Gerald Giam is the Member of Parliament for Aljunied GRC. He is the Head of Policy Research of the Workers' Party of Singapore. The opinions expressed on this page are his alone.
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.
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.
Had some good conversations with residents at Blk 16 Bedok South market this morning, together with Leon Perera, Terence Tan and Dylan Ng Foo Eng. Clearly the coronavirus and its economic fallout were on the minds of many. Most were waiting to see how the announced measures by the govt will actually help them.
Crowding in public transport is a weak link in social distancing measures that are being rolled out island-wide in view of the coronavirus pandemic. People are expected to sit at least 1 metre apart in the office and in restaurants, but then they proceed to squeeze into packed trains on the journey home. One solution would be to increase the frequency of buses and trains. That will reduce crowding and increase social distance (better than simply not talking, which one of our ministers suggested), and it is something within the control of the government and the public transport operators.
So sad to hear about Singapore’s first two Covid-19 deaths happening within hours of each other. (Update 29/3/2020: A third death has since occurred.) My deepest condolences to the families of the two patients, an elderly Singaporean lady and an Indonesian man. This is something that we had been bracing ourselves for but the news still hits you like a ton of bricks. Let’s all continue to protect ourselves, our loved ones and the people around us by doing our part.
It’s great to be back doing food distribution in East Coast GRC! Oh wait, we never went away — Fengshan is now back in East Coast! Regardless of how they change the boundaries, we will continue our mission to serve all Singaporeans. Thank you residents for your continued support!
Reading the original Twitter posts by the girl’s sister brought tears to my eyes and made my blood boil. What was not mentioned in the ST article was how the little girl was allegedly called a “black dustbin” and that she resorted to having her recess in the toilet because it was the “best place for (her) to cry and eat at the same time”. While details of these alleged incidents are still unclear and I’m sure the school and MOE are investigating, I think this should spark some soul-searching among all Singaporeans, especially us parents (my children are around that age). What values are we inculcating in our children? Do we harbour racist attitudes and inadvertently pass them on to our children? Do we teach our children to stand up to bullies, even if they are not the victims?
Glad Leon Perera asked this Parliamentary Question (PQ). It arose after my conversation with a teacher during house visits in Fengshan. This teacher voiced concern that the number of classroom teaching assistants was being reduced. I was surprised to hear this and decided to look deeper into the issue together with my colleagues from The Workers’ Party. It resulted in Leon‘s PQ. He didn’t just stop when he got the initial answer, but continued to press the Parl Sec for the detailed numbers.
This highlights the value of the ground feedback we receive from residents. If you meet our MPs and volunteers when they drop by your place during house visits, please raise up such issues of concern to us so we can bring them to Parliament for debate. We work as one #TeamWP to be your voice in Parliament!
(TLDR: There are 4 categories of AEDs. The headcount in one of the categories, AED (Teaching and Learning), is indeed being reduced while those in the other 3 categories is being increased.)
Citing perceptions on the ground, Leon Perera asked if the Allied Educator (AED) Teaching and Learning staff numbers were being reduced, or whether the Government intends to do so. (28 February 2020)Vid Credit: CNA
恭喜发财！We enjoyed our 5th year painting Fengshan ORANGE, greeting residents of all races a Happy Lunar New Year and and wishing them good health in the year ahead. As before, it was our volunteers who made it all happen! Thank you to all the residents and stallholders who showered us with their own New Year greetings. 新年快乐！
