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SINGAPORE: At the National Infectious Disease Center (NCID) screening center, an important part of defending against the pandemic has been nothing but ice cream.
Charmaine Manauis barely jokes when she says that. She is the lead infectious disease consultant for the emergency department at Tan Tock Seng Hospital, which is in charge of the detection effort.
“Ice cream is important; It makes us happy. You see everyone: they have ice cream, they cheer up ”, said the doctor about her and her colleagues.
“Plus, it’s hot in PPE. That’s why they love to eat ice cream (in the pantry) during their break.”
He certainly isn’t joking about feeling the heat underneath his yellow robes, shower caps, gloves, goggles, and N95 masks, which they wear during their seven to 10 hour shifts, except during breaks.
In full personal protective equipment.
“When I take off my yellow dress, I’m usually soaking wet. It’s very hot,” she said. “When I take off (the mask), I feel like I can breathe again.”
This has been the case for the staff running the TTSH emergency department and the screening center at the National Center for Infectious Diseases at the time of the coronavirus.
And it’s not just emergency room doctors who handle suspected Covid-19 cases.
While his department used to have about 20 doctors on duty at any time of the day, it has been a whole new game since the Chinese New Year.
Hundreds of doctors from different specialties in the hospital, from urology to otorhinolaryngology (ear, nose and throat) to plastic surgery, are being mobilized to receive training so that they can also perform Covid-19 tasks.
Since Singapore’s first confirmed case on January 23, more than 400 hospital doctors have been assigned to work at the NCID screening center across the road.
And the one coordinating his training is Manauis, the lead consultant leading the detection efforts, as CNA Insider discovers in an inside look at the front-line battle against Covid-19.
GET THE WIND OF VIRUSES ON HOLIDAYS
The 42-year-old woman and her boss, assistant assistant professor Ang Hou, head of the emergency department, were on vacation in December when they learned of a mysterious illness in Wuhan.
“I said, ‘Hm, this could be something.’ So when I came back, the department had already started evaluating,” said Manauis. “We started looking for (travelers from) Wuhan on January 2.”
Dra. Charmaine Manauis.
That was the day the Singapore Ministry of Health (MOH) announced that it was closely monitoring the pneumonia outbreak, and sent a circular to doctors here.
The whispers of severe acute respiratory syndrome (Sars) began to “float” on TTSH. “We were at the center of SARS in 2003, so that never left the department’s DNA,” Ang said.
“You can’t help but relive memories you’ve been through, especially when you know that your colleagues and friends have been greatly affected.”
However, the possibility of a second coming did not surprise him. “We were always anticipating something like Covid-19 … We knew it would not be a question of if, but when,” he said.
“We knew that by the time it came from Wuhan to Singapore, it would have been … a significant outbreak in the world or at least in this part of the region.”
Dr. Ang Hou.
The department began detecting the new coronavirus (Sars-CoV-2) in a “very small and dedicated space.”
But even “long before” the Disease Outbreak Response System alert for Singapore rose to orange, the number of people who came every day “was growing on a scale that we had to get out of (that) physical space, “he added.
As the rest of the country approached the Chinese New Year, the furniture had to be moved and the computers set up to activate the NCID detection center.
Computers had to be installed in cars for the detection center to activate.
“It was a very busy Chinese New Year for a lot of people, not because we were celebrating, but because we were preparing for the next phase of the screening,” Ang said.
By January 29, the detection center was operating 24 hours.
CLOCK: An exclusive look inside the NCID detection center (Dur 5:20)
FROM THE SCREENING CENTER TO THE SHOP
Those first weeks of center operations were “really hectic” for Manauis.
“We were on call 24/7. Every Saturday, we train (staff). During the week, we examined the protocols: we would see if our processes worked well, if we had to manage the choke points in the detection center, “he said.
One of those choke points was the X-ray rooms. “If the detection center was full, then there would be an X-ray line. And then we would need more efficiency, more radiographers,” he said.
Based on the travel history and the results of the chest radiographs, the doctors had to decide whether the patients had to be protected or could be discharged.
Patients must complete a questionnaire at the screening center.
For those who needed admission, those were uncertain times. They had many questions. “How long will I stay? What tests will they do me upstairs? How about my family? Do they need to be admitted too? cited Manauis.
The numbers submitted for detection continued to increase until the load “became quite difficult at one point,” Ang said.
This happened when the Ministry of Health changed the definition of a suspected case, after the transmission of the coronavirus in a health products store visited by Chinese tourists.
“That led to many doctors being referred by their doctors for a screening test because they had close and frequent contact with travelers from China,” Ang said.
“Many people entered various industries, whether they were taxi drivers, tourist bus drivers, people who worked in tourist attractions or hotels, airports and casinos. They were all flooding. “
Inside the projection center.
So after consulting the ministry, TTSH proceeded to rub and discharge these patients, “to keep beds for patients who were really sick and needed treatment.”
Then there was “a strange moment in time,” when the number of people who came for screening and confirmed positive cases decreased, even as the numbers increased in the rest of the world.
“We knew the numbers would go up sooner or later,” said Ang.
“We knew that the detection center might not be able to cope … so we made the decision together with the ministry to establish an advantage, to expand the number of places available.”
The tent outside the projection center.
That ended up being the case. On March 23, the TTSH team examined the largest number of people so far: more than 520. “We called it the most terrible Monday,” said Manauis.
“The patients arrived in the afternoon and at night. And at night, we have less labor. We had to open the tentage until 3 in the morning, and many patients had to wait a little longer. So it was a fight. “
MIGRANT WORKERS A NEW CHALLENGE
There are still hundreds of patients examined on a daily basis, although lately the challenge is not the numbers, but the necessary space, since the increase has been among migrant workers, and the advantage outside the detection center is “perennially full.”
“For these foreign workers, we must wait for the swab results before they can be fired (if they are negative). So we need a bigger waiting area for them, “said Manauis.
“After that, they also have to wait for transportation to take them back to their bedrooms. So they can wait up to probably 18 (a) 20 hours. “
CLOCK: Inside a COVID-19 detection center in Singapore (5:20)
While there are now swab isolation facilities such as the CherryLoft chalets, where workers can be sent after their nasal swabs, these facilities “are quite full” today, he added. Workers cannot isolate themselves.
Every day, we would have to ask ourselves if there is a vacancy, and then they still have to wait for an ambulance or dedicated transportation.
While a smear is now done in the dorms, some of the workers must go to the screening center based on their symptoms.
If they complain of chest pain or have difficulty breathing, for example, they need an x-ray, blood test, or EKG.
Whenever they are symptomatic or have had close contact with a positive case of Covid-19, samples should be taken.
A circular from the Ministry of Health sent on Thursday has also updated the cleaning criteria for everyone. Anosmia, the loss of the sense of smell, whether total or partial, is now one of the symptoms to consider, Manauis cited.
“There were (research) works that came out, and there were positive cases that presented only with anosmia,” he explained.
The other symptoms still include fever, runny nose, cough, sore throat, and gastrointestinal symptoms like diarrhea or vomiting.
Since starting with the TTSH clinical protocols and work instructions for Covid-19 detection and infection controls, Manauis has developed 61 versions for staff to follow.
There is also a workflow for foreign dorm workers, which is now in version 17.
IN THE LONG TIME
It has also trained nine batches of doctors from various departments, with up to 51 doctors in one batch.
They work a 10-day cycle as part of a group of more than 100 people, including nurses and other health workers, who run the screening center.
Most of them, including senior specialists, are volunteers, and some have done more than one rotation, although each department is also supposed to contribute a certain amount of labor.
“Detection is very different from what they do every day. So it was no surprise that they were a little apprehensive. But they were very willing to help, “said Manauis.
She is grateful for all the support. In one of this month’s training sessions, he told the doctors: “We really need your help on the front line. On behalf of the emergency department, I thank you for your volunteering. “
The point is that your department not only works at the screening center, but also handles common emergencies. To do this, the staff canceled their license and reduced their days off.
“You just have to do your job. I go day by day, everything that needs to be done, needs to be done, ”he said with a shrug.
“Everyone made sacrifices, not just me or not just the doctors … But we do this voluntarily because we know this is our job.”
Emergency cases are handled in a different area, although that does not mean that personnel must necessarily dispense with personal protective equipment. Front-screening triage nurses, for example, must wear the full kit.
“Sometimes walk-in patients … are close contacts (of a Covid-19 case), so we have to protect our front-line staff,” said Manauis.
To also protect patients, one of the changes made is to ensure that they queue at least two meters away. This, and many of the current arrangements in the emergency department, may be in effect for some time.
“For those of us who have been here for a while, who have been through other outbreaks, we know that it will potentially be a long one,” Ang said.
“It could affect some of our own members, that Sars’s memories come back, and I think it could affect them a little bit more.”
When asked about his team’s morale on Friday, Manauis, who has been with TTSH for 15 years, replied cheerfully.
“We will do everything we can to … help the nation, especially now that (the number) of positive cases has increased,” he said.
“We are still fine. We still have ice cream, so we are happy. I mean, you will have to try to keep up, because we know this will continue for a few more months.”
