Saturday, 18 July 2020

COVID-19: Rise in infections at foreign workers dormitories due to final stretch of testing, says Lawrence Wong

All foreign workers in dorms could be tested for COVID-19 before mid-August: Lawrence Wong
Positive cases among workers can be expected even after dorms cleared
By Lim Min Zhang, The Straits Times, 18 Jul 2020

As Singapore heads into the final stretch of testing and clearing all migrant workers in dormitories of the coronavirus by the middle of next month, the number of daily infections among this group can be expected to rise, Minister for National Development Lawrence Wong said yesterday.

Even after all of the workers are cleared of the virus, Mr Wong, who is co-chair of a multi-ministry task force tackling the outbreak, cautioned that positive cases can still be expected, and regular testing will need to be done.

This is similar to the case for work permit holders in the community, such as those living in private residences or Housing Board flats, where positive cases have continued to be picked up, despite some of them serving a 28-day isolation period.

He was responding to a question during a virtual press conference on why there have consistently been positive cases among work pass holders in the community.

As of Thursday, around 232,000 workers have either recovered or been tested to be free of the virus. There are about 323,000 workers staying in dorms in Singapore.

About 94 per cent of the 47,453 confirmed coronavirus cases in Singapore as of yesterday, 17 July, are dorm residents.

Mr Wong said that for the final phase of testing, many of the workers come from dorms with higher prevalence of coronavirus cases. This is why there has been an increase in confirmed cases from dorms in recent days.

"We expect this trend to continue over the coming days. But the main point is we are completing the clearance of all the workers in the dormitories quite soon," he said, adding that this could be done by the middle of August or possibly earlier.

"So, we are doing everything we can to complete that work and to allow the workers to resume work safely thereafter."

He added that even after all of them are cleared, periodic, routine testing will have to be done every fortnight.

"And I would not be surprised at all that we will still pick up positive cases, and many of them may well be older infections, but it may very well happen - just as we are seeing this for workers in the community. I think the same situation will arise later on for workers in the dorms."

For workers in the community, because they are coming from a "high viral load environment" in their dorms or work sites, there is still a chance of them being infected even after serving an isolation period, said Mr Wong.

"When we find positive cases, we have to pull them aside. We do serology tests for some of them and we find that... many of them are older infections. And that is in a way looking at the tail end of coming off a very high viral load situation."

Health Minister Gan Kim Yong, who is co-chair of the multi-ministry task force, agreed that it is not going to be the case that there will be no more infections after all the workers in the dorms are tested and cleared.

This is because there will still be transmission in the community, which is happening even today in the local population. This is why cases of acute respiratory infections are being picked up. "The numbers are small, but they are ongoing," he said.

"And therefore there will always be risk that you will trigger another series of infections, going forward. So, even after clearing all the migrant workers and the dorms, you will still be picking up cases from time to time," said Mr Gan, adding that these may be old or new infections.

He called for vigilance even after all the workers are cleared of infection until there is an effective vaccine and the virus can be wiped out.

"Before that comes about, I think we have to learn to live with the virus in the community, and do what we can to reduce the number of infections, to slow down the transmission, so that we are able to contain and control the situation."

Mr Wong added that clearing all the workers of infections in dorms would be an important milestone.

"After the clusters in the dorms flared up, we have had to manage, contain and control the flare up, but now we are reaching the final stretch and are able to very soon complete the clearance... and eventually have these workers back at work."

Why dorms with lower COVID-19 prevalence were cleared first
By Lim Min Zhang, The Straits Times, 18 Jul 2020

Although migrant worker dormitories with a lower prevalence of COVID-19 were cleared first, this does not mean that those in dorms with more cases were not taken care of, the Health Ministry's director of medical services Kenneth Mak said yesterday.

"There is a difference between testing for clearing the dorm versus testing to make sure that all people who have infections are properly looked after and treated," he said during a virtual press conference yesterday.

Those who had acute respiratory infections or were at higher risk of being infected, such as older workers, were properly looked after, with measures including pulling them out of dorms, added Associate Professor Mak.

He was responding to a question on whether the strategy to clear dorms with fewer cases first had put more workers at risk.

About 94 per cent of the 47,453 confirmed COVID-19 cases in Singapore as of yesterday are dorm residents.

Prof Mak said it was easier to clear dorms with a lower prevalence of the virus first, and that this was part of the inter-agency task force's clearing strategy. "However, now that we have cleared quite a number of the migrant workers living in these dormitories, we are coming to the dormitories with higher prevalence, and they take a little bit longer to clear," he said.

In response to why the clearance process is taking so long, Minister for National Development Lawrence Wong said efforts to clear the dorms constitute a "massive undertaking".

Some workers had to be moved out of the dorms and others kept within because they were not cleared of the virus yet, he said.

Mr Wong added that testing workers in dorms is not a straightforward process. If everyone tests negative in a block, then the entire block can be cleared, but "this has not happened", he said.

"Neither has it been the case that everyone tests positive because the safe distancing measures do help to slow down the spread of the virus. But that also means that every time you go into a block, you end up with a certain percentage that are positive, a certain percentage who test negative."

"To deal with that, you have to restart sometimes the process of isolating the workers, another 14 days of isolation, and then it repeats block after block after block across multiple dormitories, across 300,000 workers," he said.

"It is quite a massive undertaking and to be able to complete this very soon, I think it is credit to the hard work of everyone who has been serving on the front line. We would not have been able to do it without all their sacrifices."

Health Minister Gan Kim Yong also said that even if a worker has tested negative, he would still have to be observed for the next 14 days. The worker would have to be tested again because he might be asymptomatic.

"And if it turns out positive, then you have to go backwards, trace back again to see when was he infected, whether there were other close contacts that you need to ring-fence, you need to quarantine. So, it is quite a protracted process," said Mr Gan, adding that a combination of isolation, serology and polymerase chain reaction tests is used to effectively clear everyone.

At the same time, the dorms need to have no infections so workers do not get reinfected when they return, he said.

"So, I think it is important for us to understand that actually it is a systematic way and quite an extensive process that we need to go through to ensure that all 300,000 workers are cleared of this infection and are able to return to work," said Mr Gan.

Close watch on symptomatic unlinked cases in community
By Clara Chong, The Straits Times, 18 Jul 2020

Since the lifting of the circuit breaker on June 2, the number of community cases has increased, although they continue to remain low with about an average of 12 per day in the past week, Health Minister Gan Kim Yong said during a virtual press conference yesterday.

But it is still not the time to celebrate and be complacent as the country is definitely not out of the woods yet, he said.

Around half of the community cases over the last two weeks were linked, and most were detected as a result of contact tracing or proactive screening.

The majority of the unlinked cases, or seven in 10 of them, were asymptomatic at the time they were tested, and almost half were likely to be past infections as they tested positive during serology tests, Mr Gan said.

Those who are asymptomatic remain completely so throughout the entire course of illness, while pre-symptomatic individuals are asymptomatic at the time of testing, and manifest some symptoms only a day or two later.

Asymptomatic cases are generally picked up during proactive screening, such as when the COVID-19 task force conducts regular screening of front-line workers. Some might be picked up incidentally, such as when the patient is suspicious and decides to get tested.

A large proportion of the unlinked community cases was classified as such because the task force was unable to identify the specific individual or cluster that passed the infection to them, but the cases appeared to be linked broadly to the construction and related sectors, said Mr Gan.

"We are keeping an especially close watch on the symptomatic unlinked cases that are detected in the community through our routine screening," he said.

The task force has also significantly scaled up testing of those with acute respiratory infection (ARI) symptoms at first presentation to the doctor, and is now testing around 2,400 ARI cases a day on average.

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