Singapore’s COVID19 Crisis: Forgetting to Check the Blind Spot

It is with a heavy heart that I pen this follow-up piece on Singapore’s COVID19 situation.

In the past few months, the city state has been hailed as an exemplar of early, preemptive and targeted response to combat the pandemic. Other countries have studied its response.

As I wrote here on Mar. 19, despite being a densely populated high-risk state, Singapore managed to keep its cases extremely low. No deaths were reported between late January and mid-March. But even then, there were warning signs. In that same piece, I expressed concern for a potential second wave of cases that could be triggered by the massive influx of Malaysian foreign workers who rushed to enter Singapore before Malaysia closed its borders on Mar. 18. Interestingly, while Singapore did experience a second wave in late March, the new cases were not attributed to foreign workers. Most of the new cases were from Singaporeans returning home from travels to global hotspots such as the UK and US (covered here).

As it turned out, that source of new cases was only the beginning. It will be a long time before Singapore can pop the champagne, (or throw back a Tiger beer in celebration, in Singapore’s case).

At time of writing today (Apr. 21), there is a total of 9,125 confirmed COVID19 cases in Singapore – and we are now seeing more than 1,000 new cases a day. So far, the death toll remains low at just 11. Source: https://www.moh.gov.sg/covid-19. While my earlier concern for the Malaysian foreign workers who rushed into Singapore overnight has fortunately not (yet) been borne out, the primary cause for this third wave of COVID19 cases did, however, turn out to be similar.

Migrant workers who come to Singapore from Bangladesh, India and China, and who have been residing in crowded dormitories, are now suffering. Of the 1,426 new confirmed infected cases announced today — the highest single-day total reported so far — the vast majority are foreign workers living in dormitories. Only 16 cases of the new cases were Singaporeans or long-term residents.

After all that deliberate, thoughtful, and swift COVID19 response, how did Singapore see its curve move in the wrong direction?

Behind our beautiful Garden City (and the glorious food)

Anthony Bourdain, before his tragic suicide in 2018, filmed a CNN series called Parts Unknown. One of the episodes featured his visit to Singapore. While I was reminded fondly of home by the tantalizing street food of Singapore featured in the show (I went searching for chicken rice in San Francisco the next day), there was one particular conversation he had with the locals which struck me somewhat uncomfortably:

On that episode, a few local Singaporean ladies shared with Bourdain that in this country, most Singaporean women are in the corporate workforce. They further elaborated, rather matter-of-factly, that the career progression of Singaporean women isn’t hampered by childbearing.That’s because low-cost domestic helpers are widely available. These domestic workers live under the same roof as the local families, and are responsible for daily chores and childcare.

Bourdain, in his signature candid style, retorted, “that’s like bourgeois, man. You are living off the labor of an oppressed underclass.”

That conversation made me, a Malaysian-born Singaporean, and a proud one at that, rather unsettled. Deep down I knew that Bourdain was most probably right.

No system, or country, is perfect. Behind the ultra-modern high-rise buildings that dominate our stunning skyline are the faceless migrant construction workers from other developing countries who have toiled under the hot tropical sun to build them. Behind the ultra-clean streets of Singapore lined with gorgeous flowers and trees, that have earned us the moniker of “Garden City,” are the invisible cleaners. Many of them earn a low wage at jobs which few local Singaporeans would take.

When my significant other visited Singapore with me for the first time, he was quick to point out workers’ vehicles passing us by on the roads. They sit shoulder-to-shoulder at the back of open trucks. No seats. No seat belts.

These trucks are hard to miss. They are on the same roads as the luxury sedans driven by the locals who work in those office towers.

It was not a proud moment for me, nor should it be for any Singaporean.

While this situation is not unique to Singapore, we cannot deny the fact that we have more than 200,000 foreign workers living in cramped and relatively unsanitary conditions. On Mar 23, before the current turn of events, the Transient Workers Count Too (TWC2) organization, a local non-profit workers’ rights group, submitted an open letter to warn the government officials of a potential outbreak within the foreign worker dormitories.

As detailed in that public letter, these migrant workers are often housed in crowded dormitories of 12-20 men per room. In addition, some employers levy heavy fines, which can amount to a few times a worker’s daily salary, if they fail to show up at work; some even refuse to recognize medical leave of more than one or two days. These conditions render it almost impossible for these foreign workers to exercise social distancing or to stay at “home” even when unwell.

Knowing how this virus transmits so easily between people in close proximity, and how much pressure the workers are under to work even when feeling ill, this is an almost ideal situation for the virus to spread.

Unfortunately, the public warning from the workers’ rights group fell on deaf ears. It is always easy to realize on hindsight, but these migrant workers represent the exact demographic that was left out of Singapore’s early, effective COVID19 response. For example, the country’s nationwide mask distribution early in February to every household did not include these foreign laborers. In another instance, the government’s bid to reduce virus spread by restricting physicians to single hospitals has also severely impacted volunteer health services required by this vulnerable community.

These workers operate in a kind of blind spot to many Singaporeans. It showed in the country’s response.

As Bilahari Kausikan, the former Permanent Secretary at Singapore’s Ministry of Foreign Affairs remarked, the country “did drop the ball on foreign workers who are invisible to most Singaporeans.”

Not All Hope is Lost: Correcting the Course

While it is disheartening to see Singapore’s current setback, it is however encouraging to see the city state tackling the crisis head on with new and concrete measures. Josephine Teo, the Minister of Manpower, has outlined a three-pronged strategy:

1. Testing and Isolation: affected dormitories have been locked down to contain the spread. Testing has been massively expanded among workers to identify and isolate those who have been infected.
2. Social distancing: even for dormitories that have not been infected, aggressive social distancing measures have now been implemented. In total, 200,000 foreign workers are now in quarantine. Local reports have only mentioned rehousing of workers involved in essential services to separate facilities. It appears that the rest of the workforce under quarantine still have to remain in their dormitories although the government has now expanded isolation facilities on-site for the infected clusters, and is enforcing staggering shower times and communal toilet use, as well as providing them with all meals so as to reduce the use of communal kitchens.
3. Medical screening and medical support: for the 7000 workers who have been identified to be required for essential services, strict measures are taken to ensure their safety as they continue to work. Masks are provided and are to be worn at all times at work; medical screening including temperature checks are performed routinely at workplaces. Teams of healthcare workers have been deployed to attend to the workers so that they can get timely medical attention.

In these special times of need, tens of thousands of Singaporeans have rallied and donated funds to help support these migrant workers. Prime Minister of Singapore, Lee Hsien Loong, publicly pledged his commitment to take care of the welfare of the affected migrant workers. The government is also working closely with employers to ensure that these workers continue to receive their salaries and to facilitate their overseas remittance to send money home.

It is also particularly heartwarming to see the volunteers at Healthserve, a Singaporean non-profit organization, step up during this time of crisis to roll out counseling via virtual means for migrant workers hit by this pandemic, with a strong focus of ensuring their mental and emotional wellness.

Apart from efforts to combat further virus spread within the foreign workers clusters, Singapore continues to combat local transmission. After resisting a nationwide lockdown for months, it eventually became apparent to Singapore that even the most aggressive and effective contact tracing and isolation measures are not sufficient to contain the virus spread. Partly, this is because of the difficulty of stemming all imported cases.The traditional method of public health can be effective, but struggles to keep up with a virus that spreads this fast. The country has since Apr. 7 been in a one-month lockdown, which the government termed, quite curiously, the “circuit breaker” (maybe someone with an electrical engineering background conjured this term?).

New Learnings

1. The chain is only as strong as its weakest link

It is not only in Singapore where we witness an exceptionally severe impact of COVID19 on the lower socioeconomic classes. In the US, data showing racially disproportionate mortality rates have emerged in some of the poorest regions of the country. For an instance, 70% of fatal COVID019 cases in Louisiana are African Americans, even though they only make up one-third of the state population. Poverty, higher rates of co-morbidities, less access to healthcare and unfeasibility of practicing social distancing because of crowded housing conditions and jobs that can’t be done from home render certain populations particularly vulnerable. As countries all over the world get embroiled in the chaos of this pandemic, it is of utmost importance that we do not neglect the most vulnerable communities in our midst. Their lives are at risk more so than ever, and especially if we do not take the prudent steps in our policies.

As my esteemed friend Dr Jeremy Lim at Healthserve said in an interview, “If we don’t proactively look after the weakest link, then collectively, we will all pay the price.”

2. A flattened curve may not stay flattened

Singapore’s case study is a reminder that even when the curve appears to be flattened, as was the case initially, COVID19 can rapidly rear its head again when stringent social distancing measures are not in place. Short of an effective vaccine and/or herd immunity, subsequent waves of infection are highly possible if we were to loosen social distancing measures too liberally or prematurely.

In my new home in the United States, I’m watching nervously as Georgia — a state with 10.6 million people and more than 19,000 reported cases of COVID19 — announced plans to reopen its economy this Friday, Apr. 24. In the meantime, states like New York and California have recently extended their stay-at-home order to later dates in May than originally planned.

These highly varied individual state responses do not make it easier for what should have been a more coordinated nationwide effort to combat COVID19. We all know by now that a hotspot can quickly seed new clusters elsewhere, especially from a place like Georgia with one of the busiest airports in the US. But many US states did act quickly, and citizens quickly adapted to the stay-at-home orders, so hopefully we can respond quickly again if necessary. The coming months will be critical to watch as we thread the needle to save as many lives as possible, while also saving people’s economic livelihoods.

It is now Virus versus All Men. May those who have lost their lives in this pandemic live in our everlasting memory. In order for them to not have died in vain, let’s learn the right lessons to prevent more unnecessary death. For all of mankind, I pray.

Disclaimers:

This article expresses the personal views and perspectives of the author. The views and perspectives expressed here do not necessarily represent the views or perspectives of Vertex Ventures HC, or any officer, director, partner, member, manager or employee of Vertex Ventures HC, or any of its affiliated entities.