Is it time to Mass Test for COVID-19 in Singapore



In a mere 13 days, Singapore has more than doubled its confirmed cases from 1000 over 2500.



Along with the spike in numbers, the number of unlinked cases had risen significantly as well. Given the rise, some members of the public had questioned if this is the time to Mass Test for the virus?

As a non-medical person, it is not our call to decide if Mass Test is the way to stop the spread. This view is from a non-medical perspective and is solely base on available data and personal observation.




What is happening in Singapore
Base on a Straits Time report on March 26, there are currently 2900 tests done on a daily basis. Base on the average test per million people, we are at 7000 per million. The numbers have probably risen since then, If we take the figures from Worldmoeters.info that tracks countries test and cases, we had tested 72680 or about 12800 per million as of Apr 7.


Are we testing too few people?
Source: MOH

Let's Compare this to our neighbouring Countries (As of Apr 12)
Source : Worldometers
Singapore: 12423 per million

HK - 12900 per million
Australia - 13780 per million
South Korea - 10512 per million
Malaysia - 2221 per million
Taiwan - 1954 per million
Japan - 544 per million
Indonesia - 71 per million
The USA - 8138 per million

There had been calls for mass testing in Singapore citing that we had tested too few people. In reality, in terms of per million, we may not be the top but we are close to the top in the region. There had been comparisons made from Faeron Islands and Iceland who had tested about 10 % of the population. However, such comparison is skewed given that Faeron Islands only has about 48K residents and Iceland has slightly over 360K.

Comparatively, the Singapore residents stand at 5.6 million. Should we test 10% of our population, it would be more than Spain or France in terms of absolute numbers tested in those countries. For the record, Spain and France have 46 million and 65 million respectively. If they would to do the same, the numbers to be tested would be in the millions!

In addition, the data do not tell the whole tale. The data shows total swab tests and unlike Singapore, there are no unique person swab test details.

If we test more people, can stop the spread?
Another call for more testing was the notion that countries like South Korea and Taiwan .had managed to control their numbers through extensive testings.  In terms of actual numbers tested, South Korea has a higher number tested at 516K. In contrast, the total number tested in Taiwan is only 46K. The numbers provided do not support this theory as Singapore had a significantly higher average per million tested when compared to both.

Thus, a higher frequency of test does not imply a better way to stop the spread. A better measure is to track cases and their contacts. For large clusters, adhere to quarantine measures to contain it.

Do we need to Mass Test


If you look at the numbers in Singapore, We have a total of 2299 cases vs 8 deaths as of Apr 13. This is a mortality rate of 0.3%. Comparatively, the world's average rate is at 6.1%. Even if we include those critical cases, we would only be 1.6% at risk. Given the low mortality rates, there is no urgency to mass test as the numbers indicated that the current situation is under control. Unless the death rate spikes to near or above average, a mass test may not be necessary at this stage.

In addition, if we exclude the clusters at foreign workers dormitories, the spread in the wider community is still relatively manageable. Unless we see consistent figures of above 100 cases, mass testing may not be the priority for today.

With the current circuit breaker measures, having a mass test would be detrimental to it. It could potentially create crowds at Polyclinic and GP, This would be the last thing we need. Furthermore, the health care system should be a focus on treating those tested positive rather than doing test en masse for those who are healthy.

Instead of testing the low risk or healthy population, mass tests may be necessary for those that are higher risk. Given the widespread infection throughout the island on work-permit holders, this is the first group that should be earmarked for Mass Test is we were to proceed. Moreover, the bulk of the workers are involved in daily chores such as keeping the delivery lines open and maintaining the cleanliness of estates. Leaving stones unturn may prolong the period of transmission and would create a bigger impact on our way of life.

Testing would probably lead to more cases and in the short run, we may have to do our part to cover the manpower shortage. However, if testing would nip the problem in the bud, it should be done as quickly as possible. In fact, with the recent rise in numbers from such cases in the past week, mass testing may have already began for this group.


Can we do better?


Other than the impending need to test the work-permit holders, there are also other loopholes in the system.

Currently, as per MOH guidelines, those on SHN were not tested before they were released as no symptoms had surfaced during the period. Since it is known that carriers can be symptomatic, it would be best to test this group who has possible exposure before release. Should they be confirmed, members of the same household have to be tested as well.


Given that testing is now available at Polyclinic and selected GP, it would be a relatively easy procedure. That way, we will be able to prevent any potential leaks back into society. This would also help to reduce unlink cases as a result. As tests are not restrictive now, if one has reasonable reason to suspect an infection, the individual would have to take personal responsibility to be tested.

During this Circuit Breaker period, the best thing to do is to ramp up testing kits. At least, if the situation worsens, we will be ready for it.


Final word
As much as mass test sounds appealing, base on the said facts, it is probably not the tool to apply to Singapore residents at large during this stage. While it may contain the spread if the mass tests are done, to do so now would take up resources as well as potentially create new clusters.

Our view is that other than the tweaks on SHN cases, the authorities had done its part efficiently. As individuals, instead of clamouring for tests, the best way to avoid infection is to stay at home and adhere to the Circuit Measures introduced to break the rising trend of infection. Given the track record of the authorities so far, we are assured that they are on top of the situation.

Hunker down for the next month and see if the curve can be flattened. In order to make it work, everyone has to do their part.










2 comments:

  1. Very well written article. How can we reduce the risk of symptomatic spreading the virus if they have not been identified during contact tracing? This "leakage" risk can have an alarming exponential multiplier effect, if the Patient Zero is not identified for each cluster (and to the original Patient Zero; likely a Wuhan resident?)

    I would agree that it may not be ideal to perform mass test during this circuit breaker period but if the unlinked situation gets worse, we should consider government issued with controlled-number home test kits (eg: test kit serial number tagged to individual NRIC) and online reporting of test results. There would certainly be fraud or mischief but that may well be a percentage tolerance that we have to work with.

    Serology test kits for antigen and antibodies for all household members could well be already in the government's plans since we don't get much information in that arena, apart from the matter-of-fact dashboard numbers in daily press briefings.

    I would think that the more we test, the more data we would have for contact tracing, including those whom might already be positive for antibodies but are still asymptomatic. With these data, more data could be pulled in for contact tracing analysis like facial recognition from CCTV, geoposition from mobile phone base stations (regulatory privacy concern?!), ERP of cars into gantries & buildings, etc.

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    1. Thanks for your thoughts. Testing on this massive scale would require time and planning. Given the current state where the spread is worsening at the dorms, this next step may not come till fruiton until this is passes us. Hopefully, the vaccine will come before this stage is even considered. Else, we will be in for the long hual if that is not the case.

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