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From Surviving SARS to Coping with COVID-19

Nearly 17 years after SARS, another hidden enemy arrives at our shores. This enemy may have a different name, but its objective is the same – to infect and harm. For Nurse Manager (NM) Connie Ong, the enemy may have changed, but the battlefront remains the same. Connie reflects on her experiences from surviving SARS, to coping with COVID..

We turn back the clock to 2003. Connie was a Senior Staff Nurse in the National Cancer Centre Singapore. She was in charge of Clinic D and responsible for providing clinical guidance to staff nurses and junior staff. SARS crept up and cast its shadow across Singapore, causing widespread fear and panic.

In response, NCCS reduced clinic services by half and instituted two staff teams on rotation. One team would work for two weeks, while the other team would be put on standby at home and vice versa. This was to limit the cross infection of staff. Connie was transferred to Clinic A to help in the medical oncology clinic.

“If everyone in healthcare stopped working, who else would help patients?”

Take us back to 2003, how did you feel during the SARS epidemic?

Personally, I was really very fearful because we knew so little about the disease. Many of us were scared and anxious. At the time, it was an unknown virus, with unknown causes and fatal outcomes. Little to no information was available. We were literally dealing with an invisible, unknown enemy.

In April 2003, SGH was hit by the SARS outbreak. Just days after, a doctor from Tan Tock Seng Hospital (TTSH) and another from SGH died from SARS. The back to back news reports of healthcare workers dying from SARS really scared us. The fear hit even closer to home when I received news that an ex-colleague from TTSH had also lost their life because of SARS.

Photo credit: WE BEAT SARS, Public Service Division

What was it like as a nurse on the frontlines?

Morale was really low, because of pressure from patients, the public and our loved ones. Family members were fearful and pressuring some nurses to resign from their jobs because of the unknown risks. Neighbours didn’t dare to share the lift with us and taxis avoided picking healthcare workers up. When people saw us in uniform, they would turn and walk in the opposite direction. There was little knowledge of what was going on or how to handle the crisis.

Some of my colleagues were also worried about bringing the virus home to their family. We had our meals alone and could not interact with colleagues. We would talk very little because the N95 masks made it difficult. All these made us feel isolated and alone. The only time we could talk was those fleeting few minutes when we de-gowned from our PPE at the end of the day. Even then, we were too tired to speak. But we would try our best to encourage each other by saying little things like “tomorrow will be a better day”. Somehow, that kept us going.

Photo credit: WE BEAT SARS, Public Service Division

What was it like for you and your family?

At the time, my children were young and I was scared of passing anything to them. I deliberately came home late to avoid too much interaction with my children. It was a difficult time, but I thought to myself: “If everyone in healthcare stopped working, who else would help the patients?”

I was very thankful that my husband and helper were able to support me by taking care of the family and being understanding of my job responsibilities. My in-laws also supported me by boiling tonic soups and sending it over to help boost my immunity.

Were there any incidents that stood out during that difficult period?

My best friend in school called me and told me that her father was admitted to SGH and she asked me to visit him. I was very close to her family and her father treated me like his own daughter. When my friend’s father was admitted, she asked me to visit him. I turned her down.  At the time, we could not move between institutions (from NCCS to SGH) to reduce the risk of transmission. I was also worried about my own safety as the inpatient ward had a greater risk of infection. I wanted to comply with the institutional safety measures. It was a moral dilemma– sandwiched between duty as a friend and my duty as a nurse. I made the difficult choice to uphold my duty and not visit and avoided her calls. Her father passed on subsequently. I was greatly affected by the news. I felt the pain and guilt of not being there to support her. We’ve since lost contact with each other. It still pains my heart that our friendship was affected and that I had missed the chance to pay my respects to my friend’s father. Looking back, I could have handled the situation better by offering her emotional support. SARS was such a challenging period for all of us in healthcare.

Leading from the Front: Nurse Manager Connie on duty in the isolation room. Patients who need cancer treatment but exhibit symptoms like cough, sneezing or fever are isolated in this room away from other patients. All precautions are taken and nurses don high levels of personal protective equipment.

Coming back to the present, what is your role now?

I’m currently the Nurse Manager in Clinic A & B. In a leadership position, I see things very differently now compared to when I was a staff nurse in 2003. Now, I have a greater responsibility leading the staff to be ready and prepared to deal with the current situation.

How do you feel now?

COVID-19 feels like a similar enemy, so it’s natural to feel concerned, but I’m not as fearful as I was in 2003. We are ready with policies, protocols and processes to manage the challenge.

In the clinics, we work together closely as a team. Leaders work on the ground alongside my staff, so that they are supported and motivated.

What’s different between now and then?

We’ve definitely learnt lessons from the past. Plans are already in place for such a crisis and our healthcare standards and capacity have improved since 2003 when SARS struck. We now have better ways of doing things – from policies, supplies of equipment to medical technology. I feel that the public is more aware and responsible –maintaining social distance and masking up. Information is up to date and rapid, communication is so much better.

Speaking of better ways of doing things, in 2003 I remember having to keep a little notebook with me to record my movements for contact tracing. You had to write down where you had gone and who you had seen or spoke to. Now it’s either the QR code or TraceTogether app – so much better!

What are some challenges that you still face? How do you cope?

It is tiring being on the frontlines during a crisis. The threat is real and you can’t afford to be complacent. It’s critical to keep standards to ensure the safety of our patients and our staff. On days when we have the chance to release a staff member from work a little early, we know that the extra hour of rest or time with the family means so much. 

All of us –healthcare workers, the community and authorities need to work together like a family to battle this virus. Just like 2003, these are challenging times but we can overcome this challenge.