The secret to helping Singapore protect doctors during the Covid-19 pandemic

Singapore provides full body protection for hospital staff. Photo: CNA.
Singapore provides full body protection for hospital staff. Photo: CNA.

Singapore has developed an effective response plan to protect frontline physicians in the fight against Covid-19, who face great risk of infection from patients.

Patients lacking a sense of reporting, excessively long working hours, or lack of medical protective equipment, are threats to doctors around the world in the fight against the Covid-19 pandemic. , causing many to fall victim to corona viurs.

In Malaysia, a pregnant woman who did not report on her father infected with Covid-19 caused the entire hospital where she gave birth to be closed for disinfection. In the Philippines, nine doctors died from Covid-19, of which two died after treating a patient who lied about his travel history.

Meanwhile, more than 9,400 health workers in Spain were positive for corona virus, accounting for 14% of Covid-19 cases in the country. In Italy, the heart of Europe, the corona virus killed a doctor after he was forced to work without protective gloves due to severe equipment shortages.

But amid the murky picture that surrounded doctors on the front lines against Covid-19 around the world, Singapore’s experience was seen as a reason for hope, according to the South China Morning Post.

Protective equipment is the key

Singapore has now recorded 630 cases positive for Covid-19, all receiving hospital treatment. However, the number of doctors who are infected with Covid-19 in the Southeast Asian country is currently very low, with the majority of infections coming from outside treatment facilities, Health Ministry officials said.

Experts say the positive data in Singapore is not luck. A typical case that has caught the attention of international experts is the case of 41 health workers in close contact with a patient infected with corona virus in hospital.

The team of medical personnel was exposed within 2 m to a middle-aged man who was treated with intubation, a procedure that required inserting a tube into the patient’s trachea.

The procedure is thought to be extremely dangerous for health professionals because it can easily cause patients to cough, spreading virus-containing water droplets to the surrounding environment.

Medical staff did not yet know the man was positive for Covid-19. Only after the person had symptoms and was tested positive did the medical team quarantine. However, all 41 medical staff subsequently tested negative for Covid-19.

According to the report, all medical personnel in the incident used protective clothing, including surgical masks and N95 masks, considered by doctors to be the gold standard to help prevent 95% of particles in the air.

The conclusion published in the medical journal The Annals of Internal Medicine showed that “none of the health workers in the case of the infection showed that surgical masks, hand sanitizers and other standard methods were protected. they are not contagious “.

American surgeon Atul Gawande thinks the West can learn a lot from Singapore’s public health standards as well as Asian countries in its battle against Covid-19.

The results of the long-term preparation process

Medical doctors in Singapore are divided into separate groups. Photo: CNA.
Medical doctors in Singapore are divided into separate groups. Photo: CNA.

Singapore is emerging as a model for Western countries to learn from. Although the island nation is still seeing an increase in the number of Covid-19 patients, most of them are returning from abroad.

Singapore’s medical system is described as still operating smoothly. Doctors say this is the result of a pandemic-preparatory process that has been in place since the SARS outbreak nearly 20 years ago. During the SARS pandemic, the number of infected health workers accounted for 41% of the 238 patients in Singapore.

When Covid-19 broke out, hospitals in Singapore immediately switched to implementing contingency plans, requiring employees to postpone leave or travel plans as soon as the first cases were recorded.

Hospitals also quickly divided the medical team into small groups to ensure there was always enough operational force when the situation worsened, as well as giving the doctors and nurses enough time to rest.

Singapore has 13,766 doctors, equivalent to a ratio of 2.4 doctors per 1,000 people. Meanwhile, the US and Germany respectively have a ratio of doctors per 1,000 people, 2.59 and 4.2. The other two countries in Southeast Asia, Thailand and Myanmar, have fewer than one doctor per 1,000 people.

“The goal is that we can operate essential services with the highest level of security, ensuring that the functional units have separate and separate contingent forces,” said Chia Shi Lu, an orthopedic surgeon. photo at Singapore General Hospital, said.

The bottom line is to make sure that the proportion of doctors – patients is appropriate and that there is enough force for critical cases – for example, doctors who are actively involved in treatment, capable of operating a ventilator or machine hook helps pump oxygen to the patient, Ms. Chia said.

At the emergency department where pediatric emergency specialist Jade Kua treated Covid-19 patients in addition to other emergency cases, the doctor was divided into 4 groups, each group of 21 people. Each group alternates 12-hour shifts and does not interact with other groups.

“We are divided into separate groups, doing mornings, taking breaks, and vice versa. Other groups are similar, there is no personnel disturbance between groups,” Kua said.

Meanwhile, Chia said doctors were divided by specialty.

“We try to limit meeting with members of other groups. We just greet each other through the hallway. The same eating and drinking. Everything, including the cafeterias, has imposed use to keep distance from contact, “said Dr. Chia.

Not every country has a plan to respond like what Singapore has applied. According to the Global Health Security Index released in 2018, 70% of the 195 countries had low scores in preparing national pandemic response plans. About 30% of countries cannot determine which areas are not adequately prepared.

In India, a country of 1.3 billion people, only about 20,000 doctors are trained in key areas such as intensive care, emergency medical and lung disease.

In contrast, Singapore has announced a flu pandemic prevention and response plan since June 2015, and is constantly consolidating and updating.

Hospitals in Singapore regularly organize drills to cope with scenarios such as pandemics and terrorist attacks. A number of drills were witnessed and scored by representatives of the Ministry of Health, who then made recommendations to improve the quality of disaster prevention.

Singapore’s plan also includes the requirement for equipment reserves to avoid the shortage scenario as many countries are facing today, a lesson that the lion island nation learned after the SARS pandemic, when masks, gloves exhausted hands and protective clothing.

In a 2008 pandemic prepared document, experts from the Singapore Ministry of Health said that the country’s stockpile was sufficient to provide protective equipment for all front-line health workers within 5- 6 months.

During the early stages of the Covid-19 pandemic, Singapore recommended that citizens do not wear masks if they are not infected to ensure the supply of health care workers. Having the necessary protective equipment helps protect physicians in Singapore, while the worst scenario occurs in many other countries.

Medical doctors are stigmatized

Health workers in Singapore face the risk of discrimination. Photo: Today.
Health workers in Singapore face the risk of discrimination. Photo: Today.

Despite relatively safe protection in treatment facilities, health workers in Singapore face an entirely different problem, stigma.

While in Western countries like England, France, and Italy, people applaud and celebrate the sacrifices of doctors from the windows of buildings during isolation, health workers in Singapore People consider it as a host disease.

“I don’t dare to wear uniform clothes because I cannot foresee the irony. The public is scared and wearing uniforms will actually inconvenience. My colleague has been denied five times when trying to call a taxi to get to the hospital, “said a nurse at a hospital in Singapore.

The same problem is happening in India. The All India Institute of Medicine has asked the government for help after many health workers were forced to leave their homes by homeowners and neighbors fearful of the risk of disease.

“Many doctors were pushed to the streets with their luggage, nowhere else to go. This situation happened all over the country,” said the All India Medical Officer.

Jeremy Lim, an expert from Saw Swee Hock University School of Public Health, said the worst reactions and the “self-care” attitude appeared during crises, and that’s why the government had to involved.
Mr Lim warned that discrimination could negatively impact health workers’ motivation and ability to work. If health care workers become infected, the threat is tripled.

“That means there will be fewer specialists in an already overcrowded system, one more patient in need of care, and most likely a whole group of colleagues in need of isolation. We have to do everything possible to keep medical and medical personnel safe during the Covid-19 pandemic, “said Mr Lim.