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So much ink has been spilled on Singapore’s healthcare and public health response to the ongoing pandemic. Yet, there will be an end to COVID-19, and the start of 2022 feels like a good time to shift some of the public focus to our country’s long-term, pandemic-linked social challenges. In this short episode, I summarise the most urgent and obvious problems – migrant, healthcare, and economically disadvantaged essential workers – before detailing four challenges which have received less attention: First, the harm to children, adolescents, and youths; second, compounded socio-economic inequality; third, social isolation; and fourth, ambiguous loss and unresolved grief.

This episode is part of the podcast’s fifth season (https://socialservice.sg/podcast/). The feature photo is by Ng Shi Wen.

Click here to listen to the episode. A transcript is available at the end of this post.

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Transcript

So much ink has been spilled on Singapore’s healthcare and public health response to the ongoing COVID-19 pandemic. Even more ink will be spilled in the coming years and decades to evaluate how effectively the government has managed the pandemic. Our country has remained in DORSCON (“Disease Outbreak Response System Condition”) Orange since February 7, 2020. That’s over 716 days ago. And since then Singaporeans have lived through a circuit-breaking lockdown, a general election, a heightened alert phase in response to the Delta variant, and most recently a stabilisation phase with a successful vaccination drive and gradual reopening in advance of the Omicron variant. In other words, we are hoping to live with the COVID-19 virus as it ultimately becomes endemic.

Alongside politicians and policymakers, healthcare and public health experts as well as frontline workers will continue to reflect the lived experiences of Singaporeans, many of whom are understandably stressed, frustrated, anxious, confused, and maybe just tired of it all. Yet, there will be an end to the pandemic, and the start of 2022 feels like a good time to shift some of the public focus to our country’s long-term, pandemic-linked social challenges.

None of these social challenges are new. They existed before COVID-19 and were only further exacerbated or made more apparent by the pandemic. The common threads in confronting the problems are those related to building slack and redundancy in our socio-economic systems and those which prioritise structural or systemic fixes over those which disproportionately rely on individuals. For instance, it’s about moving beyond just individualised solutions such as self-care, peer support, and individual resilience.

Stating the urgent and the obvious

But let’s start with the challenges which need little to no exposition, because they have been the most urgent, obvious, and pernicious. Despite extremely high rates of vaccination and public-health experts repeating that dormitory restrictions have few public health benefits, nearly 300,000 migrant workers are still not allowed to leave except for work. There’s been some slow relaxation with up to 21,000 workers each week spending some time outside the dormitories, but this supposed milestone has been paired with embarrassing news reports of poor hygiene, low quality food, and dirty communal kitchens in the dormitories. To have workers describe their living conditions as prison-like and captive-like is, as former ambassador Tommy Koh wrote, “disgraceful”.

And similar concerns extend to foreign domestic workers, many of whom may have had their freedoms and movements severely circumscribed.

At the frontlines, whenever news headlines scream about our healthcare system being under stress as a result of spikes, healthcare workers and doctors are the ones who process the increased bed and ICU capacities for COVID-19 patients, while having to still dispense with their regular responsibilities. At the very least, concerns over their heavier workload, 80-hour work weeks, as well as sleep deprivation and exhaustion have been raised in parliament. Still, as these essential workers continue to burn out, process trauma and distress, or even deal with belligerent patient behaviour, many will continue to leave the profession in the near future so to protect their long-term well-being.

Similarly, many essential workers, including those in healthcare, are not necessarily well-compensated. Improving labour and wage conditions for these workers also bring much-needed attention to Singaporeans who are economically disadvantaged. Research in the past two years has highlighted poverty, food insecurity, and housing insecurity as issues of very immediate interest.

Finally, the brouhaha over the contact-tracing programme TraceTogether and the revelation that its data could be used for criminal investigations should not be forgotten. In the aftermath of the pandemic, as public health experts have emphasised, the conversation should ultimately shift to how and when the use of digital tools such as SafeEntry and TraceTogether would be phased out.

“Accept[ing] more harm to children in exchange for less harm to adults”

But some important social challenges have received less attention in Singapore. I highlight four, taking them in turn: First, the harm to children, adolescents, and youths; second, compounded socio-economic inequality (and not just poverty and income inequality); third, social isolation; and fourth, ambiguous loss and unresolved grief.

Unlike the 1918 influenza pandemic which killed young adults and made school-going children the most ill, the young have been spared the worst medical consequences throughout the ongoing pandemic. However, the emotional and psychological well-being of children, adolescents, and youths – in Singapore and around the world – have been adversely affected. An NYT (“The New York Times”) newsletter said the following: “For the past two years, Americans have accepted more harm to children in exchange for less harm to adults.” It cited data of the young falling behind in school, learning loss and academic under-achievement, mental health problems and suicide attempts, gun violence, social isolation, as well as behaviour problems.

In Singapore, it was also acknowledged in parliament that about 20 per cent of youths have had poor or very poor mental health. Many have been struggling with COVID-19 stressors, keeping up with their studies, and negotiating a proper work-life balance. Even though school closures and disruptions have been comparatively limited, which hopefully reduced the extent of learning loss, the country’s young have lost a great deal. Within schools traditional formats for co-curricular activities and celebratory events such as graduation and prom and parties are a thing of the past. Like everyone else young Singaporeans have not been able to gather in large groups, but adolescence is an especially important socialisation phase during which friendships and new relationships and even inter-personal conflict and strain are negotiated. The pandemic has since taken all of these away, to the detriment of children, adolescents, and youths.

It should be quickly noted too that those who work with the young also bear the brunt of the pandemic: Teachers, school leaders, mentors, counsellors, social workers, caregivers, parents. As an ST forum letter headline read in October 2021, “My wife’s a teacher. Can I have her back with the family please?”

Compounded socio-economic disparities

And among the young and everyone else, as it has always been, those from low-income households and those who are socio-economically disadvantaged and marginalised are most likely to have suffered the most. A common example involves universal digital access, made especially apparent during the circuit-breaker when some students, ostensibly on home-based learning, lacked the necessary tools and Internet access. An NUS (“National University Singapore”) research report has highlighted the necessary digital resources of computing devices, Internet connection, and digital literacy for communities in need.

It is not just about poverty and income inequality per se. The claim that those who are more well-connected and more privileged would potentially emerge from the pandemic even better positioned is not controversial. We risk the advantaged making further strides and those who are not being left further behind, thereby compounding socio-economic inequality in the long-term. For example, students who are more well-resourced are more likely to have taken advantage to advance themselves, while those in low-income households might have to take on extra employment or caregiving responsibilities, thereby taking time away from personal development. There was a neat analogy in an NYT editorial, that “even a first-class ticket on the Titanic is still a ticket on the Titanic.” The quote was in the context of the United States still facing a public-health crisis, but is also applicable to the growing social implications in Singapore.

Socially isolated

The third challenge is that of social isolation. Thus far initiatives have justifiably focused on the elderly, those who have healthcare needs, as well as Singaporeans with disabilities and those who are immunocompromised. In addition to the prolonged harm to children, adolescents, and youths, as we’ve highlighted, everyone in Singapore has missed family and extended-family gatherings, in-person community and neighbourhood events, and the ability to get together socially with friends without worrying about compliance with COVID-19 regulations. In other words, we’ve lost both spaces and opportunities to socialise.

A quick related note should be made about these spaces and opportunities. Throughout the pandemic the F&B (food and beverage) sector and artists involved in public entertainment have been clamouring for greater support, and as of this recording these is a #savemusicsg social-media movement to bring attention to the importance of live music and the nightlife in Singapore. It is also not uncommon these days to read about struggling F&B businesses having to close down to barely making ends meet.

“Every death is a human, is someone’s parent, grandparent, or loved one”

Finally, in Singapore, we’ve been lucky that per-capita deaths and serious cases of hospitalisations have been low. However, as American epidemiologist Michael Osterholm likes to remind us: “Every death is a human, is someone’s parent, grandparent, or loved one.” Yes, many Singaporeans die of different and natural causes every day. Yes, death is part of our lives. Yes, many of those who die from the virus were old and ill and unvaccinated. Nevertheless, the ways and rituals through which we mourn and remember those we have lost have also been altered by COVID-19.

Social scientist Pauline Boss has popularised the concepts of ambiguous loss and unresolved grief, about how we struggle to get closure when our losses are hard to pin down. In the context of many of us grieving for someone or something we have lost during the pandemic, she wrote: “It is not closure you need but certainty that your loved one is gone, that they understood why you could not be there to comfort them, that they loved you and forgave you in their last moments of life. Without these things, some doubts may linger for you, but that is the nature of loss. Its ending is never perfect, even in the best of times.”

In more ways than one I don’t think we, collectively as Singaporeans, have had the time or space to process what the COVID-19 pandemic has taken away from us. Between changing viral variations and evolving public-health measures and leading lives, day to day, to the best of our abilities, everyone has been cognitively stretched. Our moment to properly take a breather will come. It’s not quite here yet, but it will. And when that happens, as we take stock of our losses, those of us – more privileged and advantaged than most – ought to keep an eye and act upon these many social challenges coming our direction. In many ways, our collective recovery is just beginning.