MOAC – The Mother Of All Clusters

We were looking like the smartest kid in the class In February, except for isolated bouts of toilet paper hoarding and mask buying that potentially “sia-suayed” our country and parents. In March, we were still looking rather clever, like the blissful cool GEP kid in RI that still gets to be called gifted and yet not appearing to be a chao mugger.

Now in April, Singapore is looking like the below-average Integrated Programme kid, struggling to complete his hefty homework load and have a decent CCA record as well. He is still an IP student, but if he mucks up anymore, there is a good chance the IP school will ask him to take the O levels.

What happened?

In three words – foreign worker dormitories

This is going to be the Mother Of All Clusters (MOAC) in Singapore. As of today 11 April, the cluster comprises Mustafa, two construction sites and 6 dorms totalling 631 cases. There is another cluster of 5 cases at 31 Sungei Kadut which hasn’t been linked to the MOAC yet. About 20,000 foreign workers work in these affected dormitories. Nationally, it is estimated that there are 200,000 such workers living in foreign worker dormitories.

Just to give you a recap of how fast things have deteriorated, about 2 months ago when this hobbit wrote Part 2: The “Perfect” Communicable Disease Outbreak on Valentine’s Day, we had a grand total of 67 cases in Singapore. Now we have 2108. (Gentle reminder: no more 4D betting during CB period).

The first sub-clusters of the MOAC were declared on 25 March 20: Mustafa Centre and Toh Guan Weslite. The next cluster is the huge S11 sub-cluster which was declared on 28 March 20. Generally speaking, even with our excellent case detection and contact tracing capabilities, transmission probably took place about 10 days earlier. These cases picked up around 23 to 24 March (you need a day or two to wait for confirmatory testing results to be announced on 25 March) already included both the first and second generation of infected cases.

Therefore, the original transmission from the MOAC index case to the immediate subsequent cases probably took place around mid-March, between 10 to 15 March. We started gazetting dormitories as isolation areas (which in effect is a total lockdown of these gazetted areas) about a week ago on 5 April. The period from 15 March to 5 April is about 3 weeks. How will this turn out?

We can take some guidance from the biggest cluster of cases in neighbouring Malaysia: The Seri Petaling Tabligh Cluster. Unlike our MOAC, we do not have to guess when the original infections took place: the Tabligh event took place from 27 Feb to 1 March and was attended by some 16,000 people.

On 18 March, some two and a half weeks after the event, Malaysia went into their version of a limited lockdown – the MCO (Movement Control Order). The New Straits Times reported on 4 April (2+ weeks after MCO) that the cluster had 1545 cases. On 10 April, the cluster had grown to 1701. The growth is slowing after instituting MCO for 3 weeks.

So despite some serious intervention to have social distancing since 18 March, the cluster had grown to about 10% of the original size of the attendees. Of course, not all of the 1700 infected people had attended this event, it is just that their infections could be traced back to the people who had originally attended it

In the Malaysian Seri Petaling Tabligh cluster, most attendees had left and went back to their homes which were all over Malaysia. They had effectively dispersed, which would contribute to the spread to more cases. However, Singapore’s MOAC did not disperse, but really, the spread took place in the cramped conditions of the dormitories where many amenities are shared, which also lead to more efficient disease spread. The disease transmission dynamics could be worse in a foreign worker dormitory than in the community, where living conditions are less congested.

So it should not come as any surprise should the size of our MOAC well exceed 1000 eventually.

Nonetheless, we need to ask some hard questions.

The first foreign construction workers to be infected belong to what is known as the Seletar Aerospace Heights Construction Site cluster. This occurred around mid-February and involved 5 workers. This cluster has no proven link to the MOAC. But this would undoubted have alerted the authorities and the dormitory operators that there was a real possibility that transmission between foreign construction workers could occur.

In large organisations, the management is usually required (sometimes mandated by law even) to perform a risk analysis. They have to identify key risks and have plans to manage away the risks. Sometimes these risks cannot be managed away, but management must then draw up mitigation plans and then implement these plans to mitigate or lessen the risk.

This hobbit has no doubt that the relevant regulatory authorities and the dormitory operators are trained, hardworking and experienced; they would have identified that Covid-19 transmission among dormitory residents living in close proximity to one another is a clear and present possibility and would have instituted mitigation measures at least after mid-February when the Seletar Aerospace Heights cluster came to light.

These mitigation measures in dormitory may include simple things like

  • Temperature and symptom screening of residents
  • Segregation of residents such that different groups have different meal times, bath times, recreation times etc
  • Limitation of movement within and outside the dormitories, for example not letting residents of different floors or blocks mix and interact, or different times for different groups to go outside and buy things etc

Construction site management is also a crucial element. Different workers from different dormitories could have been asked to work in different areas of the site to discourage mixing and interaction etc.

This hobbit suspects most of the above were probably already implemented before mid-March by the dormitory operators and regulators. But yet we now have the MOAC. So it is quite baffling.

If you think about it, both the SAF and MOE have conditions that may facilitate the formation of large clusters – the army barracks in SAF and the schools and hostels in our universities. Yet, they have largely escaped unscathed for now. What is it they have done right and the dormitories haven’t? This hobbit doesn’t have the answers here.

Were the conditions in the dormitories so challenging that the mitigation plans eventually proved to be not as effective as hoped?

Perhaps MOH can conduct an in-depth epidemiological study into the MOAC, and study the transmission dynamics of Covid-19 in these dormitories and compare the results with community spread.

In the meantime, my heart goes out to the foreign construction workers, especially those in the affected dormitories in lockdown. (the rest of us are in CB mode, but these workers are literally under lockdown). We must give them adequate hope, support and care.  We cannot let 20,000 young men lose hope. Because if 20,000 young men lose hope, then the rest of us on this small island will also probably be not far from being in deep trouble as well.

 

 

 

 

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