Contextual background:

Dorm coronavirus cases: ‘Novel’ strategy in isolating those most at risk — this was the headline of an article in the Straits Times, 24 July 2020 (see footnote 1 for link)  in which was explained that Singapore’s focus was on preventing deaths, rather than transmission. Such a strategy in taking care of the migrant workers was “very novel”, said Dale Fisher, an infectious diseases consultant at National University Hospital.

Singapore had no capacity to isolate all the migrant workers as was done for the community cases, the newspaper further explained. Reading between the lines, the government’s policy becomes apparent. Sick migrant workers are left to fate, even if it means infecting other workers, unless they are at risk of death. Then only will there be intervention.

As Singapore deals with Covid-19 infections, we may pat ourselves on our backs for how well we have kept community infection rates low and how safe we have made it for the general community. Dale Fisher, senior infectious disease consultant, has said, “The (low mortality) is absolutely staggering. The rest of the world is going, ‘How did you do that?’” (see footnote 1 for link).

However, this accolade has come at a cost, paid heavily and painfully by a marginalised community — the low-wage migrant workers who have been confined to their dormitories for months, and who now, even if their dorm has been declared cleared of the virus, continue to endure severe restrictions on their freedom of movement (footnote 2).

According to Fisher, the “very novel” strategy focused on preventing deaths — rather than transmission — helped keep mortality low despite the high living density in the migrant worker dorms (more than 300,000 low-wage migrant workers are housed in dormitories).

This strategy meant that isolating workers who had tested positive was not necessarily a priority; instead, isolation was for those most at risk.

Workers who tested positive and who would be infectious may have continued to stay in the same room as workers who may not have the disease. This is borne out in the recent joint statement by the Ministry of Health (MOH) and Ministry of Manpower (MOM), when it came to light that three weeks after his test, a worker was informed that he had tested positive. In that time and even after he had been so informed, he remained housed in the same room with eleven others. The MOM-MOH statement in apology (see footnote 3) says

However, there was no impact on the “appropriateness of the clearance strategy” for Toh Guan Dormitory — where the worker was staying with 11 roommates — or the treatment and care of all the workers there, the ministries said in a joint statement on Sunday (July 19).

Leaving aside the issue of “appropriateness” of the clearance strategy, we are concerned about implementation, and in particular, the consideration given to workers confined in the dorms who may have needed medical attention not related to Covid-19.

The following three examples represent the kind of issues many other workers may have faced. Names have been changed.

Bobby suffered a back injury in June 2019. He was waiting for a re-assessment for his work injury claim when his dorm was gazetted as an isolation area, meaning that he was confined to his dorm room. In severe pain — he was also sleeping on a plank as his bed bug-infested mattress had to be thrown away — he needed to make several hospital visits and was required to undergo a swab test before each hospital visit. To avoid repeated swab tests, TWC2 wrote to MOM offering to help house him if his employer was unable to provide alternative housing. But MOM’s response was to get the employer to send Bobby a new mattress; no reference was made to our offer of accommodation. Bobby continues to be housed in the same dorm. Bobby himself sent a request to his MOM officer for a change of accommodation, stating he had several medical appointments. He was told there was “no option”.

To date, Bobby has undergone six swab tests. Thankfully, five of them have been negative with one false positive. He has missed three medical appointments so far, for fear of yet another test before the appointment. He says, “I don’t want to die of covid testing”.

Could Bobby not have been housed in cleared accommodation so that he need not endure repeat testing for each hospital visit? Is this indeed how the “clearance strategy” works — sending a worker who has tested negative back to stay in a dorm designated an isolation area each time, where he may be exposed to the infection? Clearly if he needs to be swabbed before each hospital visit, there is such a concern. Besides the pain and anxiety suffered by Bobby, is this a sensible use of resources?

Kumar suffered a work-related injury to his hand before the Covid-19 outbreak. He stays in a dorm which was “cleared” in late July. Due to the earlier “lockdown” in his dorm which was gazetted an isolation area on April 9, he has missed medical appointments and had been told to reschedule his appointments when his dorm is cleared. Hopefully, now that his dorm has been declared clear of the virus, he will be able to make that appointment. However he is not too hopeful that it will be any time soon as he has been told appointments will only be possible after August; and even then he will need to depend on his employer to take him to the appointment and bring him back to the dorm.

Raja has diabetes. He depended on medication from his home country, but his supply was disrupted by the pandemic. Getting the medicine here would have been prohibitively costly. An added challenge in this period would have been asking his employer to take him to and from the clinic.

Most workers try their very best to manage chronic conditions on their own as they feel it would jeopardise their jobs to reveal such problems to their employers.

Months without medication, he now has clear symptoms of badly controlled diabetes. When he could not ignore these symptoms, he went to a clinic in June, but lack of money meant he could only afford a 10-day supply of medication. Blood test results showed that his condition was worsening. The challenges faced by Raja and others like him with chronic ailments are reflected almost point for point in a letter from Dr Umapathi Thirugnanam and Ashwin Umapathi in Today newspaper, 24 July 2020 (see footnote 4).

Like Bobby, Kumar and Raja, many workers are denied or hampered in accessing medical attention because they are caught in circumstances over which they have no control. In our choice of strategies and measures to control and manage Covid-19 we have allowed this group of workers to fall between the cracks. The prevailing conditions – high living density and lack of capacity to house workers — may well have made extreme confinement in-situ the practical strategy.

A choice was made to treat and manage the infection differently with workers in dorms as compared to the rest of the community.

In making this choice — and praising ourselves for it — we have ignored bad outcomes that can result from being infected by the virus. There are other possibly lifelong health consequences that can come from being infected. even when people don’t die, but recover from Covid-19. There have been several reports rasing concerns about chronic fatigue, heart damage and other lasting effects (see links in footnotes 5 and 6).

Even in the present, this choice means that workers in dorms have had to endure a prolonged period of movement-restriction, often confined to their rooms and floor level in the building where their rooms are located. In some cases, the men have been confined for four months, way more than the 14-day Stay Home Notice or quarantine period that the rest of the community had to comply with.

We seem unconcerned that their well-being, mental health and other medical issues are being left to chance or to be sorted out once the Covid-19 crisis is over. Even when NGOs are prepared to step in, as in Bobby’s case, there are obstacles.

It cannot be inconceivable to policy-makers that dorm residents may have had a work injury or chronic health conditions that would need medical attention and management during this Covid-19 period. As unwitting participants in this novel strategy, their healthcare needs should have been an integral part of the plan.

This pandemic has highlighted a serious gap in the way we think about migrant workers. They are more than economic digits; they are human beings and part of our community. If Covid-19 has taught us anything, it is that we are all in this together — the virus does not differentiate.

A comprehensive healthcare policy must consider all people on the island of Singapore. The migrant worker must be a significant part of any pandemic scenario planning. And most importantly, the migrant worker’s inherent vulnerability and disempowered position has to be an integral consideration in such a plan.

1. Straits Times, 24 July 2020, Dorm coronavirus cases: ‘Novel’ strategy in isolating those most at risk. https://www.straitstimes.com/singapore/dorm-cases-novel-strategy-in-isolating-those-most-at-risk (paywall).

2. See our article Post-Covid law makes migrant workers prisoners of employers http://twc2.org.sg/2020/06/29/post-covid-law-makes-migrant-workers-prisoners-of-employers/

3. Straits Times, 20 July 2020, Ministries sorry for delay in telling worker about positive test result. https://www.straitstimes.com/singapore/courts-crime/moh-and-mom-apologise-for-delay-in-informing-worker-that-he-had-tested (paywall)

4. Today, 24 July 2020, Under-managed chronic conditions a worrying problem among migrant workers. https://www.todayonline.com/voices/under-managed-chronic-conditions-worrying-problem-among-migrant-workers

5. Sciencemag.org (American Association for the Advancement of Science), 31 July 2020, From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists. https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists

6. Statenews.com, 27 July 2020, Covid-19 infections leave an impact on the heart, raising concerns about lasting damage https://www.statnews.com/2020/07/27/covid19-concerns-about-lasting-heart-damage/