SINGAPORE: When he studies the chest x-ray of a suspected COVID-19 patient, Dr Terrence Hui is looking for a number of telltale signs, one of which is the presence of white “shadows”.

These white “shadows” are opacities in the lungs, which point to lower respiratory tract infection. This infection could mean the patient has COVID-19.

“When it (the SARS CoV-2 virus) attacks the lungs, what happens is that it causes cells and fluid to fill up these air pockets,” said Dr Hui, who is a senior resident at Tan Tock Seng Hospital (TTSH).

“Because it’s filled up, gases can’t be exchanged – you can’t exchange your carbon dioxide with your oxygen. And therefore it fails to function or serve its purpose … And when we take an x-ray, all these fluid and cells appear as white shadows on the x-ray.”

For most COVID-19 patients, x-rays only reveal very small patches of white, said Dr Hui. 

“That’s why a lot of patients are asymptomatic, they don’t really have any breathlessness or anything. Because the air will just go to other parts of the functional lungs,” he explained.

“But in a very small group of patients, the opacity starts to increase, that means more parts of the lungs are involved. And then that means the lungs would decompensate because it can’t function properly. 

READ: Most events should remain virtual for now, even as more COVID-19 restrictions are eased: Gan Kim Yong

“So what they will get is breathlessness, and then they need oxygen. In a very small group of patients, they even need intubation to help them to breathe.”

Research has shown that chest x-rays of patients who are severely ill with COVID-19 can reveal opacities which can cover more than 50 per cent of the lungs, said Dr Hui.

Opacities in the lungs are not specific to COVID-19 and can be observed in other viral and bacterial infections, noted Dr Hui. The final diagnosis of whether a patient has contracted COVID-19 will come from a swab test.

“Being able to differentiate the most serious from the mild cases is actually very useful, because it helps you triage – (a) sort of resource allocation – so … you’re using hospital resources to take care of the sicker patients,” explained Dr Hui.

Chest x-rays are also used to monitor the progress of COVID-19 patients admitted to the hospital, he added. The average COVID-19 patient undergoes three x-rays during their stay at Tan Tock Seng Hospital.

This could mean comparing the x-rays taken of a patient over various days to see how the individual is coping.

“It’s used to monitor the progress … because it guides management. So if this patient is worsening, there are more white shadows, then you want to maybe give oxygen earlier on so the patient doesn’t need to feel unwell, feel like he’s breathless before he gets the oxygen,” said Dr Hui.

DEALING WITH RISKS

There are over 300 staff at the hospital’s department of diagnostic radiography. This is made up of radiographers and radiologists as well as nurses, radiographer assistants, admin and ancillary staff.
 
Radiographers perform x-rays on patients and work in three rotating shifts round the clock. Radiologists, who are specialist doctors, access and view these images electronically, before coming up with clinical reports.
 
Currently, about 200 x-rays are conducted daily for suspected and confirmed COVID-19 patients, said Mr Surender Naini Reddy, who is TTSH’s Head of Radiography Services and Principal Radiographer. This number was as high as about 500 per day during the peak of the pandemic in March.
 
In addition to handling suspected and confirmed COVID-19 patients, the hospital’s “business as usual” operations also continue, and x-rays and CT scans are used in other scenarios.

Mr Reddy’s role sees him involved in a number tasks including management of day-to-day radiography operations, training of staff and ensuring the well being of the radiographers and ancillary staff in the department. 

A trained radiographer, Mr Reddy has worked at the hospital for over 25 years, and seen a number of outbreaks such as Severe Acute Respiratory Syndrome (SARS) and H1N1 come and go.

“The scale of the COVID-19 pandemic has surpassed SARS, H1N1 and Ebola. It’s much bigger and the duration also is much longer,” he said. 

“But thankfully we have a newly opened NCID (National Center for Infectious Diseases), built specifically to combat such an outbreak. So during the previous SARS time, we did not have an NCID. So that is a difference.”

Suspected cases of COVID-19 undergo a “structured” screening process at the NCID screening centre, said Mr Reddy.

“They have a structured screening process there, this includes when the patient enters into the NCID screening center – their detailed history will be taken – (for) example, physical examination, travel history, then they do the swab test. Then after, (the patient is) sent for an x-ray,” he added.

It takes a few minutes for a radiographer to take an x-ray and that would be electronically uploaded to a server. A radiologist will have access to the digital x-ray and a clinical diagnosis will be made within 30 mins to one hour. 

READ: Singaporeans, PRs who travel from permitted countries can tap subsidies, MediShield Life for COVID-19 hospital bill

“Now with the online technologies, we do not have to touch x-ray films, we have less touch points,” said Mr Reddy. “Now, everything is digital.”

As radiographers come into contact with suspected and confirmed COVID-19 patients when they perform x-rays, there is also a need for added precaution, said Mr Reddy.

“The risk is real because they will be directly (in) contact with the patients, but we do wear full PPE (personal protective equipment), so we are well protected,” he said. “The risk is very minimal because we take care of ourselves, (by) wearing the goggles, wearing the mask and (there is the) cleaning of the equipment.”

Staff also have been trained on how to work in the midst of a situation such as this, said Mr Reddy.

“So from the beginning of our career(s), we’ve been trained how to handle the patients in isolation rooms, how to wear the PPE, how to protect ourselves,” he said. “So we know as long as you follow the correct infection control protocols, we are very safe.” 

SINGAPORE:  A new Cabinet was announced by Prime Minister Lee Hsien Loong on Saturday (Jul 25), with key ministries shored up with new faces from this election that would bring to bear their experience in public engagement and from the private sector.

The new Cabinet has their job cut out for them. Singapore is now in the throes of a worldwide economic recession. COVID-19 has disrupted our strategic advantage in aviation, tourism and as a regional business hub.  

Gross domestic product (GDP) has contracted by 0.3 per cent year-on-year in the first quarter of 2020, while the second quarter saw a deeper decline of 12.6 per cent. 

While it is not difficult to keep tabs on the economic well-being of the country, tracking the diverse and complex sentiments of Singaporeans and their responses to government programmes that aim to address the wide-ranging challenges of COVID-19 may be less straightforward. But doing so could enhance the Government’s responsiveness and strengthen its public communications.

LISTEN: What next for Malaysian workers stuck there and Singapore businesses who hire them here?

READ: Commentary: How COVID-19 shaped this Singapore Cabinet line-up

THE LACK OF POLLS TRACKING PUBLIC SENTIMENT

Do we know enough about the challenges and changing aspirations of Singaporeans? I doubt so.

Singapore does not have a culture for regular, publicly published opinion polling, let alone an enquiry on public sentiment towards state policies and governance.

Commercial market survey companies like Blackbox Research, and local think tanks such as the Institute of Policy Studies (IPS), conduct ad hoc studies on topical issues such as race, religion and class that matter to Singaporeans. Many are also proprietary, commissioned surveys not disclosed to the public.  

In addition, few, if any, track broader public opinion regarding attitudes towards the Government. Political polls, for instance, rely a wide range of proxy indicators, such as satisfaction in how the Government tackle crises or specific issues.

These have implications for policymakers who can gauge the effectiveness of public policies and ways to improve their implementation.

REACH, formerly known as Feedback Unit, is the Government’s leading public engagement and sense-making machinery. It was set up in 1985 to connect with citizens on national and social issues. 

While this unit has made remarkable strides getting in touch with the average Singaporeans – particularly on the Internet – there is now a need to look beyond the convenient sample of participants, to look for the hard to get silent majority who may otherwise shun away from a Government-led opinion poll.

GETTING GOOD POLLING DATA IS CHALLENGING

Operationally, reliable opinion polling is never easy in a 24/7 city like Singapore. In an environment littered with scam calls, phishing emails, and financial products disguised as legitimate interviews, taking part in a survey is the last thing on our minds.

As best practice, pollsters have to make at least 10 telephone calls to find one person that will pick up the phone. 

There is also the issue of whether polls can get a representative sample that are accurate yardsticks of public opinion. Research shows there is a cognitive bias among Asian cultures in favour of processing positive over negative information.

We tend to think of the “good” things rather than the “bad” when asked to evaluate the performance of a company or a national leader. The response bias is further compounded by a cultural leaning to give “face”, leaving a dignified answer even if the experience is less than desirable. 

In contrast, Singaporeans who feel alienated by or apathetic to policies are unlikely to be involved in polls.

READ: Commentary: Why I still stay home most days even though circuit breaker has been lifted

READ: Commentary: Wear your mask properly! Uncovering the reasons behind public mask shaming

Getting a random, representative sample of the population requires patience, tenacity and a lot of goodwill with the polling agency. But there are polling methods to get around these challenges.

Global research firm Gallup, for instance, employs a mix of telephone and face-to-face interviews to ensure reliability and representativeness, and have ready polling panels representative of the US adult population.

WHY OPINION POLLS MATTER

Tracking the pulse of the nation and sharing the results widely can provide clarity and focus for the national agenda and is an endeavour worth considering investing more resources into. 

Accurate sensing about public sentiments on broad areas of concern can alert us to emerging gaps, the segments of the population that are struggling, and the profiles of those feeling disenfranchised. With that knowledge, the state and social service sectors can reach out to vulnerable individuals more promptly, resulting in a more efficient allocation of public and philanthropic resources.

During the first month of the pandemic lockdown in the US, national polling conducted by the National Opinion Research Center found more than half of adults aged 70 and above reported a disruption to their medical care, and alarmingly, one in six delayed or cancelled essential medical treatment.

Healthcare professionals have stepped up remote telehealth consultation as an interim measure. About half of those (49 per cent) who had received the treatment reported that experience as comparable to in-person consultation.

More crucially, a candid albeit dispassionate discussion on topical concerns offers a meaningful platform to stimulate national conversations to drill down into what are top-of-mind issues.

It is a starting point and a means to proactively engage the silent majority. It will bring to the fore debates traditionally dominated by political elites and eloquent public intellectuals. 

This philosophy of a deliberative engagement is not new. It was tried and tested in the form of a “Citizen Jury” more than two years ago by the Ministry of Health, which brought together over 70 ordinary citizens to discuss a specific public problem and brainstorm solutions to tackle Singapore’s war on diabetes, culminating into a report with a list of recommendations.

READ: Commentary: We need to have the right conversations about COVID-19

READ: Commentary: More government measures needed to cushion a worsening Singapore jobs market

The approach is rooted in the principle that “citizens can contribute meaningfully to co-creating and implementing ideas, especially for issues that affect them”, according to the Ministry’s website.

At a strategic level, national opinion polls are the conduits of this dialogue. Getting Singaporeans to speak out on what matters to them and debate what the trade-offs that we can accept, is the first step to engaging the masses and bridging the plurality of voices. 

Indeed, at a REACH-CNA dialogue session on Jun 15, Mr Heng spoke about a partnership to co-design and implement policies with fellow Singaporeans. “We will listen to your views and explore together what the Government can do,” he said.  

READ: Commentary: This new Ministry of Sustainability and Environment looks pretty promising

IMPROVING THE QUALITY OF POLLS

Getting an honest reading on the ground goes beyond a question and answer, requiring its conduct at regular but predictable intervals.

For the feedback to be authentic, it must also be performed by a dependable, non-partisan institution, with a mission to serve as an “opinion compass” to collate, analyse, and disseminate sentiments about the fabric of Singapore in an objective and transparent way.

For this institution to be regarded as a legitimate authority, an autonomous social enterprise can be set up for this purpose. This arrangement offers flexibility on the type of projects that can be taken up, and the nature of a social enterprise promotes a greater sense of public inclusion and ownership. 

More importantly being operationally independent will enable the institution to react more quickly to polling the evolving sentiment without going through a chain of command expected in a traditional research environment.

A model similar to the Hong Kong Public Opinion Research Institute (HKPORI) can be explored. HKPORI (originally as HKU Public Opinion Programme) was established in 1991 under The University of Hong Kong, and spun off in 2019 in a bid to widen the range of clientele.  

HKPORI is seen as an independent polling agency, and has worked with various government and non-government organisations, political groups and professional bodies to help make sense of people’s sentiments and social problems in Hong Kong.

READ: Commentary: How did Hong Kong get to a third wave of COVID-19 infections?

READ: Commentary: To save its markets, Hong Kong needs to rely on China

A recent survey on climate change released in January, for instance, has galvanised both policymakers and community to step up, debate, and implement action plans to reduce carbon footprint in the power sector and improve building energy efficiency – a rare concurrence of opinions considering the divisive relationship between the Hong Kong administration and the public following half-year long of protest movements and clashes in 2019.

Tracking and sharing the pulse of Singaporeans’ opinion on the country’s long-term challenges, particularly contested issues on the economy, population, inequality and racial identity, is the first step to engaging an increasingly diverse and sophisticated populace who wish to be engaged and make informed decisions. 

Opinion polling is not fortune-telling, but having credible and impartial polls and open but constructive dialogues on the outcome of the polls can make a difference in politics, policies and citizens’ well-being.

Leong Chan-Hoong is Associate Professor at Centre for Applied Research, Singapore University of Social Sciences. He is the Singapore National Representative for the World Association for Public Opinion Research, and the founding Principal Investigator for the Singapore Panel Study on Social Dynamics, and the Youth Study on Transitions and Evolving Pathways in Singapore.

SINGAPORE: Fireworks lit up the night sky across Singapore as the nation celebrated its 55th National Day on Sunday (Aug 9).

Fireworks were set off across 10 locations islandwide: Ang Mo Kio, Bishan, Buona Vista, Jurong Lake Gardens, Marina Reservoir, Punggol, Sembawang, Tampines, Woodlands and Yew Tee.

Lasting about five minutes, the fireworks reached a maximum height of about 220m, or 62 storeys high. It could be seen by thousands of people from their homes, although some came out to watch the fireworks where they were launched.

It was also broadcast live during the NDP 2020 evening show, held indoors at The Star Performing Arts Centre in front of a small audience of about 150 people, due to the COVID-19 pandemic.

The event featured a series of short films and performances showcasing 31 stories, interwoven with songs by local artistes.

In pictures: Singapore celebrates National Day, with a nod to COVID-19 frontliners

READ: NDP 2020 – At downsized Padang parade, frontline and essential workers get salute

Here are Sunday night’s celebrations in pictures: 

SINGAPORE: Soldiers from the Singapore Armed Forces, as well as officers from the police and the Singapore Civil Defence Force (SCDF), paid tribute to healthcare workers as Singapore’s annual National Day Parade came to the heartlands on Sunday (Aug 9).  

The sweltering weather was no deterrent to spectators in Sengkang, where residents had gathered at an open field overlooking the Tampines Expressway hours ahead of 9am, when six members of the Red Lions were scheduled to begin their descent.

Some came prepared with picnic mats and foldable chairs, while safe distancing ambassadors walked among the crowd, reminding people to stay safe amid the COVID-19 pandemic. 

In pictures: Singapore celebrates National Day, with a nod to COVID-19 frontliners

At 9am, the crowd cheered as the Red Lions, who could be seen overhead, deployed their parachutes after they leapt from a Republic of Singapore Air Force (RSAF) C-130 Hercules aircraft.

This is the first National Day where the crowd-favourite skydivers performed their display in the heartlands, with organisers bringing a scaled-down parade closer to people’s homes because of the coronavirus outbreak. 

Sengkang resident Edward Kok, who had come to watch the Red Lions with his friends, said he appreciated the chance to catch them up close, even managing to take a photo with some members of the skydiving team. 

Having the annual celebrations in the heartlands gave residents a chance to get together, said the 53-year-old commodities manager. 

READ: NDP 2020: At downsized Padang parade, frontline and essential workers get salute

The Red Lions made their way to the nearby Sengkang General Hospital – together with other personnel from the Singapore Armed Forces – to salute the healthcare workers at the frontlines of Singapore’s fight against COVID-19. 

Since the pandemic began earlier this year, Sengkang General Hospital has been supporting migrant workers at the nearby S11 Dormitory @ Punggol, the country’s largest COVID-19 cluster. On Saturday, the health ministry declared the cluster at the S11 dormitory closed.

READ: A timeline: Singapore’s biggest COVID-19 cluster at S11 dormitory closes

Across the island in Jurong East, another team of Red Lions saluted healthcare workers at the Ng Teng Fong General Hospital. 

Six of the RSAF’s F-15 fighter jets also paid tribute to healthcare workers, flying over eight hospitals in the morning.

At 11am, 13 vehicles from the Singapore Armed Forces, the Singapore Police Force and the SCDF – forming the contingent travelling the Northeast route for the mobile column this year – also stopped along Sengkang East Road for about 10 minutes to salute frontline workers at the hospital. 

Speaking at the National Centre for Infectious Diseases, Health Minister Gan Kim Yong thanked the nation’s healthcare workers, noting they had “faced tremendous challenges and made many personal sacrifices” since the pandemic started. 

Mr Dinesh Krishnojirao Shinde, together with his wife and young daughter, waited at an overhead bridge near the hospital to catch a glimpse of the mobile column. 

The 39-year-old engineer said it was “very meaningful” to see the mobile column up close, and when cheers rang out for the frontline and essential workers.

Elsewhere, residents also gathered to watch as the mobile column made its way through various estates, including Woodlands, Lakeside, Bedok and Ang Mo Kio. 

READ: ‘We will need this unity and resilience more than ever’ in fight against COVID-19, says PM Lee in National Day message

Ang Mo Kio was one of the stops along the South Route for the mobile column, which saw 14 assets travelling from Clementi to Yio Chu Kang. 

From noon, members of the public gathered along Ang Mo Kio Avenue 3 to catch sight of the vehicles, which included the police’s new fast response car.

Ang Mo Kio resident Florence Ng, who was waiting at an overhead bridge since 12.15pm, said she was happy to see part of this year’s parade up close, although she had hoped to be able to see more of the features from previous years.  

“I was hoping to see the floats, besides the military vehicles,” said the 53-year-old.

This year, the mobile column – comprising 66 assets from the various forces – traversed 200km along five routes in Singapore’s heartland estates.

SINGAPORE: Thousands of residents lined the streets of Singapore on Sunday (Aug 9), as the country marked 55 years of independence. 

There were plenty of treats for spectators in the heartlands, with the Red Lions team parachuting onto fields near Sengkang General Hospital and Ng Teng Fong General Hospital.

Several roads were closed as the mobile column passed through heartland estates. Wearing masks and waving handheld flags, the spectators lined the streets of their neighbourhood to catch a glimpse of the vehicles. 

There were also loud cheers for the frontline and essential workers from various sectors who were on board the vehicles.

The Republic of Singapore Air Force’s F-15SG fighter jets soared across the island on Sunday morning – passing hospital landmarks – as a nod to frontliners in the fight against COVID-19.

The Padang also played host to a different type of National Day Parade this year, one that was downsized amid the COVID-19 pandemic.

Here’s a look at the day in pictures: ​​​​​​