMARK THIS: Our comprehensive coverage of the coronavirus outbreak and its developments

Download our app or subscribe to our Telegram channel for the latest updates on the COVID-19 outbreak: https://cna.asia/telegram

*Pseudonyms were used for this commentary.

Dr Chris Tan Lixian is a Consultant in the Division of Dermatology, Department of Medicine, at the National University Hospital.

SINGAPORE: The drone industry in Singapore is taking off, with more companies turning to unmanned aerial vehicles for purposes like infrastructure inspection and deliveries. 

In April, local start-up F-Drones became the first company to conduct drone deliveries here. It signed a one-year deal with shipping giant Eastern Pacific Shipping that kicked off with a delivery from Marina South Pier to a vessel anchored 2.7km offshore.

Another start-up, Aerolion Technologies, was granted funding by government agencies to develop a building cleaning drone. It also recently won a contact with water agency PUB to deploy drones for canal inspections. 

And last Thursday (Aug 13), foodpanda announced that it is partnering ST Engineering to test the use of drones for food deliveries, as it flew five packets of ayam penyet to a ship 3km offshore.

READ: Foodpanda collaborates with ST Engineering on drone food delivery trials

The Singapore Unmanned Aircraft System (SG UAS) Community, which represents the interests of the nascent industry, has seen an increase in the number of member organisations from 22 last year to 39 currently.

This is expected to grow further, said Mr Sia Kheng Yok, chief executive of the Association of Aerospace Industries (Singapore), which the SG UAS Community is part of. 

Members include Singapore-based UAS service providers, manufacturers, suppliers, institutes of higher learning and end-users.

The community plays a role in supporting market development and access, as well as the development of standards and policy advocacy. Its facilities include an indoor testbed site at JTC’s Seletar Aerospace Park for the purpose of demonstrating and testing drones. 

DRONES AND THE PANDEMIC

The use of drones allows for many tasks to be carried out more efficiently, said Mr Sia, adding that the COVID-19 pandemic has spurred greater interest in unmanned aerial aircraft.

“(They) are able to operate remotely at height, in confined spaces and over distances, without placing human operators in a position of risk. Integrated with sensors and image analysis software, they can augment the work of humans in areas,” Mr Sia said. 

“During COVID-19, the ability of UA to be deployed in remote operations has seen a surge of interest – for monitoring of crowds, broadcasting of warnings, measuring temperatures, remote deliveries of PPE and lab tests,” he noted.

“UAs have the important advantage in that they can minimise face-to-face contact and the need for human interaction while carrying out tasks, enabling businesses and public agencies to perform critical services while reducing risk of exposure to the virus.”

READ: Singapore to launch maritime drone zone, mulls mandatory registration of drones

In April, the National Parks Board said it had deployed 30 drones to monitor crowds in selected parks and nature areas to ensure that visitors keep to safe distancing measures. 

The Singapore Police Force also announced in May the use of drones to patrol industrial estates during the country’s “circuit breaker” period.

That same month, Singapore-based Drone Solutions Services started a programme called “Drones in the age of COVID-19” to encourage the use of drones for purposes such as monitoring during the pandemic. 

The company’s products include drones with cameras and loudspeakers as well as tethered drone stations, which connect drones to a portable continuous power source. 

This would allow drones to remain airborne for hours at a time to monitor crowds, instead of being restricted to a battery life of between 30 and 40 minutes, said Drone Solutions executive director Gianluca Salone. 

READ: The Big Read: Rise of the drones – capable of good and evil, they pose a regulatory dilemma

Another area of potential is the use of drones in unmanned search and rescue missions, said Mr Salone, who has two decades of experience in humanitarian work with organisations such as the United Nations.

During natural disasters, for instance, drones can be equipped with devices that can locate people using their mobile phones even when there is no coverage, he said. 

Singapore could act as a hub from which such drone operations could be deployed to around the region, he suggested.  

Mr Salone, who is a water and environmental engineer by training, said he is also in discussions with agencies on underwater drones, which can be used to conduct maintenance work at places such as the Marina Barrage, as well as removing trash and oil spills from water. 

CHALLENGES AND LIMITATIONS

Mr Sia noted, however, that there are still technological limits on the performance of drones, including constraints on the payload weight as well as their access to bandwidth and communications network coverage. 

“A second constraint is the importance of ensuring safe use of airspace by UA and manned aircraft,” he said, adding that sophisticated unmanned aircraft traffic management (UTM) systems are still under development.

In recent years, drones have disrupted airport operations in various cities around the world. 

In 2018, drones disrupted flights at London’s Gatwick Airport for three days, affecting about 140,000 passengers and 1,000 flights.

Last year, unauthorised drone operations in the vicinity of Singapore’s Changi Airport, affected 38 flights and disrupted operations on one runway for 10 hours. 

READ: Eagles, lasers and nets: Options for dealing with rogue drone flights

Having a UTM system in place could help enforcement agencies pinpoint the exact location of rogue drones, rather than having to locate them visually, said Nova Systems Asia managing director Ryan Lee. 

In 2018, Singapore’s Ministry of Transport and the Civil Aviation Authority of Singapore awarded a consortium led by Nova Systems a project to undertake the research and development of UTM technologies here.

Its researchers have spent two years studying and developing measures to be able to customise and safely scale up multiple UAS operations in Singapore’s densely populated and urban environment. 

Last December, it said it successfully completed the second stage of flight trials for UTM in Singapore, including a study of the telecommunication network and the operational suitability of 4G and 5G networks. 

While a UTM system would manage the flight plans of drones, just as similar conventional air traffic control manages that of manned aircraft, it is in fact more complex, noted Mr Lee. 

This is because the system would not only have to manage multiple drones on different routes, but also account for obstacles such as buildings, trees and even birds, he said. 

READ: Drone disruptions at airports: How dangerous are they to aircraft?

The use of such UTM systems could even eventually see drones flying beyond Singapore’s shores, said Mr Sia. 

“Such UTM, user-IDs or tracking devices on UA, should be harmonised internationally to standardise the technology and one day even facilitate cross border flights,” he added.