Team:NTU-Singapore/Human Practices

Introduction

During this COVID-19 pandemic, there has been an increase in the development of diagnostics to diagnose for the SARS-CoV2 virus. In Singapore, this was one of the worst pandemic that has occurred ever since the Influenza A (H1N1) virus in 2009 and SARS outbreak in 2003. This big gap from 2009 to 2021 may cause people in the community to be out of loop regarding the development of diagnostics. Even though the government has informed the people in Singapore regarding the increase in the budget for healthcare to improve diagnostics tools, medical technologies and procedures^[1], many are still unaware of the importance of these matters.

Pre-Event

As students who have been through Singapore’s education system, both the NUS team and NTU team agreed that there was a lack of easily accessible resources available for many students that want to learn about synthetic biology and its vast application, which includes diagnostics. This motivates us to collaborate with the NUS team to brainstorm suitable content on synthetic biology and share it through an online workshop called µBioMachines. This workshop targeted both secondary school and Junior College students. With the assistance of the National Junior College Science department led by Ms Lim Wei Li, we managed to expand to various schools across the country. For this workshop, we developed content such as the basics of synthetic biology, diagnostics and agriculture.

Event

The µBioMachines workshop was conducted virtually for half a day on the 4th September 2021.

Here’s a picture with the participants of the workshop!

Basics of Synthetic Biology

At the start of the workshop, we introduced basic synthetic biology content ranging from DNA, proteins, gene editing, and visual representation of genetic codes. This is to ensure that all the students were on the same page as some may not have studied biology before.

Here are some slides that we have presented:

Applications of Synthetic Biology

The contents covered were diagnostics and agriculture. For diagnostics, we have discussed conventional and synthetic biology enabled diagnostics methods and shown the comparison between the two methods. Besides, we have shared about the importance of synthetic biology in the agriculture field and the future of agriculture. Here are some slides of the topics covered:

Here are some slides that we have presented:

Interactive Session

Game 1: Understanding Biosafety Laboratory

The participants were equally divided into breakout rooms. A link to the game was sent. The aim of the game is to introduce the basic equipment used in a biosafety laboratory as well as the safety precautions. The participants were free to move around in the laboratory to know more about the equipment in the laboratory. They were required to answer 5 questions correctly in order to win the game. Here is the set-up of the game:

Game 2: Creating Genetic Circuits using Miro Board

After the brief introduction of synthetic biology, the participants were required to solve 3 problem statements using the Miro Board. The game is to provide insights to the key elements needed to produce a genetic circuit.

For example, a simple genetic circuit involves a promoter, ribosomal binding site and a terminator for transcription.

Game 3: Diagnostics Activity

The purpose of this game is to familiarise the students with different components of polymerase chain reaction (PCR). The participants were given a recipe to carry out PCR. They will have to locate the PCR components and the equipment used in PCR in the laboratory.

Post-Event

After the workshop, we sent out a feedback survey to know how well the workshop was received by students from secondary schools and junior colleges. Based on our survey, 56.6% found the workshop to be very interesting. This shows that we have achieved our goal of creating awareness and generating interest for synthetic biology.

In the survey, we also asked if the students would be interested in participating in similar events in the future. From the pie chart below, 88.9% of the students mentioned that they are interested. This survey gave us a better understanding of the interest that these students have.

Survey

After knowing that the students would want to know more, we decided to craft out a survey regarding diagnostics for SARS-CoV2 and send it out to the general public. We conducted a survey to evaluate the importance of home testing kits in the battle against the pandemic caused by COVID-19. The impact on personal and professional lives were assessed in order to understand the importance of quick home testing. Different home tests were compared and views on a newer testing kit based on different technology, design and features was collected.

We conducted the survey with a two pronged approach. We collaborated with GXU to conduct a survey CA to gather the opinions and experiences of well informed undergraduate students from China. 848 students participated in this survey. The survey CB was conducted to include professionals from different backgrounds and occupations. We gathered our responses of people belonging to professions as mentioned below:

Accountants	Biomedical Engineers	Specialists	Interns
Airline Pilots	Business Persons	Homemaker	Social Services
Architects	Doctors	Lawyers	Teachers
Auditors	Factory Owners	Medical Students	Undergraduates
Bankers	Financial Analysts	Public Relations	Environmentalists

We asked our respondents about the problems of the testing kits. Based on the results, we concluded that one of the major problems faced is with the cost of the kits. The kits available in the marketplace are generally more expensive than what people are willing to pay according to our survey. More than 80% of respondents in survey CA feel that the kit must be priced between SGD 10-50 (~50-250 yuan) and a similar observation was found in survey CB where more than 80% respondents feel that the kit should be under SGD50.

View Survey Results here

1 / 10

Founding member of COVID-19 Testing Lab

Gokul Bhaskaran (India)

Gokul is one of the founding members of COVID-19 testing laboratory in Berhampur, India and currently a laboratory associate. He had to stay on campus to continue with his research projects and was unable to go home. He has shared about his experience starting up the COVID-19 testing laboratory amidst the pandemic. While creating the lab, they indeed faced some difficulties such as manual data entry and restrictions when getting chemicals.

Due to the increasing number of infected people and limited infrastructure, Gokul and his team members have built a BSL-2 laboratory in campus to perform rtPCR tests in order to meet the demand for COVID-19 testing. Initially, they started off with only 20 samples being tested a day, and it gradually increased to 100 and to 1000 samples per day. The turnaround time for each test is about a day. Since the government is responsible for the contract tracing, some people can receive their test results in about half a day or the next day, depending on the priority list. For interstate travel in India, it is mandatory to have a rt-PCR certificate.

2 / 10

International Student

Jeesu (Korea)

She finds the most difficult part being the many travel restrictions. Singapore requires entry approval, therefore she had to check the website constantly, since there was no timeline. As it was very competitive, there was a lot of anxiety for her since if she misses the slot, she has to wait another week. SHN and PCR has been very expensive, placing a lot of economic pressure and stress as SHN is over $2000 SGD, and she had to seriously consider if she had to stay in Korea and do online lessons or if she would be able to enter Singapore. However, international students are not able to go back to Korea as the re-entry back to Singapore is very difficult, and they might not be able to come back in time for the academic year.

She believes that although the SHN is necessary, the period is too long as the symptoms appear after 3-4 days, and it needs to be cut down as many plans are affected. She took many precautions during her travel, especially eating on the airplane, since people stay together for a long time and is hence a common place of infection. She believes that the current ART is not accurate, therefore an ART with the ability to detect different variants will be very helpful.

3 / 10

Business

Jack (Chef)

As a chef at the school canteen, Jack does COVID-19 Antigen-Rapid Tests (ART) frequently (once a fortnight) as required by the government. He thinks that ART self-test kits are very convenient and fast compared to the Polymerase Chain Reaction (PCR) tests. Therefore, in the case of being exposed to COVID-19, he would still prefer doing ART.

Chan KL (Hotel Management)

He believes that the PCR test is expensive and troublesome to carry out, but the ART is not. The ART is both cheap and convenient, and only slightly uncomfortable. He believes that an ART that can test for variants is definitely good, but the accuracy and reliability is key.

Since COVID-19, business has gone down significantly, and there is an excess in mannpower that cannot contribute as there is no business. The periodic loosening and tightening makes it very difficult for planning ahead. The hotel has had strict rules for the staff to constantly wash their hands, and take extra steps to clean every contact area, as well as improve air quality.

4 / 10

Customer Service

Fiqah (Hotel Guest Services Officer)

Being a hotel guest services officer, Fiqah is in charge of taking care of people who serve Short Home Notice (SHN) during the COVID-19 pandemic and she finds it challenging. For example, she had to coax the travellers to serve for another 7 days of SHN when there was a sudden change in the duration of SHN (14 days to 21 days). Not only that, some customers may vent their anger at the staff as they are frustrated from serving SHN. She has to manage heat stress while wearing a full proper PPE uniform throughout the day. In addition, Fiqah finds that her life becomes more mundane due to COVID-19. Also, she mentioned that it is tiring to deal with difficult customers who refuse to adhere to safety measurement measures like wearing a mask. However, the need of wearing a mask has removed her burden of showing emotions when serving the customers, regardless of how she feels on a particular day.

Fiqah has taken both ART and PCT tests before and ART test has become her weekly routine as a frontliner with a high chance of exposure. She thinks that the PCR test is quite affordable but it may be expensive for people with low income. The waiting duration for results is quite fast as the results can be easily accessed through the SingPass application. However, it does not apply to short term or long term visit pass holders as they take longer time to receive their results. On the other hand, she finds that ART is convenient and efficient, with a waiting duration of 10 minutes instead of 24 to 48 hours for PCR test. She believes that a self-test kit that can detect variants like Delta will be very helpful.

5 / 10

Customer Service

Nadhirah (Retail Assistant)

She believes that some ART tests are not convenient in terms of the number of times required to swab (some require 10 times). She has to take an ART every week, and is always nervous and frustrated. She faces a lot of anxiety as she does not know where the customers come from. She believes that it is a great idea to have an ART that can detect different variants as they have different infective capabilities. However, it is important that the test kit is easy to use.

Cabin Crew

He believes the COVID-19 tests are not very expensive, but it becomes pricey when there is a requirement for multiple testings. He reiterates that although it is troublesome, he would rather have the trouble and a more accurate result.

He believes that ART is very accessible to the public and is easy to use. It is good for a quick test if there are any insecurities or worries.

COVID-19 has impacted him in many ways, most importantly how much he depends on his job to have an income. For certain jobs, they have to be present in real lids to have an income, therefore his income was massively drained. It was an eye-opening experience has he had to find many different ways to earn money.

He believes that a specific ART that can test for variants will help as there are different infectivity rates for different variants, and the extent of precautions needed will be better customised.

6 / 10

Courier Service

Robert Christian (Food Delivery Rider)

Robert shifted everything such as school and work to virtual. However, he is busier as a food delivery rider as Grab food gets more orders now when more people stay at home. Hence, there's a higher chance of meeting more people who are possibly affected. He needs more sanitisation at hands and bags. And this causes more inconvenience to him. When he works he needs to wear a mask, try to avoid people as much as possible, and not talk during public transport. He also uses safe entry and trace together although it is inconvenient. Robert knows about both swab test and ART test kit, and he finds a test at 200$ to be expensive. In his opinion, the ART test kit is affordable but it is still a bit expensive, too. He also finds COVID-19 testing troublesome as it is not very comfortable and needs to go to clinics to do it. He finds the waiting time for the test to be quite fast although it will be better if there is a shorter waiting time. For the self-test kit, he suggests that it could be cheaper and more accurate. In case of a possible infection, he would go to the doctor and do a swab test.

7 / 10

Events Planning Industry

Conference Event Planner

The lives of event planners are some of the most impacted due to the COVID-19 pandemic. Conferences were cancelled for months with no income, and it was a hard transition to virtual events especially when Singapore lacks the proper facilities to hold them. As a result, our interviewee is paying close attention to the pandemic situation. She knows about ART and PCR swab tests and that they have different waiting time and accuracy. Moreover, she finds the COVID-19 test to be expensive as part of the payment is also for the manpower to perform the test. She finds testing troublesome because the swab test cannot be carried out by oneself. Even if one can perform a self-test, a swab test is still necessary for accuracy and to avoid false positives. On average, she finds the waiting time for test results is fine, but waiting for a day can still be a source of anxiety. She finds the ART test-kit affordable and accessible, but she feels that people refrain from it due to not knowing how to use it or how it works. She has used ART with the help of professionals and she found it less scary than people described. She prefers to do a self-test if she is in close contact with COVID-19 patients, but she will go for a swab test to confirm again for a more reliable result.

8 / 10

Education

Chong (Secondary School Teacher)

As a secondary school teacher, the repeated transition from physical to online lessons has been the most challenging. It has not only impacted her students in terms of social and emotional conditions, it is also difficult for teachers to conduct lessons due to the need to be mindful of the screen time, where a 1 hour lesson becomes a 30 min lesson. This is detrimental to the curriculum due to the many changes and the need to catch up on time lost. The safety protocols are constantly changing and it becomes challenging to constantly readjust.

She has taken both the PCR and ART tests, but she believes that the waiting time to get the result for the PCR test is too long and without a specific timeline, therefore affecting her work as she has to receive the results before she can resume teaching. She believes that although the ART test is faster, it is not as reliable and she does not trust the result, and has to wait for the PCR test to get back to work. A more accurate test can allow suitable safety protocols to be implemented faster, depending on different variants due to the varied infectivity.

NOTE: Her views do not represent MOE. They are her personal opinions.

9 / 10

Education

pHD student at Georgia Tech, Bachelor and Master’s (India)

When he joined his pHD programme, he had to defer a year due to the COVID-19 situation, and it has impacted his research since he could not go over to US from India. COVID-19 has also resulted in a loss of many close and distant relatives, however, he believes that the people around him are still going strong and are continuing to wear masks and get vaccinated.

There is a stricter selectivity of universities due to the lack of grants and funds, therefore students have to show their research to have a competitive edge. However, since India is isolating campuses, where people who are inside need to stay inside, and those outside need to stay outside, it is very difficult for the conducting of time-sensitive research.

Although his current university has excellent infrastructure (emails, social media, free masks, tests, hand sanitisers, etc) to protect the faculty from COVID-19, there is a limit to the effectiveness since the state of georgia has a law that no discrimination is allowed for people who choose to not wear masks.

He believes that an ART test that can detect variants will be very useful, however, most places only accept PCR tests. He finds the waiting time for the PCR tests to be quite long, and there are private companies who charge more for a shorter waiting duration, approximately $20 USD for 6 hours, which is very expensive for an average citizen in India. However, it is a necessary cost as most places require the test result to be submitted within a short amount of time, for example, for travelling. He also mentioned that PCR tests are very inconvenient and uncomfortable as the insertion into the nasal cavity must be done correctly for a reliable result, and he ends up sneezing the entire day.

10 / 10

Education

Saptarshi Debnath (Medicine Student)

As a medicine student, Saptarshi is working as an intern in hospital wards and he is familiar with both PCR test and ART, although ART can be less accurate. He finds the test to be at a reasonable price but it is still not affordable for everyone. The procedure of testing for PCR test is more invasive and cannot be self-performed but ART is more convenient. Logistically speaking, PCR test samples need large laboratories for reactions and are more time-consuming than ART. he finds the waiting time for tests to be shorter than before, but it is better to be shortened.

The ART is getting popular and simple to perform. Saptarshi has tried ART himself. He finds it a bit uncomfortable but in his day to day life he has gotten used to it. He agrees that a testkit that can test variants of covid-19 test will be very helpful. In his home country, many children are being treated based on their symptoms and not as COVID-19 patients as their ART test is negative. A more accurate test kit can help them to identify more patients and provide more suitable treatment.

❮ ❯

Integrated Human Practices

Our Human Practices team has reached out to people from various backgrounds such as education, business, and healthcare to present our project - casCADE while promoting the values of iGEM. We believe that interacting and connecting with society is significant in our research as we get to delve deeper into knowing the current issues and needs of the society.

Fruitful Sharing Sessions

We have carried out interviews to understand the obstacles faced by the society at their workplace or, in life during the COVID-19 pandemic. By collecting opinions and viewpoints from persons of different walks of life, we strive to curb the problem and to develop a possible solution for the society based on their needs. Throughout the interview sessions, we have carefully processed and handled the information gathered by implementing Privacy Policy to ensure information security. The interviewees we initially asked if they are comfortable with their interview session being recorded or their words to be used for this project.

COVID-19

After interviewing people from various countries, we identified that many were not comfortable with taking samples directly from their nostrils or nasopharynx. For example, some self-test kits require them to take the samples approximately 2 inches deep from the nose while those who did PCR test require their samples to be taken from nasopharynx, 5 inches deep from the nose. Based on a comparison done by The Straits Times in Singapore, some ART self test kits require more than 5 rotations in each nostril [2]. Here are some of the statements by some of the interviewees:

“The COVID-19 testing is troublesome as it is not very comfortable and you need to go to clinics to do it to make sure it is done properly”- Robert Christian, Food Delivery Rider

“The testing is troublesome because the swab test cannot be carried out by oneself. Even if one can perform a self-test using swabbing, it might not be done correctly as we are not professionals.”- Lucy, Event Planner

“PCR tests are very inconvenient and uncomfortable as the insertion into the nasal cavity must be done correctly for a reliable result. I end up sneezing the entire day.”- PhD Student, Georgia Tech

“In my home country, many children are being treated based on their symptoms and not as COVID-19 patients as their ART test is negative. A more accurate test kit could help us to identify more patients and provide more suitable treatment.”- Medical Student from India

After hearing about these struggles, we realised that comfort levels during sample collection procedures is a common concern and we believed that it should be addressed. We further analyse this concern in our surveys and identified that some experience pain when taking a nasopharynx swab (figure 1). Hence, we decided to change our sampling procedure from obtaining samples from nostrils or nasopharynx to obtaining via saliva.

Figure 1: Survey data about pain levels reported from the nasopharynx swab test.

During the initial stage of our project, we started off by using loop mediated isothermal amplification (LAMP) and probes to detect the original SARS-CoV2 gene. After realising that there has been emergence of different variants from the original gene in a short span of a few months, we decided to interview more people from different backgrounds to identify if there is a need to identify different variants in self test kits. Here are some of the statements from the interviewees:

“The current one is not really accurate, so multiple covid tests have to be taken. If ART can recognise different variants, it will be a lot easier.”- Jeesu, International student from Korea

“The current ART is very convenient, but an improved one that can test for variants is definitely good.”- Chan KL, Hotel Management

“I think ART is convenient and efficient, with a waiting duration of 10 minutes instead of 24 to 48 hours for the PCR test. A self-test kit that can detect variants like Delta will be very helpful.”- Fiqah, Hotel Guest Services Officer

“It is a great idea to have an ART that can detect different variants as they have different infective capabilities. However, it is important that the test kit is easy to use."- Nadhirah, Retail Assistant

“A more specific ART that can test for variants will help as there are different infectivity rates for different variants, and the extent of precautions needed will be better customised.”- Sam, Cabin Crew

“For the self-test kit, I think that it could be cheaper and more accurate.”- Robert Christian, Food Delivery Rider

“Although the ART test is faster, it is not as reliable and I do not trust the result, and have to wait for the PCR test to get back to work. A more accurate test can allow suitable safety protocols to be implemented faster, depending on different variants due to the varied infectivity.”- Chong, Secondary School Teacher

After the sharing sessions from the interviewees, we learnt that detecting variants is a need in the society as the different variants have different lethality and infection rates. Besides that, in surveys we conducted, we asked if it is important to detect multiple variants.

Figure 2: Survey data about interviewees' preferences for whether the proposed device should be able to differentiate between different variants.

Questions	Average of answers ranging from 0-5
How important is price?	3.46
How important is a small probability of false positives to you?	3.21
How important is a small probability of false negatives to you?	3.27
How important is a short waiting time to you?	3.22
How important is the ability to identify new covid variants to you?	3.73

Based on figure 1 and table 1, we have identified that it is important to detect different variants besides detecting only the virus itself. Besides that, some believed that the different variants may affect the accuracy of the Antigen Rapid Test (ART). From these insights, we took a step further to test for the different variants. Also, being able to detect different variants allows better isolation of infected persons to reduce the mutation that may occur between SARS-CoV2 variants. Therefore, we have decided to produce a portable COVID-19 self test kit that can detect variants of COVID-19 to meet the needs of people. Moreover, we have changed our sampling procedure from obtaining samples from nostrils or nasopharynx to obtaining samples via saliva to reduce the discomfort from the nasal swab method. We performed experiments using saliva with lentivirus in ZeroPrep to detect the E484K variant. Based on the experimental results, we find out that the virus can be detected at low sample concentrations, as seen in the figures below. Thus, saliva samples are possible for COVID-19 detection besides nasal swab samples.