Academic Medicine In Conversation:

Associate Professor Chow Wan Cheng
Group Director, Academic Medicine, SingHealth
Senior Associate Dean, Academic Medicine, Duke-NUS Medical School

Dr Limin Wijaya
Deputy Director, Undergraduate Education, Medicine Academic Clinical Programme
Senior Consultant, Department of Infectious Diseases, Singapore General Hospital

Panellists:

Professor Gregory C. Gray
Professor, Medicine, Global Health, and Environmental Health, Duke University
Professor, Program in Emerging Infectious Diseases, Duke-NUS Medical School

Professor Lee Chien Earn
Medicine Academic Clinical Programme
Deputy Group CEO (Regional Health System), SingHealth

Professor Tan Ban Hock
Medicine Academic Clinical Programme
Chief Quality Officer and Senior Consultant, Infectious Diseases, Singapore General Hospital

Dr Lim Su Fee
Deputy Director, Nursing (APN), Singapore General Hospital

Dr Lim Chee Tiong
Deputy Director, Operations, GCOO's Office, SingHealth

Ms Cheryl Lau
Senior Community Manager, Community Care, Changi General Hospital

​Interconnected in One Health: Red Flags in a Pandemic

The One Health approach has come to the fore amidst COVID-19, when human health is shown to be inextricably linked to our environment, food source safety and animal wellness.

• Interest and introduction to One Health: Emerging infectious diseases (EID), multi-drug resistant organism (MDRO) and food security.
• COVID-19 raising concerns across One Health dimensions: Food, people and environment.
• Moving beyond clinical determinants for health
• High relevance of One Health for Singapore: A country dependent on external food sources and overseas trade

Global efforts in containing COVID-19 have underscored the importance of a One Health approach to the island country of Singapore where food is imported and human density is high.

Professor Gregory C. Gray weighed in from Duke University in USA, addressing the intricacies of our interconnected world and its impact on emerging infectious diseases (EID) and causation of multi-drug resistant organisms (MDRO).

"The complex issue of antimicrobial resistance is very real," Prof Gray shared. He highlighted how antibiotics usage for livestock and poultry can create "resistant organisms which move with animals to the dinner table".

Addressing a multi-faceted issue

Prof Gray's point hit close to home as Singapore's off-shore food sources raise challenges to food security in the event of viral outbreaks.

As an Infectious Diseases specialty clinician, Professor Tan Ban Hock described clinicians who have had to firefight when treating MDRO-profile patients without antibiotics frequent usage histories.

To avoid increasing incidences of such patients, Prof Tan believed that ensuring food safety was crucial to health outcomes in addition to antibiotic stewardship and clinical environment improvements.

He shared that the approach to address the concerns of MDRO must be multi-pronged, citing it as a "supranational, trans-boundary issue".

"The One Health initiative worldwide has led to the establishment of a Food and Agriculture Organization (FAO) of the United Nations, with countries coming together to address this problem of food security and widespread antibiotic use in agriculture and even in aqua culture," Prof Tan said.

COVID-19 raised existing concerns

Associate Professor Chow Wan Cheng invited panellists Dr Lim Su Fee and Ms Cheryl Lau to share their insights on community healthcare work.

Assoc Prof Chow highlighted that healthcare sectors were no longer working in silos, as the community explored connections between the environment and public health.

Dr Lim and Ms Lau examined the issues faced by Singapore's vulnerable demographic and concerns of their food sources and living environments, both red flags in a pandemic.

Many vulnerable individuals rely on assisted food delivery while potentially living in one-or two-room government rental flats, which have no restriction on the number of related family members living together.

While safe food delivery continued in COVID-19 due to the cohesion of long-term community partners, overcrowded apartments had raised an alarming threat to epidemic prevention.

Due to the nature of infectious diseases, overcrowded living quarters directly heightened risks of infectious diseases spread through human interaction in compromised environments or public spaces.

"The best healthcare system may not give best health outcomes if the environment is not healthy," Professor Lee Chien Earn said of environmental issues being an important component when moving beyond clinical determinants of health.

Sharing from a Regional Health System perspective, he was mindful of moving the "paradigm from just looking at healthcare to looking at health".

A need for flexible emergency environments

Dr Lim Chee Tiong related his experience volunteering at the Expo Community Care Facility (CCF), sharing his takeaway from the stint as an engineer and hospital operations specialist.

With COVID-19 being an airborne disease, air quality was of utmost importance at the isolation facility. He detailed the makeshift isolation facility managing healthy airflow and sustaining negative air pressure, in addition to managing threats of dengue and chicken pox outbreaks.

With that experience, Dr Lim reflected on how it was ever more important for healthcare facilities to have flexible ventilation systems designed for emergency deployment.

Echoing the link between environmental factors and health, Dr Wijaya highlighted research by Dr Tiew Pei Yee, which established that flora in the environment closely affected airway microbiome and health outcomes due to its influence on chronic obstructive pulmonary disease (COPD) exacerbation frequency.

Preventive defense against pandemic threats

Prof Gray underscored the significance of a One Health approach for human-animal nexus and pneumonia etiology studies, so that viruses can be anticipated before they become a real threat.

Already, new roles and technology are sustaining multi-dimensional One Health activities in USA, China, the Philippines, Singapore, Pakistan, Iraq, Mongolia, Vietnam and Malaysia.

In concluding, Prof Gray highlighted that Singapore stands to benefit should it aggressively embrace "pre-emptive surveillance and deployment of One Health studies [that] can mitigate pandemic threats".