Coronavirus: Experts say big jump in infections is stretching the healthcare system

A person wearing personal protective equipment at the entrance of Singapore Expo on April 10, 2020. ST PHOTO: MARK CHEONG
A man believed to be a recovering Covid-19 patient, exits a van at the Singapore Expo community isolation facility on April 10, 2020. PHOTO: EPA-EFE

SINGAPORE - Singapore will have to change the way it handles Covid-19 patients as the recent surge in infections is stretching the capacity of the healthcare system, said interviewed experts on Thursday (April 16).

Associate Professor Hsu Liyang of the NUS Saw Swee Hock School of Public Health said more foreign workers will continue testing positive in the coming days, as those who had contracted it before being rehoused according to safe distancing measures start falling sick.

Prof Hsu, who is both an infectious diseases expert and an epidemiologist, said the spread of Covid-19 in dormitories "must be slowed or else there is a high chance that our hospitals will be overwhelmed whatever we do".

His colleague and vice-dean of research at the school, Associate Professor Alex Cook, said: "We could easily see 10,000 to 20,000 cases by the end of the month if we do not put in place fast and effective measures ensuring actual safe distancing among the workers currently in the dorms."

Professor Dale Fisher, a senior infectious diseases expert at the National University Hospital (NUH), said both healthcare facilities and manpower are still managing, "but it's stretched".

All three agreed that what is needed is a good system for isolating and monitoring patients with mild symptoms outside of hospitals.

Fortunately, these foreign workers are generally younger and in better health, so the number who may become seriously ill will likely be lower, they said.

Nevertheless, as the number of infections rises, more will need to be hospitalised.

Prof Fisher estimates that between 5 and 10 per cent would need to be hospitalised, and perhaps 1 to 2 per cent would become critically ill.

This is lower than the general population norm of 15-20 per cent falling seriously ill and about 5 per cent needing intensive care.

But Prof Cook warned that should many of the workers smoke or have high blood pressure, they risk becoming critically ill if infected.

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Singapore had a total of 11,321 acute hospital beds at the end of last year, of which 9,400 are in the public sector.

After postponing non-urgent treatments since January, bed occupancy rates at public hospitals have gone down from around 90 per cent at the start of the year to about 75 per cent by the end of March, freeing up more than 2,000 public hospital beds.

But with increasing numbers of people being infected over the past two months, these are being rapidly filled up.

On April 3, 473 Covid-19 patients were in hospital. By Thursday, the number had surged to 1,886, according to the Ministry of Health.

Private hospitals, which have slightly more than 1,600 beds, are also helping to care for coronavirus patients.

Prof Hsu suggested: "Covid-19 cases should be triaged and those with minimal risk of complications should be sent to community isolation facilities immediately rather than face a period of observation in an acute hospital.

"They will need to be monitored more carefully at the facility, so that they can be rapidly transferred to an acute hospital in the rare event that they deteriorate."

Prof Cook said the current procedure of simply moving out the less serious cases to other facilities, such as the Expo, may not be sustainable for long: "We'll have to accept that milder cases be managed outside of the formal healthcare environment."

Prof Hsu added that Singapore needs "to be agile and creative about how we deploy existing manpower and resources", such as building additional facilities and training people to care for the large influx of mild Covid-19 cases.

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