Commentary: Easy to forget to be human in managing COVID-19 twists-and-turns as a healthcare worker
But we should take heart in how healthcare workers have gone past the call of duty to evolve, jettison assumptions and sail Singapore through this pandemic, says NCID’s Dr Shawn Vasoo.
SINGAPORE: The COVID-19 pandemic is reaching its two-year mark. Life has changed in many ways; but the impact is keenly felt by those at the frontlines in healthcare.
Medical practitioners have always dealt with pathogens that spread via droplets and aerosols – such as viruses that cause measles and chickenpox – as well as airborne bacteria like tuberculosis.
But never in the world’s history, has a coronavirus caused a pandemic of this scale - not even with the original 2003 SARS-CoV virus.
The world is still grappling with COVID-19. With a new Omicron variant on the loose, and uncertainty with this and future variants, the full impact of this pandemic has yet to pass.
WE ARE STILL LEARNING ABOUT THE VIRUS
One thing humbling us greatly is what we “didn’t know” about what we didn’t and maybe still don’t know about SARS-CoV-2 in spite of our SARS experience.
Here was a virus sharing 80 per cent genomic similarity with its predecessor SARS-CoV, yet spreads much faster, with an infectious period preceding the onset of symptoms.
This was also an illness, with one in two infected being asymptomatic but perfectly capable of transmitting the disease – again unlike SARS-CoV. Despite the lower overall mortality rates, the number of deaths due to COVID-19 has outstripped SARS given the sheer number of global infections.
About one year into the pandemic, the steadily evolving SARS-CoV-2 developed into the Delta variant, becoming even more transmissible and virulent, challenging infection control measures and norms that worked in the pre-Delta era. Public health measures had to be recalibrated yet again.
We have known for some time now that RNA viruses such as SARS-COV-2 can mutate and evolve.
But the last two years have demonstrated in living colour viral evolution and adaptation – challenging and in many cases bringing health systems to their knees, forcing authorities to enact many unprecedented measures to curb its spread, “flatten the curve” and prevent hospitals from being overwhelmed.
2019 was punctuated by an imported case of monkeypox, an activation of our high-level isolation unit for a suspected case of viral haemorrhagic fever, and a resurgence of measles with an ensuing mass vaccination exercise. In retrospect, these “trial runs” at NCID were only small harbingers only of what was to come at the turn of the new year.
Still, the healthcare system has evolved greatly too in the past two years and that should give us the confidence to ride out the next phase of this pandemic.
ENGAGING THE PUBLIC
Through the pandemic, public communication has been key but there are always instances where we could have communicated better for education and assurance and explain policy shifts.
People may not have easily understood how a positive test might not imply active infection as viral shedding can occur for weeks after.
Public health measures – masking, safe management measures, vaccination eligibility – too had to be adjusted as the pandemic evolved, along with new understanding of the disease and efficacy of such measures.
Healthcare decision-makers and providers have to keep things simple and accurate, to engage with detractors and those who disagree with medical information presented.
Despite vaccination having been available for almost a year, with benefits in preventing severe disease presented robustly in Singapore and backed up by data, some still remain sceptical.
These efforts must continue as further boosters may be needed with waning immunity and updates to vaccines to address emerging variants, amid the challenge of pandemic fatigue.
For the 4 per cent of the eligible population still unvaccinated, healthcare providers must listen respectfully, while seeking to address the inquirer’s underlying concerns. Our patients may not care about how much we know, until they know how much we care about them and their health.
DIGNITY OF PATIENTS, THEIR FAMILIES AND HEALTHCARE WORKERS
The pandemic has had a tremendous toil on patients, their loved ones and healthcare workers, which is difficult to measure, and yet will have a long “tail” of impact for years to come. While most patients do recover, some have succumbed.
It is a highly stressful time for families. It is hard to be in isolation, and heart-wrenching to die alone.
Healthcare workers are also stretched. Beneath the layers of personal protective equipment – eye protection, N95 mask, gown and gloves - is a healthcare worker who is probably battle-weary.
One junior doctor, who had to admit many patients on call, and simultaneously handle several deaths in frail and often unvaccinated persons who succumbed to COVID-19 during a particular surge of cases this year, expressed that he felt “numb”.
As much as we care for patients and their families, we also need to care and support our frontliners in this pandemic.
DATA-DRIVEN HEALTHCARE POLICY
Much work involves being at hospitals – to close the gap between healthcare policy and the changing goalposts set by a rapidly changing virus.
That NCID saw the initial wave of COVID-19 patients, and currently still a substantial portion of admitted patients, allowed us to contribute valuable data informing policy.
Healthcare workers and researchers have also looked further afield for insights, combing local and international data to provide critical answers to medical questions that have shaped practical realities and the daily lives of those infected with or exposed to COVID-19.
These have informed the period of isolation after one falls ill, the period of quarantine required when exposed as a close contact, and who should be admitted to the hospital.
Questions regarding diagnostics - like the optimal sample for COVID-19, how different test modalities perform and trials of novel therapies and studies in understanding how vaccines perform and how long immunity lasts - were also pertinent issues we studied.
This pandemic has highlighted the importance of generating data for a new and unknown pathogen. It’s been a steep learning curve for Singapore as one of the first countries affected by COVID-19 outside Wuhan.
Assumptions it would behave just like SARS had to be thrown out as we discovered more about this new virus.
When the Delta variant arrived, a “re-take” was needed. Measures such as universal and periodic screening of admitted patients and healthcare workers for SARS-CoV-2 were rolled out.
These, with vaccination, augmenting infection control measures and improving air handling in facilities have helped to keep hospitals safe.
HEALTHCARE GOING DIGITAL
Looking back at a pre-pandemic medical congress where healthcare workers would squeeze into packed halls to listen to a “guru” deliver a keynote address, I now wonder how we ever did that.
Such conferences are now largely digital. The alternative is a safe-distanced hybrid of a physical and digital meeting.
Healthcare has similarly changed dramatically for both providers and patients. Telemedicine is growing. Some stable patients with chronic medical conditions requiring a few medical appointments now need only one visit (for investigations, for example), as teleconsults can be done at home, with medications delivered.
Overnight, individuals previously adamant or hesitant about change, whether doctors or patients, embraced new technologies on digital platforms for medical consultations.
This may extend to telehealth encounters with nurses and pharmacists in the future, changing how people can get access to healthcare, with hopefully improved outcomes at lower cost and higher patient satisfaction.
It is still unclear how long this pandemic will last, what impact Omicron will have and what the transition to endemicity will look like ultimately.
It is easy to forget to be human in the midst of managing a crisis, dealing with data, and updating protocols.
We need to put humanity back into the bedside, and continue to evolve as a healthcare system, society and as part of the global community as COVID-19 unfolds and new challenges arise.
Dr Shawn Vasoo is Clinical Director, National Centre for Infectious Diseases