Inside Tan Tock Seng Hospital's Fight Against The COVID-19 Pandemic

[Music] more than 26 million infected around the world hundreds of thousands have died that's a world war type of scenario world war casualty figures the first case of covet 19 emerges in uhan china in november 2019. in january 2020 singapore confirms its first case of the novel coronavirus the fight against what will become a global pandemic is about to get tougher and last much longer than healthcare workers can even imagine overnight we saw three times more singaporeans coming to our screening center my twenty painted what just transformed into a forty baited wart we called it the most terrible monday because we saw 520 cases i didn't sleep that day how do i feel one word sums it up tired tantoxing hospital is one of singapore's largest multidisciplinary hospitals next door under the sea management is the national center for infectious diseases which officially opened its doors just four months before the biggest public health crisis in the recent history of the city-state over the course of eight months in 2020 both will screen a total of more than 35 000 people for covet 19 and award thousands of infected cases almost every single staff member will be pulled into the war on the virus and it starts like this on the 30th of december there was reports from china that there were clusters of atypical pneumonia happening in muhan and the cost of it is unknown that signals that there could be something unusual happening and it's something that we need to watch closely for dr angela chao heads the department of clinical epidemiology at ncid one of its tasks is to look out for data on infectious disease trends around the world so every day they were monitoring for diseases very closely and receiving influenza and it also tells you where the countries the areas where there are active transmission or even users three days after the news from china singapore begins to screen all inbound travelers from uhan although the cause of the outbreak there is still unclear ttsh and ncid go into full outbreak mode it was never in any point in time in doubt in our mind that it would spare singapore professor leo eason was at the forefront of singapore's fight against the severe acute respiratory syndrome outbreak in the early 2000s which claimed 33 lives two of them were her colleagues at ttsh a very painful experience taught us that our systems need to be ready in the sas aftermath the hospital developed a comprehensive outbreak playbook every staff is assigned a role to play in event of an outbreak and hospital-wide drills are conducted at least once a year planning is an essential part of our state of readiness it makes an outbreak a known unknown realistically speaking dr ang hao who joined the hospital shortly before the sars outbreak now leads its emergency department which is singapore's largest and busiest emergency department has a long established history of running screening for outbreaks during peacetime we already screened partners yellow fever monkey pop ebola plague lassa fever and now kovid 19 this is new working closely with dr ang is dr charmaine manawas who develops the instructions for healthcare staff to screen patients there was a particular period where we had to screen for certain provinces in china so of course everyone isn't versed on where the provinces are so that's why they put the map here once we pick up a travel to these certain countries than they are triage to the fever area four days after screening begins ncid opens its first outbreak award to isolate suspect patients margaret soon is its nursing director with almost 30 years of experience the initial cases definitely is with a lot of anxiety because we know very little we also could tell the staff very little it's a tense period on january 8 chinese officials identify a new coronavirus that's related to sars and mers as the cause of the epidemic a day later its genome is made public scientists in singapore begin their race to develop a test kit among them is a team comprising staff from ttsh and the agency for science technology and research so when the first case arrived we could use our own in-house detection kits to be able to make the diagnosis in china the virus has spread from wuhan to other parts of the hubei province people begin to die from the infection and medical workers are contracting the disease in the line of duty in singapore ttsh isn't taking chances with the safety of its staff its infection control team ensures that everyone from doctors to cleaners is properly trained and equipped to protect themselves [Music] these strict protocols have been meticulously developed over the years by dr brenda aung another sars veteran the role of infection control to limit the spread between patients and also to try and prevent transmission to healthcare workers even contractors are mask fitted [Music] over the rest of january cases emerge elsewhere around asia on january 23rd the same day the chinese government put cities in hupei under lockdown singapore confirms its first case a 66 year old chinese national from uhan who is awarded at the singapore general hospital the day after case number two is confirmed this time at ncid it was actually a tourist from ohan so of course she couldn't quite remember where she's been what she's done finding out where she'd been and who she'd met is the job of dr chao's team in the weeks to come the role of thorough contact tracing will become even more apparent as more is learned about when and how infected persons transmit the virus from the point when they are symptomatic we look back one incubation period so 14 days the history can go back like two three weeks a lot of time to slowly joke their memories to recall where did you go with your daughter you know here i think who have rather active social life that is definitely good it's just it's a bit more challenging when you're trying to do the contact racing um to know exactly where are the places that you went to and what times you went as more close contacts of infected patients are identified the screening load at the emergency department increases ttsh decides to activate the dedicated infectious disease screening center ncid it was a very busy chinese new year for a lot of people not because we were going around celebrating furniture had to be moved in computers had to be set up we actually managed to cut two days off the activation time more nurses are also needed to triage and swap patients we have to draw nurses from various areas including nurses from operating theaters the clinics our nurse educators some of them volunteered actually the whole kang phong is involved so this is my night shift let's go and have a look a nurse at the cardiology department is one of the volunteers we practice and we do the swap on each other i tell you you won't think about do it again so far all confirmed cases here have been travellers from china singapore will restrict entry to all new travelers who've been to mainland china in the last 14 days regardless of nationality but on february 4th the inevitable happens a cluster of infections emerges from a chinese medical hall serving tourists from china the four cases signal the start of communities spread in singapore it also sparks a change in the definition of a suspect case to anyone with recent close contact with travelers from china taxi drivers tour bus drivers people who worked in tourist attractions or hotels and airports casinos they were all flooding in today it was three times more than what we saw the day before the task of making sure they stay ahead of this massive search and demand falls to this place [Music] welcome to the command center of tandoxing hospital this is where we have visibility of the entire operations industry hospital and the national center for infectious diseases this military-inspired command and control center is the first of its kind in a local healthcare facility it's overseen by dr jamie lim the hospital's chief operating officer the screen gives us visibility of the supplies that we have at the screening center how many patients do we have at that point in time we use colors to depict status when it crosses a certain threshold it either turns yellow amber and then the next threshold will be great we don't want to be reactive but we want to be ahead of the signs and sickness on that pivotal night of february 4th c3 system triggered an alarm in a span of 24 hours we open up an additional five words we had to open 100 bids within a day that was really stressful there's just a lot of coordination to making sure that the medications are there lyndon is there but when the bits fill up quickly with suspect cases who present as clinically well the team proposes a new strategy [Music] ncid clinical director sean vasu keeps the health ministry updated regularly we proposed to the ministry a swap and send home strategy where patients who do not in hospital care would receive that diagnostic test an adequate amount of medical leave to go home and self-isolate to the results come out within the next 8-24 hours at home these patients are closely monitored by the surveillance team to see if they develop symptoms those who test positive are brought in straight away by ambulance for admission to ncid we have also trained up our data analysts our biostatisticians pathologists our psychologists they were helping us with phone surveillance soon as the patient load increases as many as 50 staff are roped in to call more than 500 people a day as part of surveillance and contact tracing efforts another team working round the clock in the background is the department of laboratory medicine led by dr patha day we very quickly had to go to 24 7 operation from normal office hours right now i'm labeling the samples that we will be extracting for the next round of extraction they are another crucial link in the chain racing to provide timely confirmation of whether a suspected case has been infected or not even a negative result enables the doctors and nurses to discharge patients and free up beds for the new incoming suspect and confirmed cases almost every half an hour there will be samples coming in my busiest night throughout the night from 8 30 to the next morning 8 30 i didn't even have time to rest it was continuous running of samples [Music] the team uses the test kit developed by scientists from ttsh and a star made available to hospitals on february 6th and it comes none too soon [Music] the next day singapore raises its disease outbreak response system condition to orange alert level the disease spreads easily among people but is contained and not widespread visitors to hospitals will now have to fill in declaration forms and have the temperature taken staff are redeployed here from other departments to make this possible and as a safety measure the hospital cuts down on elective surgeries and closes some clinics i came from a acupuncture clinic a business office health department some staff like dietetic technician collis yap now work twelve hour shifts instead of normal working hours at fps is very draining my family members always remind me why i do this and why is it important thank you very much for coming on a saturday other medical staff are directed to support the screening center and outbreak warts obviously we needed more manpower the whole hospital had to cut down and leave and off days in fact i was planning for my honeymoon but i got cancelled and i came back to ncid to care for my patients but on social media accounts are shared of ambulance drivers and nurses being shunned on public transport and in public areas this paranoia however triggers the unexpected an overwhelming flood of love and encouragement for healthcare workers so we've received a lot of stuff from kids and from the public so this one is from little footprints preschool um look they have the babies uh these are the babies footprints and then the older kids wrote us letters so it's very heartwarming [Music] patients too express their gratitude mrs jung spent most of her 18 days in ncid under intensive care [Music] oh [Music] meanwhile the virus continues to spread in the community and new clusters emerge but the infection rate remains low compared to countries like italy and to some it looks like life could soon return to normal in singapore i suppose to the public that may seem like a loud period but that that silence was very worrying for us [Music] countries other than china go into lockdown and who declares covet 19 a pandemic [Music] we knew that it was a matter of time before we see the second wave we didn't know how big the second wave was going to be so we made a decision with the ministry to set up a tentach just outside the screening center if ever there is an overflow of patients coming in for screening the lab is also trying to ramp up its capacity from 500 to 800 tests a day with more staff and equipment but its efforts are hampered by a global shortage of reagents on march 21st singapore reports its first covet 19 deaths the icu team is no stranger to dealing with mortality but handling death from covet 19 is different what usa is outside the ico world what we see is the reality and the sickle cell patient unfortunately we do lost patients despite every effort we put they still pass on that was very very difficult for the families because none of them could come and see and you had to tell them over the phone what was happening and that your father or mother brother sister was was likely going to die you can imagine this is my love once i would actually want to hold their hand to see a proper go by we do have a relative actually funded during the video call we just feel a bit helpless yeah but we try our best to do what we can to help the patient and the family everybody does that yeah in the icu well spain is now emerging as a new hotspot for covet 19. by march 22nd the death toll worldwide from covet 19 is more than 11 000 and in singapore infection numbers have crept back up mainly from imported cases for the first time ever singapore closes its borders to tourists and short-term visitors the next day dr jamie lim's fears come true we called it the most terrible monday because we saw 520 cases we actually had to open tentach until 3 a.m at night with a lot of patients having to wait a little bit longer so that was a struggle i i didn't sleep that day this search in cases is due mainly to students and travelers returning home from countries going into lockdown what's it why suddenly so many patrons yeah then oh yeah we just chong mao we are 80 people if there's a job to do then we just do it ncid immediately enacts its plan to expand the number of bits in the outbreak wards so let's move to 5f okay we will go down to level 2 the capacity here at baseline is 330 bits we can expand the capacity to 586. the rooms in this building are designed in such a way that we can double stack or in some rooms triple stack but many of the bits are also being taken up by infected patients who are recovering well and in the clinical team's view can be cared for outside the hospital setting at the national level the decision is made [Music] there was a turning point in outbreak in terms of our isolation strategy this is where clinical data informs policy we knew that clinical presentation certain demographics about the patient their age and their medical history which means that we can now have younger coveted 19 cases being taken care of in the isolation facilities and most of them would recover without significant complications over a month three more community isolation facilities are set up all these are all like kind of draw plans already increase flexible it may not be already in your drawer plan but you must have a system where it is flexible enough so that it becomes situation based and we can still respond effectively on march 29th a porter who transports patients in ncid is confirmed to have contracted covet 19. an outbreak within its walls would be any hospital's nightmare it happened to ttsh during sars when some 100 staff visitors and patients were infected following exposure to the virus in its warts but this time nearly 20 years later the hospital came prepared to the fight and despite the more infectious nature of covet 19 the stringent measures from personal protection protocols to staff surveillance have prevented disease transmission so far now i can do it again everyone who enters into ncrd wears this tech all patients and staff within ncid wear a real-time tracking device which allows the staff surveillance team to quickly trace people who are in contact with the porter you can just open up all of them so you can actually see all of them have been in contact with every other people it provides granular level of visibility of where each patient is and where each staff is so this is the floor plan it shows this portal's movement history on this date the information helps ncid to identify staff at risk of contracting the virus and to quarantine them to stem a potential hospital cluster you could say this is big brother watching you but just say there's a friendly father hospital observing people again for staff a lot of safety happens as of september 13th 10 staff from ttsh and ncid have contracted covet 19 but none in the course of their work but elsewhere in singapore a time bomb is about to go off the coronavirus has been quietly spreading among migrant workers this was the dormitory with the bangladeshi workers dayden before he tested positive for the virus meanwhile though nowhere at the levels of countries like the us or italy the number of unlinked community cases has crept up on april 3rd prime minister lee sien long announces that singapore will go into circuit breaker mode closing schools and many workplaces we all have to take social distancing extremely seriously in this period because this is the only effective way to slow the transmission of the virus we do not want to wait for a situation where the cases rise sharply and then we get overwhelmed the streets of singapore have never been quieter but the scene at ttsh is very different [Music] each day up to 300 migrant workers come here to be screened the basic difference is that the migrant workers are unable to self-isolate because they live in a dorm we will have to hold them until the swab results are out if the patient is negative then they have to be transferred to a clean dorm if the swab results are positive then they may be admitted or they may be transferred to isolation facility on april 20th singapore sees 1400 new cases of covet 19 the highest numbers so far in a single day the majority of them are migrant workers i remember coming to work and overnight my twenty painted what just transformed into a forty baited what because we have to increase our capacity just to cope with this increase of infection cases it was then that we saw some of the most sick patients it was a emotional period for me personally because the patients that we see are usually fit young construction workers they had to be hospitalized for quite some time [Music] only i think about my family plus how to say my life i can i can continue my life i also very very my inside very question mark really daily new cases of covet 19 remain high throughout april and ncid warts are almost fully occupied again triggering its plan to expand into ttsh my name is nadia i'm an assistantness creation here in sandboxing and i'm a nurse working in the kobit award this is the first time when we have both covet patients and business as usual patients in the same building the first thing that we have to do is to make sure that the pathways are segregated that includes mapping of the rules and locking down the leaf or the kobe pathway so these are the two areas that is actually designated to nurse our kovid patients so let's go six general awards there are converted into outbreak wards one what is actually allocated to be the clean area the first shift is like you go in right it's not even five minutes you are like wet everywhere and then you feel like so stuffy and then you have this like fainting spells like you cannot breathe so well every cubicle there will be three big exhaust fans this actually to create negative pressure because the cubicle doesn't have an extra glass doors or an extra room finally after eight weeks of circuit breaker the rate of infection starts to slow with the reduced covet 19 patient load the additional outbreak warts at ttsh are no longer needed but for one department there is no easing up in fact our workload on microbiology for pcr has gone up a lot more it's doubled to cope the department hires additional staff and acquires new equipment that simplifies the testing process there's people who need to be cleared to go back to work like school teachers goods delivery drivers essential goods like groceries and so on the emphasis has shifted to screening which is a good thing which is part of reopening covid19 will eventually become the new normal respiratory virus that we will test for every year just as swine flu h1n1 on july 14th the lab makes a mistake a confirmed case of covet 19 has been found to be wrongly diagnosed due to a mix-up of test samples at the tantoxin hospital's laboratory to ensure that a mistake like this doesn't happen again the lab has automated its patient registration process i've got a thousand specimens to process even if we tell them take your time do they know there are patients waiting at the end of this and they want to do their best so we've had to try and manage all of that the psychological as well as the physical demands while the hospital still isn't going back to 100 business as usual it has managed to resume some elective surgeries and open certain clinics other inpatient warts have also continued to run all this while compared to sars when ttsh was designated the central treatment hospital enclosed to all non-sars patients in an outbreak people still come in with a heart attack people still break their leg and they need treatment emergency surgeries will still carry on we run essentially two hospitals tantoxin as the business as usual and ncid as the outbreak center with the same team of doctors nurses and administrators can you just page for me if there is any problem i will be in the office okay um nipping did not really reduce the illness patient ratio either at bau side and also at ncid side we deliberate plan for the ratio to be at one is to four especially because we think that adequate stuffing is important for both patient and staff safety but the months-long fight has taken a mental and emotional toll on staff and the war with covet 19 is a long way from over there's one day my husband actually come back from work having high fever i'm not scared for myself i really scared for my love once and what i don't want is because of me he got covered there is actually something really made me emotional at that period i realized that running the screening center takes a lot of effort and each of the different family groups contribute so much um [Music] yeah it's been tiring this one sorry [Music] everybody has been pulling together responding to this terrible pandemic you do a fantastic job not just during the pandemic you do a fantastic job all day every day i'm tremendously proud of my colleagues they are marvellous they are kind-hearted and you know they they really give the best in their care i think so far singapore has coped reasonably well and that again is the work of the entire healthcare system the ability to respond to the challenge however i think we shouldn't be complacent because i think the road ahead is still long and windy you

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Length: 32min 34sec (1954 seconds)

Published: Sun Sep 13 2020