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