TR EMERITUS

As of 24th April, other than being the most infected country in Southeast Asia, it is also on the Top 10 world list of Covid-19 infections in terms of residential area, infections per million, etc. The following charts are self-explainatory. Infections per million Infections per residential land mass (sq km) If only these were Olympic medals.        Read More →

As of 24th April 2020, 12pm, the Ministry of Health (MOH) has confirmed and verified an additional 897 cases of Covid-19 infection in Singapore. The breakdown is as follows: Imported Cases: 0 Dormitory Cases: 853 Community Cases: 44 Community Un-linked* : 30 (Total: 676) * Un-linked cases in the community regardless of nationality and excluding "Dormitory Cases". Total indicates the number of un-linked cases to date. Medical Workers Infected A nurse with Bukit Merah Polyclinic has been infected with Covid-19 and is currently warded at the National Centre for Infectious Diseases. Registered as case 11580, the 43 year-old female Singaporean reported onset of symptoms on 20th April, and subsequent test results confirmed COVID-19 infection on 23 April. She had not gone to work since onset of symptoms. Status of Confirmed Cases Of the 12,075 total confirmed cases, 956 have fully recovered and been discharged from hospital while 24 are in critical condition. Known Clusters An additional 9 (new) clusters were announced, bringing the total number of known clusters to 106. They are Alaunia Lodge, Westlite Juniper, 10 Shaw Road Industrial Building, 2 Sungei Kadut Avenue, 11 Tuas Avenue 10, SSKBJV Dormitory, Natureland East Coast, 112 Neythal Road Commercial Building and Strand Hotel. Item Location of Cluster Cases New 1 S11 Dormitory  @  Punggol (2 Seletar North Link) 2263 2 Sungei Tengah Lodge @ 500 Old Choa Chu Kang Road 871 3 Tuas View Dormitory @ 70 Tuas South Avenue 1 854 4 Kranji Lodge I @ 12 Kranji Road 271 5 Woodlands Lodge I @ 50 Woodlands Industrial park E4 268 6 Mandai Lodge I @ 460 Mandai Road 258 7 Changi Lodge II @ 80 Tanah Merah Coast Road 224 8 North Coast Lodge @ 51 North Coast Avenue 211 9 31 Sungei Kadut Avenue dormitory 209 10 Cochrane Lodge II @ 49 Admiralty Road West 189 11 Jurong Penjuru Dormitory @ 58 Penjuru Place 187 12 Cochrane Lodge I @ 51 Admiralty Road West 182 13 Westlite Toh Guan dormitory @ 18 Toh Guan Road East 175 14 PPT Lodge 1A @ 8 Seletar North Link 165 15 21B Senoko Loop Tellus Industrial Complex 152 16 Westlite Mandai @ 34 Mandai Estate 149 17 Kian Teck Dormitory (26 Kian Teck Avenue) 133 18 Woodlands Lodge II @ 190 Woodlands Industrial Park E7 115 19 Mustafa Centre @ 145 Syed Alwi Road 113 20 Toh Guan Dormitory @ 19A Toh Guan Road East 113 21 Jurong Apartments @ 555 Upper Jurong Road 102 22 Homestay Lodge @ 39 Kaki Bukit Avenue 3 100 23 Acacia Lodge @ 530-540 Bukit Batok Street 23 99 24 13 Senoko Way Industrial Building 96 25 17 Sungei Kadut Street 4 89 26 SJ Dormitory @ 180 Woodlands Industrial Park E5 89 27 Tuas South Dormitory @ 1 Tuas South Street 12 86 28 Tampines Dormitory @ 2 Tampines Place 84 29 Project Glory construction site 77 30 Shaw Lodge @ 12 Shaw Road 77 31 Tech Park Crescent dormitory @ 43 Tech Park Crescent 74 32 Woodlands Dormitory @ 27 Woodlands Sector 1 73 33 Kranji Dormitory @ 17 Kranji Way 73 34 Avery Lodge Dormitory @ 2D Jalan Papan 57 35 Sembawang Shipyard @ 198 Tagore Lane 56 36 18 Sungei Kadut Avenue 55 37 Pesko Engineering Pte Ltd 51 38 4 Sungei Kadut Street 2 48 39 SAFRA Jurong (private singing event) 47 40 32 Tuas View Square 47 41 CDPL Tuas Dormitory @ 6 Tuas South Street 15 46 42 51 Paya Ubi Industrial Park 42 43 Kenyon/ UBS construction site @ 9 Penang Road 41 44 Alaunia Lodge @ Admiralty Road West 41 24-4 45 Cassia @ 15 Penjuru Walk 37 46 The Jovell construction site 35 47 Hulett Dormitory @ 20 Senoko Drive 35 48 Leo dormitory @ 23 Kaki Bukit Road 3 34 49 36 Woodlands Industrial Park E1 33 50 Seatown Dormitory @ 69H Tuas South Avenue 1 33 51 12 Loyang Drive 32 52 National University Hospital @ 5 Lower Kent Ridge Road 29 53 36 Tuas View Square 29 54 PCF Sparkletots @ Fengshan 27 55 61 Senoko Drive 25 56 85 Kallang Dormitory @85 Kallang Avenue 25 57 Grace Assembly of God church 23 58 8 Sungei Kadut Avenue 23 59 Westlite Woodlands dormitory @ 2 Woodlands Sector 2 23 60 Westlite Juniper @ 23 Mandai Estate 23 24-4 61 10 Shaw Road Industrial Building 22 24-4 62 TTJ Design & Engineering Pte Ltd @ 57 Pioneer Road 20 63 17 Jalan Besut Industrial Building 19 64 CitiWall @ 34 Kaki Bukit Crescent 17 65 Lee Ah Mooi Old Age Home @ 1 Thomson Lane 16 66 5 Sungei Kadut Avenue 16 67 10 Kian Teck Crescent dormitory 15 68 59 Sungei Kadut Loop 15 69 8 Sungei Kadut Loop 14 70 Wizlearn Technologies @ Singapore Science Park 14 71 Wing Fong Court Condo @ 10 Lorong 14 Geylang 14 72 10 Kranji Link. 14 73 ABC Hostel @ 3 Jalan Kubor 13 74 2 Sungei Kadut Avenue 13 24-4 75 11 Tuas Avenue 10 12 24-4 76 Dover Court International School 11 77 234 Balestier Road 11 78 Blue Stars Dormitory @ 3 Kian Teck Lane 11 79 Life Church and Missions Singapore 10 80 Wilby Residences @ 15 Queen Street 10 81 55 Sungei Kadut Loop dormitory 10 82 Yong Thai Hang health products shop 9 83 Hero’s Pub @ Circular Road 9 84 SSKBJV Dormitory @ 31A Tanah Merah Coast Road 9 24-4 85 SingPost Centre @ 10 Eunos Road 8 8 86 Keppel Shipyard @ Pioneer Sector 1 8 87 Black Tap Restaurant @ Marina Bay Sands 8 88 Grandwork Building @ 7 Sungei Kadut Street 3 8 89 40 Tuas View Square 8 90 McDonald’s @ Forum, Lido, Geylang East Central and Parklane 7 91 Maxwell MRT station construction site@ Neil Road 6 92 Singapore Cricket Club @ A Connaught Drive 6 93 Natureland East Coast @ 907 East Coast Road 6 24-4 94 112 Neythal Road Commercial Building 6 24-4 95 Ce La Vi @ 1 Bay Front Avenue (Marina Bay Sands) 5 96 The Orange Ballroom @ Tanjong Katong Complex 5 97 6 Battery Road construction work site 5 98 ICA Building @10 Kallang Road 5 99 Seletar Aerospace Heights construction site 5 100 Strand Hotel @ 25 Bencoolen Street 5 24-4 101 Church of Singapore @ Bukit Timah 4 102 The Wedding Brocade @ Yishun 4 103 Grand Hyatt Hotel (business meeting) 3 104 A boulder+ Gym shop @ Aperia 3 105 Masjid Al-Muttaqin @ 5140 Ang Mo Kio Avenue 6 3 106 Little Gems Preschool @ 3 Ang Mo Kio Street 62 3 The island city is currently the most infected country in Southeast Asia and the 2nd most infected country in the world in terms of residential land mass. 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We were looking like the smartest kid in the class In February, except for isolated bouts of toilet paper hoarding and mask buying that potentially “sia-suayed” our country and parents. In March, we were still looking rather clever, like the blissful cool GEP kid in RI that still gets to be called gifted and yet not appearing to be a chao mugger. Now in April, Singapore is looking like the below-average Integrated Programme kid, struggling to complete his hefty homework load and have a decent CCA record as well. He is still an IP student, but if he mucks up anymore, there is a good chance the IP school will ask him to take the O levels. What happened? In three words – foreign worker dormitories This is going to be the Mother Of All Clusters (MOAC) in Singapore. As of today 11 April, the cluster comprises Mustafa, two construction sites and 6 dorms totalling 631 cases. There is another cluster of 5 cases at 31 Sungei Kadut which hasn’t been linked to the MOAC yet. About 20,000 foreign workers work in these affected dormitories. Nationally, it is estimated that there are 200,000 such workers living in foreign worker dormitories. Just to give you a recap of how fast things have deteriorated, about 2 months ago when this hobbit wrote Part 2: The “Perfect” Communicable Disease Outbreak on Valentine’s Day, we had a grand total of 67 cases in Singapore. Now we have 2108. (Gentle reminder: no more 4D betting during CB period). The first sub-clusters of the MOAC were declared on 25 March 20: Mustafa Centre and Toh Guan Weslite. The next cluster is the huge S11 sub-cluster which was declared on 28 March 20. Generally speaking, even with our excellent case detection and contact tracing capabilities, transmission probably took place about 10 days earlier. These cases picked up around 23 to 24 March (you need a day or two to wait for confirmatory testing results to be announced on 25 March) already included both the first and second generation of infected cases. Therefore, the original transmission from the MOAC index case to the immediate subsequent cases probably took place around mid-March, between 10 to 15 March. We started gazetting dormitories as isolation areas (which in effect is a total lockdown of these gazetted areas) about a week ago on 5 April. The period from 15 March to 5 April is about 3 weeks. How will this turn out? We can take some guidance from the biggest cluster of cases in neighbouring Malaysia: The Seri Petaling Tabligh Cluster. Unlike our MOAC, we do not have to guess when the original infections took place: the Tabligh event took place from 27 Feb to 1 March and was attended by some 16,000 people. On 18 March, some two and a half weeks after the event, Malaysia went into their version of a limited lockdown – the MCO (Movement Control Order). The New Straits Times reported on 4 April (2+ weeks after MCO) that the cluster had 1545 cases. On 10 April, the cluster had grown to 1701. The growth is slowing after instituting MCO for 3 weeks. So despite some serious intervention to have social distancing since 18 March, the cluster had grown to about 10% of the original size of the attendees. Of course, not all of the 1700 infected people had attended this event, it is just that their infections could be traced back to the people who had originally attended it In the Malaysian Seri Petaling Tabligh cluster, most attendees had left and went back to their homes which were all over Malaysia. They had effectively dispersed, which would contribute to the spread to more cases. However, Singapore’s MOAC did not disperse, but really, the spread took place in the cramped conditions of the dormitories where many amenities are shared, which also lead to more efficient disease spread. The disease transmission dynamics could be worse in a foreign worker dormitory than in the community, where living conditions are less congested. So it should not come as any surprise should the size of our MOAC well exceed 1000 eventually. Nonetheless, we need to ask some hard questions. The first foreign construction workers to be infected belong to what is known as the Seletar Aerospace Heights Construction Site cluster. This occurred around mid-February and involved 5 workers. This cluster has no proven link to the MOAC. But this would undoubted have alerted the authorities and the dormitory operators that there was a real possibility that transmission between foreign construction workers could occur. In large organisations, the management is usually required (sometimes mandated by law even) to perform a risk analysis. They have to identify key risks and have plans to manage away the risks. Sometimes these risks cannot be managed away, but management must then draw up mitigation plans and then implement these plans to mitigate or lessen the risk. This hobbit has no doubt that the relevant regulatory authorities and the dormitory operators are trained, hardworking and experienced; they would have identified that Covid-19 transmission among dormitory residents living in close proximity to one another is a clear and present possibility and would have instituted mitigation measures at least after mid-February when the Seletar Aerospace Heights cluster came to light. These mitigation measures in dormitory may include simple things like Temperature and symptom screening of residents Segregation of residents such that different groups have different meal times, bath times, recreation times etc Limitation of movement within and outside the dormitories, for example not letting residents of different floors or blocks mix and interact, or different times for different groups to go outside and buy things etc Construction site management is also a crucial element. Different workers from different dormitories could have been asked to work in different areas of the site to discourage mixing and interaction etc. This hobbit suspects most of the above were probably already implemented before mid-March by the dormitory operators and regulators. But yet we now have the MOAC. So it is quite baffling. If you think about it, both the SAF and MOE have conditions that may facilitate the formation of large clusters – the army barracks in SAF and the schools and hostels in our universities. Yet, they have largely escaped unscathed for now. What is it they have done right and the dormitories haven’t? This hobbit doesn’t have the answers here. Were the conditions in the dormitories so challenging that the mitigation plans eventually proved to be not as effective as hoped? Perhaps MOH can conduct an in-depth epidemiological study into the MOAC, and study the transmission dynamics of Covid-19 in these dormitories and compare the results with community spread. In the meantime, my heart goes out to the foreign construction workers, especially those in the affected dormitories in lockdown. (the rest of us are in CB mode, but these workers are literally under lockdown). We must give them adequate hope, support and care. We cannot let 20,000 young men lose hope. Because if 20,000 young men lose hope, then the rest of us on this small island will also probably be not far from being in deep trouble as well.   * The author is a medical professional who blogs at Hobbit.      Read More →