SINGAPORE - As if fighting the virus were not bad enough, Covid-19 patients have to contend with losing their sense of smell and taste too.

This got a group of chefs thinking of new ways to make their food appetising. They work in three government hospitals - Alexandra Hospital (AH), Khoo Teck Puat Hospital (KTPH) and Ng Teng Fong General Hospital (NTFGH) - where Covid-19 patients have been warded.

All were able to tailor meals quickly for these patients because the food is made in-house, rather than being outsourced, as it is in some hospitals.

Anosmia, the loss of the sense of smell, and ageusia, where the patient has a diminished sense of taste, are peculiar symptoms of the coronavirus.

Dr Ooi Say Tat, an infectious diseases doctor at KTPH, says the exact reason is not known, but because Covid-19 involves sensory nerves, patients might lose their sense of smell and/or taste.

Since nutrition is key to healing, the chefs had to come up with ways to entice patients to eat, so that they can recover.

In non-Covid-19 times, they cater to a variety of diets anyway, including for patients who, because of certain medications, lose their sense of taste and smell. They also have to stick to strict nutrition guidelines.

With Covid-19 patients, the challenge is to create food that would be appealing to a variety of nationalities - including migrant workers from India, Bangladesh, Thailand, Myanmar and China - without adding salt and fat. So they intensify the flavour of food by using more fresh herbs and spices, and offer dishes that are close to the daily diets of the patients.

All three hospitals knew, early on, that they would have to make quick changes to what they serve Covid-19 patients.

Mr Choo Kok Seng, executive chef of NTFGH in Jurong, which has 700 beds, says: "Around mid-April, we received feedback from ward nurses that Covid-19 patients did not like our current patient meals. Many of our Covid-19 patients are foreign workers from India and Bangladesh."

It was the same at KTPH in Yishun, which has 795 beds and has cared for more than 2,600 Covid-19 patients to date.

The soup and green vegetables that are part of the meal trays were returned, untouched, to the kitchen. Migrant worker patients did not take to them.

A KTPH spokesman says: "We have Bengali and Tamil interpreters, and migrant healthcare workers from Bangladesh and India, and we enlisted their help to tweak our menu. Covid-19 patients are not allowed to move around freely. The least we can do is to give them food that they can eat."

The hospital replaced the greens with more familiar vegetables - drumstick, a long, bean-like vegetable and moringa leaves, both from the same plant; and snake gourd. It was already using these vegetables for patient meals.

Rasam, a soup with tang from tamarind, is served at lunch and dinner to stimulate the appetite.

Instead of adding more salt to bring out the flavour of the food, Mr Nge Aik Tee, the executive chef, had his team intensify the flavour of the stocks they make, by using more vegetables.

Mr Ghazali Mohamad, head of the hospital's food services team, says migrant worker patients are used to eating more carbohydrates, so the hospital increased the portions, serving these patients 1½ times more rice.

The hospital's chef de partie, Mr Shaikh Arsed Ali, who is from India, makes upma, a popular Indian dish, using rice vermicelli; khichdi, a spicy porridge dish; pongal rice; and kesari, a semolina dessert.

At NTFGH, new menu items usually go through a process of evaluation by dietitians and senior management. But in unprecedented times, chef Choo was able to fast-track his new offerings and get them on meal trays.

The soup and green vegetables that migrant worker patients shunned were replaced with fruit juices and vegetable curries featuring cauliflower, eggplant and potatoes. Some new offerings the team came up with include lentil curry, masala chickpeas and chicken curry. Intensity of flavour comes from spices such as cumin, coriander and star anise.

For non-migrant worker patients, his team infuses the horfun the hospital usually serves with more wok hei, by frying the rice noodles longer to get that appetising charred flavour. Stocks are made with extra bones and with dried mushrooms, carrot and corn, to deepen the flavour.

With the western meals, fresh herbs such as thyme, and ingredients such as fresh tomatoes, perk up dishes.

AH, with 215 beds, used to outsource its meals, but in August, it debuted an in-house food services team. It operates out of a temporary kitchen while a designed-from-scratch one is being built.

Even so, it has been able to cater to the more than 950 Covid-19 patients who have been warded there.

Mr Sebastian Low, who heads the food services team, and executive chef Norman Leow focus on what they can make in-house to add to and amplify ingredients such as minced chicken patties, fish and vegetarian mock meats that the hospital buys from suppliers. In time to come, those patties will be made in-house.

For now, there is a killer makhani sauce and a green curry sauce that can go on any protein; sayur lodeh; vegetable curry bright with tamarind; tomato rice fragrant with mustard seed and curry leaves; and nasi kunyit tinged yellow with turmeric.

These dishes are also served to non-Covid-19 patients.

For dessert, there is fruit and wobbly jelly made with lemongrass-infused green tea, sweetened with xylitol, so that diabetic patients and those with difficulty swallowing can also enjoy a pretty rose-shaped dessert.

One Covid-19 patient there, a Singaporean in his 20s, was hankering after fried carrot cake. The kitchen whipped up a plate for him for breakfast, using radish cake from a supplier.

"He was very happy," says chef Leow.

NEW FOOD TEAM FOR ALEXANDRA HOSPITAL

Nobody chooses which hospital to go to because the food at one is better than at another.

However, the newly minted food services team at Alexandra Hospital wants to change the perception that hospital food is bland, boring and tasteless.

The hospital used to outsource its meals, but has hired a team of about 30 to take charge of meals for the 215-bed hospital.

Mr Sebastian Low, head of the food services team, has 20 years of experience working in hotels, restaurants and business, industrial and healthcare catering. Executive chef Norman Leow has 15 years of experience working in hotels, restaurants and cruise liners.

They are operating out of a temporary kitchen while the one they are designing from scratch is being built. It is expected to be ready in the first quarter of 2021.

The hospital is working towards making all patient meals in-house. For example, instead of relying on outside sources for teatime treats, they plan to make their own muffins and banana and marble cake, which will be free of preservatives and additives.

Patients who have difficulty swallowing will be served dishes cooked from scratch in the kitchen - for example, steamed fish and spring onions. The dish will be finely chopped or pureed by the team, instead of having soft food done for them by vendors. They hope the improved flavour of the food will entice patients to eat and recover.

Chef Leow says: "We are moving towards producing Michelin-star-level dishes. Today, the presentation of hospital meals is also changing, like serving it in casseroles instead of army style. Tasty and healthy food definitely exists."

Alexandra decided to stop outsourcing its food to have greater control and flexibility.

A spokesman says: "We have control over the quality of the raw ingredients and can ensure consistency in the meals we serve patients, especially in the taste and presentation."

Better communication between ward staff, dietitians and the people making the food is also possible because they all work on the same campus. Controlling and keeping costs down is also an important consideration.

Chef Leow says a vital part of his job is understanding patients and their needs: "I put myself in their shoes. We did a lot of R&D on our jelly to make sure patients who have difficulty swallowing can eat it."

He is also working on introducing hawker-style food such as nasi lemak, char kway teow and mee rebus. They will, of course, be tweaked to make them healthier and to comply with nutrition guidelines for patients.

Mr Low says: "You are not coming to Alexandra Hospital because our chicken masala is good."

But, Chef Leow adds, "if you are here, we really want to make you happy".

TASTE TEST

I have had enough hospital food to last at least two lifetimes and I cannot say that all of it was good. Much of it was jaw droppingly, head explodingly bad.

So when three hospitals stick their necks out to say their food is delicious, I roll my eyes and ask to taste it. That they have been able to come up quickly with food for Covid-19 patients works in their favour. But I resign myself to an entire day of bland food.

"Come hungry," says the corporate communications person from one of the hospitals.

Yeah, I think. Thanks.

After sampling the Covid-19 meals at all three hospitals on the same day, with some dishes that are served to non-Covid-19 patients too, I find myself eating humble pie.

I am startled by how good the food tastes cold, which is how I eat it, after the interviews and after my colleague Mark has taken photographs of everything from every conceivable angle.

Patients, of course, are served hot meals.

Alexandra Hospital:

On the day I visit, the protein for meals is chicken patty made with minced chicken studded with carrots, and a vegetarian mock meat.

These come from suppliers and are served with green curry and makhani sauces made in-house. The makhani sauce is both bright and just rich enough, words not usually associated with hospital food. It is perfect with the chicken patty which, somehow, is not dried out despite being stone cold.

A good accompaniment is the tomato rice, studded with mustard seeds and perfumed with whole curry leaves. I can eat this any day.

For dessert, there is a wobbly jelly made with lemongrass-infused green tea set with just enough gelatine to hold it together. Although sweetened with xylitol, a sugar substitute, it does not taste artificial.

Lessons for when I cook: Use mustard seeds and curry leaves liberally. They add bags of flavour to everything.

Khoo Teck Puat Hospital:

Where do I begin? Ok, with tangy rasam, which perks up the appetite.

The soup works and soon, I am sampling the spicy beehoon upma. I can tell the salt has been held in check, but the aroma from the spices distract me from the fact that it is low-salt.

There is a terrific terung belado too, the eggplant chunky, juicy and brightly-flavoured.

Kesari, a semolina dessert topped with cashews, pistachios and raisins, isn't too sweet and it would have been entirely possible to eat the whole serving without falling into a food coma.

For National Day, pastry chef Ng Cheng Lean had made a red-and-white jelly dessert - milk jelly at the bottom, topped with strawberry jelly on top. Delicious. Neither layer is too sweet and the strawberry layer has real fruit in it.

Lessons for when I cook: To use less salt without making food bland, use toasted and freshly-ground spices, and fresh, perky ingredients such as kaffir lime leaves and chillies.

Ng Teng Fong General Hospital:

The minute Mark is done, I zero in on the seafood horfun. The noodles have a great char and executive chef Choo Kok Seng tells me they are fried longer to get more wok hei. Instead of the usual gluggy gravy, the hospital's version is not too thick and tastes like it has been made with a good stock. The seafood is not overcooked either.

I find myself going back again and again for the masala chickpeas, so intense is the flavour. The dish is perfect with a basmati pilaf topped with cashews and raisins.

The western meal that day is spaghetti with a tomato sauce bright with fresh tomatoes and topped with fragrant thyme leaves. To go with that, there is a juicy chicken thigh, breaded with flour, egg wash and then ground-up oats.

I have always believed life is too short to eat chicken breast and am glad patients at the hospital get juicy thigh meat.

Lessons for when I cook: Use ground-up oats instead of panko crumbs when coating protein for baking or frying. There's more fibre in oats. I will be sure to eat the food hot, because cold oats have zero allure.