Chapter 2: All hands on deck

SAF personnel carrying out call centre operations.

Source: MINDEF

Introduction

It quickly became clear that the SAF would be called to action in this unprecedented “war” in a domain which was largely unfamiliar and against an enemy which was largely unknown. The SAF had experience dealing with SARS, but COVID-19 was clearly going to be a threat of a far greater magnitude. It was a cold start - there was no time to get warmed up before we had to spring into action.

Birth of the first task force

It was the second day of the Chinese New Year and BG Lee Yi-Jin, Commander 6th Singapore Division (6 Div), was getting ready to bring his kids out. But CDF LG Melvyn Ong had other plans for him. Although there had been early warning orders, there was no indication up to that point that 6 Div would be set up as a task force. BG Lee made his way to MOH for the tasking brief. He could not have imagined then what his Health Surveillance Task Force (HSTF) would have to deal with in the months ahead.

The very first line of operations by the HSTF was to assist MOH in call centre operations. They were looking out for people who were at higher risk of infection because they had interacted with visitors from Hubei, China. A battalion of soldiers was activated to set up and operate call centres in Mandai Hill Camp, armed with call scripts instead of their Singapore Assault Rifle - 21st Century (SAR 21) rifles.

Minister for Health Mr Gan Kim Yong and Permanent Secretary (Health) Mr Chan Yeng Kit visiting the Contact Tracing Centres on 11 April 2020.

Source: MINDEF

HSTF made 14,553 calls and sent 3,454 SMSes from 28 January to 9 April 2020 to monitor the health of 1,565 individuals who were at higher risk of infection as they had returned from affected countries.

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Two weeks later, with the growing number of imported COVID-19 cases, the Civil Aviation Authority of Singapore came knocking on HSTF's door, seeking assistance for temperature surveillance at the airport. Although the scope was far different from the original tasking of call centre operations, HSTF gamely took on this additional task as it was a national crisis that required all hands on deck.

HSTF deployed 19 Infrared Fever Surveillance Systems at Changi Airport before handing over to Raffles Medical Group.

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SAF personnel managing a Temperature Screening Station in Changi Airport.

Source: MINDEF

This was soon followed by the Immigration and Checkpoints Authority asking for help to conduct checks by phone on people who had been issued quarantine orders. The saying that “the reward for good work is often more work” rang true as HSTF quietly established itself as a reliable partner. The operational processes which the HSTF took over from the agencies they assisted were manpower intensive and difficult to scale up. With the pace of operations picking up, the HSTF braced itself to be ready to do more before long.

Answering the call

HSTF was presented with its biggest challenge yet when it was tasked to support MOH in contact tracing in March 2020. This was more extensive and more complicated than the previous tasks, especially after cases in the migrant worker dormitories rose dramatically. The national healthcare system came under immense pressure and MOH's capacity was maxed out.

HSTF realised that good contact tracing could make a significant impact on curbing the spread of the virus, and it was vital for the task force to support MOH well in this mission. The task force quickly visited the MOH centres and arranged on-the-job training for its members to learn the protocols and procedures. The timeline for HSTF to phase in its operations was progressively shortened as the situation worsened. With great urgency to ramp up the capability to provide this critical support, HSTF poured all its focus and energy to the task and managed to scale up its national contact tracing capacity tenfold within two weeks.

SAF Contact Tracing Teams conducting their operations.

Source: MINDEF

HSTF made 109,612 calls to over 30,000 individuals who were serving Stay-Home Notices.

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Early setbacks

HSTF's Ops Centre was in Mandai Hill Camp. Having such an Ops Centre meant that there could be more effective command and control over all the call centres as cases linked to the same cluster could be assigned to the same contact tracing centre. This was more efficient and saved considerable time. However, this concentrated arrangement also made the task force more vulnerable to the highly contagious virus.

LTC Danny Poh, who was Head Operations Branch, 6 Div, recalled the early setbacks that the team encountered shortly after the task force reorganised itself for the massive contact tracing operation. He was the SAF representative at one of the early multi-agency meetings at MOH to discuss the contact tracing processes. A few days after that meeting, he received a very unwelcome call from MOH informing him that someone who was at the meeting had tested positive for COVID-19.

LTC Danny Poh (left) back in action after his quarantine.

Source: MINDEF

By this time, the seven contact tracing centres established in Mandai Hill Camp had grown into a 700-strong outfit. There was too much at stake to take the risk of COVID-19 spreading across the call centres should LTC Poh have caught the virus. The entire HSTF would have to shut down. It was a painful decision to quarantine LTC Poh as he had a key role to play in this initial phase of the operation. That episode gave HSTF an early real-life lesson on the COVID-19 threat. Fortunately, LTC Poh tested negative and returned to operations after serving his quarantine notice.

The quick lesson on contact tracing

Contact tracing was new to HSTF and, with this being Singapore's main defence against COVID-19, it was crucial that they got it right the first time. Contact tracing served two purposes. The first was to establish the source of infection by backward tracing to track COVID-19 patients' activities from the time symptoms appeared. The second was to break the chain of transmission as quickly as possible by forward tracing to identify all close contacts.

As HSTF became more familiar with the end-to-end contact tracing process, they soon realised that effective contact tracing depended heavily on activity mapping. Activity maps were important in backward tracing for epidemiology analysis, and in forward tracing for identification and isolation of close contacts. The information in the activity maps could be pieced together to provide a detailed and accurate picture for studying the distribution and spread of the virus.

Contact tracing flow

Interoperability challenges

Fighting the virus was a huge task. HSTF had to work with many agencies, each responsible for a different process. For instance, ICA led the Stay-Home Notice enforcement tasks, MOH managed contact tracing, and the National Centre for Infectious Diseases (NCID) oversaw activity mapping. These agencies had clear responsibilities and dedicated capacities, but they faced challenges when they had to integrate their work with one another.

Contact Tracing Centre operated by a mix of SAF and MOH personnel in Mandai Hill Camp.

Source: MINDEF

The lack of a centralised body to coordinate activity mapping and contact tracing was hampering the output. There were many instances of activity maps being lost or not picked up by the contact tracing centres. The contact tracers were spending too much time extracting details from activity maps that came from different sources and trying to piece them together. There were problems because of legacy issues and a lack of clarity over roles. But the crisis situation with the very high operational demands meant that no one had breathing space, let alone time, to take a step back to find solutions.

BG Lee saw a need to tighten the processes. He decided to set up a Centralised Activity Mapping Centre within HSTF that could do activity mapping directly from Mandai Hill Camp and still pull activity maps from NCID. With this, HSTF could independently run contact tracing operations from Mandai Hill Camp.

It was clear to HSTF that its role was to support other government agencies which would remain principally responsible for the outcomes of the various lines of operations. This would allow HSTF to concentrate on executing its mission well, tapping on the organising abilities and operational expertise of the SAF, while avoiding turf issues. BG Lee knew that establishing the working relationships with other agencies in the early phase of the operations would be challenging.

Senior Minister and Coordinating Minister for National Security Mr Teo Chee Hean visiting the Combined Analysis & Coordination HQ of the HSTF at Mandai Hill Camp.

Source: MINDEF

"Initially, there were some challenges working with other agencies. There were already many established processes and inter-agency boundaries to follow, and these were there for good reason. But the situation had changed, so we had to go in with fresh eyes and no baggage, and try to be objective about what was needed to get the job done. At the same time, we were mindful that the SAF was there only to help out during the crisis; we would not be doing this forever.

So I reminded our people to set aside any perceived cultural differences and be constructive and forward-looking as a team. The onus was on us to convince them that what we were suggesting would improve the processes and outcomes given the present circumstances. And we should lean forward more to support the other agencies which were already very stretched."

BG Lee Yi-Jin
Commander HSTF

To be fair, dealing with the unknowns of the novel COVID-19 was not easy for everyone. There were times when both MOH and HSTF were equally puzzled, grappling with new discoveries about the virus and the corresponding changes in national policies. The many twists and turns made the contingency measures appear reactionary. HSTF soon realised that to get ahead of the virus, the modus operandi of all the government agencies in our WoG approach had to be fundamentally reviewed so that we could anticipate rather than merely react. Working hand in hand with the other agencies, HSTF invested precious time and manpower into building anticipatory planning and functioning capabilities. Such capabilities allowed proper contingency planning so that there would not be knee-jerk reactions, and decisions could be made after careful consideration of potential blind spots and pitfalls.

Technology challenges

It became more and more challenging to do contact tracing promptly, especially after cases surged in April 2020. Data poured in from multiple sources in different formats. The Ministry of Manpower (MOM) and MOH collected data diligently, but the numerous sources only caused confusion. Worse, the data not only did not include activity mapping and close contacts, but was also sometimes inaccurate. It reached a point where the contact tracers were spending more time locating activity maps than doing actual contact tracing.

There was no common platform to work on and it became very urgent to fix the need to make better and quicker sense of the data. There was a critical need to standardise how activity maps should be created, stored and accessed. The massive contact tracing operations would not be sustainable if they continued to rely only on Microsoft Excel. HSTF quickly looked to DSTA for a technology solution.

Initial challenges in contract tracing processes

MAJ Lee Yiu Wing, Battalion 2IC 6th Signal Battalion, who was responsible for digital solutions and regarded as the chief technology officer of HSTF, had the idea of creating a web-based application to enhance end-to-end contact tracing processes. He knew that the lack of software development talents in his project team was the biggest challenge. They had the funds to employ contractors to develop contact tracing software, but the process would take too long. So MAJ Lee looked for resources within the SAF and DSTA. With support from Comd HSTF and the Army's Chief Signals Officer, DSTA and SAF in-house programmers from HQ Signals and Command Systems and the Republic of Singapore Air Force (RSAF) Innovation SWiFT Office soon came on board for the digitisation journey. Another challenge for MAJ Lee's team was to resolve the differences with the IT systems developed by other ministries. The project team often found that it required extra effort to integrate its product into MOH's system. And there was resistance even from within HSTF.

LTA Kong Yu Jian and his team from RSAF Innovation SWiFT Office discussing how to integrate data sources on a single platform.

Source: MINDEF

The first prototypes of the SwiftCobra application required iterative improvements which incorporated user feedback. HSTF doubled down on its innovation efforts to come up with an ops-tech solution for more efficient data collection and integration. This was resource intensive and time consuming, and some outcomes had to be aborted. After two weeks, the first version of the web-based application was rolled out on MOH's intranet. MAJ Lee and his team engaged the Activity Mapping Centres constantly to refine the processes for contact tracing. But it took some time to get the new processes implemented by the relevant government entities. When SwiftCobra was eventually adopted by all of them, most of the problems of integrating the data from the various sources were resolved.

"There was resistance to using the new system from the Centre Head and activity mappers. We managed to launch the system only because the order came down from the HSTF HQ. But getting buy-in from the ops users and sustaining the trust of the HSTF HQ were battles for the team. . . . The team's pinnacle moment was when our system was successfully integrated with the other ministries' systems… We had started with building an internal system to serve the SAF but were soon requested by MOH to extend it to all the public hospitals."

MAJ Lee Yiu Wing
Battalion 2IC, 6th Signal Battalion

HSTF traced 53,906 COVID-19 cases and raised Quarantine Orders for 163,806 individuals.

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The SwiftCobra system had gone beyond digitising activity maps. It featured links that were also developed across the WoG IT infrastructure so that contact tracing could be done seamlessly with synchronised data sources. When SwiftCobra and the national applications of SafeEntry and TraceTogether were integrated, the time taken by the contact tracing teams to identify and quarantine a close contact was more than halved, from four days to less than two days. HSTF can look back on SwiftCobra as one of many successful solutions that were born from the ops-tech partnership that yielded better operational outcomes with reduced manpower, and played an important role in enabling HSTF to accomplish its mission. SwiftCobra continues to be used for contact tracing.

System design for SwiftCobra

Sustaining the force

A digitised Activity Map on SwiftCobra.

Source: MINDEF

The SAF servicemen and servicewomen manning HSTF's seven fully operationalised contact tracing centres and a centralised activity mapping centre were new to their tasks but everyone pressed on. Every day, HSTF officers spent long hours making calls, often having to deal with angry people. The pressure grew for more manpower to sustain the task force.

While HSTF tried to reduce the need for manpower by continually streamlining the operational processes, it recognised that it was equally important to reorganise structures so that operations would be more efficient. But the process to review some technical aspects of the operations was often protracted. Most stakeholders did not have much appetite for change, so changes had to be introduced gradually to gain buy-in. Sometimes, many revisions and iterations were needed before the business processes and operations could be enhanced. There were also agencies which quickly dismissed HSTF's ideas because they did not have enough resources to support the changes. HSTF had to learn how to package proposals and secure the necessary resources, and it had to learn fast. It did not want any needed change in structure or process to be bogged down by insufficient resources.

There had been a measure of success by MOH and HSTF in curbing the transmission of COVID-19, but the fight was far from over. Singapore's social fabric, economic progress, and the people's spirit would be put to more painful tests. And the SAF would have to continue to play its part in the national “war” against COVID-19.