SINGAPORE - More than for any other sector, Covid-19 has been a trial by fire for the healthcare industry.
As SingHealth's deputy group chief executive of medical and clinical services Fong Kok Yong puts it, the ongoing pandemic is a black swan event, or a severe and unexpected event that caught everyone off guard, forcing the sector to learn, adapt and respond to rapidly changing circumstances.
"Even with preparations and experience with past disease outbreaks such as Sars and H1N1, no health system fully anticipated Covid-19's massive and prolonged impact," he told Insight.
Even the world's most sophisticated health systems, in countries like the United States and Italy, were overwhelmed by the ferocity of Covid-19's spread, with deaths worldwide skyrocketing as hospitals busted their capacity limits.
Fortunately, Singapore's handling of the pandemic meant that its healthcare facilities were not overwhelmed. Healthcare workers were spared the despair that many of their overseas counterparts faced when making impossible choices like which patients to treat and which to allow to die.
Nevertheless, the pandemic has left its mark here.
Professor Fong said that, if anything, it has strengthened Singapore's healthcare system, and many of the radical changes born of necessity may prove to be long-lasting fixtures.
"For SingHealth, Covid-19 was a burning platform that brought about the development and acceleration of healthcare initiatives that benefit patients and improve care delivery," he said.
The nascent field of telehealth, for instance, has now become mainstream in the wake of the widespread adoption of video-conferencing tools like Zoom.
National Healthcare Group Polyclinics (NHGP) chief executive Chong Phui-Nah said the implementation of remote video consultations was a key change made at the group in response to Covid-19.
Last year, it introduced four new telehealth offerings for its allied health services, including remote physiotherapy, dietetics, psychological services and tuberculosis care.
It also began offering telehealth services to nursing home residents who previously had to be transported to a clinic to see a doctor.
Prof Chong said more than 134,000 telehealth sessions were conducted across NHGP's six polyclinics last year.
She added: "While the Covid-19 situation in Singapore has stabilised, NHGP sees telehealth services as the new norm of care, allowing patients who are in-between clinic visits to continue receiving medical care in the safety and convenience of their homes."
Similarly, both the National University Health System (NUHS) and SingHealth reported a marked uptake in telehealth services.
As a result, they have added new telehealth services and ramped up existing ones.
"NUHS is currently working on the expansion of its telehealth services across all institutions within the healthcare cluster in order to offer this service to more patients," its group chief digital officer Peter Forbes said.
SingHealth's Prof Fong said patients have also become more receptive to such services.
This may be especially true for mental health services.
The Department of Psychological Medicine at KK Women's and Children's Hospital, which is under SingHealth, started offering video consultation for patients in February last year.
By October, it had conducted 1,516 sessions for adults and children with mental and emotional health conditions such as mood or anxiety disorders and depression.
Ms Cristina Gonzalez, a counselling psychologist at Alliance Counselling, said video-conferencing lowered the barrier to entry for mental healthcare, with more-accessible online therapy and telehealth in general becoming normalised.
She said some of her new clients found it less daunting to try therapy from the safety and familiarity of their homes.
But it also comes with limitations, as counsellors may have a harder time connecting with the client over a video call if they are not already familiar with the patient's needs, Ms Gonzalez noted.
"You don't have a full reading of what's going on with the client, so I would prefer a combination of telehealth and face-to-face sessions. It can be really hard to dig into emotions on the computer."
Ms Gonzalez said she hopes the heightened public awareness of mental health issues underscored by the pandemic will persist.
Those who have found exercise helpful for improving their mood during the circuit breaker should continue to maintain this habit, she said, and workers should remember to maintain work-life balance whether they are working from home or the office.
Besides telehealth, the pandemic has also accelerated the adoption of innovations and technology like smart devices and robotics in other aspects of healthcare.
Associate Professor Mahesh Choolani, president-elect of the College of Clinician Scientists under the Academy of Medicine Singapore, said one change is the way healthcare institutions now manage patient flow.
Instead of coming in, taking a queue number and crowding in waiting rooms, patients are notified on their phones when their turn comes, said Prof Choolani, who heads the obstetrics and gynaecology department at the National University Hospital.
This is something patients will appreciate regardless of Covid-19.
Another is the use of robots and Internet-enabled devices which allow physicians to remotely track patients' vital signs and make diagnoses without needing to be physically present.
These robots or sensors can even be used in patients' homes so that their chronic conditions can be monitored without their having to be in hospital, which frees up beds for acute care.
The use of such technology helps in managing infection amid a pandemic, Prof Choolani said, as well as reduces manpower requirements and makes hospital operations more efficient and less costly.
The pandemic has also been a catalyst for collaboration and innovation, he added, bringing together experts across different countries and disciplines - from medical experts to engineers and data scientists.
This can be seen in the clinical trials for various Covid-19 vaccines, many of which involved cross-border collaboration and yet were conducted over weeks or months instead of years while maintaining the same high standards of rigour.
Prof Choolani said Duke-NUS Medical School's partnership with American biotechnology firm Arcturus Therapeutics to produce a Covid-19 vaccine could in the future herald Singapore's further participation in international efforts like the development of cutting-edge health technologies.
He said: "The world is never going to be the same again. It's going to be a much smaller place. Information flow is now effectively real time, and geographical boundaries and time zones have little impact.
"I think the collaborations are going to be quite phenomenal and Singapore will be well poised to get engaged in therapeutics and diagnostics efforts."
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