Coronavirus: what Singapore's home test kits can teach Hong Kong about the ART of war on Covid-19

When bank worker Angelica Lim caught Covid-19 over the Lunar New Year, she was told to isolate for three days and then do a rapid antigen test using a home kit.

Under Singapore's rules, anyone who gets Covid-19 and has no symptoms can leave self-isolation after 72 hours if they test negative on an ART - as the self-test kit is referred to in the city state. If they continue testing positive, they are only allowed to leave self-isolation after a full seven days.

The 24-year-old set about testing herself as often as she could, sometimes up to twice a day, in the hope she would return a negative result before the full seven days were up.

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Luckily for Lim, there was no shortage of kits. Plenty had already been sent to her through the mail by the government and her member of parliament's team had also left some on her doorstep.

Lim didn't even need to buy them, even though the kits are widely available across the island and cost only about S$5 (US$3.70) each.

Since June last year, test kits have been made readily available to consumers at various retail points from pharmacies to supermarkets. About 9 million have been sold so far. Regular self-testing is part of the country's broader plan for living with the virus, as outlined in a speech by Prime Minister Lee Hsien Loong in May last year, and the approach is already paying dividends.

As of January, the website of Singapore's Health Sciences Authority has listed 13 test kits approved for over-the-counter sales at supermarkets. The government has also distributed close to 25 million ART kits to households so residents can test themselves when they feel unwell, before meeting elderly relatives or entering the workplace.

That has helped give a measure of confidence to people in a country that on Wednesday eased some social distancing restrictions even amid a surge of Omicron cases - it recently recorded 191,882 infections in 28 days.

People are now allowed to host five visitors inside their homes at any one time (instead of five unique visitors per day previously). Outside their homes, they no longer need to maintain a distance of 1 metre from other people if they are wearing masks.

Travellers arriving in the country also no longer need to pay for the more expensive polymerase chain reaction (PCR) tests, which cost S$125 (US$93). Instead they can take an ART within 24 hours of arrival, supervised by health care professionals.

Singapore is embracing the cheaper ART tests not only to benefit the wallets of tourists, but all Singaporeans, with the central bank last month saying the cost of PCR tests were driving inflation.

Its move is also part of a wider trend in which countries are turning to home-testing to battle the faster-spreading, yet less-virulent Omicron variant.

Last month, the United States, Canada and Australia all faced a shortage of antigen kits after advising their populations to self-test in an effort to prevent health care systems from being overwhelmed.

Abbott, which manufactures the Panbio Covid-19 Rapid Antigen Self-Tests, told This Week in Asia that it was seeing "unprecedented demand for rapid testing globally".

"We're sending the tests out as fast as we can make them," said a spokesperson.

Abbott, which has multiple manufacturing sites across the world including in China, Germany and South Korea, said it can produce over 100 million test kits every month.

The Standard Q Covid-19 Ag kits distributed by the Singapore government are manufactured by SD Biosensor in South Korea.

The prices for ART kits vary, from US$15 in the US, to 4-5 euros (US$4.5-5.5) in France, and A$20-30 (US$14-21) in Australia.

The appeal of the antigen tests lies not only in their cost, but in their speed. They typically show results within 15 minutes, while PCR tests require samples to be sent to a lab for processing. This is because the antigen tests detect proteins from the virus, while the PCR tests detect fragments of the virus itself.

The drawback of the antigen tests is lower accuracy. Antigen tests have a sensitivity of 80 per cent, compared to the 99.5 per cent for PCR tests.

But fans of the antigen test say this drawback is more than compensated for by the way they let relatively healthier Covid-19 sufferers know to self-isolate rather than head to a hospital, easing the pressure on health services.

This could prove useful in Hong Kong, which is struggling against a tide of new infections and has started giving out rapid test kits to workers in care homes. The government has sourced 100 million of these kits, aiming to distribute a million a day to high-risk individuals once they arrive, Chief Executive Carrie Lam Cheng Yuet-ngor said on Tuesday. Hong Kong authorities have advised people who test positive using a home kit to seek medical attention by undergoing a formal PCR test at private clinics but to then remain at home and await instructions from authorities rather than rushing to a hospital.

Singapore is now streamlining the process. There is no mandate for people to confirm their ART results with PCR tests but many have been heading to doctors to get their infection recorded in government systems as those who have recovered from Covid-19 and were already vaccinated do not have to get booster shots for now. To alleviate strain on the health care system, the government will for four weeks allow positive Covid-19 status to be certified at test centres where people will undergo supervised self-swabs using ART kits.

Like Hong Kong, which has seen rising numbers and demand for tests, Singapore has also experienced a run on kits due to a surge in infections and people testing themselves before Lunar New Year gatherings.

Last Wednesday, in a mall in central Singapore, Watsons pharmacy had run out of test kits but the nearby Raffles City Market Place supermarket still had 14 boxes sold in sets of five for S$26.40.

On Tuesday afternoon, at a mall on Orchard Road, Guardian pharmacy had only single test kits left and was limiting sales to two per customer.

In Hong Kong, customers complained that pharmacies had either sold out of the kits or were selling them at inflated prices to cash in on the shortage.

A cashier at Raffles City Market Place told This Week in Asia that the test kits had been selling like hot cakes for weeks; the pharmacist at Guardian said she wasn't sure when new stock would arrive.

Still, the test kits have not run out entirely. Vending machines across the island dispense kits reserved for people required by the government to self-test. These tend to be residents with a positive Covid-19 case in their household; they can use their identity cards to pick up six kits for free from vending machines.

Also, many households have spare kits left over from previous government distributions.

So far in Singapore, 113 million test kits have been sold or distributed. In a parliamentary response in November, trade minister Gan Kim Yong said the government had not received any reports of businesses profiteering from the sale of these kits. The government told local media that it had a stockpile of the kits and it released some to retailers last week when demand surged. It did not detail how it secured the stockpile but in the first year of the pandemic, it spent more than S$1 billion hedging bets on viable vaccines.

Meanwhile in Hong Kong, what few test kits remain are being sold at prices as high as HK$300 (US$38).

Manufacturers are ramping up production. Abbott said it had shipped over 1.4 billion tests worldwide and supplied "millions" to Singapore.

Roche Diagnostics, which distributes the SD Biosensor Sars-CoV-2 Antigen Self-Test Nasal in Singapore, said it was doing "everything possible" to meet the enormous demand by investing in its supply chain and working closely with SD Biosensor.

Roche Diagnostics declined to share specifics on supplies and pricing.

This article originally appeared on the South China Morning Post (SCMP).

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