Singapore-Hong Kong travel bubble: tourists could spend US$600 on four Covid-19 tests

When news of the Singapore-Hong Kong travel bubble broke last week, Tan Wei Sheng rushed to book a December flight to the city before pent-up demand sent prices surging.

The cost of his business class ticket was offset by his miles redemption, but the 40-year-old Singaporean doctor would also have to fork out about S$200 (US$150) for Covid-19 testing, and it is unclear yet just how many of these polymerase chain reaction (PCR) tests he would have to take.

As part of the in-principle agreement for the travel bubble, eligible travellers would not have to serve a quarantine or stick to a predetermined itinerary, but would need to take pre-departure tests.

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But in making the announcement last Thursday, Singapore's transport minister Ong Ye Kung also said that "each territory, each party, should be also free to impose their own administrative arrangements". He listed on-arrival testing as one example.

While the details of the travel bubble have not been announced, health care experts said that Covid-19 testing could amount to more than S$800 (US$600).

"Clearly, the maximum number of times of testing that travellers could be faced with could be four tests, meaning two pre-departure and two post-arrival tests when travelling between Singapore and Hong Kong," said Teo Yik Ying, the dean of National University of Singapore's (NUS) Saw Swee Hock School of Public Health.

Tan, the doctor, said he was willing to fork out the fees for testing since this would be his only trip this year. "I am happy to channel all the money saved from the other cancelled holidays this year into doing the swab," he said.

But not all travellers would have the same view, especially those travelling with bigger families. Teo said there would also be a degree of fatigue that came with repeated testing. But he noted it would not deter "keen" tourists given the pent-up demand.

Nanyang Technological University tourism expert Wong King Yin said in the longer-term, travel could become less attractive and also less accessible to segments of the population if it came with an additional S$800 cost for testing.

"Because the economy is already doing badly, a lot of people's incomes may be less than before, and some have already lost their jobs. The ability to travel may be very different from pre-Covid," Wong said.

Already, a global survey by online travel agency Booking.com of more than 20,000 travellers found that of the 499 Hongkongers polled, 65 per cent said they would be more conscious of price when it comes to searching and planning a trip. Of the 496 Singaporeans, this figure stands at 70 per cent, according to the survey results released on Tuesday.

Leong Hoe Nam, an infectious diseases expert from Mount Elizabeth Novena Hospital, said while those who had bought a ticket to Hong Kong could "certainly afford" the cost of testing, the fees could stifle - or backfire on - the Singapore government's plans to restart travel and the economy.

Teo said that as the number of travellers increases with more travel bubbles formed with other countries, there would be economies of scale that could reduce the testing costs. But Leong said more needed to be done to make testing more affordable, and this would mean looking beyond PCR testing.

PCR tests look for fragments of the virus' genetic material in a patient sample and are considered the "gold standard" test for Covid-19. The entire process, however, requires trained personnel to swab the patients and takes up to 48 hours as the samples are sent to a laboratory for processing.

"For Singapore, [the PCR test] is almost at cost as we speak," Teo said. "It brought us to a certain stage in managing the disease, but going forward we need something even cheaper, faster and better."

Singapore currently deploys PCR tests typically for its key frontline workers and low-wage migrant workers, who are tested fortnightly due to the high incidence rate among this group, Teo said. Other tests that the country is considering include antigen tests which would be cheaper and faster, he added.

Antigen test kits also require a swab and look for proteins on the virus' surface and can yield quick results, usually within minutes, while serology tests, which detect the presence of antibodies, are used to tell if a person was infected in the past and not to diagnose patients.

"Presently, it is about understanding what are the settings that other tests can be deployed, and whether there is a need for repeated or confirmatory tests," added Teo. He added serology tests - blood tests that look for antibodies in your blood - had also been deployed to complement current testing regimes, primarily to understand the state of infection that a patient was in, as well as to understand the degree of seroprevalence in different segments of the Singapore community.

Chinese University of Hong Kong professor David Hui said that using rapid antigen tests was not an approach recommended by the World Health Organization (WHO), pointing to how the organisation noted in a September paper that such tests were not accurate in some situations, such as for asymptomatic patients.

Infectious diseases doctor Hsu Li Yang, also the programme leader for infectious diseases at the NUS Saw Swee Hock School of Public Health, however, thought they were a potential alternative to PCR tests "if the incidence of Covid-19 is extremely low, such as they are at present". Authorities would have to factor in antigen test kits' lower sensitivity and weigh that against them providing a more rapid result and being "far cheaper" at around S$30 per test, he said.

Emergency departments across Hong Kong's public hospitals have been using a rapid PCR test, known as the GeneXpert test, which is more reliable, Hui said. This costs around HK$350 (US$45), compared with a laboratory PCR test that typically costs HK$1,500 to HK$2,500 in private hospitals. The rapid test would also take only 30 minutes, compared to the latter, which takes up to three hours.

Leong said more accurate and faster antigen testing was now in the pipeline, and that new ways of testing could be done using gene-editing technology CRISPR.

In May, Singapore media outlets had reported that a team at the Nanyang Technological University (NTU) was working on such a diagnostic kit that could yield results in 20 to 30 minutes.

"These are supposedly much cheaper, easier to implement, and have much faster turnaround time," Leong said. "I expect a new swab to be available which you take three hours before departure at the airport, and you will check in at the same time. Once negative, you can continue to fly."

Meanwhile, Ong Ye Kung, the city state's transport minister, on October 6 had said Singapore was exploring tests other than PCR ones, and would deploy them when it was practical.

He said Singapore was running trials for "less intrusive tests using deep throat saliva" and was also developing antigen rapid test kits, and looking into "breathalyser tests that can deliver results on the spot, without having to send samples to a laboratory".

Researchers from the NUS, for example, on Tuesday announced that they had developed a breathalyser test that could detect Covid-19 within a minute. The institute said the test achieved more than 90 per cent accuracy in a clinical trial involving some 180 patients, and added that it could be an attractive solution for mass screening given how it was easy to administer and would not need specially-trained staff.

It would be similar to breathalysers for alcohol intoxication, where a person testing for the virus would just have to blow into a disposable mouthpiece, but instead of picking up alcohol, it would detect organic compounds in a person's breath that researchers believe act as Covid-19 disease indicators.

The performance of the breathalyser tests would need to be tested before the authorities determined if they were sufficient for operational deployment. "It would only be a boon if the sensitivity and specificity of such tests are sufficiently high to confer the confidence that we will not miss out on diagnosing incoming travellers that are truly infected, and generate many false positives amongst truly healthy travellers," Teo said.

"Once we have the evidence to suggest that screening with a breathalyser is sufficiently accurate, I am sure this will be helpful to boost the travel and aviation sector."

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

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