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I always wondered about other patients with chronic fever and how they cope with pandemic-related restrictions. But surprisingly, there were hardly any results on Google. It made me realize that patients with chronic fever are few and far between, so I decided to write this to share my own experience as a patient with chronic autoimmune fever.

Warning: Long, long post ahead.

When the pandemic was looming on the horizon early this year, I was already anticipating the potential challenges I will face. When SARS hit our shores in 2003, temperature screening became commonplace. I thought it was something that will happen again and was already thinking to myself – “jialat, I will be denied access everywhere at this rate.”

I had an existing letter from my rheumatologist certifying that I have a chronic fever of a non-infectious nature. And it saved my ass a couple of times when my fever got detected at airports overseas (I’ve noted that Hong Kong airport’s thermal scanners are particularly aggressive).

So I guessed the letter would be enough when Covid-19 eventually hit our shores and temperature screening became ubiquitous.

I digress – but I do feel a bit bitter when I see signs everywhere stating that “anyone with a temperature of 37.5 and above will be declined access”. Maybe I take it a bit personally because my temperature is almost always between 37.5 and 38.3 degrees and it feels as if the sign is speaking to me.

Singapore went through a “lockdown” period (“Circuit Breaker”, they called it) from April to June. Subsequently, the country started opening up in phases. When it did, temperature screening became mandatory (when it was only sporadic prior to the lockdown). My first inkling of things to come was when I was declined access to a supermarket when I wanted to get a drink en route home after a short trip to the postbox. Unfortunately, I left my doctor’s letter at home. No biggie though – home was just 3 streets away, so I could simply walk back to hydrate.

The bigger problem started when I resumed my regular physiotherapy and medical appointments after the lockdown (such medical services were deemed “non-essential” and were suspended during the lockdown except for emergencies).

I was detained at my regular hospital despite holding a doctor’s letter from a doctor based in that hospital. I had a temperature of 37.8 so the screener was adamant about not allowing me entry despite me explaining I had a medical condition that caused chronic fever. Multiple phone calls later (including one to my rheumatologist), I was finally allowed in. I was already late for my appointment, and very very frustrated.

I subsequently shared about that experience online in a desperate bid to spread awareness.

There are people who live with a fever everyday. Not all fever = Covid-19 infection.

Yes, we are rare. But we exist.

The following week, I received a phone call from the hospital. It was from their senior management who heard about my situation and wanted to help. We had a very long chat about the struggles of people with chronic fever during this period, while he also shared how he had to make special arrangements for cancer patients (who may also have sporadic fevers due to their treatments). He gave me his direct line and email address and told me to contact him everytime before I come down for my appointments, so he can make the necessary arrangements.

I cannot be more grateful for this senior manager. My subsequent entries to the hospital were mostly smooth – apart from a couple of isolated incidents where the temperature screener was seemingly “caught out”, until they looked into their system and saw my name under an alert for special arrangement, then they will wave me in.

Hospitals aside, I was starting to become fairly worried about how I would treated outside should I encounter a similar situation where my fever gets picked up.

So I wrote to Singapore’s Ministry of Health (MOH) in late June to share my situation and to seek their advice. I was linked to a helpful officer named Jeffrey. Not surprisingly, he acknowledged that my case is exceedingly rare and that their guidelines to business owners on infection control are based on common information.

I quote part of his message here:

The issue you are facing is legitimate though uncommon, and MOH seeks to strike a balance being comprehensive and ease of staff implementation in its communication / guidelines to businesses.

You may wish to bring a copy of our previous correspondence and show it to businesses together with your doctor’s letter, for their consideration in allowing you entry.

Since then, I always carried a folder around with my doctor’s letter, my medical history, and my printout of my emails with MOH. Just in case.

I’m fully aware that I’m immunocompromised and shouldn’t be lurking around outside. But occasionally I need to do errands. And as the country opened up further, I wished to pick up the occasional coffee. (I will share more about my own precautions later in this post.)

Additionally, Singapore was holding its General Elections just a month away in July and I wasn’t sure if I’d be allowed to vote. I eventually forfeited my vote though – especially after hearing that those found with fever will have to vote during a “Special Voting Hour” which is also for those on Stay Home Notices. That will put me in close proximity with people who potentially have Covid-19. That’s just stupid.

Regardless, I’m super grateful that I have all these people around to assist me as I navigate these uncharted waters as a person with chronic fever. But internally, I still harboured my own worries about other potential issues I could encounter with entry to places. Every time I encountered a temperature screening station, my hand will instinctively reach for that folder in my bag, as I mentally geared myself up to explain my fever.

Fast forward several months later, I realized that most of my worries were unfounded and that my worries have since evolved into a new kind of worry – how many legitimate infectious fevers are actually slipping past the net?

On one occasion when I was entering Orchard Gateway mall, the siren obviously sounded when I went past the thermal camera.

“Uh oh”, I thought. My hand slid into my bag as I braced myself to get stopped.

But nothing happened. The screener didn’t even look up.

As for most of the handheld thermometers that scans the forehead, and those “self service” white thermal scanners? They are nothing more than random number generators. It’s come to a point where my eyes will roll upwards when one of these machines tell me that I have “normal temperature” of 36.4 degrees.

During my latest appointment with my rheumatologist, I had a chat with one of the nurses who shared that forehead temperature scanners can be hopelessly inaccurate especially when a person sweats (inevitable in hot and humid Singapore) which cools his/her skin’s surface. At the same time, she was checking my temperature with the in-ear thermometer and my reading was (not surprisingly) 37.9 degrees.

These days, I glance at the people around me and wonder “how many of them have a legitimate infectious fever that are not being picked up?” I swear, temperature screening is nothing more than a placebo.

But still, I bring my medical folder with me everywhere I go, as I’ll never know when I encounter an accurate forehead temperature scanner that surprises me.

Now, for the TL;DRs.

If you have any medical condition that causes chronic fever:

• Get a letter from your doctor/physician stating so – and that letter should ideally state that your fever is chronic and is not due to any infection. Bring this letter everywhere you go.
• Get in touch with your local Ministry of Health to seek their advice. Singapore’s health ministry was exceptionally helpful in my case, and I hope your country’s health ministry will be the same too. Better still if they allow you to use that email correspondence to back you up if you encounter problems outside.
• For crucial errands such as medical or dental appointments, always let the clinic know of your chronic fever in advance. And request them to get in touch with the hospital to make the necessary arrangements to make your access fuss-free. If the clinic is situated in a private/office building, request for them to get in touch with the building management.
• If you have to enter places that require you to make a health declaration (especially hospitals), never ever lie in your declaration. If it asks if you have a fever of 37.5 and above, never ever select “no” and think you can get away with it. But when you do, let the triage/screener know that you have declared “YES” to this and why.

Precautions to take if you’re immunocompromised:

• Always wear a mask. (Even in non-pandemic times.)
• Avoid anyone who is not wearing a mask.
• Never share food directly from the same plate, share drinks from the same cup, or share utensils. (Even in non-pandemic times.)
• If you make any plans to go out, only head to well-ventilated places. If you want to check out a café and that café has outdoor seating, sit outdoors. Go to parks, beaches (if they are not crowded) or explore the streets of a new neighbourhood. If you need to go to a mall to get stuff, don’t go on weekends.
• Since you’re immunocompromised, you’ve likely lived with a medical condition for while and have already developed an intuition for what’s safe/not since it’s part of our survival instinct. Use that intuition. If your brain sends you alarm signals, heed it.
• If your friends pressure you into dangerous situations eg. parties (that are not supposed to happen, by the way) or gatherings more than 5 people, refuse. Also, do consider dropping them as your friends.
• Keep washing your hands and don’t touch your face and eyes. (Also applies to healthy people.)
• Keep to your current medication schedule as directed by your doctor/physician and don’t do any unnecessary adjustments during this time unless absolutely necessary.