PCF Sparkletots Fengshan cluster: How 1 Covid-19 case turned into 25 cases in 5 days

The PCF Sparkletots preschool in Fengshan located on Bedok North Street 2 has become the centre of scrutiny in recent days.

Run by the People's Action Party Community Foundation (PCF), which operates more than 360 preschools islandwide, it is from here that 25 of Singapore's latest locally-spread Covid-19 cases has sprung forth — making it home to our second-largest local cluster.

From it emerged a total of 25 cases as of Friday (Mar. 27) night: 16 of the centre's staff, and nine who are according to the Ministry of Health (MOH) relatives of the school's principal — case 601, a 47-year-old female Singapore citizen.

First, everything that happened in a timeline

So here's a rundown of the cases, when and how they surfaced, as well as all the publicly-available information we have on them now, corralled from Minister for Social & Family development Desmond Lee, as well as statements from the Ministry of Social Development (MSF), PCF and information from MOH.

And our story starts almost a week prior to the first case in this cluster testing positive for Covid-19.

Tuesday, Mar. 17: School principal develops symptoms but stays on in school, goes for evening external group training

• PCF Fengshan's principal goes to work feeling well.
• She feels symptoms in the afternoon, but stays on for a meeting with her staff.
• In the evening, she attends a training with "about" 30 staff from other PCF preschool centres.

Wednesday, Mar. 18: Principal sees a doctor and gets placed on MC till Mar. 20. Case 516 enters centre.

• It is on this day that Case 516, a Nursery 2 teacher, the cluster's first announced case, goes to the PCF Fengshan campus for administrative work.
• She clears health checks and temperature screening that were in place before entering.

Friday, Mar. 20: Other school staff start developing symptoms, including Case 516.

• Case 516 seeks medical attention for her symptoms.

Monday, Mar. 23: Cases 516 and 521, the cluster's first two cases, test positive for Covid-19.

Tuesday, Mar. 24: PCF announces 1-day closure, Cases 516 and 521 are announced as local unlinked cases

PCF releases a statement early in the day informing the public that one of its Fengshan Sparkletots teachers tested positive for Covid-19:

"The teacher was on leave from Mar. 18 to 20, 2020 and was last in the centre for a few hours on Mar. 18 to attend to some work which did not involve conducting of lessons for children.

As the teacher’s last contact with the Centre was two days before the onset of symptoms and she was well while in the Centre, it is MOH and ECDA’s assessment that there is no need to close the Centre for 14 days based on current available facts.

As an added precautionary measure, the Centre was closed today (Mar. 24, 2020) for a thorough cleaning and disinfection of the premises. MOH is conducting contact tracing. Barring further developments, classes and programmes will resume tomorrow Mar. 25, 2020."

We learn later in the evening from MOH's daily update that the teacher is case 516.

At that point in time, the ministry has yet to connect case 516 with case 521 (a family member of the Fengshan Sparkletots principal) in its announcement.

• Case 516 is identified as a 42-year-old female citizen with no travel history and classified as a local unlinked case.
• Case 521 is identified as a 37-year-old female citizen with travel history to Malaysia. She, too, however, is classified as a local unlinked case.

Meanwhile, four family cases are confirmed on Mar. 24. MOH would announce these cases the next day.

• Four relatives of case 521 test positive for Covid-19: cases 566 and 567, a 67-year-old female and a 70-year-old male, both of whom, like 521, have travel history to Malaysia. Case 572, a 26-year-old female, didn't have travel history, as well as case 601, a 47-year-old female (the PCF Sparkletots principal).

After PCF Fengshan said it will only be closed for a day, more than 10 other staff report that they've all been falling sick since the Friday before (Mar. 20).

The school makes the decision on Mar. 25 to stay closed until Apr. 7, while sending all of PCF Sparkletots Fengshan's staff for Covid-19 swab tests.

It also places about 110 of its school-going children and an additional 10 staff on quarantine orders.

And on the same day, a flurry of nine new cases are confirmed among the staff who were tested:

• Cases 583, 584, 602, 609 and 610 are identified as contacts of the Nursery 2 teacher (case 516), PCF Fengshan's first confirmed case.
• Cases 603, 604, 605 and 612 are classified as part of the new PCF Fengshan cluster, with no established contacts with earlier cases.

Total cases confirmed at the end of March 24: 2 + 4 + 9 = 15

Wednesday, Mar. 25: The puzzle piece fits, connecting the principal's family and her school. The new cluster is confirmed and announced.

Four more cases are confirmed among the preschool's staff:

• Cases 614, 617, 624 and 660.

A fifth relative of the school's principal, a 49-year-old male citizen, tests positive as well. He is Case 638.

Taking the new total number of confirmed cases at the end of Mar. 25 to 20.

The roughly 30 PCF Sparkletots staffers from various other centres who were at the training with Case 601 (the principal) are quarantined, although it's not clear which day this started.

Photo via Cheryl Chan's Facebook page

Meanwhile, Fengshan SMC MP Cheryl Chan takes to Facebook in defence of the first PCF teaching staff to test positive, saying that she "unknowingly contracted the virus" and that "none of (the PCF staff) would knowingly do anything that put the children at risks [sic]".

PCF announces it is closing all its centres for three days. Its CEO Victor Bay adds in a statement that it is convening an internal committee of inquiry to look into how the cluster came about, with a view to investigate the matter and take “appropriate staff disciplinary action where warranted”.

Thursday, Mar. 26: Minister Desmond Lee meets the media

Photo by Sumita Thiagarajan

By Thursday morning, Minister Lee has an additional confirmed case (660) to reveal to the media — it was not announced together with the cluster the night before.

It is here he shares more of the Ministry of Health's and ECDA's rationale behind initially deciding to only close the Fengshan Sparkletots for a day:

"We look at the sequence — by the hour and by the day. We started with that one teacher. And when MOH checked, that teacher had been away from the school for quite a number of days. And the last time the teacher was in the centre, she was well based on their assessments.

And therefore because there was that distance of time, space, they felt there was no need to close the centre because just on that case alone there wasn't a public health risk to the rest of the centre."

But even then, events unfolded so rapidly that it had no chance to resume operations the next day anyway. So one might argue that decision becomes moot. But we'll come back to Lee in a bit.

Meanwhile, four more cases are confirmed — this time on the side of the school's principal's family:

• A toddler, two children and a teenager aged two, six, 11 and 13 become cases 705, 706, 707 and 708, and are warded at KK Women's and Children's Hospital. They are related to Case 521, the first of the principal's family to be infected.

Friday, Mar. 27: One more staffer tests positive, number of cases overtakes Grace Assembly of God cluster of 23 cases

And then, Friday brings the confirmation of one more case in this cluster: a 67-year-old non-teaching staff at the centre becomes case 716.

The total number of cases in the cluster is now 25.

And now, regarding that COI...

It's been awhile since we've heard the term "COI" — in the past year or two we heard it bandied around quite a bit more in relation to military deaths that happened in the course of training exercises — but one has indeed been convened by the PAP Community Foundation to look into how this cluster came about.

We tried asking the spokespersons for PCF what the terms of reference for this internally-formed committee are, and haven't yet heard from them after close to two days.

So here are three questions we have of our own that we hope the COI can dig into in the course of their inquiry:

1) Why did the Fengshan Sparkletots principal feel the need to stay on at work even though she felt unwell by the afternoon of Mar. 17?

Many online are heaping blame on her for doing this — of course, especially in this time, with so much already having been said about how mildly symptoms can appear for Covid-19, it's true she should have said she wasn't feeling well and made a beeline straight for the doctor, and then home.

But it might be worthwhile for the committee to study why this didn't seem like an option for her — or if she considered it, why she didn't choose to do so.

One preschool teacher took to Facebook to express his disappointment and explain some of the challenges folks like him face every day at work.

He raised the fact that it is common to go to work despite feeling unwell out of concern about burdening others with their work if they did not, facing pressure from parents who need their care of their children and send them to preschool even though they aren't well, and their supervisors too.

Another reader wrote to us expressing similar sentiment, asserting the possibility of a number of preschool teachers hailing from China or the Philippines, for instance, not being able to come back to Singapore to resume work, and those left here having to pull extra shifts to fill in for them.

There also exist anecdotal claims of performance appraisals being linked to the number of medical leave days one takes, an alleged lack of provision of masks for children or staff who are unwell, as well as a failure to revise typical training hour requirements for teachers in extraordinary situations like the ongoing outbreak.

Lots to dig into here, it looks like.

2) Is this the perfect opportunity to emphasise social responsibility?

We have no way of knowing right now the motivations behind the Fengshan Sparkletots principal's decision-making process that fateful day she was at school and started feeling sick.

Nobody, her included (we're willing to venture), would have done what she did thinking they might really be carrying the SARS-CoV-2 virus.

And so certainly, Fengshan SMC MP Cheryl Chan is not wrong to assert that the cluster's confirmed Patient 1 (Case 516) "unknowingly contracted the virus" — after all, which regular person would knowingly contract it? — but Chan says it's "not a blame game"; it's "about getting the facts right and helping with the situation".

Here are some facts, with a bit of straightforward logical extrapolation:

• The principal (Case 601) doesn't live with her relatives who are infected, but three of her infected family members have travel history to Malaysia. Four of them tested positive before she did.
• Case 516 was on leave between Mar. 18 and 20, but it hasn't been stated if she was at work on the 17th, the day much of the contagion appears to have happened.
• When a person tests positive for the virus does not have bearing over whether the person contracted it earlier than another who tests positive later on or not. Case 516 started developing symptoms on the 20th. Case 601 (the principal) developed symptoms on the afternoon of the 17th.

These are just some alternative ways of thinking and reviewing the facts we have at hand to "help with the situation".

Which leads us to the topic of social responsibility.

One can certainly help the situation by pointing out, issuing reminders, (and learning from) where others have failed to practise social responsibility.

Before the conclusion of the COI's work, however — and possibly even before it has managed to make much headway at all — Chan has already concluded that "it is not her (the teacher's) fault".

While it is not ideal to jump to conclusions and shine the spotlight on Cases 516 and 601, it is important to assess whether certain actions or behaviour by the individuals who are part of the cluster have resulted in the intensity of the Covid-19 outbreak at the Fengshan Sparkletots centre.

As early as Mar. 10, MOH did remind Singaporeans that "social responsibility is a critical factor in slowing the transmission of the virus".

MOH noted that "many of the locally transmitted cases were the result of the socially irresponsible actions of a few individuals who attended events and activities despite being unwell".

In his meeting with the media, Minister Desmond Lee also touched on the point of blaming the individuals involved:

"And some may perceive that in this particular case some of the teachers who were not well, one or more teachers who were not well, ought to have left the centre immediately rather than carry on with their duties for a couple more hours.

But I hope that parents, the public and other colleagues recognise the realities on the ground and not look at it in a two-dimensional way — because I'm sure the teachers concerned, the operators, the managers on hindsight have seen the facts, and I'm sure they will take the necessary measures hereafter and do the necessary in order to hold to account the causes of what happened.

But nevertheless, this is not the time for us to pin and assign blame; the key is to make sure we uplift and uphold the morale of the entire sector and continue to give assurance to parents."

In another part of the session, he said:

"Having said that, I think we should not jump to any conclusions and say that any one teacher or the principal had been the entry point for this Covid-19 (cluster). I think let's have a heart for the feelings of the teachers concerned; there is no indication at all whether they were complacent or broken the rules, or in some sense they were quite zealous in making sure the children were cared for. But perhaps some moments lost... couple minutes, hours, who's for us to say, but let MOH do their assessment before we draw any conclusions."

Lee makes a fair point in the first part of what he said — alluding to the first question we have for the COI, recognising the "realities on the ground" — also acknowledging that it may be necessary to hold individuals to account for what happened.

Additionally, he notes the very important issue of a lack of complete information about all that has happened — all that we do already know notwithstanding — that does simply mean we should hold our conclusions about who's responsible for this virus cluster.

Not, however, that we shouldn't find ways to learn from some of the mistakes that can be observed from the facts made known so far.

These were pointed out, alongside some additional tips, by the frequently-interviewed infectious diseases experts, Leong Hoe Nam and Paul Tambyah, in this nifty Straits Times report that touched on the possibility of this cluster having been a "super-spreader event":

It's also worth bearing in mind the fact that the government has been quite naggy about this whole social responsibility thing — having the discipline to stay at home when one isn't, to repeat, "100 per cent" well, no matter what you're missing: work, exercise, leisure, entertainment or social gatherings.

So this really isn't a new concept for us. Blame our compulsion (and perhaps our national culture?) to work hard and long hours, perhaps, but in this time, we really don't have many excuses left for not being careful with ourselves and our movements when we take ill.

3) Do preschools ultimately need to close in this outbreak to protect the well-being of the children — and indeed, the centres' staff?

Minister Lee rightfully points out that young children are assumed to be collateral to their parents and caregivers' movements and circumstances — a couple of the toddlers in Singapore who have tested positive for Covid-19 contracted it from their parents who returned from work travel, or from family travel, upon their return to Singapore.

In preschools especially, it's imaginably tough to practise social distancing or to police proper personal hygiene habits — there isn't always much space to work with at the care centre, excursions (and thus opportunities for open-environment time) outside have been suspended in the outbreak and, I mean... have you tried keeping a group of kids still and separated before? Or tried to get a toddler to cover his or her mouth when sneezing or coughing?

It is tempting, therefore, for ECDA to make the call for all of Singapore's 1,900+ preschools to shut their doors, pending the unforeseeable future of the SARS-CoV-2 virus no longer being a threat.

But again, he stresses repeatedly, thousands of working parents in Singapore, many of whom are paid their wages by the hour, or by the day, simply cannot afford that and do not have alternatives to preschool or daycare for their young children at their disposal — many of those who do have already taken their children out of the preschools.

So far, none of the PCF Sparkletots children have tested positive for Covid-19 — Lee mentioned that five of them who fell ill during the period of question tested negative — but it doesn't mean they are more immune to it than their teachers or the older staff who work at the centre.

All that being said, there's much to give pause in what happened to lead to this large, and possibly still-growing, cluster.

And we can only hope to learn as much as we can, as quickly as we can, before more clusters like this spring up and overwhelm our healthcare system.

Mothership Explains is a series where we dig deep into the important, interesting, and confusing going-ons in our world and try to, well, explain them.

This series aims to provide in-depth, easy-to-understand explanations to keep our readers up to date on not just what is going on in the world, but also the “why’s”.

Top image adapted from photo by Fasiha Nazren