Speaker 1: Now
Speaker 2: health matters with Daniel Martin. It's health matters right here
Speaker 2: on CN 8938. I'm Daniel Martin. Welcome in everybody. We
Speaker 2: have to talk about food poisoning or gastroenteritis. You've all
Speaker 2: been following the story of what happened in the bite
Speaker 2: downs office said Juan Raffles Key as of this interview
Speaker 2: on August the first Thursday, that's when this interview is
Speaker 2: first airing. 100 and 30 people
Speaker 2: from those officers have reported gastroenteritis symptoms according to the
Speaker 2: Moh and the Singapore Food Agency day after day. We're
Speaker 2: hearing about more and more people reporting some of these symptoms.
Speaker 2: You've also seen some reports on some media outlets talking
Speaker 2: about how every floor in that office during that lunch
Speaker 2: time and post lunchtime period were full of
Speaker 2: employees who saw vomit on the floor. Colleagues wincing in pain,
Speaker 2: every toilet being full because people were having such severe
Speaker 2: bouts of food poisoning. But how is this possible? How
Speaker 2: can it be so severe? It's food poisoning? We've all
Speaker 2: had it. How quickly and badly can it strike Doctor Desmond?
Speaker 2: Why is back on the show? He's a gastroenterologist based
Speaker 2: at Mount Elizabeth Novena Specialist Center doctor. Why Hello.
Speaker 1: Hi, Daniel. You look very good. Thank you for chatting.
Speaker 2: It's
Speaker 2: been a long time that we chat. Indeed. The minute
Speaker 2: I saw this, I was like, I have to talk
Speaker 2: to doctor. Why? He'll, he'll give me the real deal
Speaker 2: on what's going on. Come on, doctor. Why, how can
Speaker 2: it be so serious? How can it be people vomiting
Speaker 2: uncontrollably and mass falling, lying on the floor, wincing in
Speaker 2: pain so bad.
Speaker 1: Ok, let me give you some broad perspective. In America.
Speaker 1: It was a who? Sorry. We estimated that there were
Speaker 1: 600 million cases of gastroenteritis worldwide every year, 600 million
Speaker 1: worldwide cases every year in Singapore. Actually, we have been
Speaker 1: having quite a fair number of gastroenteritis. We saw a
Speaker 1: dip in 2020 after 2021 and 22 the number of
Speaker 1: cases start to go up, guess what happened in 2020
Speaker 1: COVID-19. So we don't make the run and that's why
Speaker 1: you say for food poisoning so
Speaker 2: died during those times.
Speaker 1: It did during 2020 is when people we make around,
Speaker 1: we start to go up again. So food poisoning means
Speaker 1: we eat some either bacteria, virus or parasite or the toxin.
Speaker 1: Our stomach doesn't like it and they react by either vomiting.
Speaker 1: If you're lucky. If you're not lucky, the food, the
Speaker 1: stuff goes to the small intestine in the last
Speaker 1: intestine, they cause ha in a small and large intestine
Speaker 1: and they can have cramp fever and diarrhea. I will
Speaker 1: argue that from my experience, the more violent you want
Speaker 1: me to think out is almost like a stomach washing
Speaker 1: or gastric lava. You actually get rid of the 30 stuff.
Speaker 1: You get well faster. If you go down to cause
Speaker 1: a small intestine, you may have more diarrhea for a
Speaker 1: week for four days after one week.
Speaker 2: Right? Because it infects you deeper once it goes down.
Speaker 1: No, if you go to the small intestine, the only
Speaker 1: way to go out is the anus. So when it
Speaker 1: passes through the small and the last intestine, it cause
Speaker 1: a swelling, it caused a food poisoning and it cause
Speaker 1: infection and they will cause a severe diarrhea. If you
Speaker 1: vomit a lot, maybe it's not a bad thing
Speaker 2: but doctor why we've all maybe had some experience with
Speaker 2: food poisoning. But for it to happen, these people were
Speaker 2: having lunch and then it happened very quickly after that.
Speaker 2: Can the symptoms come on so quickly after ingesting
Speaker 2: potentially food that has been infected with a virus,
Speaker 1: it can be very quick. It's almost always within one
Speaker 1: or two hours after food. And the first symptom is
Speaker 1: always tummy, pain and vomiting and the pain get better
Speaker 1: after they vomit out. So it is highly
Speaker 1: possible
Speaker 2: why so severe, I mean, you've read the cases of
Speaker 2: what's happening here as well. Why so severe does it,
Speaker 2: does it relate to the, just that high quantities of
Speaker 2: the V the viral was high.
Speaker 1: Yeah. So we have to make, we have to take
Speaker 1: note of that the food that they mentioned from news report,
Speaker 1: they were actually buffet spread in the restaurant. The food
Speaker 1: were not prepared in the building. They were prepared. One
Speaker 1: in that I think is very far away. And another
Speaker 1: one in Yishun that are also very far away. So
Speaker 1: they prepare the food. In the fact
Speaker 1: in the what we call, uh, in, in the factory,
Speaker 1: they have to store it properly. Transport back to the, uh, uh, uh, to,
Speaker 1: to the office in the Shenzhen Shenton way, I think.
Speaker 1: And then they warm it up and serve. So, the
Speaker 1: question mark is, is there any problem in the transport?
Speaker 1: And is there a problem in the kitchen?
Speaker 2: Mhm. Mhm.
Speaker 2: And does it mean that there's a high viral load
Speaker 2: if so, if the symptoms are so severe is what
Speaker 2: I mean? Yeah,
Speaker 1: definitely. Most likely they have a very high viral load. So,
Speaker 1: but we need further testing to confirm that what the
Speaker 1: food agency and the ne A will do will be
Speaker 1: dead in a clinical study like that. They need to
Speaker 1: ask 100 and 30 people that have problem, ask them
Speaker 1: maybe 200 questions.
Speaker 1: What have you eaten from morning till now? Maybe turkey ham, maybe,
Speaker 1: maybe ham, maybe salad, maybe fried chicken rice, whatever. And
Speaker 1: they compare with other people that in the same building
Speaker 1: that didn't have any symptoms. They compare the two and
Speaker 1: then they can use statistics to find out which is
Speaker 1: the more likely kind of the food from that they
Speaker 1: can further investigate to find out what's the cause. But
Speaker 1: most likely a lot of toxin are being
Speaker 1: spread into the food. So, yeah, but we're the way
Speaker 1: for the by single food agency
Speaker 2: with such violent symptoms, like repeated visits to the bathroom
Speaker 2: to vomit or with diarrhea. And many of these repeated cases,
Speaker 2: as I said, can you, can you harm your body
Speaker 2: like your esophagus, your anal tract and things like that
Speaker 2: because you're going so regularly.
Speaker 1: Yeah, you're right. So if you vomit a lot, you
Speaker 1: can have sore throat, you can, you can sometimes tear
Speaker 1: some blood vessel and vomit blood. Usually they stop by itself.
Speaker 1: If we have a lot of diarrhea, they are p
Speaker 1: you're right. Sometimes they are powers and they have an
Speaker 1: no sore, but usually they are fine. So I want
Speaker 1: my patients if you just have diarrhea, just drink a
Speaker 1: lot of fluid or maybe a carbonated drink, maybe some
Speaker 1: electrolyte drink, maybe some juices to come to, to, to
Speaker 1: replenish the lost fruit and water. But even
Speaker 1: if you have vomiting and diarrhea, then you may want
Speaker 1: to go to the hospital or Urgent Care Center for
Speaker 1: IV three. Because if you both vomit and diarrhea, you
Speaker 1: can get very ill. And I told my patient to
Speaker 1: look for three warning symptoms. The first is if you
Speaker 1: found that you haven't pee much, maybe you're very dehydrated. Right.
Speaker 1: Number two is when we are dehydrated, we tend to
Speaker 1: feel giddy when we change posture. So my patient will
Speaker 1: tell me, oh, when they stand up from a sitting position,
Speaker 1: they suddenly see
Speaker 1: start. That is when the volume is, is contracted. So they,
Speaker 1: they have what we call postural hypertension. Number three is
Speaker 1: if they find that the heart rate goes up, it
Speaker 1: also means that they are very sick and the heart
Speaker 1: and the pump harder to, to because of the contracted
Speaker 1: blood volume, not for these three symptoms. But if we
Speaker 1: have both vomiting and diarrhea, you most suddenly go to
Speaker 1: a UCC to have a drip to replenish the fluid.
Speaker 2: So it's really about treating the symptoms. It's not about
Speaker 2: doing something to defeat the virus.
Speaker 1: Yeah, you're right. So the uh actually most of the
Speaker 1: cases are caused by viruses, rarely by bacteria. We have
Speaker 1: one very powerful stool test. It's called the G I
Speaker 1: PC R micro. Already, you can test for almost everything
Speaker 1: including viruses, parasite and bacteria. We will run it on
Speaker 1: patient like uh like in this case, for example, we
Speaker 1: can identify what they are from my limited experience of
Speaker 1: seeing the diarrhea cases in Singapore. I would say 90%
Speaker 1: of viruses, 10% of parasite or bacteria. So
Speaker 1: most of the time I told my patient antibiotic will
Speaker 1: not help sometimes make it worse. So I will hydrate
Speaker 1: you with salt and water. They feel much better after
Speaker 1: just about one pint of fluid to go inside and
Speaker 1: the two time will come out 56 hours later. Really?
Speaker 1: We need antibiotic. We can start it but it probably you,
Speaker 1: most of the time is not bacteria and they don't
Speaker 1: need antibiotics. Doctor.
Speaker 2: Why do you, speaking of testing, do you think in
Speaker 2: cases like this of mass food poisoning, that testing will
Speaker 2: help in terms of identifying the source here?
Speaker 1: I think definitely because uh if they are so sick
Speaker 1: to vomit until they
Speaker 1: what scrolling on the floor with a lot of pain,
Speaker 1: if it turned out to be say Kylo Peter salmonella
Speaker 1: or other other infectious bacteria, they need antibiotic quick. But
Speaker 1: if it had turned out to be say a virus,
Speaker 1: then we can say just hydrate and they will get well.
Speaker 1: So I think it's important to find the cause of
Speaker 1: it by running this special to test. They are available
Speaker 1: in almost all hospital.
Speaker 2: Ok. All I can almost think of and I feel
Speaker 2: such pity as well for the people obviously involved, but
Speaker 2: the poor cleaners
Speaker 2: that were involved and had to on the spot deal
Speaker 2: with the situation.
Speaker 2: Could they also have been exposing themselves to this virus by,
Speaker 2: by cleaning up these areas?
Speaker 1: Excellent. Ok. They are the very important people, not just
Speaker 1: for the health and well being, but if we are
Speaker 1: not careful, they can spread it. So I told all
Speaker 1: my patients if someone vomit or had diarrhea and dirty
Speaker 1: the floor, do not just wipe it with a towel.
Speaker 1: You have to use either bleach, all of us bleach
Speaker 1: at home when you can clean the toilet bleach your
Speaker 1: shirt or a detergent or just wash the dish, washing
Speaker 1: detergent. Use this to clean. You can most of the
Speaker 1: time deactivate the uh the nature of the viruses. So
Speaker 1: the cleaner, very important, the cleaner had to wear gloves.
Speaker 1: The cleaner had to wear a mask because sometimes the
Speaker 1: vomit may be, may aerosolize and go to the air
Speaker 1: and they breathing. So we don't want the uh cleaner
Speaker 1: to spread the virus of the bacteria from 426 to
Speaker 1: 425 and 24. So they are very, very important, but
Speaker 1: I'm sure they know what to do. These are professional
Speaker 2: but it was a, a very, um,
Speaker 2: very rushed situation from what I understand. So I hope like,
Speaker 2: you know, they did follow their protocols and protected themselves
Speaker 2: as well. Are you concerned to why that we've got
Speaker 2: this food poisoning instance? And a little over a week ago,
Speaker 2: we had the case of the CD F area as well.
Speaker 2: Over 100 cases there. Is this
Speaker 2: about something in the air that's traveling around or do
Speaker 2: you think it's just about food handling guidelines that need
Speaker 2: to be
Speaker 2: properly?
Speaker 1: I think there are two issues here. Many studies have
Speaker 1: shown that when temperature goes up, there will be more
Speaker 1: food poisoning cases. Number two, when the human,
Speaker 1: the tea goes up, say after rain, for example, when
Speaker 1: the air is moist, bacteria may proliferate faster. So humidity
Speaker 1: and higher temperature will increase the risk of food poisoning.
Speaker 1: That's number one. Number two, frankly, we are at the
Speaker 1: mercy of the food handler as a chef.
Speaker 1: Uh So, uh and they are being controlled by the
Speaker 1: Singapore Food Agency. We depend on them. We rely on
Speaker 1: food agency to maybe do a periodic check to rate
Speaker 1: these places regularly to make sure that they follow the rules.
Speaker 1: For instance, there's one first poisoning in 2018 by a
Speaker 1: uh I think by a caterer called Spitz, when they
Speaker 1: raided the restaurant, they find that
Speaker 1: about 20% of the staff had not gone for proper training,
Speaker 1: proper training. Actually, for you and me to work in
Speaker 1: the food industry, we need to go for a course.
Speaker 1: We need to pass an exam and also we need
Speaker 1: to pass a still test, make sure we don't carry
Speaker 1: any bacteria or virus. So for that instance, they find
Speaker 1: that they didn't pass the 20% of the staff didn't
Speaker 1: pass the course,
Speaker 1: maybe illegal, illegal worker, you know, untrained worker. Also, there
Speaker 1: are a lot of best practices that you and I
Speaker 1: know are common sense. For example, you shouldn't use the
Speaker 1: same knife and the same chopping board for both raw
Speaker 1: and cook food. This common sense. So they, to follow,
Speaker 1: they should have an area for Coke area for raw food. Yeah.
Speaker 1: So another thing that I always take note is that
Speaker 1: we ask ourselves when they cook the food
Speaker 1: in the food, they may have put the food in
Speaker 1: the very early morning. They may not have stored it properly.
Speaker 1: They send the food over here, uh at, at my restaurant,
Speaker 1: I mean, at, at my office maybe by 12 noon,
Speaker 1: then they may have four or five hours outside. And
Speaker 1: Food agency actually recommend food should only be exposed in
Speaker 1: the open air for two hours. Beyond that, we run
Speaker 1: the risk that with this high temperature in Singapore right now,
Speaker 1: that the bacteria may actually proliferate
Speaker 1: problem. So another thing is that because we don't wash
Speaker 1: the food, we all wash your hand. So if I
Speaker 1: go to buffet like that, I will try to find
Speaker 1: the food that a co ready to eat food like
Speaker 1: ham salad, I will take it with a pinch of salt.
Speaker 2: That's
Speaker 2: a good point as well. I go for the ready
Speaker 2: cooked on the soups, the noodles, the stuff that you're
Speaker 2: cooking right in front of me. Does he kill the virus?
Speaker 1: He will kill virus? So, uh in fact, when in
Speaker 1: one of the studies that uh Singapore Food Agency and
Speaker 1: ne A did uh that they look at four years
Speaker 1: of gastro and try this outbreak from 2018 to 2021.
Speaker 1: They find that actually most of them are by food caterer,
Speaker 1: followed by restaurant Hawker Center actually have very low risk,
Speaker 1: less than 1% of,
Speaker 1: of a foot outbreak. Because when you go to buy
Speaker 1: a t the Fried Uncle Fry in front of you,
Speaker 1: it's cute all the best. So I think go for
Speaker 1: cook food. Save that. We look for food that are
Speaker 1: what we call ready to eat. We have to have
Speaker 1: a lot of faith that they handled well. From the
Speaker 1: fridge to the plate. Doctor.
Speaker 2: Why? This was great. Thank you so much for your
Speaker 2: time today. Thank
Speaker 1: you, Daniel. Thank you for having
Speaker 2: me. Doctor Desmond. Why? Gastroenterologist based at Mount Elizabeth Novena
Speaker 2: Specialist Center? That's today's health matters. I'm Daniel Martin. Thanks
Speaker 2: so much for joining me.
Speaker 2: Before making any decisions based on the information in our program.
Speaker 2: Please consult a medical professional.