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Ho Ching explains our 4 levels of medical support and calls the “ex-nurse’s” bluff, twice

By May 19, 2020Current

TL;DR – She also explains the difference between CEC and Expo, and tells us recovered migrant workers can be such valuable resource.

Since Singaporeans are spending so much time following COVID-19-related news so ardently, surely you must have watched that widely-shared video of migrant workers behaving “rowdily” by now. And yes, also read that much-forwarded message from the ex-nurse.

The care facility manager, Mandarin Oriental, had also clarified that the video was taken over a week ago. They’d explained that queues at the facility were orderly except for that small section of 300 patients. The facility houses over 2,600 patients. According to Mandarin Oriental, the situation has improved as they have worked out measures to ensure orderliness, including staggering the meal collection timing.

If you have been hibernating for the past 24 hours, here, we wrote about it too yesterday. Go catch up.

Mdm Ho Ching also shared our post.

And she shared it along with a long commentary of her own.

There’re lots of useful information in Mdm Ho’s commentary and it sheds light on some things:

  • Explained differences in sleeping arrangements between Changi Exhibition Centre (CEC) and Expo
  • Called the so-called ex-nurse’s bluff by explaining how different COVID-19 patients receive different levels of care
  • Questioned authenticity of the ex-nurse’s claim that she’s not paid for her work
  • Explained differences between Community Care Facility (CCF) and CRF (Community Recovery Facility)
  • Taught us about the four levels of medical support
  • Shared how recovered migrant workers can be a valuable resource who can help do many things
  • Reminded everyone that “After all, at heart, we are all human beings.”

Here’s her post in full with a little “intervention” from us.

Other than formatting to make it easier to read and stick, we’ve also included useful links in case you want to find out further about whichever points. Note that the headers and emphasis are all ours.

Source: Ho Ching’s Facebook, 19 May 2020

Differences in rooming arrangements in CEC and Expo

Firstly, the patients at Changi Exhibition Centre (CEC) don’t have individual rooms in which they must be confined to stay – this is bcos they are all covided patients, and can freely mix with each other.

At the Expo, the patients share 2 beds to a cubicle, except in 2 halls that were prepared earlier. However, the patients are not confined to their rooms, and can mingle freely among themselves.

So this issue about migrant worker patients being unhygienic by mixing around is just rubbish.

And if this is supposedly an observation by an ex-nurse, that “nurse” has a lot to learn, to put it politely.

Claim that migrant workers at CEC have pre-existing illnesses is false

Second, if the “nurse” claims that these migrant workers all have diabetes, etc, then he or she is either ignorant or throwing smoke.

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The CCFs are for younger patients who are healthy without underlying conditions.

Patients who are older, or who have underlying conditions, are sent to the hospitals.

This is bcos patients who have underlying conditions such as diabetes, obesity, heart, or other problems, have a higher risk of complications and the risk of degenerating into a severe illness.

Many young patients have mild illness from covid, regardless of whether they are millennials or migrant workers, regardless of whether they speak English, Hokkien, French or Bengali, regardless of whether they brush teeth or not.

Scientists and clinicians have not yet figured out why children or younger ppl seem to be getting off with the vast majority having a mild illness from which they recover over 2~3 weeks.

The risks of severe illness and death are clearly link with age plus underlying illnesses.

So the patients at CCFs are all young and healthy.

Even then, there could be a handful of healthy young people, whose illness may take a turn for the worse. They may need oxygen support. Such patients would immediately be sent to hospitals.

So if there is really an ex-nurse grumbling that the changi exhibition centre, or CEC, is full of migrant workers in poor health, then this must be a very ignorant “nurse” who knows or knew very little of his or her patients.

Ex-nurses recalled to help with COVID-19 are paid

Finally, an ex-nurse who was recalled to help and not getting paid? Really?

Really, really, really?

If so, i think that this poor “ex-nurse” if he or she exists, would have every right to go complain to their supervisor, employer, or MOM, don’t you think?

Patients typically stay for about 2 weeks in the CCFs

Oh, just to share that for patients with mild or no symptoms, esp healthy young adults, recovery is about 2 weeks from first symptoms.

The dangerous period for these young healthy patients with no underlying conditions seems to around 7-11 days, when the illness may take a sudden turn for the worse. So young patients elsewhere do die from covid complications.

One international observer was puzzled why Sg doesn’t seem to have a lot more critical cases. One theory is that the bulk of our patients are young and have lower risk of serious illness or death from covid.

So for our patients in our CCFs, they would stay for about 2 weeks, if they continue to show mild symptoms and do not need oxygen support.

Thereafter, they will be decanted to a Community Recovery Facility (CRF).

Medical support tiered at 4 levels: CRF, CCF, Hospitals, ICU

And the difference between a CCF and CRF?

We can think of our medical support at 4 levels.

The critical ones go into ICU, where they could be needing intubation or even ecmo to help them get enough oxygen while their bodies are fighting the virus. Or if they have other underlying conditions, then a whole plethora of specialists can be called in to deal with the specifics of each case.

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The deaths are mostly older folks, esp those with underlying conditions.

Then we have the ones who are moderate or severe, who need oxygen support, usually in the form of oxygen supplement. They may be asked to lie prone, on their stomach, to help their lungs oxygenate better.

These will also be supported in hospitals.

Then we have the mild ones – where they may have some fever which goes off and on, where their appetite is poor, and whom the nursing and medical staff would need to remind and ensure that they have adequate hydration plus food.

So those mild young ones are in the CCFs, while older ones are in hospitals.

So there is a medical team to look after these young healthy mild patients at the CCFs, who can decide to evacuate them to the hospitals if there are signs of breathlessness or other complications.

Others will continue to recover, and one sign of recovery is the return of the appetite. Suddenly, the patient may feel hungry, whether during the day, or at 3am in the morning!

After 2 weeks in a CCF, the patients are ready to be transferred to a CRF.

Here, the patients are past the danger zone – the likelihood of turning seriously ill is low, and they are for all intents and purposes, recovered.

When it comes to saving lives, not only are we stubborn, we’re kiasu too

We just want to be kiasu (read: extra careful) to monitor them for another week to be doubly sure.

We have heard of patients in other countries where they have been discharged and suddenly find themselves turning dangerously ill with an overreactive immune response from their own immune system.

So it’s good to be cautious, until we gather more data of our own.

So the medical support at CRF is a step down from the CCF level of medical depth.

And after one week at the CRF, the patient could be sent back to a dorm or to a temporary dorm.

Recovered migrant workers as a valuable resource

But think of this.

If we have recovered migrant workers, they are a valuable resource who can help do many things.

If we can test and confirm that they have the neutralising antibodies, then it means they have immunity, and thus can help undertake various tasks and jobs in the red zones.

Of course, we will need to provide the requisite training. And we should also get the permissions from MOM, their employers and the worker themselves.

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These can be a very very impactful wat to scale our covid healthcorp capacity, as more and more of our migrant workers recover. These jobs can range from swabbing other migrant workers, to helping to deep clean the dorms, etc.

With that, it becomes a form of self help, a gotong royong, not just among Singaporeans and non dorm residents, but also among our migrant workers.

After all, at heart, we are all human beings.


 

It is clear to see that the Government is serious about saving lives.

And to borrow Mdm Ho’s words, the Government is serious about saving everyone’s lives, “regardless of whether they are millennials or migrant workers, regardless of whether they speak English, Hokkien, French or Bengali, regardless of whether they brush teeth or not”.

Personally, I feel really safe here in Singapore during this coronavirus outbreak. I think the Government has done a good job allocating resources such that our healthcare system is not overwhelmed.

Cabin crew from Singapore Airlines, SilkAir and FlyScoot began their journey at TTSH as Care Ambassadors (via TTSH)

Just consider how they have structured the whole tiered care programme to deal with the pandemic. This frees up the hospitals and medical resources to focus on delivering treatment to patients who need it. No one need to fear dying from lack of medical help or attention here.

The way also utilises facilities that are otherwise left idle during this economic slowdown, and recruits Singaporeans to work on temporary assignments which can help them cope with financial challenges during this difficult time. All these could keeping some businesses and people alive as many commercial activities come to a near total standstill.

This is not the case in some other countries.

But it cannot just be the Government, you know.

In this instance, it’s also up to the migrant workers to work with the care facility staff and personnel. Combating COVID-19 also involves all of us, including adhering to the circuit breaker measures, including not pretending to be “ex-nurses” and be spreading falsehoods, including not spreading messages, images or videos without context or checking source.

We can be less quick to judge people who refuse to put on masks in public. They might have issues or some personal pain that we do not know about. Maybe they’re allergic to masks? Have breathing difficulties or even mental health issues? Don’t be too quick to label them covidiots.

The real covidiots are those out to deliberately create fake news and fake views to spread uncertainty, unhappiness.

So, don’t be like the “ex-nurse’.

 

 

 

 

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Maggie O

Author Maggie O

Digital extrovert. Social introvert (warning: 93% introverted!) In the day, I work to put cai-png on the table and ice-cream in the fridge. In the night, I read a lot and write a little. Also, all views expressed in my contribution pieces here are based on my personal opinions, and they do not reflect the ideas, ideologies, or points of view of my employer (past, current and future).

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