COVID-19: Rigorous testing could help revive travel but challenges remain, say experts

COVID-19: Rigorous testing could help revive travel but challenges remain, say experts

Changi Airport 29
Changi Airport's Terminal 3's transit area during the COVID-19 outbreak. (Photo: Jeremy Long)

SINGAPORE: While rigorous COVID-19 testing and shortened stay-home notices could help revive mass travel, it is unlikely to be an easy process, say experts.

Last month, Transport Minister Ong Ye Kung said that Singapore may have to consider replacing the two-week isolation period for the overwhelming majority of travellers with a "rigorous testing regime" as part of efforts to revive the country's air hub.

READ: Singapore may have to consider replacing 2-week COVID-19 isolation with 'rigorous testing regime' for travellers: Ong Ye Kung

Mr Ong had said international travel could start with other countries and territories where virus transmission risk profiles are "similar to or better than" Singapore's.

Measures could include "unilaterally opening up" to passengers from countries and regions that have kept the coronavirus "under control", as well as the proliferation of reciprocal green lanes for business travel and expanding them to include general travel as well, he said.

Singapore currently has cross-border travel arrangements with China, Malaysia, Brunei and South Korea. Singapore and Japan on Friday (Sep 11) also announced that they will launch a "reciprocal green lane" to facilitate essential business and official travel between the two countries on Sep 18.

It is in talks to resume essential business travel with Japan, and officials were tasked to finalise an agreement by September.

Earlier this week, the Singapore Consulate-General in Hong Kong had also said it welcomes discussions with Hong Kong on the gradual resumption of cross-border travel between both sides, with safeguards in place.

READ: Singapore welcomes talks with Hong Kong on resuming cross-border travel

Health experts told CNA that there are several operational considerations that need to be kept in mind when setting up a comprehensive testing regime for incoming travellers.

Associate Professor Hsu Li Yang, who is an infectious disease expert from the National University of Singapore's Saw Swee Hock School of Public Health, noted the question would have to be asked if travellers were willing to fork out money to pay for tests. Polymerase Chain Reaction (PCR) tests would cost about S$130 at “cost price”, he pointed out.

"Ultimately it's a matter of costs and logistics,” he said. “Unless they are returning citizens, or those are coming for essential reasons, there's really no reason for Singapore to absorb the costs of all these tests.”

In addition, Dr Hsu noted that the “operational scale” of tests carried would also need to be considered, keeping in mind Singapore's testing capacity and the potential number of incoming travellers. “That capacity is an important factor in determining whether we can test everybody or not,” he added.

Dr Paul Tambyah, who is the president of the Asia Pacific Society of Clinical Microbiology and Infection, noted that rigorous testing can be done, but this would require better tests than currently available.

He explained how having a test like a pregnancy test which could give results which are 99.9 per cent accurate in minutes could allow testing to be "done routinely without too much cost or inconvenience”. Rather than providing a urine sample, when it comes to COVID-19 tests, a saliva sample could be used instead. 

“We are not there yet but are getting nearer every day,” he noted.

A COVID-19 testing facility for passengers and employees is seen during a media tour at  Newark Lib
A COVID-19 testing facility for passengers and employees is seen during a media tour at Newark Liberty International Airport Terminal B in Newark, New Jersey, U.S., September 8, 2020. REUTERS/Shannon Stapleton

When it comes to pre-departure and post-arrival tests, it is also important to note what kind of tests are being conducted, said Associate Professor Josip Car who is from the Nanyang Technological University.

“One could argue that doing two tests is better than one. As a public health researcher, what I would say matters just as equally is which test is being done, as not all are same and have differing durations and efficacies, and the time difference between the tests,” said Dr Car, who is the director of the Lee Kong Chian School of Medicine’s Centre of Population Health Sciences.

“Also, this formula is never static when it comes to science: There’s discussion in the scientific community now whether the thresholds for considering a test ‘positive’ or ‘negative’ should be revised in order to reflect the latest scientific understanding about viral loads, transmission potentials, which might potentially see a reduced number of positive test cases as a result.”

Pre-departure and post-arrival tests also do not guarantee a 100 per cent success rate in ensuring those with the virus are detected, added Dr Tambyah. 

“It is better than nothing but should not give public health officials on either side a false sense of confidence,” he explained. “They should be accompanied by good contact tracing and surveillance while we wait for better rapid point of care tests which can be deployed at borders or elsewhere.”

And there is a need to remain vigilant, noted Dr Jeremy Lim, co-director of global health at the NUS Saw Swee Hock School of Public Health.

"We have to be very vigilant with false declarations, false negatives and so on. And we cannot let our guard down on the other measures like mask-wearing ... The Government has to tread a fine balance in assuring Singaporeans that we can reopen borders but also re-exhorting them - you still have to wear your mask, you still have to safe distance and so on," he explained.

‘RISK VERSUS BENEFIT’ ASSESSMENT

Earlier last month, it was announced that travellers entering from Brunei and New Zealand from Sep 1 would not be required to serve a stay-home notice but will take a COVID-19 test upon arrival.

READ: Singapore to waive stay-home notice for New Zealand and Brunei travellers, will test them for COVID-19 on arrival

Travellers coming from some low-risk countries and regions also had their stay-home notices reduced from 14 days to seven days. The isolation period can be served at their place of residence. 

These countries and regions are Australia (excluding Victoria state), Macau, mainland China, Taiwan, Vietnam and Malaysia. They will be tested before the end of the isolation period.

All other incoming travellers will continue to serve their 14-day stay-home notices at dedicated isolation facilities, and will be subject to a COVID-19 test before the end of the notices.

Public healthcare experts noted that the duration of the 14-day stay-home notice is to account for the length of the virus’ incubation period.

Given that this is so, the decision to cut short home notices will have to be made on “risk versus benefit” calculations, said Dr Tambyah.

READ: COVID-19: PM Muhyiddin hopes Malaysia, Singapore can finalise procedures for daily commuting

“The incubation period for the virus cannot be shortened as this is a biological phenomenon. However, public health decisions are not based on science alone,” he said.

“Policy makers have to make a call based on risk versus benefit calculations and put in place risk mitigation strategies. For example, in Singapore, we are heavily connected to Malaysia and the control there seems to be very good for now. As such, the stay-home notice period for Malaysians with Singapore work passes has been reduced to seven days. The risk to public health of not having Malaysian workers has been viewed as greater than the risk of a small number of them incubating the virus and transmitting it. 

“When the data are analysed after the policy has been in place for a while, we will know whether this risk-benefit calculation was justified.”

Infectious diseases expert Professor Dale Fisher suggested that more countries could be added to the same category as New Zealand and Brunei.

“It (the public health risk) is country-specific - the public health risk for someone coming from a country that's really got no cases is absolutely negligible," noted Dr Fisher, who is the chair of Infection Prevention and Control at the National University Health System (NUHS). 

"There's never no risk, but you have to have a sensible approach to risk.” 

Dr Fisher noted that there may not even be a need for swab tests for travellers entering Singapore from such countries. These tests and their administration could be a waste of manpower and resources, he pointed out and Singapore has good systems in place to ensure that even in the off chance that they are COVID-19 positive, the spread will be limited.
 
“(It is) just like (how) a case in the community isn't spreading to 30 others like the outbreaks we had before the circuit breaker. We're not having those now because of masks and social distancing and stopping large gatherings. This is a big reason why you can open borders. Even if someone comes in, (it) probably won’t turn into much,” he said.

Dr Hsu agreed, and also noted that the risk of an imported case causing a cluster in Singapore is “very low” due to the compulsory mask-wearing policy as well as safe distancing measures.

“The risk of an imported case causing a cluster is actually very low, especially with all the safe distancing measures in place. But if we drop the mask rule, and if we allow bigger-sized gatherings then obviously the risk will start to go up,” he noted.

"WAITING FOR THE GREEN LIGHT"

Even as countries gradually open their borders, experts CNA spoke to acknowledged that there is a demand for travel but said there remain numerous obstacles for those hoping to go abroad.

Mr Christopher Khoo, the managing director for international tourism consultancy Masterconsult Services, noted that Singaporeans have become “COVID fatigued”.

“Honestly, I think we all are COVID fatigued already - I wouldn’t say not scared of COVID anymore but we are learning to live with it,” he noted. 

"Internationally, I'm sure that there is demand. Everybody is experiencing some form of cabin fever in one way, shape or form. But I think everybody's also very cautious, whether they are from a country that is doing well ... or whether they're the country that's like India and then looking at other countries which are less prevalent, they all face different kinds of considerations."

Dynasty Travel’s director of public relations and communications Alicia Seah noted how her company had received a number of enquiries on travel packages to New Zealand when Singapore's plans to ease travel restrictions were announced.

New Zealand's border remains closed to all but citizens and residents, a spokesperson for Immigration New Zealand told CNA following the announcement.

READ: New Zealand aware of Singapore's intent to establish travel, advisory to residents remains unchanged

“Our customers had expressed to travel to places such as New Zealand, Australia, Japan, Thailand and Maldives and Malaysia once travel restrictions are lifted and a no quarantine policy (is) in place,” said Ms Seah.

Spread of the coronavirus disease (COVID-19), in Singapore
People, some of them wearing protective face masks, at Singapore's Changi Airport on Mar 30, 2020, following the COVID-19 outbreak. (File photo: Reuters/Edgar Su)

“Around us, if you ask 10 people, they are just all waiting for the green light. Of course, they will also book cautiously. Depending on which country they feel the healthcare systems are robust. That's one. Second is that the health and hygiene protocols are all in place. And also, travel insurance. I think these are things that they will look at before they book a tour,” Ms Seah explained.

However, a number of considerations remain - for one, the stay-home notices that Singaporeans face when they return home, noted Mr Khoo.

“The main sticking point … is even if a country like Japan ... or whoever wants to accept us, coming back we would still be subjected to stay-home notices. And until that is relaxed, or until that has changed in a significant way, I think that it would impact a lot of outbound demand,” he pointed out.

Relaxing the 14-day stay-home notice can have a “mitigating effect”, but might be outweighed by the hassle and high cost incurred to travel during this period, said Mr Kevin Wee, a senior lecturer at the School of Business Management at Nanyang Polytechnic.

“The hassle of travelling during this time includes serving stay-home or quarantine notice at the destination country and home country upon return, higher costs for flights and various COVID-19 tests, and high costs for COVID-19 related medical treatment should the traveller fall ill,” he said. 

READ: Singapore Airlines Group to cut about 4,300 positions as COVID-19 batters aviation industry

“In addition, leisure travellers might not be able to visit attractions given the tighter entry requirements to guard against visitors who have been to another country within the past two weeks.”

Mr Wee also pointed out how the re-emergence of new “waves” of the virus could also occur anytime as evidenced in Europe. 

“Travellers themselves must first be assured that it is safe to travel, and that the benefits of travelling outweigh the cost and hassle incurred when travelling during this period. The increase in travellers would most probably only start after the COVID-19 vaccine is ready,” he said. 

READ: Campaign to encourage domestic tourism will cushion COVID-19 blow, but not make up for drop in international travel, say observers

While Singapore is now regarded as one of the safer destinations during the worldwide pandemic, the pandemic will continue to dampen demand. 

“For a Japanese tourist, a Chinese tourist, a New Zealander - even for them, it’s not a matter of how attractive Singapore is right now, it's not a matter of how much cabin fever they (tourists) have got. It’s just the fact that COVID-19 is around and it will dampen outbound travel (from those countries),” added Mr Khoo. 

“Travel will rebound and I am certain it will rebound and rebound strongly. But it will not be the same as it was pre-COVID.”

Source: CNA/mt

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