WEBVTT - Gastroenteritis: How bad it can get 0:00:01.110 --> 0:00:01.730 Now 0:00:02.019 --> 0:00:05.849 health matters with Daniel Martin. It's health matters right here 0:00:05.860 --> 0:00:09.409 on CN 8938. I'm Daniel Martin. Welcome in everybody. We 0:00:09.420 --> 0:00:13.319 have to talk about food poisoning or gastroenteritis. You've all 0:00:13.329 --> 0:00:16.329 been following the story of what happened in the bite 0:00:16.379 --> 0:00:20.909 downs office said Juan Raffles Key as of this interview 0:00:20.920 --> 0:00:23.719 on August the first Thursday, that's when this interview is 0:00:23.729 --> 0:00:26.770 first airing. 100 and 30 people 0:00:27.200 --> 0:00:32.369 from those officers have reported gastroenteritis symptoms according to the 0:00:32.380 --> 0:00:36.380 Moh and the Singapore Food Agency day after day. We're 0:00:36.389 --> 0:00:39.299 hearing about more and more people reporting some of these symptoms. 0:00:39.520 --> 0:00:42.470 You've also seen some reports on some media outlets talking 0:00:42.479 --> 0:00:46.759 about how every floor in that office during that lunch 0:00:46.770 --> 0:00:49.700 time and post lunchtime period were full of 0:00:50.299 --> 0:00:55.770 employees who saw vomit on the floor. Colleagues wincing in pain, 0:00:55.779 --> 0:00:59.830 every toilet being full because people were having such severe 0:00:59.840 --> 0:01:03.470 bouts of food poisoning. But how is this possible? How 0:01:03.479 --> 0:01:06.569 can it be so severe? It's food poisoning? We've all 0:01:06.580 --> 0:01:10.518 had it. How quickly and badly can it strike Doctor Desmond? 0:01:10.529 --> 0:01:13.279 Why is back on the show? He's a gastroenterologist based 0:01:13.290 --> 0:01:16.410 at Mount Elizabeth Novena Specialist Center doctor. Why Hello. 0:01:17.389 --> 0:01:19.900 Hi, Daniel. You look very good. Thank you for chatting. 0:01:19.930 --> 0:01:20.199 It's 0:01:20.209 --> 0:01:22.980 been a long time that we chat. Indeed. The minute 0:01:22.989 --> 0:01:24.199 I saw this, I was like, I have to talk 0:01:24.209 --> 0:01:27.139 to doctor. Why? He'll, he'll give me the real deal 0:01:27.150 --> 0:01:29.459 on what's going on. Come on, doctor. Why, how can 0:01:29.470 --> 0:01:32.349 it be so serious? How can it be people vomiting 0:01:32.360 --> 0:01:37.500 uncontrollably and mass falling, lying on the floor, wincing in 0:01:37.510 --> 0:01:38.739 pain so bad. 0:01:39.309 --> 0:01:42.690 Ok, let me give you some broad perspective. In America. 0:01:42.699 --> 0:01:45.209 It was a who? Sorry. We estimated that there were 0:01:45.230 --> 0:01:50.559 600 million cases of gastroenteritis worldwide every year, 600 million 0:01:50.569 --> 0:01:54.199 worldwide cases every year in Singapore. Actually, we have been 0:01:54.220 --> 0:01:57.059 having quite a fair number of gastroenteritis. We saw a 0:01:57.069 --> 0:02:01.519 dip in 2020 after 2021 and 22 the number of 0:02:01.529 --> 0:02:03.919 cases start to go up, guess what happened in 2020 0:02:04.133 --> 0:02:07.242 COVID-19. So we don't make the run and that's why 0:02:07.252 --> 0:02:09.033 you say for food poisoning so 0:02:09.822 --> 0:02:11.113 died during those times. 0:02:11.431 --> 0:02:14.772 It did during 2020 is when people we make around, 0:02:14.782 --> 0:02:16.983 we start to go up again. So food poisoning means 0:02:16.992 --> 0:02:20.431 we eat some either bacteria, virus or parasite or the toxin. 0:02:20.673 --> 0:02:23.832 Our stomach doesn't like it and they react by either vomiting. 0:02:23.843 --> 0:02:26.453 If you're lucky. If you're not lucky, the food, the 0:02:26.632 --> 0:02:28.563 stuff goes to the small intestine in the last 0:02:28.656 --> 0:02:31.445 intestine, they cause ha in a small and large intestine 0:02:31.455 --> 0:02:34.535 and they can have cramp fever and diarrhea. I will 0:02:34.546 --> 0:02:36.916 argue that from my experience, the more violent you want 0:02:36.925 --> 0:02:40.076 me to think out is almost like a stomach washing 0:02:40.085 --> 0:02:42.644 or gastric lava. You actually get rid of the 30 stuff. 0:02:42.656 --> 0:02:44.666 You get well faster. If you go down to cause 0:02:44.675 --> 0:02:47.424 a small intestine, you may have more diarrhea for a 0:02:47.436 --> 0:02:49.496 week for four days after one week. 0:02:49.505 --> 0:02:52.876 Right? Because it infects you deeper once it goes down. 0:02:53.580 --> 0:02:55.860 No, if you go to the small intestine, the only 0:02:55.869 --> 0:02:58.079 way to go out is the anus. So when it 0:02:58.089 --> 0:03:00.470 passes through the small and the last intestine, it cause 0:03:00.479 --> 0:03:03.758 a swelling, it caused a food poisoning and it cause 0:03:03.770 --> 0:03:06.889 infection and they will cause a severe diarrhea. If you 0:03:06.899 --> 0:03:09.220 vomit a lot, maybe it's not a bad thing 0:03:09.970 --> 0:03:12.089 but doctor why we've all maybe had some experience with 0:03:12.100 --> 0:03:16.000 food poisoning. But for it to happen, these people were 0:03:16.008 --> 0:03:18.770 having lunch and then it happened very quickly after that. 0:03:18.788 --> 0:03:21.500 Can the symptoms come on so quickly after ingesting 0:03:21.750 --> 0:03:26.089 potentially food that has been infected with a virus, 0:03:26.660 --> 0:03:29.419 it can be very quick. It's almost always within one 0:03:29.429 --> 0:03:32.020 or two hours after food. And the first symptom is 0:03:32.029 --> 0:03:34.649 always tummy, pain and vomiting and the pain get better 0:03:34.660 --> 0:03:36.520 after they vomit out. So it is highly 0:03:36.529 --> 0:03:37.210 possible 0:03:37.229 --> 0:03:39.880 why so severe, I mean, you've read the cases of 0:03:39.889 --> 0:03:42.550 what's happening here as well. Why so severe does it, 0:03:42.559 --> 0:03:46.479 does it relate to the, just that high quantities of 0:03:46.490 --> 0:03:47.809 the V the viral was high. 0:03:48.419 --> 0:03:50.149 Yeah. So we have to make, we have to take 0:03:50.160 --> 0:03:53.279 note of that the food that they mentioned from news report, 0:03:53.289 --> 0:03:57.000 they were actually buffet spread in the restaurant. The food 0:03:57.009 --> 0:03:59.690 were not prepared in the building. They were prepared. One 0:03:59.699 --> 0:04:02.020 in that I think is very far away. And another 0:04:02.029 --> 0:04:04.570 one in Yishun that are also very far away. So 0:04:04.580 --> 0:04:06.039 they prepare the food. In the fact 0:04:06.464 --> 0:04:08.904 in the what we call, uh, in, in the factory, 0:04:09.035 --> 0:04:12.785 they have to store it properly. Transport back to the, uh, uh, uh, to, 0:04:12.794 --> 0:04:15.964 to the office in the Shenzhen Shenton way, I think. 0:04:16.024 --> 0:04:18.295 And then they warm it up and serve. So, the 0:04:18.303 --> 0:04:21.114 question mark is, is there any problem in the transport? 0:04:21.125 --> 0:04:22.894 And is there a problem in the kitchen? 0:04:22.904 --> 0:04:23.734 Mhm. Mhm. 0:04:24.200 --> 0:04:26.690 And does it mean that there's a high viral load 0:04:26.700 --> 0:04:29.369 if so, if the symptoms are so severe is what 0:04:29.380 --> 0:04:29.899 I mean? Yeah, 0:04:29.910 --> 0:04:33.659 definitely. Most likely they have a very high viral load. So, 0:04:33.670 --> 0:04:36.940 but we need further testing to confirm that what the 0:04:37.178 --> 0:04:39.549 food agency and the ne A will do will be 0:04:39.559 --> 0:04:41.928 dead in a clinical study like that. They need to 0:04:41.940 --> 0:04:44.920 ask 100 and 30 people that have problem, ask them 0:04:44.928 --> 0:04:45.820 maybe 200 questions. 0:04:45.933 --> 0:04:49.472 What have you eaten from morning till now? Maybe turkey ham, maybe, 0:04:49.483 --> 0:04:53.622 maybe ham, maybe salad, maybe fried chicken rice, whatever. And 0:04:53.632 --> 0:04:56.433 they compare with other people that in the same building 0:04:56.442 --> 0:04:59.312 that didn't have any symptoms. They compare the two and 0:04:59.322 --> 0:05:01.233 then they can use statistics to find out which is 0:05:01.243 --> 0:05:03.192 the more likely kind of the food from that they 0:05:03.202 --> 0:05:05.412 can further investigate to find out what's the cause. But 0:05:05.423 --> 0:05:07.463 most likely a lot of toxin are being 0:05:07.915 --> 0:05:11.355 spread into the food. So, yeah, but we're the way 0:05:11.365 --> 0:05:13.325 for the by single food agency 0:05:13.415 --> 0:05:18.436 with such violent symptoms, like repeated visits to the bathroom 0:05:18.446 --> 0:05:22.015 to vomit or with diarrhea. And many of these repeated cases, 0:05:22.026 --> 0:05:24.726 as I said, can you, can you harm your body 0:05:24.735 --> 0:05:28.126 like your esophagus, your anal tract and things like that 0:05:28.135 --> 0:05:29.325 because you're going so regularly. 0:05:29.959 --> 0:05:31.769 Yeah, you're right. So if you vomit a lot, you 0:05:31.779 --> 0:05:33.779 can have sore throat, you can, you can sometimes tear 0:05:33.790 --> 0:05:36.720 some blood vessel and vomit blood. Usually they stop by itself. 0:05:36.730 --> 0:05:38.339 If we have a lot of diarrhea, they are p 0:05:38.730 --> 0:05:40.678 you're right. Sometimes they are powers and they have an 0:05:40.690 --> 0:05:43.630 no sore, but usually they are fine. So I want 0:05:43.640 --> 0:05:46.190 my patients if you just have diarrhea, just drink a 0:05:46.200 --> 0:05:49.328 lot of fluid or maybe a carbonated drink, maybe some 0:05:49.339 --> 0:05:52.859 electrolyte drink, maybe some juices to come to, to, to 0:05:52.869 --> 0:05:55.219 replenish the lost fruit and water. But even 0:05:55.333 --> 0:05:57.871 if you have vomiting and diarrhea, then you may want 0:05:57.882 --> 0:06:00.712 to go to the hospital or Urgent Care Center for 0:06:00.722 --> 0:06:03.322 IV three. Because if you both vomit and diarrhea, you 0:06:03.333 --> 0:06:05.113 can get very ill. And I told my patient to 0:06:05.122 --> 0:06:07.993 look for three warning symptoms. The first is if you 0:06:08.002 --> 0:06:11.722 found that you haven't pee much, maybe you're very dehydrated. Right. 0:06:11.763 --> 0:06:14.303 Number two is when we are dehydrated, we tend to 0:06:14.322 --> 0:06:17.561 feel giddy when we change posture. So my patient will 0:06:17.572 --> 0:06:19.822 tell me, oh, when they stand up from a sitting position, 0:06:19.833 --> 0:06:20.592 they suddenly see 0:06:20.705 --> 0:06:24.604 start. That is when the volume is, is contracted. So they, 0:06:24.615 --> 0:06:27.885 they have what we call postural hypertension. Number three is 0:06:27.895 --> 0:06:29.976 if they find that the heart rate goes up, it 0:06:29.985 --> 0:06:31.795 also means that they are very sick and the heart 0:06:31.805 --> 0:06:33.936 and the pump harder to, to because of the contracted 0:06:33.946 --> 0:06:36.445 blood volume, not for these three symptoms. But if we 0:06:36.455 --> 0:06:39.555 have both vomiting and diarrhea, you most suddenly go to 0:06:39.565 --> 0:06:42.786 a UCC to have a drip to replenish the fluid. 0:06:42.976 --> 0:06:46.045 So it's really about treating the symptoms. It's not about 0:06:46.455 --> 0:06:49.005 doing something to defeat the virus. 0:06:49.549 --> 0:06:52.390 Yeah, you're right. So the uh actually most of the 0:06:52.399 --> 0:06:55.679 cases are caused by viruses, rarely by bacteria. We have 0:06:55.690 --> 0:06:58.839 one very powerful stool test. It's called the G I 0:06:58.850 --> 0:07:01.690 PC R micro. Already, you can test for almost everything 0:07:01.730 --> 0:07:05.409 including viruses, parasite and bacteria. We will run it on 0:07:05.420 --> 0:07:08.669 patient like uh like in this case, for example, we 0:07:08.678 --> 0:07:10.899 can identify what they are from my limited experience of 0:07:10.910 --> 0:07:14.290 seeing the diarrhea cases in Singapore. I would say 90% 0:07:14.299 --> 0:07:17.589 of viruses, 10% of parasite or bacteria. So 0:07:17.674 --> 0:07:20.165 most of the time I told my patient antibiotic will 0:07:20.174 --> 0:07:22.565 not help sometimes make it worse. So I will hydrate 0:07:22.575 --> 0:07:25.364 you with salt and water. They feel much better after 0:07:25.375 --> 0:07:28.375 just about one pint of fluid to go inside and 0:07:28.385 --> 0:07:31.214 the two time will come out 56 hours later. Really? 0:07:31.225 --> 0:07:34.024 We need antibiotic. We can start it but it probably you, 0:07:34.035 --> 0:07:36.184 most of the time is not bacteria and they don't 0:07:36.195 --> 0:07:37.654 need antibiotics. Doctor. 0:07:37.665 --> 0:07:40.005 Why do you, speaking of testing, do you think in 0:07:40.015 --> 0:07:43.255 cases like this of mass food poisoning, that testing will 0:07:43.265 --> 0:07:45.744 help in terms of identifying the source here? 0:07:46.440 --> 0:07:48.760 I think definitely because uh if they are so sick 0:07:48.769 --> 0:07:49.739 to vomit until they 0:07:50.190 --> 0:07:52.820 what scrolling on the floor with a lot of pain, 0:07:53.029 --> 0:07:56.450 if it turned out to be say Kylo Peter salmonella 0:07:56.459 --> 0:08:01.989 or other other infectious bacteria, they need antibiotic quick. But 0:08:02.000 --> 0:08:03.890 if it had turned out to be say a virus, 0:08:03.899 --> 0:08:06.089 then we can say just hydrate and they will get well. 0:08:06.100 --> 0:08:08.529 So I think it's important to find the cause of 0:08:08.540 --> 0:08:10.880 it by running this special to test. They are available 0:08:10.890 --> 0:08:12.140 in almost all hospital. 0:08:12.149 --> 0:08:14.390 Ok. All I can almost think of and I feel 0:08:14.399 --> 0:08:17.559 such pity as well for the people obviously involved, but 0:08:17.570 --> 0:08:18.929 the poor cleaners 0:08:19.320 --> 0:08:22.130 that were involved and had to on the spot deal 0:08:22.140 --> 0:08:23.100 with the situation. 0:08:23.329 --> 0:08:27.209 Could they also have been exposing themselves to this virus by, 0:08:27.220 --> 0:08:28.850 by cleaning up these areas? 0:08:28.890 --> 0:08:32.409 Excellent. Ok. They are the very important people, not just 0:08:32.419 --> 0:08:34.200 for the health and well being, but if we are 0:08:34.210 --> 0:08:35.950 not careful, they can spread it. So I told all 0:08:35.960 --> 0:08:39.229 my patients if someone vomit or had diarrhea and dirty 0:08:39.239 --> 0:08:41.380 the floor, do not just wipe it with a towel. 0:08:41.390 --> 0:08:44.169 You have to use either bleach, all of us bleach 0:08:44.179 --> 0:08:46.239 at home when you can clean the toilet bleach your 0:08:46.250 --> 0:08:50.109 shirt or a detergent or just wash the dish, washing 0:08:50.335 --> 0:08:53.093 detergent. Use this to clean. You can most of the 0:08:53.104 --> 0:08:56.484 time deactivate the uh the nature of the viruses. So 0:08:56.525 --> 0:08:58.955 the cleaner, very important, the cleaner had to wear gloves. 0:08:58.965 --> 0:09:00.964 The cleaner had to wear a mask because sometimes the 0:09:00.974 --> 0:09:04.015 vomit may be, may aerosolize and go to the air 0:09:04.025 --> 0:09:06.664 and they breathing. So we don't want the uh cleaner 0:09:06.674 --> 0:09:10.195 to spread the virus of the bacteria from 426 to 0:09:10.205 --> 0:09:13.364 425 and 24. So they are very, very important, but 0:09:13.375 --> 0:09:15.194 I'm sure they know what to do. These are professional 0:09:15.335 --> 0:09:18.864 but it was a, a very, um, 0:09:19.359 --> 0:09:23.840 very rushed situation from what I understand. So I hope like, 0:09:23.869 --> 0:09:26.219 you know, they did follow their protocols and protected themselves 0:09:26.229 --> 0:09:28.849 as well. Are you concerned to why that we've got 0:09:28.859 --> 0:09:32.039 this food poisoning instance? And a little over a week ago, 0:09:32.049 --> 0:09:34.020 we had the case of the CD F area as well. 0:09:34.030 --> 0:09:38.059 Over 100 cases there. Is this 0:09:38.750 --> 0:09:42.799 about something in the air that's traveling around or do 0:09:42.809 --> 0:09:45.469 you think it's just about food handling guidelines that need 0:09:45.479 --> 0:09:45.659 to be 0:09:45.770 --> 0:09:46.049 properly? 0:09:46.059 --> 0:09:48.400 I think there are two issues here. Many studies have 0:09:48.409 --> 0:09:51.359 shown that when temperature goes up, there will be more 0:09:51.369 --> 0:09:53.799 food poisoning cases. Number two, when the human, 0:09:53.905 --> 0:09:55.974 the tea goes up, say after rain, for example, when 0:09:55.984 --> 0:10:00.544 the air is moist, bacteria may proliferate faster. So humidity 0:10:00.554 --> 0:10:03.195 and higher temperature will increase the risk of food poisoning. 0:10:03.205 --> 0:10:06.714 That's number one. Number two, frankly, we are at the 0:10:06.724 --> 0:10:08.994 mercy of the food handler as a chef. 0:10:09.320 --> 0:10:11.809 Uh So, uh and they are being controlled by the 0:10:11.820 --> 0:10:14.669 Singapore Food Agency. We depend on them. We rely on 0:10:14.880 --> 0:10:17.789 food agency to maybe do a periodic check to rate 0:10:17.799 --> 0:10:20.250 these places regularly to make sure that they follow the rules. 0:10:20.260 --> 0:10:23.369 For instance, there's one first poisoning in 2018 by a 0:10:23.599 --> 0:10:26.460 uh I think by a caterer called Spitz, when they 0:10:26.469 --> 0:10:28.169 raided the restaurant, they find that 0:10:28.250 --> 0:10:31.770 about 20% of the staff had not gone for proper training, 0:10:31.799 --> 0:10:34.559 proper training. Actually, for you and me to work in 0:10:34.570 --> 0:10:36.358 the food industry, we need to go for a course. 0:10:36.369 --> 0:10:38.468 We need to pass an exam and also we need 0:10:38.479 --> 0:10:40.289 to pass a still test, make sure we don't carry 0:10:40.299 --> 0:10:43.539 any bacteria or virus. So for that instance, they find 0:10:43.549 --> 0:10:46.020 that they didn't pass the 20% of the staff didn't 0:10:46.030 --> 0:10:46.809 pass the course, 0:10:47.450 --> 0:10:52.449 maybe illegal, illegal worker, you know, untrained worker. Also, there 0:10:52.460 --> 0:10:54.260 are a lot of best practices that you and I 0:10:54.270 --> 0:10:56.679 know are common sense. For example, you shouldn't use the 0:10:56.690 --> 0:10:59.570 same knife and the same chopping board for both raw 0:10:59.580 --> 0:11:02.469 and cook food. This common sense. So they, to follow, 0:11:02.479 --> 0:11:05.299 they should have an area for Coke area for raw food. Yeah. 0:11:05.309 --> 0:11:08.229 So another thing that I always take note is that 0:11:08.239 --> 0:11:10.190 we ask ourselves when they cook the food 0:11:10.372 --> 0:11:12.473 in the food, they may have put the food in 0:11:12.482 --> 0:11:15.103 the very early morning. They may not have stored it properly. 0:11:15.112 --> 0:11:17.713 They send the food over here, uh at, at my restaurant, 0:11:17.723 --> 0:11:20.393 I mean, at, at my office maybe by 12 noon, 0:11:20.403 --> 0:11:22.343 then they may have four or five hours outside. And 0:11:22.552 --> 0:11:25.793 Food agency actually recommend food should only be exposed in 0:11:25.802 --> 0:11:28.263 the open air for two hours. Beyond that, we run 0:11:28.273 --> 0:11:31.232 the risk that with this high temperature in Singapore right now, 0:11:31.242 --> 0:11:33.192 that the bacteria may actually proliferate 0:11:33.405 --> 0:11:36.685 problem. So another thing is that because we don't wash 0:11:36.695 --> 0:11:38.466 the food, we all wash your hand. So if I 0:11:38.476 --> 0:11:40.856 go to buffet like that, I will try to find 0:11:40.866 --> 0:11:44.116 the food that a co ready to eat food like 0:11:44.125 --> 0:11:46.945 ham salad, I will take it with a pinch of salt. 0:11:46.995 --> 0:11:47.296 That's 0:11:47.306 --> 0:11:50.085 a good point as well. I go for the ready 0:11:50.096 --> 0:11:52.366 cooked on the soups, the noodles, the stuff that you're 0:11:52.375 --> 0:11:56.074 cooking right in front of me. Does he kill the virus? 0:11:56.900 --> 0:11:59.950 He will kill virus? So, uh in fact, when in 0:11:59.960 --> 0:12:01.929 one of the studies that uh Singapore Food Agency and 0:12:01.940 --> 0:12:04.409 ne A did uh that they look at four years 0:12:04.419 --> 0:12:07.580 of gastro and try this outbreak from 2018 to 2021. 0:12:07.729 --> 0:12:10.270 They find that actually most of them are by food caterer, 0:12:10.280 --> 0:12:13.909 followed by restaurant Hawker Center actually have very low risk, 0:12:13.919 --> 0:12:15.059 less than 1% of, 0:12:15.304 --> 0:12:17.544 of a foot outbreak. Because when you go to buy 0:12:17.554 --> 0:12:20.084 a t the Fried Uncle Fry in front of you, 0:12:20.094 --> 0:12:22.954 it's cute all the best. So I think go for 0:12:22.965 --> 0:12:25.223 cook food. Save that. We look for food that are 0:12:25.244 --> 0:12:27.765 what we call ready to eat. We have to have 0:12:27.775 --> 0:12:29.625 a lot of faith that they handled well. From the 0:12:29.635 --> 0:12:31.125 fridge to the plate. Doctor. 0:12:31.135 --> 0:12:32.704 Why? This was great. Thank you so much for your 0:12:32.715 --> 0:12:34.164 time today. Thank 0:12:34.174 --> 0:12:35.015 you, Daniel. Thank you for having 0:12:35.025 --> 0:12:38.375 me. Doctor Desmond. Why? Gastroenterologist based at Mount Elizabeth Novena 0:12:38.385 --> 0:12:42.255 Specialist Center? That's today's health matters. I'm Daniel Martin. Thanks 0:12:42.265 --> 0:12:43.414 so much for joining me. 0:12:47.719 --> 0:12:51.380 Before making any decisions based on the information in our program. 0:12:51.390 --> 0:12:53.309 Please consult a medical professional.