Commentary: The systematic testing Singapore needs to ditch circuit breakers for good
A system of testing may be expensive but will be less costly than if circuit breakers have to be slapped on again, say NUS Business School’s Neo Kok Beng and Jia Zhunan.
SINGAPORE: With Singapore in Phase 1 of a post-circuit breaker new normal, the country is treading carefully in reopening the economy.
While there is some level of acceptance infection numbers will go up, business, education and family activities must conform to specific, imposed constraints to mitigate the emergence of a second, unmanageable wave that necessitate the reversion to circuit breakers to curb movements and non-essential activities.
The impact of the pandemic has been swift and undiscriminating. With more than 5 million infected worldwide and the death toll hovering at 300,000, COVID-19 has revealed the vulnerabilities of economies and industries, especially healthcare, tourism and retail.
Globally, the World Bank’s most optimistic scenario predicts a fall of 2 per cent in global GDP this year.
Drastic measures enacted, including the closure of non-essential businesses, have created massive economic shocks to business activity, trade and supply chains. Sluggish growth and growing unemployment may be the world’s new normal for a while.
Governments are in a delicate position, having to balance the health of citizens against the rupture of entire enterprises and numerous jobs.
The circuit breakers have bought Singapore valuable time to ramp up testing and help the healthcare system cope with the surge in the foreign worker dormitories.
The Government’s plan in containing the pandemic is a three-prong strategy of the identification of symptoms, determination of the virus through testing and contact tracing, and the isolation of suspected cases, including quarantine and stay-home-notices.
Singapore has already allocated a total of S$92.9 billion or 19.2 per cent of GDP to save livelihoods through four different budgets - Unity, Resilience, Solidarity and Fortitude.
While we are fortunate that public coffers can afford such cash injections, the larger question is what novel approach can truly overcome this fear of a seemingly inevitable second wave.
A ROADMAP TO RESPONSIBLY REOPEN ECONOMIES
Enter Nobel laureate and former World Bank chief economist Professor Paul Romer. Dr Romer has proposed a roadmap to responsibly reopen economies. He calls it a “comprehensive periodic test and isolate policy”.
At the heart of it is a systematic plan to test everyone, isolate the infected and retest every two weeks. He believes this would make it safe for Americans to return to work while keeping the infection rate below 5 per cent of the population until a vaccine is ready.
The plan outlines how 7 per cent of Americans are to be tested once every 14 days at an estimated investment of US$100 billion per year, assuming US$10 per test.
He argues doing nothing is worse. The US economy suffers a loss of US$500 billion from lost output each month and lost capacity to produce in the future.
This new system would need new technological innovations, primarily, rapid real-time testing that is easy to administer on-site, can detect asymptomatic cases and is cost-effective.
It would also require governments to invest in a pandemic surveillance infrastructure that is scalable, accessible to the public and able to deliver immediate results onsite.
With this approach, a country can determine and isolate hidden reservoirs of infections within the two- to 14-day incubation period.
There is a higher chance economic activities can resume, with lower risks of job loss. If standards can be agreed on, borders need not be closed as asymptomatic cases can be detected at point-of-entry.
In fact, the economy might benefit as the country becomes a “safe haven” for non-infected travellers, since they need not be quarantined.
The Singapore Government is ramping up testing, with the launch of a first drive-through test site for priority groups and an announcement of four ad hoc screening centres in Singapore, but more can be done to leverage and scale up emerging technology in this fight.
In particular, instead of swab tests, new breath analyser devices developed by the National University of Singapore’s Nanoscience and Nanotechnology Institute that can detect lung cancer and tuberculosis can be re-purposed for the mass screening of COVID-19 for real-time and on-site analysis.
Other studies have used the same technology to detect influenza in asymptomatic patients.
Clinical trials are currently ongoing at the National Centre of Infectious Diseases to determine the technology’s sensitivity and specificity for COVID-19.
A PANDEMIC SURVEILLANCE PLAN FOR SINGAPORE
COVID-19 has cost Singapore dearly. The Government has spent a great deal, including tens of billions in support for wages, rental and cash payments.
A systematic approach to testing will not come cheap.
Using the current standard of polymerase chain reaction (PCR) testing, which typically takes more than four hours for results, would cost S$1.14 billion to test 5.7 million residents at S$200 per test in existing testing and laboratory facilities in our estimates. To test everyone every 14 days over one year would rack up a bill of S$29.7 billion.
Serological tests are not suitable for pandemic surveillance as they are only useful for identifying people who have previously been infected with the coronavirus. They do not show whether a person is currently being infected.
For breath analysis testing, the same approach will incur an initial investment of S$2.75 billion comprising a one-time infrastructure deployment of 2,700 stations in residential estates, workplaces and points of entry at S$1.35 billion that can last 10 years, and an annual testing cost of S$1.4 billion for the 5.7 million residents at S$10 per test every 14 days.
This is less costly than the S$3.8 billion budget that DPM Heng has allocated to support 75 per cent of workers’ salaries for the extension of circuit breaker for four weeks ending Jun 1.
Entry to business, commercial and community premises for large-scale, one-off events like the National Day Parade, Formula 1 Grand Prix, concerts or wedding banquets, can be facilitated through such testing facilities onsite, enabling mobility and movement even if there are unlinked infection cases in Singapore.
With consensus among countries on such testing protocols, Singapore may also be on a stronger footing to explore the issuance of “pandemic-free visas” by partnering with arrival and destination ports.
If this technology can be further developed to put reusable, pocket breath analysers in the hands of Singaporeans and a system of declaration and checks be instituted, that will be another game-changer negating the need for stations and the manpower to operate them.
A PARADIGM SHIFT
Countries need a paradigm shift to tackle COVID-19 that doesn’t involve pulling circuit breakers if cases spike, which kill businesses and can endanger livelihoods.
Our healthcare spending should look at pandemic prevention and management so that we can break out of the forced choice of health or the economy when an infectious disease hits.
It will be a bold challenge for Singapore to find a novel approach in tackling the scourge of COVID-19 but we can meet that with confidence.
Adjunct Associate Professor Neo Kok Beng teaches technology innovation and entrepreneurship at the National University of Singapore. He is the lead instructor of Graduate Research Innovation Programme (GRIP), the flagship innovation programme for DeepTech ventures.
Dr Jia Zhunan is co-founder and CEO of Breathonix, a NUS GRIP venture in breath analysis. She has a PhD in Breathomics from the NUS Graduate School for Integrative Sciences and Engineering.