SGH rushed out a PCR test for the new COVID-19 virus, and then found itself having just enough reagents to last 9 days to conduct the tests.

After SARS in 2003 and H1N1 in 2009, the SGH Molecular Pathology Laboratory (MPL) made preparations for the next pandemic. For the two molecular virologists leading the laboratory – Dr Lynette Oon and Dr Chan Kian Sing -  it was almost an obsession - they always factored pandemic considerations into all their decision-making.

Ever vigilant, Dr Lynette Oon noticed reports of four cases of pneumonia of unknown cases as early as December 2019, and followed the progression closely. By early January 2020, the Laboratory knew it was a matter of time before the virus found its way to Singapore and decided to develop a test for it.

SGH became the first service laboratory to offer the test which identifies the novel virus. The new test proved itself the very first day it was used – by detecting Singapore’s first case at 2.30pm, and the National Public Health Laboratory confirmed it by 6.00pm, with the news released to Singapore the same evening, on 23 January 2020.

Equally important was how they anticipated shortages in supplies and stockpiled in advance, and planned ahead for a surge in demand for testing. This was the story:

“In early March 2020, MOH mandated further increases in national laboratory testing capacity and asked SGH to double its capacity to 600 samples per day. To manage the increase in specimens, SGH placed an order for three automated nucleic acid extractors but Germany then banned exports of all their extractors and restricted the use of the critical RNA extraction reagent to only Europe.

Kian Sing expressed his worries. “We realised there wasn’t any stockpile of the reagent. They were running so low that it was scary how many days of stock were left – nine days. There was now no point getting the new extractors.

Bryan Tan, Medical Laboratory Technologist, was among the team who worked tirelessly
to develop the diagnostic test for the novel virus for clinical use in January 2020.

Lynette made frantic phone calls to other vendors. Only one vendor had the equipment in Singapore, but it was their demonstration unit. This was the instrument running the first FDA32 approved SARS-CoV-2 PCR test in the market. It was almost fully automated, capable of a throughput of over 1,000 tests per day. The company was also willing to commit to providing the necessary reagents. There was a catch though – the equipment could not fit into the laboratory because of its size. Measuring 3 metres by 1.3 metres and weighing nearly 1,700 kg, it was a behemoth by laboratory standards. With a growing global waiting list for this instrument, the SGH team had to act fast to find a solution and secure this precious capability. Thankfully, the Immunology Laboratory provided their Immunofluorescence room to house the equipment.

The vendor started installing the instrument on 30 March 2020. With outbreaks in the dormitories escalating, validation of the test and training of staff proceeded at breakneck speed. Validation of the test was completed on 10 April, just as the avalanche of samples from the dormitories started. Over the next four months, the laboratory tested up to 1,100 samples a day from dormitories, community care facilities, polyclinics as well as SGH itself.”

Excerpt is from "Singapore General Hospital Purpose with Passion – Our COVID-19 Stories" book. Read more stories from the book here


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