How Singapore prevented COVID-19 spreading among healthcare workers

All around the world, people are being told to stay at home. 

In a matter of weeks, millions of workers have switched to a home office, students are learning from their bedrooms, and we are complying with regulations only to venture outside for essential activities.

While many of us have quickly become used to this insular ‘new normal’, there are some who continue going out to work: supermarket staff, food haulers, and of course those who are caring for the sick, the healthcare workers on the front line of our response to COVID-19.

Healthcare workers are both the most needed, but also the most at risk during the pandemic.

How can we ensure they are protected?

To answer this question, we can learn from the successes – and failures – when other countries have tackled the same wicked problem.

China learnt quickly in Wuhan

In the initial COVID-19 outbreak in Wuhan, China, 1,300 healthcare workers were infected, and they spread the disease to friends and family. Their infection rate was more than three times higher than that of the broader population. 

Dr Li Wenliang, a 34-year-old doctor from Wuhan, was one of the first Chinese doctors to alert officials to the outbreak. He was also one of the first public faces to die from the disease.

Eventually, there were not enough doctors and nurses in Wuhan, and the government was forced to bring in 42,000 extra healthcare workers to help. 

The measures put in place in Wuhan for the second tranche of healthcare workers meant none developed COVID-19.

What did they do? Wuhan went into lockdown. Healthcare workers who were seeing patients who may have been infected with COVID-19 were not allowed to live with their families. They also wore full personal protective equipment including goggles, head coverings, N95 masks and gowns.

Tragically, most other countries would not be able to provide an equivalent level of protection simply because they lack the PPE stockpiles.

Singapore: Planning and preparation

Singapore has also been able to prevent healthcare workers, to a large degree, from becoming infected.

At the time of writing, there have been just over 1,300 COVID-19 confirmed cases in the island state, including a small number of healthcare workers.

Singapore has been preparing for a pandemic ever since the SARS crisis in 2003, when healthcare workers made up 41 per cent of the country’s 238 infections.

Since then, hospitals have regularly practiced for incidents such as pandemics or terrorist attacks in Singapore, according to an article in the South China Morning Post. 

The country’s Ministry of Health grades the hospitals’ performances and tells them how they could improve.

During the SARS crisis, masks, gloves, and gowns were in short supply, which hampered Singapore’s response. Part of Singapore’s planning includes stockpiling PPE to avoid the types of shortages we are seeing elsewhere around the world during the COVID-19 crisis, including in Australia. 

Some estimate that Singapore’s PPE stockpile is enough to last up to 6 months, even if used by all front-line healthcare workers.

According to an article in The New Yorker, Singapore’s healthcare workers have been asked to wear regular surgical masks for all patient interactions, to use gloves and proper hand hygiene, and to disinfect all surfaces in between patient consultations. 

Special N95 masks, face-protectors, goggles, and gowns are only used in Singapore during procedures in which respiratory secretions may be ‘aerosolized’, for example, when intubating a patient and for confirmed or suspected cases of COVID-19. 

During the COVID-19 response, Singapore has told its citizens not to wear masks in order to conserve them for healthcare workers.

Singapore’s healthcare staff work in teams

Singapore’s hospitals have also split their workforces into teams to ensure they will always have enough workers during the crisis, but also to ensure workers get enough rest. Teams work alternating shifts and do not interact with each other in order to avoid the spread of infection.

In Singapore, the emphasis is on ensuring there are enough doctors for every patient, and that there are enough specialists for critical work such as providing intensive care and operating mechanical ventilators.

Patients with suspicious symptoms or who have had exposures to COVID-19 through travel or a contact, are separated from other patients and treated in separate locations by separate teams. 

Social distancing is practiced in clinics and hospitals.

If someone unexpectedly tests positive, they try to trace every contact and then quarantine only those who had close contact with the infected person. Nuanced levels of social contact determine the risk of contracting COVID-19 and the most suitable response. The level of social contact depends on how long the contact lasted, how far apart they were, and what protective equipment, if any, was worn. 

As COVID-19 spreads around the globe, countries are affected in waves. China was affected first, and is now easing restrictions as others ramp them up. The staggered responses provide an opportunity for nations to learn from each other. Every nation’s response may be different, but the lessons they can pass on are relevant to all.