In a recent webinar hosted by GEST (Global Embolization Oncology Symposium Technologies), Kristen Alexa Lee (Singapore General Hospital, Singapore) shares her experience of navigating the COVID-19 pandemic as a pregnant healthcare worker.
Singapore is using the DORSCON risk assessment system, conceptualised following the 2003 SARS (Severe acute respiratory syndrome) epidemic to provide guidance to the public. Currently, the country is at DORSCON orange, which means the disease is severe, spreads easily, but not spread widely, and is being contained. “It has been almost three months since the first COVID-19 case was diagnosed in Singapore, and we have certainly gone through waves of calm and panic,” Lee says.
Detailing the pandemic experience in her country, she explains: “Thanks to aggressive contact tracing and testing, we have [had] a lot of initial success in the containment of the outbreak in the first two months. We actually had our second wave with [the] return of Singapore nationals and other visitors from overseas sometime in February/March, and with progressive quarantine measures and strict travel restrictions, the surge of imported cases has largely ceased.
“Unfortunately, we are actually now tackling a new surge of cases. There are new foreign clusters which are popping up from foreign worker dormitories.” While part of this is due to increased testing, Lee adds that healthcare workers across the country are bracing for a surge of inpatient and intensive care unit (ICU) admissions in the coming weeks.
However, she asserts that the SARS experience in 2003 has “truly created an urgency for early action”. As measures were put in place within hospitals and the community in a timely manner, she adds, “Personally, despite the situation, I have felt safe both at work and outside of work.”
Education on appropriate infection control measures and ensuring compliance to quarantine are among many of the public health initiatives in Singapore that, according to Lee, the government are advocating. “They have largely been focusing on social distancing and protecting the vulnerable, such as the elderly and pregnant women.”
Due to an array of measures taken within the hospital, Lee acknowledges that they are seeing minimal social transmissions and healthcare worker infections. “Compared to SARS in 2003, 41% of the cases were infected healthcare workers. Now, in 2020 for COVID-19, less than 1% of cases are infected healthcare workers, and those are believed to be acquired from the community.”
She explains that early on, protocols were set in place for perimeter control, and screening occurs for all patients on arrival. Guidelines are also in place to identify suspect cases for immediate isolation and evaluation, while compliance to all policies regarding segregation, social distancing, and travel restrictions are strictly enforced. There are clear directives for staff with any respiratory symptoms to seek medical attention at the staff clinic, Lee says, adding that all healthcare workers at her hospital are obliged to take their temperature twice a day to ensure there are no fevers.
Yet, regarding restrictions on work responsibilities for pregnant healthcare workers, Lee comments that there is only one, as the N95 mask has been deemed unsuitable. Therefore, she says all pregnant staff have been reassigned to areas where only surgical masks are needed, and must avoid participating in aerosol-generating procedures.
“As the situation continues to evolve, we have to revise my day-to-day role. My main concern was that I did not want to compromise our man power. But working together with my chief, we are able to find productive ways to scale back my patient-fronting duties.”
Given that the number of outpatient procedures have been reduced, Lee has taken on diagnostic duties, which are usually assigned to interventional radiologists. She also now helps with the management of outpatient requests, and developing systems to triage such patients. “During peacetimes, our list usually runs from anywhere of 40–50 cases per day. For essential outpatient services, it is important to have a detailed and systematic workflow, so patients can still receive the care that they need.”
Pregnant radiographers and nurses have largely continued their duties, Lee affirms, but are taken out of rotation whenever contact with a suspected COVID-positive patient is required.
“Even though we may be tackling different phases of the pandemic around the world, there is no question that this is a very trying time for many healthcare workers. For expecting mothers, the information on pregnancy and COVID-19 is still relatively scarce.”
Addressing staff that are currently pregnant, Lee urges them to “be familiar with your hospitals occupational health policy regarding pregnant healthcare worker, and continue to have open and honest discussions with your departmental leadership, to minimise your risk.
“Continue to protect yourself with strict infection control measures. For some of us, we need to revise as necessary to minimise our patient-fronting activities. Ultimately, it is important to remember that we are all contributing to this fight, and segregation does not mean isolation.”
Maureen Kohi (University of California San Francisco [UCSF], San Francisco, USA), who was co-moderating the webinar discussion with John Kauffman (Oregon Health and Science University, Portland, USA), praised Lee’s work, saying: “All we have done at UCSF [for pregnant woman during the COVID-19 pandemic], we have done because of her [Lee] and her experience, and what she brings to the table.”