Part 2: MOAC – The Mother of All Clusters

We are now quarter-way through the circuit breaker (CB) mode, two weeks down and about another six more to go. The situation is not quite encouraging as yet. Of course, this is already by hobbit standards, and hobbits are by nature optimistic, as opposed to elves and dwarves.

For one, as of this afternoon, the number of Covid-19 cases in Singapore has exceeded 10,000.

Secondly, if you look at the doubling time of the epidemic in Singapore, it is now about 5 days. This is shorter that what was quoted previous by WHO when the disease first appeared – 7.4 days.

The other issue is that of unlinked cases. From the MOH website, you can see there are two types of unlinked cases:

• unlinked community cases and
• unlinked work permit cases NOT residing in dormitories.

From 8 April till 21 April, the total unlinked cases from these two categories reported each day has varied between 24 and 31. But on 21 April, the number went up to 44 (23+21). We hope this high number of 44 is a once-off aberration.

The largest sub-cluster of the MOAC, the S11 dormitory cluster now has 2143 cases as of 21 April. This dormitory has a capacity to house 13000 foreign workers. Assuming full occupancy, the prevalence of Covid-19 in this dormitory has reached a staggering 16.5%. And this number may get higher as we test more of the dormitory residents. To illustrate the mind-boggling effects of exponential growth, on 6 April (10 days after the S11 cluster was declared), it was reported in The Straits Times that the S11 cluster had 88 cases. 15 days later, it has grown to 2143 cases (21 April 20). The larger picture is also rather discouraging, as clusters are now found in 28 out of 43 dormitories.

There are actually three phases in the local outbreak with respect to the foreign worker dormitories, which this hobbit will call the MOAC War. The first phase was really the preparatory phase which took place in early January till early or mid-February, right up till the Seletar Aerospace Heights Cluster was declared in mid-February. The 2^nd phase would stretch from the end of Phase 1 (when we realised that a foreign worker cluster was not a possibility but a reality) to March 25, when the first foreign worker clusters were declared: the Mustafa and Toh Guan Weslite clusters. Since March 25, we have been in Phase 3 for exactly 4 weeks, the phase that entails the entire healthcare system battling MOAC. After 4 weeks, there are now some 7500 foreign permit workers infected, with the 3 largest foreign worker clusters being S11 (2143 cases), Sungei Tengah Lodge (629) and Tuas View Dormitory (519) (MOH report dated 21 April). These numbers are deeply disconcerting if not frightening.

Another key factor is that the number of patients now being admitted into our restructured hospitals has reached about 3500. Notwithstanding that most of these patients are young patients, we only have about 9500 beds in the public acute hospital system, and 3500 is a very sizeable proportion of the total.

What is heartening to note is that the number Covid-19 patients requiring ICU beds have consistently remained in the 20 to 30 range. But I can imagine that the doctors and nurses are now locked in a daily titanic life-and-death struggle against the virus in the restructured hospitals. There are also hundreds if not thousands of doctors and nurses now manning isolation facilities in private hospitals, community isolation facilities and community hospitals. A friend of mine has described his experience fighting the virus akin to the elves at Helm’s Deep keeping waves and waves of orcs at bay. No matter what you do and how hard you try, the virus just keeps coming, relentless and unforgiving. And you fear that sooner or later, you will run out of energy and arrows and be overwhelmed.

All this is rather gloomy even for a hobbit like me that is usually given to a cheery disposition. Let’s move on to something hopefully more encouraging and reassuring.

It was reported in The Straits Times on 22 April that during the press conference given the day before, the Manpower Minister said her ministry had instructed the dorm operators as early as early January to put in place mitigation measures, including asking the operators to “raise the standards of hygiene and sharing information with workers how to protect themselves against the virus”. Later on, further measures were introduced, including safe distancing, and closing non-essential facilities such as TV rooms. These measures would probably correspond to Phases 1 and 2 of the MOAC War that have been described above.

The Minister then went on to say that more stringent measures, which were only recently introduced in the CB period, would “need to have been done in the context of a circuit breaker where most work has stopped” (quoted from The Straits Times dated 22 April 20, Page A6). These more stringent measures that have since been implemented in the CB period, include:

• not allowing the workers to cook in communal kitchens located within the dorms,
• not allowing them to go out on their rest days and interacting with their friends,
• not even allowing them to go to work,
• dispersing the workers to live elsewhere so as to make the dormitories less crowded (as they are doing now).

The circuit breaker was announced in the first week of April, which would have been in Phase 3 of the MOAC War.

It is interesting that the Minister has said that these measures could only be implemented during the circuit breaker period. Let us take a break to think about this in some detail. For a start, what is a circuit breaker, really? Although obvious, it must still be said that to break a circuit, the circuit must first exist before the breaker can be applied. The pre-existence of a circuit is therefore a precondition for the application of a breaker. In other words, there must be something to break in the first place. This is opposed to say, a lockdown. You can apply a lockdown or like the Malaysians, apply a Movement Control Order, even when there are no infections because the lockdown or MCO could be aimed at preventing any infection or transmission from taking place when they may be no infections at all in the first place. But, a circuit breaker can only be justified when there is something already going around (i.e. a circuit). As you can see from the numbers above, there was already some serious circuitous phenomenon or disease transmission in existence when the CB was applied 2 weeks ago.

I may be wrong, but what the Minister is saying is that really, a lot of mitigation measures had been done before the CB was announced. As such, we need to look at these two illuminating points:

• Whatever more serious measures that could have been done, could only have been done in the CB period, when the disease was already transmitting so significantly that it required a CB to be applied. These serious measures therefore cannot be preventative or pre-emptive, (before a circuit has taken or is allowed to take place).
• But in hindsight, we also know that the mitigation measures implemented in Phases 1 and 2 could not and did not prevent a big circuit forming which necessitated a CB.

Therefore, taking these two points together, this would also imply that MOAC was really inevitable.

Yes, in conclusion, it now appears that MOAC is an inevitability. And by logical extension, the war against MOAC is also an inevitable war.

This is a very crucial and enlightening point that bears repeating. This is because as we battle MOAC and CB is extended to eight weeks, it is also inevitable that there will be much suffering and economic loss, despite the Finance Minister announcing a slew of generous assistance measures. Many workers will suffer hefty pay cuts, and many may even lose their jobs. Some businesses will close as well. Many healthcare workers are working tirelessly, exposing themselves to the possibility of mortal harm. The whole country is probably suffering from high levels of emotional stress as well, from the social distancing, as well as coping with the repeated and increasingly severe limitations to personal freedoms that battling Covid-19 demands during this CB period.

But we all need to suffer and put up with this because now we know this has always been an inevitable war. Because it has been implied that MOAC was inevitable, it also means no one should or could be held responsible or accountable for it.

As such, I urge all of you, especially my fellow healthcare workers, to just accept this revelation of inevitability and press on with the fight.