Workplace Occup Environ Med: first published as 10.1136/oemed-2020-106626 on 8 June 2020. Downloaded from SHORT REPORT Migrant workers and COVID-19 David Koh 1,2 1Institute of Health Sciences, ABSTRact Key messages Universiti Brunei Darussalam, Objectives Daily numbers of COVID-19 in Singapore Gadong, Brunei Darussalam 2 from March to May 2020, the cause of a surge in cases Saw Swee Hock School What is already known about this subject? of Public Health, National in April and the national response were examined, and ► Millions of low- skilled migrant workers live in University of Singapore, regulations on migrant worker accommodation studied. housing conditions where social distancing is Singapore Methods Information was gathered from daily reports difficult to practise, with poor hygiene. During provided by the Ministry of Health, Singapore Statues a pandemic, these housing sites could be flash Correspondence to online and a Ministerial statement given at a Parliament Professor David Koh, Institute points for spread of infection among these sitting on 4 May 2020. of Health Sciences, Universiti workers. Brunei Darussalam, Gadong Results A marked escalation in the daily number of BE1410, Brunei Darussalam; new COVID-19 cases was seen in early April 2020. What are the new findings? david_ koh@ nuhs. edu. sg The majority of cases occurred among an estimated ► From early April 2020, a marked escalation of 295 000 low-skilled migrant workers living in foreign Received 17 April 2020 new cases of COVID-19 was observed among Revised 7 May 2020 worker dormitories. As of 6 May 2020, there were low- skilled migrant workers living in dormitories Accepted 29 May 2020 17 758 confirmed COVID-19 cases among dormitory in Singapore. By 6 May 2020, these infected Published Online First workers (88% of 20 198 nationally confirmed cases). 8 June 2020 workers formed 87.9% of the 20 198 cases of One dormitory housing approximately 13 000 workers cases of COVID-19 confirmed in Singapore. had 19.4% of residents infected. The national response included mobilising several government agencies and How might this impact on policy or clinical public volunteers. There was extensive testing of workers practice in the foreseeable future? in dormitories, segregation of healthy and infected ► Unsatisfactory housing and social overcrowding workers, and daily observation for fever and symptoms. in accommodation for low-skilled migrant Twenty-four dormitories were declared as ’isolation workers need to be addressed before any areas’, with residents quarantined for 14 days. New pandemic occurs. If this is not done, epicentres housing, for example, vacant public housing flats, military of the disease can arise in these housing areas. camps, exhibition centres, floating hotels have been Once they occur, management of these localised provided that will allow for appropriate social distancing. outbreaks have to be swift and comprehensive, Conclusion The COVID-19 pandemic has highlighted in order to avoid spillover infections to the migrant workers as a vulnerable occupational group. general population. Ideally, matters related to inadequate housing of http://oem.bmj.com/ vulnerable migrant workers need to be addressed before a pandemic. stores and remittance services, and are managed by operators regulated by the Ministry of Manpower. The residents are mainly males from South Asia employed in the construction, marine and other INTRODUCTION low wage sectors. In addition, there are about The International Labour Organization (ILO) esti- 1200 factory-converted dormitories (which can on October 4, 2021 by guest. Protected copyright. mates that there are 244 million migrants around the accommodate 50–500 workers) that house another world.1 A significant number of these migrants are 95 000 workers. Another 20 000 workers live in low or semiskilled workers, who live under condi- construction temporary quarters at their worksites, tions that pose concerns of social overcrowding and usually with <40 persons per site.2 unsatisfactory hygiene. While their housing condi- tions have generally improved over the years, the METHODS conditions are not ideal for a pandemic situation. The number of daily new cases of COVID-19 in COVID-19 has highlighted the vulnerability of March, April and early May 2020 in Singapore; the migrant workers as an occupational group. cause of a surge of cases in April 2020; the national Singapore is an island city- state of 721 square response to the huge increase in cases; and regu- kilometres and a population of 5.7 million residents. lations on migrant worker accommodation were © Author(s) (or their It has over a million migrant workers, among which examined. employer(s)) 2020. No several hundred thousand low- skilled migrant Information was gathered from daily reports commercial re- use. See rights workers live in dormitories. Approximately 200 provided by the Ministry of Health, Singapore.3 and permissions. Published thousand workers are housed in 43 large purpose- These reports provided information on the number by BMJ. built dormitories of over a thousand residents. of newly diagnosed cases, and the distribution To cite: Koh D. The larger dormitories can house 3000 to 25 000 of the cases among imported cases who arrived Occup Environ Med workers and are designed for communal living, to Singapore from overseas, and non- imported 2020;77:634–636. with common recreational facilities, mini grocery cases. The non- imported cases are categorised 634 Koh D. Occup Environ Med 2020;77:634–636. doi:10.1136/oemed-2020-106626 Workplace Occup Environ Med: first published as 10.1136/oemed-2020-106626 on 8 June 2020. Downloaded from Figure 1 Number of new cases of confirmed COVID-19 in Singapore, 1 March–5 May 2020 [Source: Ministry of Health]. into Community Cases (residents and employment pass holders The national response excluding work permit holders and dormitory residents), work The national response was swift and comprehensive. A multi- permit holders not residing in dormitories and work permit agency task force including health, manpower, military and holders residing in dormitories. police personnel was immediately formed. Among the sweeping Migrant workers in Singapore can either hold an Employ- measures implemented were extensive testing of dormitory ment Pass or a Work Permit. Skilled workers earning more than workers, segregation of healthy and infected workers, observa- SGD3600 per month hold employment passes, while Work tion for fever and symptoms several times a day, and setting up Permit holders are semiskilled workers working in the construc- of dormitory on- site healthcare facilities. tion, manufacturing, marine shipyard, process or services sector.4 The local community also helped in the response. Within days, The principal legislation relating to the housing of migrant websites that offered English to Bengali (tinyurl. com/ covidben- workers in dormitories was examined from the Singapore gali) and English to Tamil translations (http:// better. sg/ migr antw 5 Statues online website. Additional information was gathered orke rtra nsla tions) to medical care teams were developed. This from a Ministerial statement given in a Singapore Parliament helped overcome the language barrier and allowed non- Bengali 2 sitting on 4 May 2020. and non- Tamil- speaking healthcare workers to conduct an initial consultation without an interpreter. The websites also enabled RESULTS medical personnel to contact a group of volunteer interpreters http://oem.bmj.com/ In Singapore, cases of COVID-19 are confirmed by a posi- directly. About 3000 healthcare professionals signed up to the tive finding of a nasal swab which undergoes PCR testing for SG Healthcare Corps since its launch in April to marshal volun- SARS-CoV -2. The total number of confirmed cases of COVID-19 teers. Many were deployed to assist in the management of the increased from 105 on 1st March, to 226 on 15th March, 926 dormitory infections. on 31st March, 3699 on 15th April, 16 169 on 30th April 2020 Massive logistic arrangements have been made to provide and 20 198 on 6th May 2020 (figure 1).3 housing facilities that will allow for appropriate social distancing. The small rise in cases in March was mainly due to ‘imported’ These included vacant public housing flats, military camps, exhi- on October 4, 2021 by guest. Protected copyright. cases of citizens and long- term residents who returned from bition centres and even floating hotels. Preparations were put other infected countries. They were quarantined or given Stay in place for food delivery, hygiene maintenance, monitoring at Home notices for 14 days on their return to Singapore since and enforcement of quarantine, WiFi for workers to commu- mid- March (depending on which country they returned from), nicate with family and for entertainment and distribution of and were monitored daily for fever and symptoms of COVID- ‘care packs’ that contained reusable masks, hand sanitisers and 19. From 15 to 31 March, 714 new cases of COVID-19 were thermometers. confirmed in Singapore, of whom 439 (61%) were imported cases. A surge of cases seen from early April was caused by a large DISCUSSION number of locally transmitted infections. The majority of the International recommendations for housing standards for new cases occurred among low- skilled migrant workers living in workers have been produced by the ILO.8 In Singapore, dormi- dormitories scattered throughout Singapore. As of 6 May 2020, tories housing over a thousand residents are regulated by