All it takes is one infected individual to send an entire community tumbling. Large-scale testing is one way for countries to accurately identify infected people and stem the spread of Covid-19.

In late March, Singapore’s Agency of Science, Technology and Research (A*STAR) and Tan Tock Seng Hospital (TTSH) co-developed a highly accurate test kit for Covid-19 in less than a month. The test kits have since been implemented in 13 labs and hospitals in Singapore and sent to more than 20 countries, says A*STAR.

How did A*STAR create an effective kit in such a short amount of time, and what are their plans to tackle the virus moving forward?

Fortitude and cooperation

Developing a high-performance diagnostic test kit was no small feat, requiring coordination from biomedical experts, government institutions and commercial partners alike. The combined efforts of A*STAR and its partners culminated in the Fortitude 2.0 test kit, which can churn out real-time test results in 90 minutes. As of May 2020, over 500,000 of these kits are being manufactured by local biotech companies every week for use in Singapore and beyond, The Straits Times reported.

On the research front, different teams of biomedical experts worked on separate parts of the Covid-19 puzzle, piecing together a cohesive test solution. For instance, studying Covid-19’s evolution was a task delegated to A*STAR’s Bioinformatics Institute, while the Experimental Drug Development Centre built upon this information to develop test kit prototypes, an A*STAR spokesperson tells GovInsider.

Yet another team from Tan Tock Seng Hospital “provided the clinical expertise and utility” on the most useful samples, “helped optimise test parameters, and evaluated the kit,” the A*STAR spokesperson explains.

A*STAR had to set appropriate manufacturing standards for the kits to make them commercially viable. To do this, they collaborated with the National Public Health Laboratory at the Singapore’s National Centre for Infectious Diseases (NCID). The Diagnostics Development (DxD) Hub, part of A*STAR’s commercialisation arm, stepped in to support the development and production of the kits.

Rapid test kit

Not stopping at the Fortitude 2.0 kits, A*STAR researchers have developed a new test kit that takes just one hour to determine if a person has been infected with Covid-19, The Straits Times reported. This new rapid test, co-developed with Duke-NUS Medical School and leading global firm GenScript Biotech Corporation, will be useful for testing potential vaccines and contact tracing.

Such tests would be much more flexible than conventional laboratory tests, including the Fortitude 2.0 Kit. The Fortitude Kit requires specialised equipment for “sample extraction and preparation processes”, explains Dr Weng Ruifen, Principal Manager of Diagnostics Development (DxD) Hub at A*STAR. Executing and interpreting the test also “requires trained personnel with the necessary technical skillsets”, she added.

Conversely, rapid point-of-care diagnostic tests are designed to be conducted at or near the point of patient care, Dr Weng says. “They are usually relatively to administer, and tend to be more portable”.

These features would prove useful in helping Singapore reach its target of 40,000 Covid-19 tests per day, a goal stated by Health Minister Gan Kim Yong in May.

How it all started: Lessons from SARS

A*STAR credits increased vigilance in the aftermath of the 2003 SARS outbreak for Singapore’s capacity to quickly respond to Covid-19.

“The outbreak of SARS in 2003 was a ‘wake up’ call for Singapore about how infectious diseases know no borders,” remarks the A*STAR spokesperson. “It also focused the mindset of scientists here on the importance of the translational outcomes of research that could help the clinical community and improve lives.”

Today, researchers in Singapore have built a network that spans across A*STAR, universities, public hospitals and government agencies to facilitate information-sharing. Since then, continual investments in biomedical sciences have also “allowed Singapore to build a pool of talent and capabilities that can be called upon rapidly to respond to the needs of the nation.”

This watchfulness played no small role in scientists’ ability to respond to the rapidly evolving Covid-19 situation.

Active surveillance to combat an ever-mutating enemy

Even as production levels for the Fortitude 2.0 Kit are higher than ever, researchers must continue their work. Covid-19 is mutating even as it spreads, and there is always the potential for the virus to evolve and render test results inaccurate.

“The evolution of Covid-19 is continually tracked by our bioinformatics scientists,” says the A*STAR spokesperson. “Active surveillance of the viral genome is key to ensuring that the diagnostic test kits remain sensitive in detecting the virus in Covid-19 patients”, and constant monitoring informs “continual enhancement efforts for the primers used in test kits.”

“A*STAR is doing its best to keep the Fortitude diagnostic test kit at the frontier and well able to deal with viral mutations.”

As the Covid-19 situation evolves day after day, no one is sure of what the future will bring. But one thing is certain — Singapore can count on its researchers to work on cutting-edge solutions that tackle these problems.