Waste recycling in Singapore

During a recent sitting of Parliament, I asked Minister for Sustainability and the Environment Grace Fu two questions about waste recycling in Singapore. First, I wanted to know what percentage of Singapore’s recyclable waste gets exported every year, and second, I requested an update on the expansion of our domestic waste recycling industry.

My concern was that, due to insufficient domestic capacity to recycle waste, much of the waste may be getting shipped overseas. This could result in an increased carbon footprint. More importantly, I feared that some of the waste may not ultimately get recycled. If that happened, it would negate some of the efforts Singaporeans are making to recycle their waste like household paper, plastics and metals.

In response to my first question, the Minister said that 34% of Singapore’s recyclable waste was exported last year. This had declined from 41% in 2015. (Note: This coincided with a 8.7% decline in the total waste recycled in that period, for reasons which were not explained in the answer.) The Minister pointed out that if there is no export market for recycled waste, or if the cost of recycling outweighs the value of the recycled product, the waste collector may treat them as general waste and send them to the incineration plant.

On the expansion of the domestic waste recycling industry, the Minister recognised this need. She pointed to a study by NEA which found that it was feasible to develop domestic recycling capabilities for both e-waste and plastic waste. She said that MSE and NEA will work closely with stakeholders to strengthen our local recycling capabilities.

I think it is important that we continue in this direction. Closing the “waste loops” will encourage more Singaporeans to participate in recycling efforts, and this will ultimately preserve our environment for future generations.

Here are the full answers to my questions on 5 Oct 2020:

PERCENTAGE OF SINGAPORE’S RECYCLABLE WASTE EXPORTED

Mr Gerald Giam Yean Song asked the Minister for Sustainability and the
Environment (a) in each of the last five years, how many tonnes and what percentage of Singapore’s recyclable waste has been exported; and (b) how does the Ministry ensure that the exported recyclable waste ultimately gets recycled instead of being incinerated or deposited in landfills overseas.

Ms Grace Fu Hai Yien: We exported about 1,889,000 tonnes of recyclable waste in 2015, 1,757,000 tonnes in 2016, 1,637,000 tonnes in 2017, 1,579,000 tonnes in 2018 and 1,439,000 tonnes in 2019. This corresponds to 41% of Singapore’s total waste recycled in 2015, 37% in 2016, 35% in 2017, 33% in 2018 and 34% in 2019.

Ferrous and non-ferrous metals, paper and cardboard waste made up about 90% of the total amount of recyclables exported in 2019. These recyclables have commercial value and fetch competitive prices when exported.

Recyclables that are contaminated with hazardous or other wastes, are governed by the Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and Their Disposal (Basel Convention), which is a Multilateral Environmental Agreement that regulates the import, export and transit of hazardous wastes and other wastes.

Our companies are regularly reminded about Singapore’s obligations under the Basel Convention, and NEA will investigate and enforce against any violations. While we are aware of the countries where our recyclables are exported to, we do not have information on how the recyclables are processed and treated in the countries of import, or if they are further exported. We are unable to gather data from companies that are outside our jurisdiction.

Recyclables have an intrinsic value. The value is a function of the value of the recycled material, the market price of its substitute, and the cost of recycling, including transportation to an export destination. If there is no export market for it, or if the cost of recycling outweighs the value of the recycled product, the waste collector may choose not to collect the recyclables but to treat them as general waste and send them to the incineration plant. Therefore, my Ministry recognises the need to build up our local recycling capabilities. For example, we are working with the private sector to develop mechanical recycling solutions to turn waste plastics into plastic pellets for manufacturing new products. And chemical recycling to process contaminated plastics that cannot be mechanically recycled.

For e-waste, we are developing capabilities to recycle Large Household Appliances, ICT products, batteries and lamps to support the upcoming e-waste Extended Producer Responsibility framework. This will allow us to better extract resources from waste and close our waste loops locally through a circular economy approach.

EXPANSION OF DOMESTIC WASTE RECYCLING INDUSTRY

Mr Gerald Giam Yean Song asked the Minister for Sustainability and the
Environment (a) whether he can provide an update on (i) the expansion of our domestic waste recycling industry and (ii) NEA’s study on e-waste and plastics recycling solutions and technologies and its assessment of their suitability for local adoption; and (b) whether there has been a cost-benefit analysis of exporting recyclables versus owning the capabilities to process them, considering the carbon footprint of transport and the environmental impact on developing countries that import recyclable waste.

Ms Grace Fu Hai Yien: My Ministry recognises the need for Singapore to build local recycling capabilities. The National Environment Agency (NEA) commissioned a recycling landscape study in 2018, which found that it was feasible to develop domestic recycling capabilities for both e-waste and plastic waste. These recommendations provided the inputs to our circular economy approach outlined in the Zero Waste Masterplan that we launched in 2019. The Masterplan will enable us to better extract resources from waste, and create economic opportunities and good jobs for Singaporeans.

We are making good progress in developing local recycling capabilities, working with the private sector. Over the next three years, we expect three new e-waste recycling facilities to be set up that will allow us to recycle more than 64,000 tonnes of e-waste per year. At the same time, we are working with research institutes and companies to develop solutions in treating and recycling e-waste in a more energy-efficient and eco-friendly manner. For example, the NTU Singapore-CEA Alliance for Research in Circular Economy (SCARCE) is developing innovative solutions to treat and recover resources from e-waste like lithium ion batteries and silicon solar panels, and finding ways to detoxify and recycle plastic parts in e-waste.

We are also exploring mechanical recycling and chemical recycling solutions for plastics with industry players. Chemical recycling is an added option to process contaminated plastics that cannot be mechanically recycled. More recycling capabilities are expected to evolve with our upcoming Extended Producer Responsibility (EPR) framework for packaging waste, including plastics. To recover more plastics from our waste for recycling, NEA is also conducting a feasibility study for a pilot Plastic Recovery Facility (PRF). If feasible, the pilot PRF will be the first such facility built by the government.

We have not done a cost-benefit analysis to compare exporting recyclables with processing them locally. While we are aware of the countries where our recyclables are exported to, we do not have information on how the recyclables are processed and treated in the countries of import, or if they are further exported. We are unable to gather data from companies that are outside our jurisdiction. Nevertheless, we are committed to building up our local capabilities to treat and close our waste loops locally, where feasible, both physically and economically, to enhance our resource resilience. As the COVID-19 pandemic has shown, we are vulnerable to global supply chain disruption, including disruption to cross-border flow of our recyclables for recycling. As such, my Ministry and the NEA will continue to work closely with all stakeholders to strengthen our local recycling capabilities.

The cost of returning $52 billion to the reserves

Delivered in Parliament on 14 October 2020 during the debate on the Supplementary Budget.

The economic crisis caused by the COVID-19 pandemic has been unprecedented in scale and depth. This crisis also marked just the second and third time in history that the Government drew on its past reserves to fund the recovery package. At $52 billion, these were the largest ever draws on past reserves—13 times what was drawn in 2009 during the Global Financial Crisis.

During the debate on his Ministerial Statement in June, the Deputy Prime Minister clarified that there is no legal or constitutional obligation for the Government to restore the draw from past reserves. Nevertheless, he said that the Government is committed to rebuilding the reserves, although he said that the Government cannot be definitive about how long that would take.

Can the DPM now clarify if the Government intends to return all of the $52 billion drawn and if it will include interest?

I am concerned that a commitment to restore $52 billion within a short timeframe may subject our people to unnecessary levels of austerity and constrain the Government’s fiscal space. Austerity can have a contractionary effect on the economy. It could slow economic growth and cause some painful cuts to public services, which might impact the poor.

Can the DPM assure Singaporeans that they will not have to go through a period of austerity after the economic crisis is over, in order to restore the reserves?

If the Government’s commitment remains to restore the full amount to the reserves, then will the DPM share the broad timelines for this restoration?

I am aware that he responded to similar questions from Members back in June, but he did not give any indication as to how long it will take. He only said that it would depend on Singapore’s economy emerging stronger so that we would be in a better position to build up our resources.

Sir, a timeline of two years, 20 years or 30 years will make a huge difference in the provision required in the budgets of current and future governments. This will translate to vastly different levels of tax hikes and spending cuts required to meet these provisions.

For example, a restoration timeline of two years will require the provision of $26 billion a year. This is clearly impossible even in the best of times, as the Government’s highest ever budget surplus was $10.9 billion in FY2017, which was an exceptional year. Even a timeline of 30 years will still require a provision of $1.7 billion a year on average. This is more than the combined FY2020 budget for the Prime Minister’s Office and the Ministry of Foreign Affairs.

During this 30-year period, we could also face multiple economic crises where more deficit spending might be necessary. There might even be a need for a further draw on past reserves to battle another deep crisis, which would set the timeline back even further.

Given the budget impact of potential provisions to restore this extraordinarily large amount to the reserves, I feel it is important for the Government to provide more clarity about its broad timelines to do so.

The $52 billion draw on past reserves during this crisis was necessary to prevent excessive job losses, make up for a decline in investments, boost consumer spending and stabilise aggregate demand. The reserves have served their purpose in this crisis. As we plan beyond this current crisis, let us consider carefully how much we want to burden the next generation of Singaporeans with the committed repayment of this draw on past reserves.

减轻医疗费用的负担

以下是2020年9月4日我国会发言中的其中一段:

议长先生,医疗费用对于许多新加坡人而言,都是一个十分沉重的负担。尤其对于那些长期与慢性疾病对抗的患者来说,更是如此。因此,我希望政府能够进一步地降低保健储蓄的使用限制,帮助年长者减少须以现金偿还的医疗费用。

很多居民都曾因昂贵的医疗费用而向我们提出抱怨。有些甚至因负担不起治疗而不去复诊。长此下去,一旦病患的病情恶化到必须住院的情况,不管是对病患或者是对我们的医疗系统来说,负担都会增加。

有鉴于此,我想向卫生部提议,将所有其他的慢性疾病一并列入保健储蓄的可支付项目之中,并让60岁以上的年长者免去年提款限额的限制。我相信这样的安排可以减轻年长者因医疗费而造成的精神压力,让他们能更安心地就医。

Caring for vulnerable members of society

This is a speech I made during the debate on the President’s address at the opening of Parliament on 4 September 2020.

Mr Speaker, I support the Motion of Thanks to the President for her address.

I would first like to express my gratitude to the voters of Aljunied GRC for giving me the opportunity to contribute in this House again. I cherish the trust that you have placed in my teammates and I, and we will do our very best to represent your concerns and work towards building a better future for Singapore.

While we may be called “the Opposition” for historical reasons, we stand here not necessarily to oppose, but to work with Parliamentary colleagues, along and across the aisle, to refine existing policies and propose new approaches to the challenges we face as a nation. Singapore’s economic, social and security challenges have grown more complex over the years. The policy responses must rise to the challenge. To do so, we need earnest and robust discussions on substantive policy matters both in and out of Parliament.

Today I would like to discuss ways in which we can improve how we care for some of the more vulnerable members of our society. I will touch on the concerns of people with disabilities, means testing, healthcare expenses and the welfare of migrant workers.

People with Disabilities

People with disabilities (or PwDs) are not a homogeneous group but a diverse community. They include individuals with physical, sensory, intellectual and developmental challenges of varying degrees.

I raised disability issues seven years ago during my previous term in Parliament, specifically about improving public transport and pedestrian infrastructure accessibility for the visually-impaired. I am glad to see some progress has been made since then, although some gaps still remain.

For example, most junctions with traffic lights still don’t have audible pedestrian signals (APS) and for those that do have the chirping sound turned off at 9 or 10pm to avoid disturbing nearby residents. This could pose a safety risk for visually-impaired pedestrians who are out at night.

I hope MOT will re-consider my proposal to add vibrotactile walk indications at these crossings. These are special buttons positioned at the traffic signals which vibrate when it is safe to walk. These complement the APS and can continue to operate even late at night without disturbing the peace.

In my conversations with PwDs, the number one issue on their minds is jobs — not unlike most other Singaporeans. They are not asking for handouts, but more equal opportunities in employment. However, PwDs face much higher hurdles, and not just because of their disabilities.

One such hurdle is that it is common for employers to assume PwDs will not be able to perform on the job just because of their limitations. PwDs have shared with me their unpleasant job search experiences, whereby they met all the job requirements, only to be rejected when the employer learned that they had a disability. In fact, with modern assistive technologies, PwDs can be as productive at work as their able-bodied colleagues.

The government has done well to provide schemes like the Enabling Employment Credit and the Assistive Technology Fund. This needs to be complemented with better public education, for both employers and the general public, in order to clear misconceptions about PwDs in the workplace. We also need to ensure that employers do not discriminate on the basis of disability by introducing anti-discrimination legislation.

Means testing

Another area that needs to move forward faster with the times is our approach to means testing for social assistance schemes. The process often requires too much paperwork and imposes an undue burden on the very people we are trying to help. Mr Leon Perera, also raised this issue in his speech on Tuesday.

The application for Public Assistance, for example, requires applicants to submit at least 10 documents to prove their neediness. Some of these documents require applicants to log in to government websites with their SingPass and print out documents such as CPF statements, both of which can be an obstacle for those with no computers and printers at home. When they apply for assistance schemes with other government agencies, or need to renew their assistance, the same exercise has to be repeated.

The process for PwDs applying for disability support is not a walk in the park either. They need to get a doctor’s certification of their disability — and pay the clinic for this service. They then need to repeat this process for every agency they are applying for support from.

All this is a painfully low-tech way of means testing. In fact, we already have the capability to integrate and automate such systems. For example, the Tax Portal from IRAS pulls data from multiple sources to fill up a taxpayer’s income, deductions and reliefs, and computes their taxable income after just a few clicks. The Government has also been building its capabilities in data analytics.

We clearly have the technical capabilities to collect taxes efficiently and seamlessly. Can we now develop the same capabilities for disbursing social assistance to deserving individuals and families? For PwDs, the Government could create a centralised system that keeps track of each individual’s disability, which can be tapped into by various agencies to assess if they are qualified for disability benefits.

I am glad to learn from the Minister-in-charge of the Smart Nation Initiative in his addendum to the President’s address that all Government services will be digital from end-to-end by 2023. I hope our means testing process will be one of the first to go paperless and “presence-less”. By doing so, deserving citizens can receive the help they need more quickly and conveniently, and won’t fall through the cracks just because they have difficulty gathering and submitting the necessary documents.

Healthcare expenses

My third area of concern is helping Singaporeans cope with the burden of healthcare expenses.

Chronic diseases are imposing an increasing burden on our ageing population. The Ministry of Health has said in its addendum to the President’s address that it will look to identifying best practices that can help us in our fight to better manage diabetes and other chronic diseases.

A key challenge in chronic disease management is ensuring that patients follow their treatment regimens and show up for their regular appointments with their family doctors. I have met residents who have lamented about the high costs of treatment for their chronic conditions. Some have shared about missing appointments because of cost concerns. In the long run, missed or delayed treatment will cost both the patients and the healthcare system more if their conditions worsen and they need to be hospitalised.

I welcome the introduction of the MediSave700 scheme, which allows patients with multiple conditions to draw up to $700 a year from their MediSave accounts. This is up from $500 a year currently.

However, I remain concerned about the limitations of the scheme. Patients whose condition is not one of the 20 chronic conditions specified under the Chronic Disease Management Programme, or whose treatment costs exceed $700 a year, still have to fork out cash for their treatment.

I have two suggestions for MOH to consider. First, that MediSave withdrawals be allowed for the treatment of all chronic conditions, not just those on the CDMP list. This will ensure that no one is excluded just because they suffer from a less common chronic condition. Second, the annual withdrawal limits for MediSave should be removed for patients who have sufficient MediSave balances and are over the age of 60.

To reduce the risk of a “buffet syndrome”, these two changes can be rolled out first at polyclinics and restructured hospitals, where tight procedures are already in place to ensure that only medically-necessary treatment is prescribed.

议长先生,医疗费用对于许多新加坡人而言,都是一个十分沉重的负担。尤其对于那些长期与慢性疾病对抗的患者来说,更是如此。因此,我希望政府能够进一步地降低保健储蓄的使用限制,帮助年长者减少须以现金偿还的医疗费用。

很多居民都曾因昂贵的医疗费用而向我们提出抱怨。有些甚至因负担不起治疗而不去复诊。长此下去,一旦病患的病情恶化到必须住院的情况,不管是对病患或者是对我们的医疗系统来说,负担都会增加。

有鉴于此,我想向卫生部提议,将所有其他的慢性疾病一并列入保健储蓄的可支付项目之中,并让60岁以上的年长者免去年提款限额的限制。我相信这样的安排可以减轻年长者因医疗费而造成的精神压力,让他们能更安心地就医。

Migrant workers’ welfare

My fourth area of concern is the welfare of migrant workers. These are some of the most disadvantaged yet invisible members of our society. They are neither voters nor Singaporeans, but they are part of the Singapore community and their interests must be protected too, as is befitting a developed country like ours.

At the heart of many of the issues that migrant workers in Singapore face, is their lack of bargaining power vis-à-vis other parties like employers, the government and employment agencies. This makes them susceptible to being taken advantage of. NGOs have reported that migrant workers often pay as much as $10,000 to secure jobs in Singapore. The costs include agent fees, course fees and sometimes kickbacks. When their contracts end, some are asked to make cash payments of up to $4,000 to third party “agents” to renew their contracts or find subsequent jobs.

For both these fees, they take up huge loans and spend many months servicing them on the back of their salaries of around $500 to $800 a month. This makes them almost like indentured labour for much of their time in Singapore. A few unscrupulous employers are in on the act, working with illegal agents to profit off the workers they employ.

Because such payments are usually made in cash, there is often no paper trail to prove the offences if they file a complaint with MOM. Furthermore, workers risk losing their jobs and being sent home if their employers find out they have filed a complaint. Hence many violations go unreported.

I urge MOM to step up enforcement and intelligence gathering, so that errant parties will be taken to task and made an example of.

We could also set up a jobs portal for employers to list available jobs so that workers don’t have to go through intermediaries to find new companies to work for once their contracts end. This will reduce the opportunities for collecting kickbacks and correct some of the power imbalance that currently exists.

Conclusion

Mr Speaker, it has been said that the true measure of any society can be found in how it treats its most vulnerable members. The President alluded to this in her address too.

We have come so far as a country, uplifting the standard of living of generations of our people. Let us take this progress to the next level as we further improve how we care for the vulnerable members in our society.

Thank you.


[1] NRIC of all adults in household, birth certificate of all children in household, latest CPF statement, bank book, medical certificates, marriage/divorce certificate, latest power supply bill, latest S&CC bill, latest HDB statement.

A new path for our nation

These are the remarks I made as part of the first Hammer Show of General Election 2020: Why should you vote for WP?

The Covid-19 crisis has been a wake up call for many Singaporeans who saw with their own eyes that the PAP is not infallible. We went from “gold standard” to “cautionary tale” in just a matter of weeks.

While not everything about the virus could have been anticipated, there were clearly some blind spots that the PAP missed. To be clear, it is only fair that I acknowledge that they have done a competent job over the years in making Singapore a safe and efficient country with a good international reputation. We have no intention of undoing these gains.

However, many older Singaporeans have observed that the PAP of today is a shadow of the PAP of previous generations. They have done well to maintain the status quo, but the status quo falls short of what we aspire to as a nation. Singapore deserves much better.

We, the citizens of Singapore—and not just the Workers’ Party alone—must begin to chart a new path for our nation, for the sake our children’s future.

We need a new economic model, which places a premium on the talents and passion of Singaporean workers.

We aspire to a new social compact, where every Singaporean is assured of a strong safety net to catch them if they fall on hard times, so they can bounce back stronger.

We want to live in a secure home where families are strengthened and parents can raise happy, well-rounded children.

And we desire a newfound freedom for our people to embrace a diversity of ideas and engage in constructive debates to forge the best way forward.

Over the next few days, my colleagues and I will be sharing more details about our vision for Singapore. I invite you to tune in to assess us for yourselves before making your choice. We in the Workers’ Party are ordinary citizens just like you. We face the same challenges you do—earning a living and raising children.

My wife and I both work full time, and we have two young kids. My older one is sitting for the PSLE next month, while her “tutor” has taken time off to campaign in this Election! I joined the Workers’ Party almost 12 years ago, a few months after she was born. I had a comfortable job and a happy family. “Why put that all at risk?”, people asked me.

My answer then, and now is: Singapore needs a strong and credible opposition to progress to our next level of development, and I want to do my part to build it. I’m pleased to report that never lost my job. My 10-year old son helps me at grassroots events and my wife is the wind beneath my wings.

I was an NCMP in the 12th Parliament of Singapore. During that time I asked over 150 Parliamentary Questions. I debated policies with cabinet ministers and presented counter proposals on many issues, including our response to the population white paper, reducing the cost of healthcare, MRT breakdowns and salaries for low wage workers.

If you give us a chance to serve you again, we will continue to work hard to take good care of you and your estate. We will tap on the knowledge of experts and the wisdom of Singaporeans to come up with practical proposals in Parliament.

We will work for Singapore, and walk with you. :)

Constituency Political Broadcast – Aljunied GRC

Source: Mediacorp Channel 5

This is the text of the Constituency Political Broadcast for the Workers’ Party’s Aljunied GRC team, which was aired on 3 July 2020 on Channel 5.

Voters of Aljunied GRC, the PAP keeps saying there’s no need to vote for the opposition as the NCMP scheme ensures your voice in Parliament. Don’t be swayed by this argument.

Parliament is not just a talk shop where MPs make speeches. It exists to make laws, which are voted on by MPs.

The PAP will feel safe as long as their two-thirds majority is not threatened. But once the opposition gains more seats, they will be forced to consult you, and you will also get a more responsive government.

I have been an NCMP before and I know the limitations of that position. Without constituents to serve and a town to manage, it’s hard to establish a base.

I worked the ground for almost four years in Fengshan SMC after the 2015 Election. We ran a food distribution programme for over 240 families.

For the last few months, I have been covering the duties of Mr Low Thia Khiang in Aljunied GRC. This has allowed me to walk the ground, familiarise myself with the constituency, and get to know many residents, in ways I could not when I was an NCMP.

When I was in Parliament, I filed over 150 questions and spoke on healthcare, transport and manpower issues. I debated with ministers over the population white paper and Medishield insurance payouts.

Please allow me to use the experience I have gained to serve a second term in Parliament.

阿裕尼集选区的选民,这次大选,你的决定会影响到你的孩子跟孙子的未来。

我们工人党进入国会,是希望能迈向一个有制衡的国会,也能更完善地讨论政策来改善人民的生活。

请支持我们的团队,让我们在未来的几年为你服务,代表你在国会发表意见。

让你的一票成就未来。投工人党一票!

Make your vote count. Vote for the Workers’ Party!

Resolving the $100 million TraceTogether dilemma

TraceTogether
Image: GovTech

Japan recently announced that it will soon launch its own contact tracing smartphone app. According to the Straits Times, to protect users’ privacy, the app does not collect names, phone numbers, user locations or any other personal information. This follows the launch of SwissCovid, an app built in Switzerland which boasts of similarly strong privacy protections.

Both apps use software jointly created by Apple and Google, called the Exposure Notifications System, which uses Bluetooth technology to help health authorities perform contact tracing, while ensuring that user privacy and data security remain central to the design.

Singapore’s Government Technology Agency (GovTech) built its own TraceTogether app on a different protocol. Jason Bay, TraceTogether’s product lead at GovTech, wrote in a blog that since March, GovTech had been working with Apple and Google on the specifications for contact tracing technology which “allows cross-border interoperability.” He wrote this on April 10th, the day that Apple and Google announced their partnership to create the Exposure Notifications API.

It is widely known that TraceTogether does not work well on Apple’s iPhones, which are used by a third of smartphone users in Singapore. This is because iOS, the operating system running Apple devices, suspends Bluetooth scanning when the app is running in the background, preventing it from collecting data from contacts in the proximity of the user.

Mr Bay posted as recently as April 20th that GovTech will continue to work with Apple and Google to improve TraceTogether using the new API. It therefore came as a surprise when on June 5th, Dr Vivian Balakrishnan, Minister-in-charge of the Smart Nation Initiative, told Parliament, “We have had repeated discussions at both the technical and policy level with Apple, but we have not yet been able to find a satisfactory solution.”

The government has not announced any further plans to use the Apple-Google API. Instead, it plans to issue a wearable device to all Singapore residents and make it mandatory for everyone to carry it around. On June 13th it was reported that the government had already awarded a tender to a company to manufacture the first 300,000 units of the device. Based on the tender price for the pilot batch, CNA estimated that the device will cost $110 million to be rolled out nationwide.

Why couldn’t TraceTogether be made to work with the Apple-Google software? Dr Balakrishnan did not elaborate on what the technical and policy issues were. However, an examination of the two main protocols used by contact tracing apps around the world could give us some clues.

Centralised vs decentralised contact tracing

TraceTogether uses BlueTrace, a centralised report processing protocol. When a person tests positive for Covid-19, they will be required to upload the entire contact log from their phones onto a central server managed by the government for the purpose of contact matching and tracing.

TraceTogether’s current protocol also has no special privileges over normal apps, preventing the app from running Bluetooth scanning in the background.

Contact Tracing
Image: BBC

Exposure Notifications, on the other hand, employs a decentralised report processing protocol. User data is not stored in a central server and the matching of Covid-positive cases is done on users’ devices. Users can still opt to share their phone number and details of their symptoms with health authorities through the app, so that they can be contacted and receive advice on the next course of action to take.

Because the Exposure Notifications protocol is implemented at the operating system level, it allows for more efficient operation as a background process. It could also extend battery life and improve detection across iPhone and Android devices.

Several countries which initially pursued the development of centralised contact tracing apps have now decided to adopt the decentralised architecture pushed by Apple and Google. In late April, Germany abandoned a home-grown app design in favour of a “strongly decentralised” approach after Apple refused to budge on the settings of its iPhones.

At least 22 countries have now received access to use Exposure Notifications, including Austria, Belgium, Germany, Ireland, Italy, Latvia, Poland, and several U.S. states.

Even Australia, which created its COVIDSafe app based on TraceTogether’s open source code, is now exploring a switch to Exposure Notifications.

Why do we need a contact tracing app?

With all the privacy risks that contact tracing technology brings, why do we even need to use it? Don’t the traditional modes of contact tracing suffice?

Effective contact tracing and widespread community testing have been recognised as the twin keys to enable the safe and wide opening of economies from Covid-induced lockdowns, of the sort we have endured in Singapore for the past three months.

Manual contact tracing involves interviewing the patient and asking them to recall all their movements for the past 14 days to determine whom they came into close contact with. Large teams of contact tracers then track down these contacts to instruct them to self-isolate or get tested. This is a laborious exercise which can take a few days. The delay could result in an infected person roaming the streets for several days, unknowingly transmitting the virus to others.

Contact tracing apps, if widely adopted, can instantly alert all the close contacts of a new case and instruct them what to do next, drastically reducing the time needed for contact tracing and stopping the spread of infections.

Contact Tracing 1
Contact Tracing 2

The win-win solution for Singapore

The Covid-19 pandemic has done much damage to our economy, with as much as a 7% GDP contraction expected in 2020. It is the worst recession in our nation’s history. Therefore any solution that will allow us to safely reopen our economy should be considered. Contact tracing apps can provide a way forward.

We need not make a false choice between privacy and public health. The Exposure Notifications System provides both privacy protections and privileged operating system access to allow contact tracing apps to work on almost all smartphones, even when they are locked.

By improving privacy protections and reducing the battery drain on phones, an enhanced TraceTogether app will become more attractive for Singapore residents to install on their phones, improving its current 25% adoption rate to a level closer to what is needed for effective contact tracing.

As more coronavirus-torn countries manage to contain their outbreaks, talks are underway on the establishment of “travel bubbles”. This would allow quarantine-free movement across borders. An important prerequisite would be effective contact tracing.

Interoperability between contact tracing apps would certainly help. As more countries around the world decide to adopt the decentralised protocol created by Apple and Google, it makes sense for Singapore to move in sync with them, to enable TraceTogether to “talk” to apps in other countries.

Given that 91% of the population in Singapore uses smartphones, rolling out a working contact tracing phone app can be done much more easily and cheaply than issuing a hardware dongle to all 5.7 million residents. It is also more seamless to fix bugs or add enhancements to an app and roll out an update to App Store or Play Store. If the hardware token has a serious bug, that’s $110 million down the drain.

It is still not too late to reverse course. The TraceTogether app should be re-programmed to adopt Apple and Google’s Exposure Notifications system. This will enable the app to run effectively on all smartphones, maximise adoption, protect privacy, enable cross-border interoperability and, most importantly, become a real weapon in our battle against Covid-19. The wearable device then only needs to be issued to the 9% of residents who don’t own a smartphone, saving taxpayers over $100 million.

MOH’s “surveillance programme” for Covid-19 testing an encouraging development

Photo by Summer Chan on Unsplash

The headline “MOH flags concern over unlinked COVID-19 cases” may sound rather ominous, but MOH’s announcement of its “ongoing surveillance programme, where a small sample of patients at our primary care facilities are tested for COVID-19 infections” is an encouraging development. MOH added that they have “picked up some cases through these tests, which is an indication of undetected cases in the community.”

MOH did not elaborate on how this “small sample” of patients is selected. However, it is likely that not all of them present the typical Covid-19 symptoms and risk factors, but they were still tested as part of this programme. As I had explained in my posts last week and and this week (links below), it is important that the pool of patients tested for Covid-19 is widened beyond the symptomatic. This is because up to 70% of those infected with the disease may be asymptomatic. They could end up being “silent spreaders”, which not only infect others but also make contact tracing extremely difficult.

The only way to identify more of these undetected cases in the community is to do more community testing. This allows the authorities to isolate more positive cases and staunch the spread.

Also read:
http://geraldgiam.sg/2020/04/community-testing-for-covid-19/
http://geraldgiam.sg/2020/04/identifying-the-silent-spreaders/

Identifying the “silent spreaders”

Photo by Martin Lopez from Pexels

If up to 70% of those infected with Covid-19 are asymptomatic (or pre-symptomatic), then we need a way to identify and isolate these “silent spreaders”. Wearing a mask will help but it will be delaying the inevitable — they will eventually spread it to someone, whether at home or in their workplace.

This is where more widespread testing is needed. We could start by swabbing anyone who reports even mild symptoms and all the workers in the affected dorms (where active case-finding is already in progress).

If there aren’t enough test kits or chemical reagents, then let’s make it a national priority to source for them or manufacture them locally. This is a national emergency and time is of the essence.

Community testing for Covid-19

With a record 140 local cases of Covid-19 recorded yesterday (Apr 8th) in Singapore, it is timely to examine whether there are further approaches to containing the Covid-19 pandemic that can complement the so-called “circuit breaker”, which is in place until May 4th. (Update: There were 284 new locally-transmitted infections on Apr 9th, double the previous day’s record.)

One approach I hope the Ministry of Health (MOH) is considering is community-based testing for the coronavirus. This approach has been advocated by infectious diseases experts and is even being implemented in some countries like Iceland. However to-date, there has not been much public discussion about it in Singapore.

Photo by Chokniti Khongchum from Pexels

Community-based testing involves the testing of a large percentage of a country’s population for Covid-19, even those who may be asymptomatic or have only mild symptoms. By preemptively identifying individuals who are carrying the virus, we can isolate and treat them, and prevent further community spread. If done correctly, this may enable governments to slowly lift some of the draconian lockdown measures which are causing much pain for businesses and workers.

Singapore’s current approach to coronavirus testing is to focus on individuals with symptoms. When asked why testing has not been used more widely, the Director of Medical Services (DMS) said on April 6th that MOH’s approach is to test in a very targeted fashion so as not to waste the tests. He said that Singapore does not see the need for widespread community-based testing now, although it is “something (MOH) might review and consider doing in the future.”

The DMS said that Singapore has the capacity to continue its targeted testing approach. However, it is unclear whether we have the capacity for community-based testing. In the UK, a shortage of chemical reagents has limited the number of tests they can run a day. Could this constraint be the reason for Singapore’s current testing approach? It would be good if MOH could share the constraints it faces and its plans to overcome them.

Another concern about community-based testing might be the cost. Currently, each antigen test costs around $140, while the antibody test costs around $25. This cost varies from country to country. The antigen test (reverse transcription polymerase chain reaction or RT-PCR) tells if a patient currently has the virus, while the antibody (serological) test indicates if a patient had the virus. Tests are typically run a few times on each patient to confirm a negative result.

If community testing were to be rolled out nation-wide, we are looking at the order of hundreds of millions of dollars. This cost could be mitigated as more competing diagnostic test kits enter the market, leading to greater price competition. Indeed, the HSA is already expediting the approval of Covid-19 diagnostic tests.

The current “circuit breaker” in Singapore will last until May 4th. It may well be extended if infection rates do not come down. The economic and social costs of an extended lockdown could far exceed the cost of mass community testing.

We could begin mass testing on the foreign worker population living in the three dormitories which have been declared as isolation areas. Their crowded and cramped living conditions are breeding grounds for the spread of the virus. Many of the local transmissions reported in the past week have been linked to these dorms.

The government should test all the workers in those dorms immediately, even those who have not shown any symptoms, and quickly isolate and treat those who test positive. This will prevent the further spread of the coronavirus in the dorms. It will also enable those who test negative to be moved to other housing facilities. Many of these workers need to leave their dorms to work in essential services.

Photo: Kevin Lim, The Straits Times

Carrying out community testing on a nation-wide scale requires an incredible amount of coordination and resources. It is not something that can be rolled out overnight. Mass testing would involve, among other things, the development of digital technologies to coordinate the roll-out of the tests and the purchase of enough personal protective equipment to conduct the tests. Without adequate preparation, hospitals and clinics will be overwhelmed by test requests.

The government needs to start planning for community testing earlier, rather than later when the need becomes too acute. If we move too late, a global shortage of test kits could be a problem, as other countries snap them up faster than they can be produced.