Singapore's Covid-19 Response: Are Migrant Workers' Lives Put At Risk?
7 May 2020
Singapore has had a relatively low death-rate amongst those who have been infected with Covid-19. As at 6 May 2020, we have had 20 deaths out of the 20,198 confirmed Covid-19 cases.
However, there have been other deceased individuals who have been diagnosed with Covid-19, but whose deaths have not been included into the national death tally for Covid-19. To date, we have known of 6 such cases, with 5 of these individuals being migrant workers between the ages of 30 and 50. HOME understands that while one of these deaths was caused by a fall from a height, for the other four cases, the causes of death have not been attributed to complications arising out of Covid-19, but to heart-related issues, such as heart attacks and ischaemic heart disease.
There have been reports of the Covid-19 virus making individuals susceptible to blood clots leading to heart attacks (see here and here), heart damage and strokes, regardless of age.
Distinguishing between deaths from Covid-19 and deaths with Covid-19 is a very technical matter, not understood by many. For migrant workers who have lost their friends and coworkers suddenly, it aggravates their anxiety and stress. Besides stating that these deaths were not due to complications arising out of Covid-19, it has not been clear why they have not been counted into the official tally of Covid-19 deaths. Clearer explanations and reporting deaths due to comorbidities as part of daily situation reports will provide clarity on the parameters which the authorities are using to define whether a death is caused by the disease.
In light of the reports mentioned above, the message that migrant workers are much less likely to become seriously ill with Covid-19 as they are young, ignores the fact that those they may still die from it if complications arise. We are repeatedly told that the graveness of the Covid-19 situation in Singapore is mitigated by the fact that the bulk of the cases are made up of young migrant workers. However, a pattern has emerged, where migrant workers in their 30s and 40s have contracted the disease, and passed away due to heart-related problems. We cannot ignore this phenomenon, and this requires that the authorities acknowledge this issue and offer clear explanations as to why these deaths have not been attributed to Covid-19. The implications of such an acknowledgement are important because workers are still living in crowded rooms and therefore more susceptible to catching the virus. In a survey released by HOME and CARE of 100 workers living in the dormitories, more than 60% said that their rooms are crammed, and 80% said that it was difficult to do social distancing. We are also troubled by accounts by some migrant workers who have tested positive for Covid-19, who face delays in being removed from their crowded rooms to receive medical attention. Our reluctance to reduce the density of the dormitories suggests that we are prepared to let migrant workers get infected as long as it does not spread to the rest of the population: this approach only reinforces discrimination and exclusion of the migrant worker community.
This pandemic requires an examination of the issue of effective access to healthcare that HOME has raised before. Many migrant workers don’t receive regular medical attention, and are afraid of seeing a doctor for fear of incurring higher costs for their employers and losing their jobs. As a result, they may also not be aware of underlying medical conditions they have developed, and may have more adverse clinical outcomes while contracting an unknown disease such as Covid-19. A lack of information from the authorities about how the virus works will only compound this problem as we may be left with more deaths in our migrant worker community due to undetected underlying conditions.
It is widely accepted that little is conclusively known about this disease, so there may not be sufficient data available to share. However, it will be reassuring to our migrant workers to inform them what is known, rather than to state, without clear reasoning, why the deaths of their compatriots have not been classified as having been caused by Covid-19 when they have been diagnosed with the same. Our migrant worker population is anxious as they are aware that they are at high risk of contracting the virus.
Call to Action
We urge for more efforts to reduce the density of dorms. Older patients may not be the only ones susceptible to poor clinical outcomes and living in close proximity with other workers, some of whom may be asymptomatic, will make these workers more vulnerable; and
Reduce opacity around decision making and offering explanations surrounding decisions made by authorities, particularly when it involves life and death matters, strengthens public trust, in how the outbreak among the migrant community is being managed.