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.
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.
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.