SINGAPORE - Retiree Subramaniam Sellamma, 70, and her husband, 81, are feeling the strain of social isolation.

They are used to visiting their granddaughters for a few hours every weekday, but they have not seen Mayla, aged three, and Kyara, one, for three weeks now.

Madam Sellamma, who used to work as a senior clerk at port operator PSA, says: "We want to hug them, but we cannot; we have to distance ourselves. We also don't want the grandchildren to get (the coronavirus).

"I call them almost every day, but sometimes they don't want to go on a WhatsApp video call, they say 'Appachi (grandmother), I will call you later.'"

Her husband Sinnadurai Ramanathan watches videos of their granddaughters, which their son sends them, over and over again.

Occasionally, they wave to a lonely 92-year-old neighbour from the window of their Spottiswoode Park Housing Board flat.

The coronavirus pandemic has meant that many seniors - a group that is vulnerable to the virus - are further isolated, even from their family members, as social distancing is important for their own safety.

Some doctors say contact with one's grandchildren is best avoided, due to the risk of transmission from persons who do not display symptoms of the coronavirus.

Dr Lim Hui Ling, medical director and senior family physician at International Medical Clinic, says it can be difficult to differentiate between symptoms of the coronavirus and other conditions, such as when diagnosing an allergy-related cough in a child.

The most common coronavirus symptoms are fever, fatigue and a dry cough.

At least 10 people in Singapore had contracted the disease from those without symptoms, according to a new study of such patients here.

It was published on Wednesday by the United States' Centres for Disease Control and Prevention and co-authored by Associate Professor Vernon Lee, director of communicable diseases at Singapore's Ministry of Health.

Says Dr Lim: "Young children probably shouldn't be visiting Grandma and Grandpa, as they may not understand social distancing and run up and hug them.

"There is also risk of exposure if the children are touching surfaces in their grandparents' home, such as the doorknobs and kitchen counters."

UNDERLYING HEALTH ISSUES

Madam Sellamma says safe distancing was a decision she and her husband took jointly with their 39-year-old son, the younger of their two children.

The elderly couple have underlying health conditions.

Their medical issues heighten their feelings of loneliness, a common problem for seniors who tend to be socially isolated even under ordinary circumstances.

Says Madam Sellamma: "Before, when the children went to childcare and came back with runny noses, I would be prone to all that."

When she and her husband leave their flat for their daily meals, she sometimes feels as if others keep their distance from them.

Madam Sellamma has high blood pressure and post-nasal drip, a condition in which mucus runs down the back of the throat, causing a chronic cough.

"I need to cough to clear my throat. Maybe others think, 'this Ah Soh has this health problem, stay away'," she says.

Her husband, a retired building maintenance technician, has diabetes and mild dementia.

Experts say mental health conditions such as dementia can make self-isolation even more challenging.

Mr Jason Foo, chief executive of the Alzheimer's Disease Association of Singapore, says: "Persons with dementia feel most comfortable when there is a fixed routine. Some of them may not see why they should be isolated or understand the need to keep a distance from others. "It will be a struggle to keep them in a confined space. This may trigger behaviour such as repeatedly trying to open the door."

GRANDPARENTING FROM AFAR

Social distancing has not deterred another senior who is grandparenting from afar, however.

Retired nurse Lai Kum Yoong, 81, has been cooking Cantonese tonic soups and other dishes for dinner for her son's family - which includes two grandsons who are serving stay-home notices, a 14-day self-isolation period, after returning from their universities in Britain.

Instead of cooking dinner in her son's home, of which she and her husband have moved out, she takes the food to her son's doorstep, where a domestic helper collects it.

Madam Lai, who used to stay with her son and his family several days a week, says: "I miss the grandsons so much. Usually when they come back for holidays, we go out to eat as a family."

She used to run cooking sessions at Tsao Foundation for fellow seniors. "Cooking is my passion. Sharing what I cook is a joy and a way of showing love for my family."

Besides adhering to guidelines to prevent the spread of the coronavirus - such as washing one's hands with soap and not touching one's face - International Medical Clinic's Dr Lim says that "if possible, the elderly shouldn't be the caregivers for their grandchildren, especially if their immunity is weakened".

But this is not always practical for three-generation families, in which grandparents are often the caregivers.

Retired university librarian Jacqueline Yip, 72, and her husband, 73, pick up four grandchildren - aged between three and eight - from a child- and student-care centre every day.

For most of the week, the two youngest grandchildren live with the elderly couple, whose daughter and son have two children each.

Madam Yip says: "I'm still caring for the grandchildren as usual. I cannot do otherwise. Their parents are working full time. I remind the grandchildren to wash their hands once they come home, though."

Even if seniors live with their grandchildren, there are still social-distancing measures that can be employed, says Dr Lim.

These include not coming into contact with their grandchildren's bodily fluids as far as possible, such as when feeding the little ones, wiping their mouths and noses or helping them with toileting.

But Dr Piotr Chlebicki, an infectious-disease specialist at Mount Alvernia Hospital, advises maintaining a sense of perspective when it comes to avoiding contact with young ones in the same household, especially since the crisis looks set to last for months.

"Social distancing is not something that has to be done all at once," he says, referring to how avoiding crowds and social gatherings can be followed by restricting family visits.

"If local transmission becomes more active, people can limit their social contact even more. Likewise, when the situation improves, some social activities can be resumed."