Less intrusive Covid-19 tests should be considered for persons with disabilities, say experts

SINGAPORE – Public health would not be compromised in any significant way if persons with disabilities who cannot bear traditional Covid-19 testing methods like nasal swabs are given less intrusive tests, experts said, following accounts by caregivers whose loved ones were traumatised by the process.

Associate Professor Alex Cook, vice-dean of research at the Saw Swee Hock School of Public Health, said on Tuesday (June 8): “Whatever the standard protocols are, those who are given the task of implementing the protocols need also to be given the agency and responsibility to interpret the protocols flexibly.

“For instance, if someone with special needs really cannot manage a nasal swab, there are other possibilities such as the breathalyser or a saliva-based test.”

Prof Cook acknowledged that alternative tests might not be as accurate as the gold standard polymerase chain reaction, but said Singapore’s system is robust enough such that “we can accept that loss of accuracy for a few special cases”.

Ms Cindy Chee, whose 18-year-old son, Matthew, has autism, wrote a Facebook post on Sunday that drew hundreds of reactions about how Matthew was exempted only after he became very distressed in the swabbing tent. Another caregiver, Ms Amilia Koh, wrote about how her 34-year-old brother struggled for 30 minutes before she was allowed to step in to calm him. Her post on Monday drew more than 3,500 reactions.

In response, the Ministry of Health said in a Facebook post early Wednesday that it said it would engage “relevant professionals” as well as volunteers from the National Council of Social Service to work with it on training personnel to deal with people with disabilities. It also said it would study the effectiveness of alternative tests.

Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that while breathalyser tests may not be that accurate, saliva tests had been shown in Singapore to be “as good and possibly better” than nasal swabs.

Prof Tambyah also mooted the idea of stool testing as a viable option for individuals who are unable to undergo swab tests.

“We have found wastewater surveillance to be very effective in picking up the HDB outbreaks so perhaps stool or even wastewater testing would be a non-invasive way of determining over time whether someone with disabilities is infected,” said Prof Tambyah.

On whether it is possible for persons with disabilities to be exempted from testing completely, he said some countries have kept them under group quarantine for 14 days after exposure to the Covid-19 virus, but “that is not easy either”.

MP Denise Phua, who is an advocate for persons with disabilities, told ST that there is no one-size-fits-all approach as every need is different, requiring tailored support.

“Some have sensory issues and unfamiliar sights, noise, measures such as swabbing, injections and unfamiliar persons, can potentially give rise to fear and challenging behaviour,” she said.

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She added that the Ministry of Education has currently arranged for special education students to be vaccinated at their schools, a place they are familiar with.

Ms Alina Chua, principal autism consultant and psychologist at the Autism Resource Centre (Singapore), added that quarantine orders can be challenging for people with autism, especially at quarantine facilities, because it disrupts their regular routines and removes them from familiar living environments.

Caregivers also need to thoroughly prepare loved ones with autism for any Covid-19 measures they have to go through by explaining them carefully.

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“We can introduce change in small steps, for example starting to wear a mask for 2 minutes, then 5 minutes and progressively longer,” said Ms Chua.

The public can help caregivers of those with autism by checking with them before stepping in as they might unintentionally add stress to the situation.

Ms Chua said: “When the situation proves challenging for the individual, it is helpful to give them space away from crowds, so that they have the time they need to settle.”

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