Singapore’s coronavirus success story hits a snag

Hailed as a model for its early success in containing the spread of the coronavirus, Singapore is now having to explain an alarming surge in infections—more than 75 percent of which are among low-paid migrant workers who live in shared dormitories. The sudden rise in cases not only shines a spotlight on the difficult lives of Singapore's often invisible foreign laborers but also foreshadows how difficult it will be for any country to eradicate a virus that has brought the world to a standstill.

From its first reported case on Jan. 23, Singapore had until March 21 recorded fewer than 390 infections with zero deaths, earning praise from the World Health Organization. Then, over the past week, the numbers soared.

On April 20, the Ministry of Health's website announced the highest number of new coronavirus cases in a single day: There were 1,426 new recorded infections with 1,396 of these—about 98 percent—among migrant workers. Singapore now has the largest infected population in Southeast Asia with more than 8,000 cases, of which three-quarters are among the country's foreigners who work as cleaners, construction workers, and laborers.

"We are working to break the chain of transmission in the dorms, to reduce the number of new cases," Prime Minister Lee Hsien Loong wrote in a Facebook post. "It will take some time to show results, so we must expect to see more dorm cases for a while longer."

On Sunday, Lee's government told 180,000 foreign workers who work in construction and their dependents that they could not leave their homes for the next two weeks.

Mohammad Munir, a worker from Bangladesh who has been in Singapore for five years, told me on the phone he had no complaints with the living situation in his dorm. "I get three meals a day, there is a medical team to take our temperature, and the government has promised us that we will get paid," he said. But, he added, "I cannot stop worrying. Every day there are new cases, and the situation is very serious. You think, the next one is going to be me."

A large proportion of Singapore's 323,000 foreign male workers drawn from countries such as India and Bangladesh are employed in low-wage jobs such as construction, loading goods at shipyards, and cleaning and maintenance. They live in dorms that can house anywhere between 3,000 and 25,000 people. The workers share communal facilities including toilets and showers, television rooms, and minimarts. A single bedroom can accommodate as many as 20 men—making it impossible to implement social distancing.

The largest types of facilities, so-called purpose-built dorms, house around 200,000 workers and are operated by independent companies that charge employers between $200 and $300 a month per worker. Workers typically pay $90 a month for three meals a day.

As of April 18, half the purpose-built dorms have been found to be hot spots or clusters where at least one person has tested positive for the virus. Another 95,000 workers live in 1,200 smaller dorms with each housing between 50 and 100 people. A dozen of these have been declared off-limit isolation areas after workers there tested positive for coronavirus.

The surge could be attributed to more active testing of workers, said Alex Cook, vice dean of research at the Saw Swee Hock School of Public Health at the National University of Singapore. To tackle the surge, "The same methods in principle should be used as in the general population: test for cases, isolate the positives and quarantine and test contacts," he said in an email response.

But quarantining with a family in an apartment is one thing; isolating with dozens of other men with shared bathrooms means infection can spread much more easily. And that is exactly what seems to have happened for Singapore's foreign migrants.

Singapore's initial response to the coronavirus pandemic was hailed as a gold standard. "This is what success looks like. Everything goes forward with modifications as needed, and you keep doing this until there's a vaccine or a treatment," wrote Dale Fisher, the chair of infection control at the National University Hospital, in the South China Morning Post on March 25.

Despite its geographic proximity to China, the initial epicenter of the pandemic, Singapore seemed relatively relaxed in how it was handling the global coronavirus outbreak. Until April 7, schools and restaurants were open. People were going to work. It was fine to meet friends, provided gatherings didn't exceed 10 people. Even now, with what Singapore calls a circuit-breaker—a second shutdown of sorts—public transportation is up and running, and people can go out to buy groceries and medicine and exercise in parks while wearing masks. Hair salons are open for haircuts, deemed an essential service, though hair-dyeing is not and, so, boxes of DIY hair dye have sold out at pharmacies.

Singapore, it was said, was ready for COVID-19 even before its first case, a 66-year-old tourist from Wuhan, on Jan. 23. Its readiness had been prompted by past experience in dealing with SARS in 2002 and fine-tuned with its swine flu (H1N1) outbreak in 2009.

Typically, the acronym-loving nation had a crisis management plan called DORS, or Disease Outbreak Response System. It reviewed its infrastructure capacities and built isolation hospitals. It ramped up its testing capacity.

Three weeks before its first case, Singapore's Changi Airport had already begun screening passengers from Wuhan, gradually expanding screening to all incoming passengers and requiring all travelers to stay at home for 14 days after arrival. To make sure there were no transgressions, these passengers would receive messages on their phones and were required to click on a link to ensure that they were, in fact, staying at home.

A multiministry task force chaired by the ministers for health and national development was set up on Jan. 22, and a combination of aggressive contact-tracing, liberal testing, and community engagement with the transparent sharing of information on government websites and through WhatsApp messages paid off in the early days.

A country known for its low tolerance for violations was quick to demonstrate just how serious it was. A newsvendor who returned to Singapore from India and violated his stay-home notice now faces an eight-week jail term. On April 18, 200 people were fined $200 each for breaching safe distance norms. Another 80 were fined for not wearing masks.

Despite Singapore's early success in dealing with the pandemic, it is now clear that its system was only as strong as its weakest link: migrant workers.

With a population of 5.8 million people, Singapore is home to 981,000 work permit holders. While most of these immigrants are wealthy and work in the country's lucrative corporate world, 323,000 of them live in dormitories. This relatively cheap labor force working in construction, transportation, logistics, food and beverage, elder care, sanitation, and as domestic helpers—cooks, nannies, and live-in cleaners—has fed Singapore's growth story, building its shiny new malls and office complexes, its metro rail and luxury resorts.

Even now, work is underway to complete a new dormitory near Changi Airport that will accommodate 2,900 workers, reports the Straits Times. When complete, this dorm will house workers who are building the airport's Terminal 5. Most construction projects have been put on hold during the circuit-breaker, but some such as Changi Airport's third runway have been exempted.

The first infected migrant worker was reported on Feb. 8—a 39-year-old Bangladeshi construction worker who caught the disease after visiting Mustafa Centre, a popular mall for South Asians. And then it spread like wildfire in his dorm and among the migrant work force. Breaking up the ratio of confirmed cases among groups is instructive: While 1.46 percent of migrants living in dormitories have tested positive, only 0.02 percent of Singaporean citizens and permanent residents have the coronavirus, according to the Ministry of Health.

But despite the recent surge, Singapore may still be better prepared than most other countries. Between April 3 and 16, the number of hospitalized COVID-19 patients went up from 473 to 1,886, reports the Straits Times. Singapore has 11,321 acute hospital beds, of which 9,400 are in the public sector. Non-urgent treatments have been postponed, and this has freed up more than 2,000 public hospital beds. A former water park and resort has been converted into a 500-patient-capacity isolation facility. And two halls at the Singapore Expo Convention and Exhibition Centre have been repurposed to care for 950 patients.

Meanwhile, 7,000 healthy workers, many employed in essential services, have been tested and moved to temporary living quarters including vacant Housing and Development Board apartments and two offshore floating facilities.

"The government has moved aggressively and quickly to deal with the newly emerging cases among migrant workers," said Jawed Ashraf, India's high commissioner to Singapore. "It has assured workers of their salaries, three meals, and medical help. Communities are also stepping up. There is no problem of resources, and it helps enormously that the government is so transparent with information about what it is doing."

But, in other quarters, there is concern that the government, initially focused on the Singaporean population, has woken a little late to worker measures. "Foreign workers are housed 12 to 20 men per room in double-decker beds," Deborah Fordyce, the president of Transient Workers Count Too, wrote on March 23 in an open letter. She asked the government to announce its plans to rehouse workers should clusters break out in dorms. "The risk of a new cluster among this group remains undeniable," she said.

Phil Robertson, deputy director of Human Rights Watch's Asia division, said the outbreak among migrant workers is no surprise. "Singapore ignored warning signs out of a mixture of hubris and negligence and continued to treat migrants as expendable second-class people whose problems could be addressed later," he said. "There may well be plenty of COVID-19 positive people in those dormitories who are asymptomatic so the government strategy appears to condemn much of that population to contract the virus sooner or later."

COVID-19 has brought into the spotlight problems that already existed among low-wage migrants, wrote Laavanya Kathiravelu, an assistant professor at the Nanyang Technological University, in Academia SG, a website maintained by a group of Singaporean academics.

"For example, the difficulties of living in tight, crowded spaces in dormitories have been exacerbated. Existing problems of hygiene indicated by bedbugs and rat infestations have become important public health concerns," she wrote. But, she added, the discourse of containment, used to justify the seclusion of migrants in dormitories, "now enables greater restrictions on their movement, with thousands effectively locked into their rooms for weeks."

There is growing concern over Singapore's reliance on cheap foreign labor. "Do we need so many of them?" asked associate editor Ven Sreenivasan in the Straits Times. Calling for Singaporeans to be "more open-minded to the nobility of work. Any work," Sreenivasan argued that "over-dependence on foreign labour can expose companies and employers to unforeseen circumstances, as is the case now."

Migrant workers have literally lived at the fringes, with most dorms located at the edges of the island nation. "I can only hope that when all this is over, the sad realities related both to their living conditions and marginalization in society will be fully addressed," said Christine Pelly, another representative of Transient Workers Count Too. "These workers cannot be seen as a separate community but an integral part of Singapore."

That sentiment has resonance at the highest levels of government. Responding to a letter published in the Chinese-language daily Lianhe Zaobao linking the surge in COVID-19 among migrant workers to poor personal hygiene, Home Affairs and Law Minister K. Shanmugam had something to say. Dismissing the letter as xenophobic, he said it was possible for Singaporeans to be professionals and managers because foreign workers form the base of the country's economy. "Our duty as Singaporeans, really, is to show them empathy and take care of them," he wrote.

Namita Bhandare is a Delhi-based freelance journalist and author who writes a regular column for The Hindustan Times.

Disclaimer: This article first appeared on foreignpolicy.com, and is published by special syndication arrangement.