COVID-19: Notes From the Front Line, Singapore’s Primary Health Care Perspective

Containment Measures

Visits were streamlined following a fixed protocol within our network (Figure 1). Reception counter nurses triaged all patients to identify suspect cases following a strict protocol and a health declaration form (Supplemental Figure 1, http://www.AnnFamMed.org/content/18/3/259/suppl/DC1) drawn from government guidelines regarding suspect case definition. These were updated according to the evolving situation locally and globally.

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Figure 1

Institution workflow for patients with respiratory tract symptoms.

LRTI = lower respiratory tract infection; URTI = upper respiratory tract infection

Once identified, the cases were immediately isolated in a designated room in the clinic for assessment by the doctor. If a patient fit the suspect case definition, this patient remained in isolation until evacuation for further evaluation by a dedicated public ambulance service to the NCID.

According to the natural progression of upper respiratory tract infections, nonsuspect cases were given 3 to 5 days of home medical leave and were highlighted for subsequent review via the group’s electronic medical records (EMR) system. This enabled clinicians to track cases and allowed for longitudinal information flow within the network. Patients were then contacted by the clinic and reviewed via telephone call on the last day of their medical leave. Those who reported persistent symptoms were advised to visit the clinic for further workup while those who reported worsening symptoms such as breathlessness may have been brought from their home via the public ambulance service directly to the NCID for further evaluation. In the event a patient felt a progression of symptoms during the period of medical leave, they could either consult a doctor via the network’s telemedicine mobile application or make a physical trip to the clinic for evaluation.

These measures worked in concert with government containment measures such as a mandatory 14-day stay-home restriction on returning travelers from high-risk regions of the world.

Infection Control Measures

Extensive infection control measures were put in place to prevent cross-contamination from potential positive cases to other patients and health care workers.

All medical staff within the network were promptly updated on new developments via multiple communication channels lke e-mail and secure mobile chat groups. This minimized difficulties with information access.

Appropriate training for health care workers was also enforced using one-on-one sessions and multimedia information guides. All medical staff were trained in the appropriate use and disposal of personal protective equipment (PPE). Doctors planned the management and disposition of patients according to the latest directives from the Ministry of Health while nurses were instructed in appropriate decontamination. This optimized the education of infection control measures at the level of the individual health care workers.

PPE resources were provided by both institution and government stockpiles with reassurance of adequate supplies for staff protection throughout the pandemic (Supplemental Figure 2). PPE was worn by reception staff for all patients at the counter, and by doctors during patient consultation—in both isolation room and normal consult room. Compliance to PPE guidelines was strictly enforced at all levels.

If a suspect case was identified and sent to NCID, the clinic would undergo subsequent decontamination prior to resuming services.