4 questions from the Mandarin Orchard hotel's Covid-19 infections

SHNs are meant to isolate potential Covid-19 cases to prevent local transmissions. So how did this happen?

Andrew Koay | December 24, 2020, 04:55 PM

On Dec. 19, the Ministry of Health (MOH) announced that it was investigating 13 cases of Covid-19 infection amongst individuals serving their Stay-Home Notices (SHN) at the Mandarin Orchard hotel.

The 13 travellers had been confirmed to be infected between Nov. 2 and 11 after serving their SHNs between Oct. 22 and Nov. 11.

Curiously they had come to Singapore from 10 different countries — they were classified as imported cases — yet they were observed to have high genetic similarity in the genome of the SARS-CoV-2 virus that they’d been infected with.

This finding meant that there is a possibility that all 13 likely caught the virus from a similar source and that they may had been infected while serving their SHN, during which individuals are meant to be isolated from others.

In the days following MOH’s announcement, tests on the over 500 of the hotel’s employees uncovered that 11 staffers had previously been infected with Covid-19.

Here are four questions this puzzling sequence of events has got us asking:

1) How did Covid-19 spread amongst the SHN people and the hotel staff?

Our first question is the most obvious one.

SHN’s are served for the purpose of minimising the local transmission of Covid-19 from imported cases.

During their SHN’s at hotels, travellers are to stay in their rooms for 14 days and are tested for Covid-19 a few days before the SHN ends. They are not allowed to have any contact with individuals outside the rooms

So how exactly did these travellers get infected while serving their SHNs?

Speaking to the media on Dec. 22, Education Minister Lawrence Wong — who heads the Multi-Ministry Task Force on Covid-19 together with Health Minister Gan Kim Yong — said that no breach in operations had been discovered yet.

Wong said,

"In this case, we did not detect a breach yet, but somehow something had happened. We don't quite know what is it, but the genome sequencing suggests that there were travellers on SHN who were infected, who shared the same strain or genome type in terms of the infection. So (the incident) suggesting that something had happened, but not quite sure what is it (yet). You could have different hypothesis. It may or may not have been a breach. Don't know. A lot of investigation work still needs to be carried out"

He did however said that the infections at Mandarin Orchard were a “reminder that things can go wrong” and how infectious Covid-19 is.

A report by The Straits Times, which cited several medical experts, suggested that hotel staff could have unwittingly spread the virus to those serving their SHNs.

Asok Kurup, who chairs the Academy of Medicine’s Chapter of Infectious Disease Physicians, told The Straits Times that while ventilation and sewage should be investigated as possible avenues of spread, the “human factor is more likely”.

Another option is the virus spreading through the use of common objects such as towels and bedsheets that were distributed after cleaning.

2) What are the implications of 11 hotel staff having previously been infected?

Serological tests returned that 11 staffers at the Mandarin Orchard had previously been infected with Covid-19, though by the time of the tests they had recovered from the virus.

As undetected Covid-19 cases, these hotel employees would have presumably gone about their daily lives interacting with others in the community.

Could these employees have accidentally spread the virus in the community, and are there now more undetected cases in the community that we’ve yet to pick up on?

MOH announced that as a precaution, it would test the close contacts of these employees for Covid-19 and conduct serological tests.

When the results of these come back, we’ll have a better idea if the impact of the Mandarin Orchard infections will be felt beyond the premises of the hotel.

Regardless, Wong is already convinced that there are already cases in the community that are yet to be detected.

"I am sure the virus is still circulating around in our midst," he told reporters on Dec. 22.

3) Should staff at hotels who facilitate SHNs be required to go through regular testing?

There are several groups of workers in Singapore that have to go through rostered routine testing (RRT).

Under this scheme, workers in targeted groups are required to take a swab test for Covid-19 every 14 days.

Currently, those who have to undergo RRT include workers from:

  • Construction sector and supporting personnel
  • Marine offshore and process sector and supporting personnel
  • Maritime sector and supporting personnel
  • Manufacturing and services workers living in dormitories
  • Front-line workers

Presently staffers at hotels facilitating SHNs, are not required to undergo RRT.

Yet, with there now being a possibility that hotel staff could be infected by imported cases (or vice versa), should the government consider adding them to the RRT regime?

It might be an overreaction to one isolated incident but if MOH’s investigations discover that transmission in such situations is easier than previously thought, that would put hotel staffers very much on the front-lines of Singapore’s fight against Covid-19.

4) How should staycationers feel about this news?

MOH has been at pains to make clear that those serving SHNs at the Mandarin Orchard were housed in a dedicated tower and floors at the hotel.

They were segregated from all other guests, and no interaction was allowed.

As a precaution, Mandarin Orchard has stopped accepting new guests and existing guests have also been checked-out while the restaurant and event spaces within the hotel have also been closed.

So should staycationers stay away from hotels where SHNs are being served?

Once MOH has determined how exactly the virus was passed around in the hotel, those looking for a local getaway will have more information to make an informed decision.

But hotels too could come forward with their protocols in these situations, perhaps letting prospective guests know where exactly SHNs are being served, if staff working in those areas ever handle work related to non-SHN guests, and if their employees have been tested for Covid-19.

These would provide an assurance to staycationers who without a doubt, will be looking for a peaceful getaway this December period.

Whatever the case, the infections at the Mandarin Orchard are a good reminder to heed Wong's words:

"Do not push the boundaries. This is not the time to let our guard down. This is not the time to think that, you know, we are safe, Singapore is very safe and therefore, we can afford to push the boundaries, relax and just enjoy ourselves with large gatherings."

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