SINGAPORE - More patients to tend to, working overtime and recalled for duty on days off, no time for toilet breaks, exhaustion and feeling burnt out.
This is what many healthcare workers in hospitals have been going through since local Covid-19 cases rose to the thousands daily from mid-September.
For nurse Anne (not her real name), the number of infected patients she has to monitor in a Covid-19 ward of a SingHealth hospital has doubled.
In July and early August, the 24-year-old and her colleague took care of six patients at any one time. Now, they look after 12.
"We don't even have time to go on breaks. I would just push through and sometimes don't even use the toilet," she said.
Like Anne, the healthcare workers The Straits Times spoke to declined to reveal their names - and, in some cases, the hospitals they work in - because of work policies.
The manpower shortage in the sector has also been compounded by quarantine orders. Senior Minister of State for Health Janil Puthucheary told Parliament on Oct 4 that close to 400 healthcare workers have tested positive for Covid-19.
Cathy, a former cardiac technologist at Tan Tock Seng Hospital (TTSH), said: "When someone is suspected to have contracted Covid-19, it means that more than half the department would have to be down for quarantine."
However, new health measures announced last Saturday (Oct 9) may provide some respite for healthcare workers, as quarantine orders have been replaced with antigen rapid tests.
Those who receive health risk warnings should immediately self-isolate and take an ART. They can continue with normal activities if they test negative, but must continue taking an ART daily for the next week.
The home recovery scheme was also expanded to more groups, including vaccinated people aged 70 to 79. But it will take a while for the hospital load to ease as there were 1,698 cases warded on Monday.
Nurse Belinda, who is in her 20s and works in an isolation ward for suspected cases in TTSH, said: "The physical work is more taxing now with toileting and changing of diapers. The patients are weaker and sicker, and their care plans are more complex."
TTSH chief nurse Hoi Shu Yin said since the hospital has battled three to four waves of infections over close to two years - from the dorm outbreak last year, the hospital cluster in April, and the ongoing wave - the nurses are grappling with "a certain level of fatigue".
"They say, 'Can we have more nurses?'... They look and sound tired, and some will be sharing how much they miss their families," she added.
Adjunct Associate Professor Habeebul Rahman, chairman of TTSH's well-being committee, said: "(As for )the doctors, there was a sense of how long are we going to do this for and what's the end point?"
Dr Hoi said it has been really challenging to balance the manpower resources to take care of both the Covid-infected and business-as-usual patients.
Hospitals have been asked to postpone less urgent operations and appointments to prioritise resources for Covid-19 patients.
But Dr Francis, a junior doctor in a public hospital, is worried that delaying elective procedures would affect timely diagnoses and treatment. "I worry for doctors - that this backlog of elective surgeries is going to create a surge in surgical load once this wave is over."
Some nurses said the manpower crunch is more keenly felt in the non-pandemic wards.
Diana, a nurse in her 30s who works in a C-class ward in a SingHealth hospital, said since early September, a few of her colleagues have been quarantined as their family members were infected.
The ward with 45 patients is now handled by six nurses per shift, instead of the usual nine. This means that two nurses are taking care of 15 patients.
Diana said: "You cannot rush if you're looking after the elderly. It will take a while to settle one patient."
The Ministry of Health (MOH) said last week that waiting time at public hospitals, from the emergency department (ED) to admission for non-Covid-19 patients, has risen by 34 per cent from July to last month.
Dr Francis said he has seen some patients who had to stay multiple nights in the ED before getting a ward bed.
As part of managing the manpower constraints, about 900 individuals - including nurses not in active practice and people registered with the Singapore Healthcare Corps - have stepped forward to help, MOH said last week.
They are being progressively referred to the public hospitals.
Some hospitals have also deployed nursing aides to ease the strain on nurses in the wards, so that they can focus on clinical tasks.
Last month, TTSH introduced a mental well-being day off, where employees can choose an additional day to take leave on top of their existing days off.
TTSH chief nurse Hoi said: "We were all asked to take leave. Even though we are stretched... we do want to schedule breaks for our staff so they can rest and recharge."
She added: "It is a very strong message, a call to our staff to really take their minds off work... I think it is the care and support that we give to each other that matters a lot."
When TTSH saw its first few Covid-19 deaths last year, the hospital started running support groups for the doctors and staff who cared for those patients.
The rate and number of such deaths in Singapore have more than doubled in the past month compared with the period of March last year to August this year.
"There was that sense of not being able to save patients' lives... that sense of things going out of control that threatens morale sometimes," said Prof Habeebul, who also heads TTSH's psychiatry department.
Over the past month, there have been more than 100 deaths linked to Covid-19, bringing the country's death toll to 172 as at Monday.
Prof Habeebul added that over the course of the support groups, the hospital's leaders have also provided reassurance.
"They told the doctors that they will manage this over time. And with some patients, no matter how hard you try, there are things beyond your control, and the idea is to do your best."
The hospital has about 140 welfare officers to look after staff well-being.