Demographic shift in COVID-19 patients in Singapore from an aged, at-risk population to young migrant workers with reduced risk of severe disease

Ngiam, Jinghao Nicholas; Chew, Nicholas; Tham, Sai Meng; Beh, Darius; Lim, Zhen Yu; Li, Tony; Cen, Shuyun; Tambyah, Paul Anantharajah; Santosa, Amelia; Sia, Ching‐Hui; Cross, Gail Brenda

doi:10.1016/j.ijid.2020.11.157

Cited by 43 publications

(52 citation statements)

References 26 publications

(18 reference statements)

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“…The narrative of COVID-19 in Singapore during the period of study was largely dominated by outbreaks in foreign workers’ dormitories involving young, relatively healthy men who were asymptomatic or mildly symptomatic [ 30 ]. This translated to one of the lowest case-fatality rates in the world.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

Lim

Shahidah

Saffari

et al. 2021

IJERPH

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This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended adult OHCA during the pandemic (January–May 2020) and pre-pandemic (January–May 2018 and 2019) periods. Pre-hospital return of spontaneous circulation (ROSC) was the primary outcome. Binary logistic regression was used to calculate the adjusted odds ratios (aOR) for the characteristics of OHCA. Of the 3893 OHCA patients (median age 72 years, 63.7% males), 1400 occurred during the pandemic period and 2493 during the pre-pandemic period. Compared with the pre-pandemic period, OHCAs during the pandemic period more likely occurred at home (aOR: 1.48; 95% CI: 1.24–1.75) and were witnessed (aOR: 1.71; 95% CI: 1.49–1.97). They received less bystander CPR (aOR: 0.70; 95% CI: 0.61–0.81) despite 65% of witnessed arrests by a family member, and waited longer for EMS (OR ≥ 10 min: 1.71, 95% CI 1.46–2.00). Pre-hospital ROSC was less likely during the pandemic period (aOR: 0.67; 95% CI: 0.53–0.84). The pandemic saw increased OHCA incidence and worse outcomes in Singapore, likely indirect effects of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

Lim

Shahidah

Saffari

et al. 2021

IJERPH

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“…We used data from the COVID- cases, 16 and (2) dormitories housing migrant workers. 9,15 Surveys were administered in participants' native languages (English, Bengali, Tamil, or Mandarin), and were available in both written text and audio recordings to ensure access regardless of literacy level.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…For example, having borne the brunt of infection clusters, many migrant groups have come under extended quarantine protocols as governments acted to control the COVID-19 spread. [13][14][15] Relative to the general population, migrant workers have also experienced heightened threats of financial instability, and decreased access to official COVID-19 information. [4][5][6] Together, these factors emphasize the need for cohort studies assessing the mental health burden of COVID-19 within this population.…”

Section: Introductionmentioning

confidence: 99%

Mental Health of International Migrant Workers Amidst Large-Scale Dormitory Outbreaks of COVID-19: A Population Survey

Saw

Tan

Buvanaswari

et al. 2021

Preprint

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SummaryBackgroundIn the COVID-19 pandemic, international migrant workers have faced increased vulnerability on account of their status. This study examined the mental health burden of COVID-19 amongst low-waged migrant workers involved in large-scale dormitory outbreaks within Singapore.MethodsBetween 22 June to 11 October 2020, questionnaires were distributed in-person and online to 1011 migrant workers undergoing movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with each DASS-21 subscale.FindingsComplete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore).InterpretationThe risk factors identified underscore how the ongoing pandemic may impact the mental health of migrant workers. At the same time, we observed resilience within the cohort, with no evidence of increased symptomology (relative to the general population).FundingJY Pillay Global Asia GrantResearch in ContextEvidence before this studyWe searched PubMed and Google Scholar for articles published in English between Jan 1, 2020 and Feb 20, 2021 using the following keywords: (“COVID*” OR “coronavirus”) AND (“mental*” OR “psychiatr*”) AND (“labo*r migra*” OR “migrant work” OR “foreign-work” OR “immigrant work” OR “economic migra*” OR “economic immigra*”). Focusing on international migrant workers employed in low-wage manual labour positions, we identified commentaries and interview-based studies describing the stressors faced by workers during the COVID-19 pandemic. However, we found no study documenting mental health symptoms within this group.Added value of this studyTo our knowledge, this is the first mental health survey of low-wage migrant workers during the COVID-19 pandemic. We observed that the mental health burden was highest amongst participants who encountered pandemic-related adversities (complete movement restrictions, testing positive for COVID-19), perceived the situation negatively (being fearful of their health or job, or judging their health to be poorer), or had higher exposure to COVID-19 rumours.Implications of the available evidenceOur findings provide a basis to identify and support at-risk migrant workers during the pandemic. Although we did not observe elevated rates of depression, anxiety, and stress symptoms within the migrant worker cohort, individual workers who experience poor mental health may find it harder to access health-care services (relative to the general population). Correspondingly, targeted support for at-risk migrant workers may serve to reduce mental health inequalities.

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“…This policy allowed the unique opportunity to characterize and evaluates a large number of COVID-19 patients, with or without the presence of fever. 10 …”

Section: Introductionmentioning

confidence: 99%

Fever as a predictor of adverse outcomes in COVID-19

Chew

Ngiam

Tham

et al. 2021

QJM: An International Journal of Medicine

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Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. We examined the associations between symptomology, presence of fever, and outcomes of a COVID-19 cohort. Methods Between 23rd January to 30th April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into 4 groups based on symptomology and fever – Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic, Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (p = 0.003), C-reactive protein (CRP) levels (p < 0.001) and lymphopenia (p = 0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, p = 0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (p < 0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, p = 0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin, CRP. Presence of symptoms was not associated with the composite end-point. Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.

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Demographic shift in COVID-19 patients in Singapore from an aged, at-risk population to young migrant workers with reduced risk of severe disease

Cited by 43 publications

References 26 publications

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

Mental Health of International Migrant Workers Amidst Large-Scale Dormitory Outbreaks of COVID-19: A Population Survey

Fever as a predictor of adverse outcomes in COVID-19

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