​Tan Tock Seng Hospital converted the wards on two floors into areas dedicated to treating Covid-19 patients.ST PHOTO: KUA CHEE SIONG

SINGAPORE - When the severe acute respiratory syndrome (Sars) broke out in Singapore in 2003, Dr Hoi Shu Yin, then a front-line nurse at Tan Tock Seng Hospital (TTSH), saw the uncertainties and damage it caused.

So when the coronavirus cases started to rise in recent weeks, the 41-year-old dug deep into her Sars experience to get the hospital ready to cope with the surge in patients.

Said the deputy director of nursing at TTSH on Monday (April 27): "We learnt a lot from Sars, so our response is one of preparedness, and we're able to anticipate quite clearly what steps to take, even before the situation materialises."

She added: "Even before we saw the exponential surge (in cases), we were already well under way in our preparations."

TTSH, which is under the National Healthcare Group, is one of several hospitals that has had to cope with the spike in infected cases, the vast majority of whom are foreign workers living in dormitories.

It did so by converting the wards on two of its 13 floors into areas dedicated to treating only Covid-19 patients earlier this month.

Also, more than 380 nurses have been trained to support operations at the neighbouring National Centre for Infectious Diseases (NCID), which has had to expand its capacity from 330 to 586 beds.

There are now 230 more beds for Covid-19 patients in TTSH, as well as 36 beds in its Intensive Care Unit (ICU) for those with more severe symptoms.

Dr Hoi and fellow deputy director of nursing Laura Ho, 48, are in the team of 10 nursing leaders behind the changes.

Dr Hoi Shu Yin (left) and Ms Laura Ho, deputy directors of nursing at TTSH. PHOTO: TAN TOCK SENG HOSPITAL

A nurse preparing to don her personal protective equipment in one of the converted wards at TTSH. ST PHOTO: KUA CHEE SIONG

Dr Hoi explained: "Nurses are in charge of the wards, so we have to make sure they are equipped with the right facilities to take care of the patients and ensure their safety. We also have to ensure the environment is set up to keep our staff safe."

Converting a ward into a specialised Covid-19 one is not a simple process. Four main factors are taken into account.

First, the right wards need to be selected for conversion.

Dr Hoi said TTSH avoided converting the wards that deal with cardiac patients, as they have specialised equipment and facilities. Also given a miss are wards with nurses who care for stroke patients, as they have undergone specialised training.

As a result, the chosen ones are the surgical and general medicine wards, as the hospital has other facilities to care for such patients.

Lifts have been set aside to be used solely for admission of Covid-19 patients at TTSH. ST PHOTO: KUA CHEE SIONG

Cordons restrict public access to Ward 11 on the 11th floor of TTSH. ST PHOTO: KUA CHEE SIONG

Second, the right infrastructure needs to be put in place. Giant exhaust fans were installed in some of the chosen wards to turn them into negative pressure rooms, and signs were also put up at the wards to remind staff to take precautions, as they were now in Covid-19 wards.

Third is the human element, said Ms Ho.

It is a balancing act between sending the optimal number of staff to the new wards to avoid exhausting the nurses or compromising patient safety, and ensuring critical operations elsewhere in the hospital are not affected.

Fourth, those deployed must be equipped with the right skills, as some would have previously worked in other wards before being trained to care for Covid-19 patients.

Such nurses were given special training, including drills on how to handle specimens taken from patients or transport patients on the correct route.

There are now 230 more beds for Covid-19 patients in TTSH. ST PHOTO: KUA CHEE SIONG

A rest area for staff in one of the converted wards at TTSH. ST PHOTO: KUA CHEE SIONG

An important part of equipping these nurses and staff is peer support.

Ms Ho said: "The situation can change anytime, we must be ready for any (change). We have to constantly engage the ground to reassure them, to make sure our staff know they're ready."

One beneficiary of such support was assistant nurse clinician Nur Nadia Mohd Nasir, 32, who moved from nursing the elderly to caring for Covid-19 patients in one week.

She said: "Initially, we were all very anxious, but with the support of and encouragement from peers and management, we managed pretty well. It was quite a seamless transition."

Another institution taking measures to cope with the surge is Alexandra Hospital, which is under the National University Health System (NUHS) healthcare cluster.

It has cared for 259 Covid-19 patients since the start of the outbreak, about 200 of whom are migrant workers.

Its spokesman said bed capacity has been expanded by more than 30 per cent, with about 100 beds set aside for coronavirus patients.

The hospital had also converted two empty wards into isolation wards with negative pressure rooms, and converted two general wards into Covid-19 wards for patients who do not need oxygen support.

Three rooms in an isolation ward were converted into ICU rooms.

Overseeing the opening of some of the new wards was assistant director of nursing Doreen Heng, a nurse for 24 years who had previously helped turn a disused ward into a ward for Sars patients.

Ms Heng said: "Due to the fast-evolving nature of the situation, the teams at the hospital have had to be nimble, flexible and efficient in adapting to the changing face of the pandemic."

Ng Teng Fong General Hospital, also under NUHS, has converted coronavirus wards too and turned its Community Hub at Jurong Community Hospital to a housing area for its Emergency Department patients.

It also hastened the training of its nurses, shortened their induction programme and condensed their classroom training from six weeks to three before sending them to the wards.

SingHealth's deputy group chief executive officer Fong Kok Yong said that 14 wards across four of its hospitals had been converted into wards for Covid-19 patients.

In addition, one of SingHealth's hospitals, Bright Vision Hospital, was designated by the Ministry of Health to receive Covid-19 patients who are clinically stable but still require inpatient medical care. In order to fulfil this role, existing patients in Bright Vision Hospital were transferred to neighbouring community hospitals.

Prof Fong said: "The conversion of wards does not, in any way, compromise care for all other patients. For example, at the Singapore General Hospital (SGH), we have been optimising hospital resources by transferring certain groups of patients whose medical conditions are stable to licensed wards in the Outram Community Hospital, which is situated in the same campus. These patients continue to receive quality care from our medical teams at the community hospital."