Responding to COVID-19: how an academic infectious diseases division mobilized in Singapore

Abstract

Background On January 30, COVID-19 was declared a Public Health Emergency of International Concern—a week after Singapore’s first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore’s third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. Main body With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt—undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation’s first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19. Conclusion Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.

The Not So Obvious Impact of COVID 19: The Hidden “Curriculum”

“…We diligently execute and apply them strictly in the appropriate contexts. [4][5][6] The hidden curriculum in our subconscious mind has certainly help us manage change better. The changes in workflow, clinical pathways, testing regimes, vaccination protocols, PPE (personal protective equipment) recommendations, as the pandemic progressed have enabled us to have a more growth mindset.…”

“…This is already being incorporated gradually into practice as part of the formal curriculum, as well as the less overt, hidden curriculum. [1,5,19] Home is Where the Heart is "Work from home", "home-based learning" and the such have become our tag line during the pandemic. People have now become so used to remote connectivity, from the comforts of their home.…”

“…Some of these were intended, planned and incorporated into pathways and practices. [1,[4][5][6] There were also many lessons and new experiences. Without our complete realization, there were also many less obvious lessons: the hidden curriculum.…”

Acute medical units during the first wave of the COVID-19 pandemic: a cross-national exploratory study of impact and responses

“…15 There have been reports of nosocomial spread, 16,17 which may be preventable with proactive planning and preparedness. 18,19 This is particularly important as the non-COVID-19 clinical burden remained significant 6 throughout the pandemic and is likely to increase. Equally, appropriate measures and monitoring systems are needed to maintain staff wellbeing for sustainability of service.…”

Serial antigen rapid testing in staff of a large acute hospital

“…On July 30, 2021, serial ART was introduced as a more sustainable, less resource-intensive method of ensuring early identification of COVID-19-positive staff to mitigate transmission to patients at a time when community levels of COVID-19 were increasing. 7 In addition, symptomatic staff were asked to present immediately for testing. Universal mask wearing for staff had been in place since February, 2020.…”