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

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

A patient gets a nasal swab for COVID-19 testing at a Healthway Medical clinic. (Photo: Healthway Medical Group)

SINGAPORE: Healthcare providers and general practitioner clinics are gearing up for an expected rise in demand for COVID-19 testing as Singapore resumes more activities, with Phase 3 of the country's reopening set to begin on Dec 28.  

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

“We anticipate more demand coming from the private sector intending to explore testing for their employees for situations like return-to-work, conferences and major meetings,” said Dr Faizal Kassim, medical director of Fullerton Health’s primary care division.

“Our major clients in both the transport and semi-conductor industries have expressed interest to work with us to have some form of routine, asymptomatic testing for their employees for various scenarios,” he added.

READ: Social gatherings of up to 8 people allowed come Dec 28, further reopening of activities in the community in Phase 3​​​​​​​

READ: F&B businesses welcome Phase 3 announcement, say customers hungry to dine in bigger groups

Currently, pilots are being conducted for sports events, performances and MICE meetings of up to a few hundred people, where participants have to undergo tests. Nightclubs and KTVs are also due to start a pilot next month where patrons would have to take tests before a night out or to sing karaoke.

These are generally Antigen Rapid Tests (ART), which are less invasive than Polymerase Chain Reaction (PCR) tests. The 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 the results are usually known in 24 to 48 hours.

“NO INCENTIVE” FOR VOLUNTARY TESTING

While doctors anticipate a rise in demand for coronavirus testing, clinics CNA checked with said there has been no increase in people asking for voluntary testing since Dec 1. That's when the authorities did away with the need to seek approval for COVID-19 testing. 

Doing a Rapid Antigen Test. (Photo: Raffles Medical Group)

Dr John Cheng, head of primary care at Healthway Medical Group, said that about 30 per cent of all PCR swab tests conducted at its clinics are for travel, while 70 per cent are patients who have COVID-19 symptoms such as fever and cough.

This has not changed after voluntary testing started, he said, adding that people may 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 lane for business travellers from all countries

READ: New short-stay facility Connect@Changi set to open to business travellers in February

“We have not seen any patients who do not fall within the above two groups coming in for voluntary swab tests. This is not surprising as I believe that many are waiting for less invasive methods of testing before considering taking one,” said Dr Cheng.

“At this point in time, unless an individual is unwell, there remains little incentive for them to pay for a voluntary swab test.”

PCR tests cost about 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 do expect to see some individuals requesting these tests in the coming weeks as we prepare for Phase 3 in Singapore's reopening, which will see the resumption of economic and community activities on a wider scale, as well as business and leisure travel,” Dr Cheng said. 

He added that Healthway is working with its partners to anticipate a surge in demand for ART tests, especially for pre-event screening purposes.

People waiting to take COVID-19 tests. (Photo: Fullerton Health)

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

"In anticipation of projected increase in test demand, we have also concurrently invested in increased laboratory capacities that will see us ramp up 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 its clinics are seeing more demand for the ART tests, while there is a small percentage taking serology tests catered to specific travel routes. Mainland China, for instance, requires travellers to take a serology test before their flight.

A serology test detects antibodies using a blood sample. It is not a means of diagnosis for COVID-19 but looks for past exposure 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 highly sensitive and highly specific.

High sensitivity means that they can detect even low levels of viral genetic material within a patient’s sample, and have a lower chance of false negatives. A test with high specificity would avoid false-positive results - that is, diagnosing those without the virus as positive.

READ: Marina Bay Sands theatre to reopen on Dec 18 with live concert featuring Benjamin Kheng, other local artistes

“This test is also able to detect the virus within days of infection, even those who are asymptomatic,” he said.

"The current turnaround time for PCR tests range from 24 hours to two to three days. Apart from the initial temporary pain and discomfort from the nasal swab, the PCR test has little to no side effects.”

PCR tests detect virus genetic material which has been amplified using the polymerase chain reaction, while ART tests are able to detect one or more specific proteins from 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 tests will remain the definitive method when testing for COVID-19," he said.

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

WHEN TO TEST?

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

The actual "machine" or test time for RT-PCR tests is within four hours, but it takes time to transport the specimens to a laboratory, process the sample and test them in batches.

"There is currently a tradeoff in terms of time, cost and sensitivity. For tests where the results are needed within an hour, such as right before an event, then rapid antigen tests will need to be done by default," said Associate Professor Hsu Li Yang, vice dean of global health at the National University of Singapore's (NUS) Saw Swee Hock School of Public Health.

But this could change. There are PCR tests, yet to be commercialised, that can yield results in under 10 minutes, said Assoc Prof Hsu.

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

"For every infection, we always have the 'worried well' ... That reflects guilt and anxiety a lot more than actual risk of disease. The key is that the tests are now available and people who need them will get them in public healthcare clinics while those who are just anxious can pay for the reassurance," said the president of the Asia Pacific Society of Clinical Microbiology and Infection.

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

But Assoc Prof Hsu said he discourages people who are well from getting tested for COVID-19.

"The tests involve a certain amount of cost and discomfort (for tests where swabs are required), and while false-positive tests are rare, there is considerable inconvenience to many if they occur, as in the recent cruise ship case," he said.

THE VACCINE FACTOR

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

"I think eventually, testing prior to flights or events will disappear when vaccination is more widespread or the disease disappears thanks to global vaccination efforts," he said.

There will, however, continue to be considerable testing done next year as Singapore is unlikely to get sufficient doses of the vaccine to cover the population here until the second half of the year, Assoc Prof Hsu said.

Later on, it is likely that some sort of strategy - perhaps an app that verifies if a person has been vaccinated - will allow those who have been vaccinated to be exempted from testing, he suggested. 

"That would make the most sense because testing also involves considerable costs. If the majority of the population are vaccinated, perhaps it may be possible to do away with testing except in clinical scenarios when a person is ill," he said.

COVID-19 test providers in Singapore can be found on MOH’s website.

 

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Source: CNA/hm(gs)

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