While attempts to stem the spread of Covid-19 has led to the shutdown of virtually all economic and social activity in Singapore, life grinding to a halt in the city-state is giving rise to a different public health issue: poor mental health

Dr John, a Singaporean physician in his late 30s, hasn’t gotten much sleep since February, when national authorities heightened the city-state’s public controls to contain the Covid-19 outbreak.

For John, a family physician who preferred not to be identified by his real name, the stress of his job that month turned to panic after one of his patients was infected by the novel coronavirus.

Even though he had just one encounter with the patient for whom he conducted a physical examination, Dr John’s thoughts leaped when he realised the patient was diagnosed positive, racing as he thought of how he could share the news with his own family, which includes an infant son.

And then paranoia set in. What if the other patients he had seen, or subsequent ones, were also carrying the virus?

“This virus has affected me tremendously,” he told the Globe. “I feel like I have been attacked on all fronts, financially, emotionally, spiritually.”

Overwhelmed with stress and anxiety, Dr John cut half of his patient load over the last two months and began to seek help via tele-counselling sessions.

“There was a time of wondering if there was enough personal protective equipment for healthcare workers, and then all my investments tanked,” said the doctor in his late 30s.

The ongoing march of the global pandemic has clearly affected the lives of those who have been tested positive, but there is another, more insidious, crisis creeping up on those who have not – one with a reach that may be more widespread.

“Covid-19 is more a mental challenge than a physical disease for many of us,” said Dr Leong Choon Kit, who runs Mission Medical Clinic in Hougang.

Dr Leong said he’s personally counselled more than 15 colleagues in the past month who have exhibited illogical and irrational behaviors.

“Very early in the outbreak, a former classmate called me up out of the blue and asked me to look after his sons if he dies. And he insists that I must agree to explain to them how he ‘died’ from the virus,” he recalled.

But it’s not just the frontline workers whose mental health has taken a hit.

Business owner Fareed Mohammed now clocks about four hours of sleep each night, down from his usual seven. The director of powerEDGE – a firm that provides on-site power and utilities training on-site – spends his new waking hours fretting about how badly his business will dip.

His company has already been hit by the economic fallout of the novel coronavirus outbreak and now Mohammed must consider how to be responsible to employees while keeping the firm afloat.

“It keeps getting worse, and worse and worse,” he said, referring to the tightening measures put in place by the Singaporean government to control the spread of the contagious disease.

The mounting shutdowns have led many organisations to make contingency plans only to scrap them soon after. Earlier this month, state authorities ordered most workplaces closed temporarily, excluding those that provide essential services or are in key economic sectors, in a social distancing plan the state is calling a “circuit breaker”.

Fareed Mohammed now clocks about four hours of sleep each night, down from his usual seven, due to Covid-19 stress. Photo: Supplied

Then, on April 21, that initial one month shutdown was extended to at least June 1.

Employers can take this time to demonstrate care for their employees, said Frieda Chan, a social worker with non-profit organisation Unity Movement.



“One way is by offering counseling or some form of mental health assistance,” Chan suggested. “This is an opportunity to send a signal that they care. Such investments can go a long way.”

But even for business leaders like Mohammed, the restrictions have already taken a toll.

“Has this crisis affected me mentally? You bet,” he said.

Fareed isn’t alone in that. Victor Pok directs Vivakids, a social enterprise that runs enrichment programmes for youngsters, and said the pandemic conditions have only heightened his pre-existing anxiety.

That’s not only due to the uncertainties surrounding his business, but also because his family members weren’t on the same page regarding the seriousness of the pandemic – at least not initially.

“My wife was quite cool about it at first, so my daughter thought her father was overly paranoid,” Pok said. “Then my own mum was a source of my stress because I couldn’t get her to stay at home.”

His anxiety flaring, Pok confessed he’s been coping mostly by stress eating.

The emotional well-being of Singaporeans came under the spotlight earlier this month when members of parliament pushed for greater access to mental health support in the city. The national health ministry had previously maintained that psychological treatments would be considered non-essential, with only some exceptions.

Singaporean parliamentarian Anthea Ong said the social magnitude of this outbreak has been overwhelming for many because of its “widespread and multilayered problems”, ranging from health to jobs and businesses.

“When we have little control in the midst of the public health and economic crisis, feelings of anxiety can naturally arise. The fear of death is usually greater than death itself, especially when there’s still no cure or vaccine in sight,” said Ong, a social entrepreneur and founder of Hush Tea Bar and A Good Space co-op.

We have to address the social and psychological aspects of this outbreak. Don’t forget that the post-traumatic stress will linger with us even after the virus blows over Singapore general surgeon Ganesh Ramalingam

Ong stressed in parliament that, as community activities cease, many senior citizens will be left to “battle loneliness”.

Many have also spoken up for the mental state of migrant workers – nearly 20,000 of whom are now quarantined after a number of Covid-19 clusters have emerged among their dormitories.

Cai Yinzhou, an advocate for the community, has stressed the need to address their mental health while they are cooped up in isolation. Volunteers from the informal COVID Migrant Support Coalition have put up short tutorials online, through which they can learn a new language or skill, such as photography.

Non-profit group Healthserve has also put together an online resource – available in English, Mandarin, Tamil, and Bengali – providing information on how to manage stress, anxiety and fear.

Ganesh Ramalingam is a Singapore general surgeon who has urged the state and individuals not to disregard the pandemic’s impact on mental health. He notes the number of patients walking in with complaints of gastric reflux or gallbladder infections has tripled over the past few weeks, a spike he says could be due to the stress and anxiety brought on by the Covid-19 outbreak.

“We have to address the social and psychological aspects of this outbreak,” Dr Ramalingam said. “Don’t forget that the post-traumatic stress will linger with us even after the virus blows over.”

Mental Health Tips Several health practitioners and advocates recommended to the Globe some methods for keeping calm and carrying on during these troubling times: Acknowledge your feelings (and those of your loved ones)

Let everyone have an opportunity to express their fears and anxiety. “Don’t pretend the problems are not there or that these problems will not affect us,” Dr Leong said. “Face it square on.” Keep hobbies in your routine

Continue to do the things that add value to life. For some, this may be listening to music, screening a movie or going for a socially distanced walk in the park. Iconic arts institutions, such as The Metropolitan Opera, and many Broadway productions have started offering free streamings for online viewers. Amazon’s audio platform Audible has also released hundreds of its titles for free to ease cabin fever for those at home. Learn a new skill and clean up bad habits

Graphic designer and part-time yoga instructor Benny Ong said the authorities’ advisories to stay home have motivated him to take up online classes to “enhance his knowledge and teaching skills.” It has also prompted him to “eat clean, healthy and less.” “It is a good time to educate my family about eating what we need and not wasting food,” Ong said. Stay connected

Staying in touch with distant friends and family is easier than ever with video calling applications like Zoom and FaceTime. Singaporeans have also found creative ways to “hang out” with friends at virtual happy hours, film screenings and board game nights. Watch out for neighbours, especially the elderly

At a time when social workers are no longer knocking on doors as regularly as before, it’s all the more important for community members to look out for one another. “Those who feel suffocated from social isolation must also learn to reach out, especially now that their concerns are less visible,” said behavioral coach Evangeline Yeh, who founded and directs Unity Movement. Evangeline Yeh and Frieda Chan of Unity Movement. Photo: Kelly Ng Deepen familial bonds

Being stuck at home has presented an opportunity for family members to reconnect and deepen their bonds. “I’ve heard some friends say they are not used to facing their spouses for this many hours and are at a loss for what to do,” said Frieda Chan, a Unity Movement social worker. “Time to hark back and find inspiration from your dating days.” Count your blessings

Ms Ong suggested using this opportunity to start a daily practice of being grateful for what we have now – tangible and intangible – even as we deal with the fear of potential loss. “You can do this as a gratitude journal at the end of each day, or as a family, at the dinner table, with each other.”

For those who have mastered such tactics, pandemic conditions can be a time to slow down and reclaim their time. Social leaders hope that when the battle with Covid-19 finally comes to an end, Singapore will emerge as a more united and resilient society.

The crisis has rallied residents of the country in a way not seen for a long time, Ms Ong remarked.

“I am embracing this change with a lot of hope because never have I seen so much of a community spirit, of a Singapore slowing down in the rat race and giving appreciation to those performing essential services who are often invisible and underappreciated,” she said.