Pre-event testing: Logistics, cost among concerns

Medical officer Stephanie Yeap is looking forward to her big day in December, when the 26-year-old marries Mr Timothy Lim, also 26.

Dr Yeap, who is with Singapore General Hospital, hopes to have more than 200 guests at the wedding.

"It being a momentous day for us, we want to have as many family members and friends who can be there in person to celebrate with us," she said, mindful of the Covid-19 situation and how it can lay waste to the best of plans.

Still, the couple have reason to cheer. New Ministry of Health (MOH) regulations that kicked in yesterday permit selected activities to host more attendees with pre-event testing (PET).

Almost three months after Singapore entered phase three of Covid-19 control measures, MOH announced a list of activities that can be scaled up - marriage solemnisations, wedding receptions, live performances, pilot business-to-business events and pilot spectator events which are seated.

Live performances, pilot business-to-business events and sports events with seated spectators may now have up to 750 attendees with PET, which is not required if there are 250 or fewer people attending.

For Dr Yeap and Mr Lim, it means 250 people can attend the wedding reception, up from the original 100. The number includes the couple but excludes vendors.

"We have not yet sent out invitations as the wedding is eight months away. In view of the unpredictable Covid situation, we intend to issue them only about three months from the event," said Dr Yeap.

PET for everyone, including the couple, is mandatory for receptions involving more than 100 attendees.

The test must be done no more than 24 hours before the end of their participation at the event.

Those who have received the second dose of either the Pfizer-BioNTech vaccine or the Moderna Covid-19 vaccine at least two weeks before the event are exempted.

For pre-event testing, the Ministry of Health recommends an antigen rapid test, as it is cheaper and faster than the polymerase chain reaction test.

Antigen rapid tests usually take less than 30 minutes, while a polymerase chain reaction test, though more accurate, can take up to 48 hours.

For large events requiring pre-event testing, the ministry allows organisers to arrange for antigen rapid tests for attendees at a clinic, or hire an approved test provider to conduct the tests at the event venue.

Organisers can also require attendees to go for an antigen rapid test on their own at an approved clinic.

Dr Stephen Tong, medical director at Bethesda Medical Centre, which provides antigen rapid tests, said that to conduct a large number of tests on-site, certain conditions must be met.

He said the test site will need separate areas for registration, swabbing, sample processing, waiting for results and isolating those tested positive, plus areas for staff to put on and remove medical attire, and a biohazard waste area.

The site must have a separate entrance and exit, and enough space for safe distancing.

Dr Tong estimates that 13 staff are needed to complete antigen rapid tests for 250 people in two hours, and about triple the manpower to test 750 people in the same amount of time.

The Health Ministry said on its website that pre-event testing is necessary to reduce risks of positive Covid-19 cases at events so that more activities can resume safely.

After obtaining a negative result, the test provider will issue a Covid-19 test result notice to the attendee. This must be shown with a valid photo identification to gain entry into events that require pre-event testing. The test must have been administered no more than 24 hours before the end of the event.

If the antigen rapid test is positive or invalid, this may suggest Covid-19 infection but could also be a false positive. If this happens, the Health Ministry requires a confirmatory polymerase chain reaction test as soon as possible.

Attendees should ask the organiser whether they would receive a refund if they miss the event due to a positive or invalid antigen rapid test result.

Mr Lim, a graduating university student pursuing a career in banking and finance, said: "The first concern that comes to mind is the cost of testing. Another concern is whether all our guests are willing and able to get tested as this could potentially lead to some last-minute absentees from our wedding banquet."

For PET, MOH encourages the use of antigen rapid tests (ARTs) instead of the more sensitive, but slower, polymerase chain reaction (PCR) test, which is more commonly used for symptomatic individuals and exit swabs for those serving stay-home notice or a quarantine order.

Attendees are responsible for the cost of the PET and they would have to contact the event organiser or relevant enterprise to inquire about any fees involved if testing is provided at the venue.

Hotels such as Fairmont Singapore told The Sunday Times that wedding couples are worried about who will pay for PET and how to identify vaccinated guests.

Ms Elaine Teo, assistant director of event management at Mandarin Oriental, Singapore, said it has arranged for PET to be done in the hotel's air-conditioned boardrooms.

She added that it has also arranged for guests to arrive at staggered times for their tests, and a holding area where they wait for results. There are also designated routes that guests take before and after the test, to minimise cross-interaction.

But like Four Seasons Hotel Singapore, which told The Sunday Times it cannot accommodate PET because of space constraints, not all hotels can meet the logistical requirements of PET on their premises.

Dr Stephen Tong, medical director at Bethesda Medical Centre, which provides ART, said: "We need to ensure the site is not only big enough to maintain social distancing for the staff and participants, but properly separated from other guests who do not need tests. There must also be separate entrance and exits, and adequate ventilation."

Dr Tong said up to 13 staff are needed to test 250 attendees in two hours, and up to 33 staff are needed to test 750 attendees in the same amount of time.

According to earlier reports, ARTs usually take less than 30 minutes, compared with up to 48 hours for a PCR test.

ARTs are also much cheaper, costing about $20 to $50 a test, as compared with $160 to $200 for a PCR test.

As long as the result is valid, the individual will be allowed to enter and remain at the event.

This means the person must get tested before the start of the event, and not more than 24 hours before the end of the event.

A Fullerton Health spokesman said that ART can be conducted at its testing centre or on-site. It costs $45 per test at its testing centre.

Additional costs apply if the test is conducted at the event venue itself. It depends on manpower deployed and duration needed to complete the swabbing.

The cost of testing at the testing centre for 250 and 750 people will be $11,250 and $33,750, respectively.

Ms Josephine Tan, chief marketing officer of Doctor Anywhere, said it will cost about $30 per person for on-site PET.

Bethesda Medical Centre provides ARTs at $33 per test for events of up to 250 people, and generally does not charge more for larger events.

The challenge of arranging for PET, as well as the costs involved, has put some couples off expanding the guest list despite relaxed measures.

Ms Maggie Seah, 25, an industrial designer who will be holding her wedding in December, said: "If all of my guests are not vaccinated by my wedding, I will not exceed 100 attendees.

"It is too much of a hassle and even if we get everyone tested on site, it doesn't set the right mood for celebrations."

Organisers of other big events are also trying to navigate the changes.

The Singapore Chinese Cultural Centre (SCCC) is expecting 750 attendees for its Sing.Lang concert in June at the Singapore Indoor Stadium.

Mr Lee Ee Wurn, director of programmes at SCCC, said PET will be conducted at the Singapore Sports Hub Visitors Centre and audiences must book their time slots for their ART when buying tickets.

As for the costs involved in testing, Mr Lee said they are still being worked out.

A spokesman for Singapore Sports Hub said that event organisers determine the payment for PET and work with them on the logistics if PET is conducted on-site.

For Mice events, or meetings, incentives, conventions and exhibitions, paying for PET is not the biggest concern.

Mr Thomas Lim, founder and chief executive of TLC Events, said Mice events often involve overseas attendees.

The primary concern is whether they would be able to attend the event.

Mr Lim said: "With this kind of event scale, you need months to plan. We do not know three, four months down the road what the protocol will be again."

The opening of Singapore International Energy Week at the Sands Expo and Convention Centre on Oct 26 last year was the first event to hold pre-event Covid-19 swabbing.

Around 215 tests were carried out that day with no one testing positive.

Correction note: An earlier version of this story said Singapore Sports Hub has yet to decide on the logistics for PET and payment involved. Singapore Sports Hub has clarified that event organisers determine the payment for PET and work with them on the logistics if PET is conducted on-site.