Clinics expect increased demand for COVID-19 testing as Singapore resumes more activities

SINGAPORE: Health care providers and general practitioner clinics are preparing for an expected increase in demand for COVID-19 testing as Singapore resumes more activities, with Phase 3 of the country’s reopening to begin on 28 December.

Fullerton Health, which provides COVID-19 testing at seven of its clinics, as well as for events such as concerts and mixed martial arts (MMA) competitions, said it expects more requests for testing at events and for people to return to the venue. job.

“We anticipate increased demand from the private sector to explore testing for their employees in situations such as return to work, conferences and important meetings,” said Dr. Faizal Kassim, Chief Medical Officer of Fullerton’s Primary Care Division. Health.

“Our major customers in the transportation and semiconductor industries have expressed interest in working with us to have some kind of routine asymptomatic testing for their employees in various settings,” he added.

READ: Social gatherings of up to 8 people allowed on December 28, reopening of community activities in Phase 3

READ: F&B companies welcome Phase 3 announcement, say customers are hungry to dine in larger groups

Currently, pilots are underway for sporting events, performances and MICE meetings of up to a few hundred people, where participants must undergo tests. Nightclubs and KTV will also start a pilot program next month in which customers would have to test before going out at night or singing karaoke.

These are generally rapid antigen tests (ART), which are less invasive than polymerase chain reaction (PCR) tests. Results are also available more quickly, in 15 to 30 minutes, while PCR tests require the deep nasal swab sample to be sent to a laboratory and results are generally known in 24 to 48 hours.

“NO INCENTIVE” FOR VOLUNTARY TESTING

While doctors anticipate an increase in demand for coronavirus testing, the clinics CNA consulted with said there has been no increase in people requesting voluntary testing since Dec. 1. That’s when authorities removed the need to seek approval for COVID-19 testing.

Dr. John Cheng, chief of primary care at Healthway Medical Group, said that about 30 percent of all PCR smear tests performed at his clinics are for travel, while 70 percent are patients who have symptoms of COVID-19 such as fever and cough.

This hasn’t changed after voluntary testing began, he said, adding that people can come forward only when there are less invasive forms of testing. The Healthway group has 38 clinics that offer testing.

READ: Singapore to launch segregated travel route for business travelers from all countries

READ: New Connect @ Changi short stay facility to open to business travelers in February

“We have not seen any patients who do not belong to the two previous groups who undergo voluntary swab tests. This is not surprising as I think many are waiting for less invasive testing methods before considering taking one, ”said Dr. Cheng.

“At this time, unless a person is unwell, there is little incentive for them to pay for a voluntary swab test.”

PCR tests cost around S $ 200 currently, while most ART tests range from S $ 50 to S $ 80, according to a list of test providers published by the Ministry of Health (MOH).

“However, we hope to see some people requesting these tests in the coming weeks as we prepare for Phase 3 in the reopening of Singapore, which will see the resumption of economic and community activities on a broader scale, as well as travel of business and pleasure. ”Dr. Cheng said.

He added that Healthway is working with its partners to anticipate an increase in demand for ART testing, especially for pre-event screening purposes.

Yong Yih Ming, general manager of Raffles Medical Group, said that it is also increasing testing capacity to facilitate Singapore’s reopening. It has launched a Raffles Connect app for customers to book test appointments, make payments, and receive PCR test results.

“In anticipation of the projected increase in demand for testing, we have also invested at the same time in increased laboratory capacity that will allow us to increase daily testing capacity to between 8,000 and 10,000 tests,” he said.

READ: Air Travel Bubbles, More Green Lanes Part of Plans for Singapore to ‘Revive’ Changi Air Hub Amid COVID-19: Ong Ye Kung

Fullerton’s Dr. Faizal said his clinics are seeing increased demand for ART testing, while there is a small percentage performing serological testing for specific travel routes. Mainland China, for example, requires travelers to undergo a serological test before their flight.

A serological test detects antibodies using a blood sample. It is not a means of diagnosing COVID-19, but looks for past exposures or infections.

TYPES OF TESTS

Explaining the differences between PCR and ART tests, Dr. Cheng said that PCR tests are currently the “operational gold standard” in clinical practice, as they are very sensitive and very specific.

High sensitivity means that they can detect even low levels of viral genetic material within a patient’s sample and have a lower probability of false negatives. A test with high specificity would avoid false positive results, that is, diagnosing as positive those who do not have the virus.

READ: Marina Bay Sands Theater will reopen on December 18 with a live concert with Benjamin Kheng and other local artists

“This test is also capable of detecting the virus within a few days of infection, even those who are asymptomatic,” he said.

“The current turnaround time for PCR tests ranges from 24 hours to two to three days. Aside from the initial temporary pain and discomfort of the nasal swab, the PCR test has little or no side effects.”

PCR tests detect genetic material from the virus that has been amplified by the polymerase chain reaction, while ART tests can detect one or more specific proteins of the COVID-19 virus particle.

ART tests provide results in less than an hour, which is ideal for pre-event testing, Dr. Cheng said.

“However, (ART tests) tend to be less sensitive, so PCR testing will remain the definitive method when testing for COVID-19,” he said.

PCR tests can also use deep saliva as samples, but only one of those tests has recently been approved for use in Singapore by the Health Sciences Authority.

WHEN TO PERFORM THE TEST?

The current longer turnaround time for PCR tests makes them unsuitable for situations where a quick result is required.

Actual “machine” or test time for RT-PCR testing is four hours, but it takes time to transport samples to a laboratory, process, and analyze in batches.

“There is currently a trade-off in terms of time, cost and sensitivity. For tests where results are needed within an hour, such as just before an event, rapid antigen tests should be done by default,” said the professor. associate Hsu. Li Yang, vice dean for global health at the National University of Singapore (NUS) Saw Swee Hock School of Public Health.

But this could change. There are PCR tests, yet to be commercialized, that can produce results in less than 10 minutes, Assoc Prof Hsu said.

If a member of the public wants to be tested to make sure they are not infected, they can get a PCR test at a private clinic, said Professor Paul Tambyah, an infectious disease expert.

“For every infection, we always have the ‘worried well’ … That reflects guilt and anxiety far more than the actual risk of disease. The key is that the tests are now available and the people who need them will receive them at the Public health care clinics, while those who are simply anxious can pay for peace of mind, “said the president of the Asia Pacific Society for Clinical Microbiology and Infection.

READ: 83-year-old cruise passenger tests negative twice for COVID-19 after initial positive result

But Associate Professor Hsu said it discourages people who are fine from getting tested for COVID-19.

“Testing involves a certain amount of cost and inconvenience (for tests that require swabs), and while false positive tests are rare, there are considerable drawbacks for many if they do occur, as in the recent case of a cruise ship. “, said .

THE VACCINE FACTOR

Professor Tambyah added that the question of which test to use may become less relevant with vaccination.

“I believe that over time, pre-flight tests or events will disappear when vaccination is more widespread or the disease disappears thanks to global vaccination efforts,” he said.

However, considerable testing will continue next year as Singapore is unlikely to get enough doses of the vaccine to cover the population here until the second half of the year, Associate Professor Hsu said.

Later, some kind of strategy, perhaps an app that checks to see if a person has been vaccinated, is likely to allow those who have been vaccinated to be exempted from testing, he suggested.

“That would make more sense because testing also carries considerable costs. If the majority of the population is vaccinated, it may be possible to eliminate testing, except in clinical settings when a person is sick,” he said.

COVID-19 testing providers in Singapore can be found on the Ministry of Health website.

CHECK THIS: Our comprehensive coverage of the coronavirus outbreak and its developments

Download our app or subscribe to our Telegram channel for the latest updates on the coronavirus outbreak: https://cna.asia/telegram