# Qualitas Health > Singapore ### Posts #### ABC's of Health Screenings By Dr Clarence Yeo MB ChB (Dublin) A Health screening involves the use of simple tests on apparently healthy individuals to identify those who have risk factors or early stages of a disease, but do not yet have symptoms. For many, going for a health screen can be a daunting affair. The apprehension and trepidation of undergoing physical examination and screening tests at a clinic may stem from a fear of discovering a disease they have. It is a form of denial – they assure themselves they are fine while worrying, deep down, that they are not. Some people avoid tests out of pure apathy – this is a phenomenon referred to as information aversion. They would rather not know about a problem with their health so that they do not have to fret about it, hence they see health screening as an unnecessary stress or anxiety. To others, they question the rationale of scouring for issues with their health when they feel perfectly well. In my experience, this would be by far the most common occurrence. They have the misconception that if they do not have any symptoms, they are in the pink of health and hence do not require any health screenings. But the benefits of taking a health screening far outweigh the fear and discomfort of taking one. Benefits Early detection makes a disease more responsive to treatment In reality, many diseases have no symptoms, especially in the early stages, and this is precisely the rationale and basis of a health screening – to pick up a disease as early as possible. A disease is more responsive to treatment when picked up early. Finding out about your health problems early empowers you to take charge of your own physical and mental well-being, and to change your own health outcomes. You are able to take steps to make the necessary lifestyle changes or seek the right treatment to improve your health. Early detection stops an ailment from becoming a chronic disease Catching an ailment in the early stage may prevent it from becoming a chronic disease. Complications of the disease can also be avoided and hence, morbidity and mortality, as well as healthcare costs of the disease. are reduced. Hence, health screening is our greatest weapon in fighting chronic diseases. Early detection helps contain infectious diseases You can prevent yourself from spreading a contagious disease unknowingly, especially to loved ones. Diagnosing infectious and transmissible conditions allows you to be treated immediately, and precautions can be adopted to protect your family members and immediate contacts (e.g. Hepatitis B). It's not that painful, really... Patients often assume health screening will be uncomfortable or painful, invasive or involve unnecessary risks. Health screening, in general, is not an unpleasant experience. Other than venipuncture for blood taking, there is no pain involved. Tests are usually not invasive, and carry minimal or no risks. It doesn't take that much time... The duration of a health screening depending on how comprehensive it is, shouldn't take more than 30 minutes. However, time spent for a health screening is time well spent because it’s an investment in your health. Conclusion Health screening should be perceived and regarded positively. It helps to detect diseases and identify common risk factors for chronic diseases, thus enabling you to take steps to protect yourself. It also gives you a sense of reassurance and well-being when it turns out to be normal. Health screening is not only the best protection for your health but also the best resource for improving your overall health and wellbeing. #### Chinese New Year 2022 SMMs for Singapore Chinese New Year is almost here and many people are planning their reunions and celebrations with family and friends. The Singapore government has announced that current COVID-19 safe management rules will stay in place during the Chinese New Year period. The government does not expect the Omicron wave to pass before the festive period, which is why the regulations will stay in place. The safe management measures are staying in place to help prevent any overloading to Singapore’s healthcare system. Remember to continue exercising personal and social responsibility by ensuring that you and others you are meeting are fully vaccinated or have completed an ART. We can still have a fun an meaningful new year celebration while complying with the rules that help keep ourselves, friends and family safe. At home Social gatherings at home are limited to groups of 5. This means a reunion dinner or reception at home must have a maximum of 5 people. Each household is allowed up to 5 unique visitors a day. All visitors are encouraged to complete and ART before gatherings. At restaurants Multiple table bookings exceeding 5 people are not allowed, except for people from the same household. Large events Large-scale receptions, religious processions and dinner banquets are not allowed.   Other COVID-19 rules announced on 21 January: Visits to hospitals and residential care homes are suspended from 24 Jan to 20 Feb. Isolation period cut from 10 days to 7 days for vaccinated patients, children below 12. Booster shots extended to those aged 12-17 years from early February. VTL travellers entering Singapore from 24 Jan required to do ART only on days they intend to leave home/hotel.     #### Haemorrhoids – A Common Cause of Blood In Stool By Dr Choo Weng Yue MBBS NUS Haemorrhoids and piles are synonymous. About one in three people in Singapore suffer from haemorrhoids. It comes about when blood vessels in the anus are enlarged and bulging due to chronic straining from difficult bowel movement. This would inevitably lead to internal haemorrhoids. Another type of haemorrhoids is external haemorrhoids - this usually happens when someone has chronic constipation or constantly strains very hard such as carrying heavy loads during work or strenuous exercise. The part of the dilated blood vessels that become enlarged also determines the type of haemorrhoids that develop. Enlargement of blood vessels that are higher up the anus, above the dentate line would lead to internal haemorrhoids. Whereas, blood vessel enlargement below that line would lead to external haemorrhoids instead. The main presenting symptoms are rectal bleeding, anal discomfort and pain, as well as swelling at the anus. Bleeding occurs during bowel movement and it can be mild - appearing as drops of blood during cleaning or in the toilet bowl. Sometimes the bleeding can be copious and this would usually cause alarm and distress to the individual. External haemorrhoids would present as painful lumps at the anal verge. This type of haemorrhoids usually does not bleed but sometimes do when they rupture. It is usually more likely that the bleeding comes from a concurrent presence of internal haemorrhoids. A common cause of severe pain from external haemorrhoids is thrombosis (blood clot) within the haemorrhoid. Sometimes, an individual may feel a burning discomfort or itch around the anus. Oral medication can be prescribed to treat less severe haemorrhoids. Haemorrhoids that are small or not bleeding profusely rarely require surgery. If there is itch or burning discomfort, specially formulated creams can help to soothe the discomfort. For medical treatment to be effective, avoidance of constipation will help to alleviate the bleeding and pain. A good diet is important to ensure regular and smooth bowel movement. A high fibre diet which comprises lots of fruits and vegetables plus adequate fluid intake is the key to successful treatment. Good toilet habits of not spending too much time sitting on the throne while doing your business and texting, browsing the web on your smart device at the same time will influence the outcome of treatment too. If the above non-surgical treatment fails, another treatment method is Rubber-band Ligation. As the name suggests, a small rubber band can be applied directly to the base of the prolapsed haemorrhoid using a mechanical metal device. This will successfully remove the haemorrhoid by stopping the blood flow to the ligated haemorrhoid, causing it to eventually shrivel up and fall off. If the ligation is applied correctly and above the dentate line, the patient will feel no pain. In instances when non surgical treatment methods are unsuitable as in the case of large and prolapsed haemorrhoids, surgical intervention would be required. The different types of surgical intervention will be determined by the colorectal surgeon. Different types of surgery can range from Conventional Excisional Haemorrhoidectomy to the more current Transanal Haemorrhoidal Dearterialization surgery. Caveats: Not all bleeding from the anus are due to haemorrhoids. Likewise, not all lumps at or near the anus are due to haemorrhoids. Do consult your family doctor in order to get the correct diagnosis and treatment. Your doctor will do a simple examination in the clinic which consists of physical examination, digital rectal examination and sometimes proctoscopy, which may cause slight discomfort. If the diagnosis cannot be determined in the clinic, your doctor will refer you for further assessment which usually comprises of colonoscopy or even CT scan of the abdomen if required. Do consult your family doctor if you have blood in your stools. You do not have to suffer in silence and hope your symptoms away. #### Influenza Vaccinations By Dr Clarence Yeo MB ChB (Dublin) Vaccination is your best protection against influenza in the upcoming “flu season”. In Singapore, influenza occurs throughout the year with the main influenza peak season usually happening from December to February the following year. This corresponds to the “Northern hemisphere influenza season”. There is usually another small peak around May to June every year and this corresponds to the Southern hemisphere influenza season. The Northern Hemisphere 2020/2021 influenza vaccine has recently become available and we encourage yearly vaccination for all those at risk. The Ministry of Health Singapore recommends that the following groups of “high risk” individuals be vaccinated: Persons aged 65 years or older; Young children (aged 6 months to 59 months); Pregnant women (all stages); Persons with chronic medical diseases (including cardiovascular, pulmonary, metabolic, renal, neurologic, hepatic, or haematologic disorders); Persons who are immunosuppressed; and Anyone staying in intermediate or long-term care facilities. Most individuals above the age of 6 months can receive the influenza vaccine as long as they do not have an existing allergic reaction to any of the components of the influenza vaccine, especially allergic reactions to egg protein. It will take approximately 2 weeks after vaccination for your body to produce antibodies against the vaccine strains. Thus, it is important to get your vaccination before the flu season starts. The influenza strains undergo continuous changes and the influenza vaccines need to be “updated” every season. As a result, you need to receive annual influenza vaccinations. Fluarix Tetra registered in Singapore covers 4 strains – 2 for influenza A and 2 for influenza B. We are pleased to inform you that it is now available at our clinic. From 1 November 2020 Under the Enhanced Subsidies for the Vaccination Subsidy Scheme, Pioneer and Merdeka Generation patients will only need to Co-pay $9/$18 for the vaccine. Medisave can be also be used for this vaccination under the National Adult Immunisation Schedule (NAIS). #### Meeting the challenges of primary healthcare in Singapore Frontier Healthcare Group, which joined Qualitas’ network in Singapore last year, has a vision to deliver efficient and equitable primary care to its communities in a system that is still fragmented. To this end, it opened the Frontier Family Medicine Clinic in 2013. Dr Koh Thuan Wee, Clinical Head of Frontier Family Medicine Clinic, explains how they are working to close the gaps in primary care in Singapore. Even as the challenges of each country’s healthcare system are unique, the healthcare gaps from the patient’s perspective are mostly generic. Specialisation of healthcare has brought about efficiencies and improvement in outcomes, but the answer to the ensuing fragmentation of care remains elusive. Primary care is still the best solution to this conundrum. However, entrenching primary care as the foundation of an integrated healthcare system remains complex and challenging. With the support of the Ministry of Health (MOH) in Singapore, Frontier Family Medicine Clinic (FFMC) was founded in 2013 by a group of like-minded primary care physicians, specialists and administrators from Frontier Healthcare Group (Frontier) and the National University Healthcare System (NUHS). The aim was to establish a team-based primary care medical centre delivering patient-centric integrated care. This team-based care was made possible by interorganisational staffing from both Frontier and NUHS. Besides the Primary Care Physicians, there were case managers (nursing), allied healthcare providers, pharmacists and care coordinators to name a few. Primary care physicians were upskilled by specialists with shared protocols and regular curbside consultations to manage complex chronic patients in the community - rheumatoid arthritis, parkinson’s disease, psoriasis, epilepsy, liver failure and the list goes on. A common Electronic Medical Record system shared between FFMC and the National University Hospital improved continuity of care with accurate information exchange between doctors at each visit. A government-subsidised dispensary within FFMC ensured that there was a financial gradient for the transition of care from the hospital to the primary care team. An army of care coordinators helped the patients to navigate the complex healthcare system, ensuring a seamless transfer from hospital to primary care. FFMC became a repository of the patients’ healthcare information as their care was consolidated from different specialties into Primary Care. With this setup and for once in primary care, FFMC was able to put in place system-level goals as Frontier and NUHS worked together to reduce emergency department visits, specialist outpatient clinics attendances, hospital admissions and lengths of stay. The initial results were encouraging but as a single and only private medical centre working with a tertiary hospital in co-managing complex chronic patients, the overall impact was negligible in the private sector. (In Singapore, the public hospitals refer the bulk of their chronic patients to the large primary care centres/polyclinics). FFMC continues its vision of providing comprehensive and holistic integrated care in the community. To date, we are managing close to 3000 chronic disease patients who are mainly referred by NUHS entities, although we also have walk-in patients from the community. In the coming years, as our MOH plans and prioritises to anchor preventive care and chronic disease management with the primary care sector, FFMC looks forward to an enhanced role in population health management within the western sector of Singapore. Transformation of care is an ongoing endeavour and remains the topmost priority of all healthcare systems as society and disease patterns evolve and costs escalate. At FFMC, we believe that we have a model of care that can make a difference in this transformation effort. However, this is not a one-entity show. An engaged leadership (from various stakeholders) with common vision at all levels remains necessary to put in place policies and goals to reach the end state of an integrated healthcare system with primary care as its foundation.   This article was previously published in the Qualitas Medical Group newsletter NETWORK (Volume 6, Issue 1, Quarter 1, 2022) #### Omicron – what you need to know All viruses change over time. We all know that the SARS-CoV-2 virus, which causes COVID-19, has had quite a few variants since it first emerged in 2020. These changes affect different properties of the virus, such as the how easily it spreads, the associated diseases’ severity and even the performance of vaccines. So far, five variants have been detected, including Omicron. The current dominant variant (the most widespread) is Delta. Reducing transmission through proven methods, such as vaccination, is one of the crucial aspects of the WHO’s and all government’s strategy of dealing with all variants. What we know about Omicron The latest variant – Omicron – was first identified in November 2021. As with previous variants, the World Health Organization (WHO) and its network of international experts have been monitoring and studying Omicron to identify its behaviour and inform the world about how they may respond to it. Spread Though it is not yet clear whether the Omicron variant is will spread more easily than the original virus, there is a possibility that it might, just like previous variants (for example, Delta). Researchers around the world are currently conducting studies to understand Omicron’s spread. Severity of disease Studies are still ongoing on whether Omicron causes a more severe disease than the other variants. Though the WHO has not confirmed it, the US Center for Disease Control has warned citizens to be aware that the Omicron variant may spread even to people who have been vaccinated, though they are likely to experience milder symptoms than the unvaccinated or not show symptoms at all. They will, however, remain in an infectious state. Vaccinations Current vaccines are expected to protect against severe illness and deaths due to infection with the Omicron variant. However, because the Omicron variant may spread more easily, vaccinated people may still be infected, though with less severe symptoms. Vaccinations remain the most effective way to reduce severe disease and death, including against the dominant circulating variant, Delta.   Recommended actions for countries The WHO recommends that countries continue to implement effective public health measures to reduce COVID-19 circulation, using risk analysis and a science-based approach. Countries are also encouraged to share reports and research.   Recommended actions for people The most effective steps to reduce the spread of the COVID-19 virus in any of the variants is to Keep a physical distance of at least 1 metre from others Wear a well-fitting mask Open windows to improve ventilation Avoid poorly ventilated areas or crowded spaces Keep hands clean Cough or sneeze into a bent elbow or tissue Get vaccinated     Information sources: World Health Organization, Centre for Disease Control #### Qualitas Health Embarks on a New Chapter as ‘Your Healthcare Partner’ In a significant stride towards redefining our identity and enhancing our service offerings, we are excited to unveil our new tagline: Your Healthcare Partner. This change heralds a new era of growth and strategic expansion for us! For over a quarter of a century, Qualitas Health has been synonymous with excellence in healthcare. With a network spanning 351 healthcare facilities across the Asia Pacific, we have consistently been at the forefront of delivering high-quality medical services. Today, as we embrace a broader vision, Qualitas Health is setting a new benchmark in integrated, patient-centred care. A New Vision for Comprehensive Care As healthcare needs evolve, so does the approach of those who manage and deliver care. Recognising the growing demand for integrated and holistic healthcare solutions, Qualitas Health is leading the charge in revolutionising how medical services are provided. The introduction of the tagline ‘Your Healthcare Partner’ reflects our deep commitment to being a comprehensive provider of healthcare services. Our approach brings a wide array of medical disciplines under one roof. From primary care to specialist services like ophthalmology, and specialist procedures as well as dental, medical imaging, and occupational medicine, all the way to rehabilitation and retail pharmacy, and recently a healthcare marketplace —patients have access to an extensive range of healthcare options. This multi-disciplinary model not only minimises the hassle of multiple appointments but also ensures a cohesive treatment plan that covers all aspects of a patient’s health. Leveraging Technology to Enhance Patient Care At the heart of our innovative strategy is the adoption of cutting-edge technology. With advanced imaging tools, we offer faster and more precise diagnoses. Moreover, through telemedicine, patients who aren’t mobile or live in remote locations can receive timely medical consultations broadening the reach of our exemplary services. We also enhance patient engagement and management through digital support services, including the patient portal. The portal provide crucial access to medical records and test results, empowering patients to take an active role in managing their health. Beyond Healthcare: A Partner in Progress The impact of Qualitas Health extends beyond direct patient care. Through our healthcare facilities planning and consultancy, we aid other healthcare providers in refining their operations and elevating patient care standards. This collaborative approach not only improves the healthcare landscape but also sets a new standard for the industry. Dato’ Dr Noorul Ameen Mohamed Ishack, Chairman and Founder of Qualitas Health, reflects on this transformative journey: “With these changes, we have revisited who we are and what we call ourselves. We are not just a healthcare provider; we are a holistic healthcare partner.” As Qualitas Health continues to expand and evolve, our commitment to maintaining the highest standards of care and pushing the boundaries of what is possible in healthcare remains unchanged. Your Healthcare Partner is not just a tagline—it's a promise, a commitment, and a way forward for us and all our stakeholders. #### Singapore’s Covid-19 Response Keeps Cases Low International Medical Clinic medical director Dr Lim Hui Ling says the experience of the SARS pandemic and cooperative Singaporeans have kept Covid-19 numbers low. “When I first heard about COVID-19 in January 2020, I thought it would blow over like the swine flu or bird flu have in the past. As we all know now, that wasn't to be the case,” says Dr Lim Hui Ling of IMC, part of the Qualitas network of clinics. “One year later, I'm dressed head-to-toe in scrubs, and each afternoon I change into full PPE gear to treat patients at the acute clinic we hold at our centre. Patients attend the acute clinic if they have a fever or difficulty breathing, which are symptoms of COVID-19. She’s been a family doctor at the International Medical Clinic since 2002. While all her appointments are typically face-to-face, she’s now seeing patients at the clinic and over Zoom. As a council member of the College of Physicians, she also advises other doctors on how to cope with the crisis. Singapore was the first country in Asia to approve the Pfizer-BioNTech coronavirus vaccine. “I was given my first dose of the vaccine on January 14. I did experience a couple of side effects after having the vaccine. The next day my arm was quite sore, and I couldn't lift it to comb my hair. I also had a bit of fever, which came on in the afternoon and lasted until bedtime. However, when I woke up two mornings after receiving the shot, I felt absolutely fine.” There are 26 doctors at the IMC, and they’ve seen three positive COVID-19 cases during the entirety of the pandemic. “This isn't my first brush with a virus. From November 2002 to July 2003, Asia was hit by the SARS pandemic. It didn't last as long as COVID-19 has, but it was scary. Healthcare workers died, including people I knew.” SARS was the blueprint on how to deal with COVID-19 “It was a huge learning curve for many of us who hadn't experienced anything like it before, and it also gave us the blueprint on how to deal with COVID-19. The Ministry of Health gave national guidance on managing COVID-19 patients, which we modified to work for our clinic. Due to SARS, we had the experience of infection control, we knew how to split the clinic, how to triage patients, and we always have PPE stockpiled in our warehouse.” As Singapore is a small country, it was able to pivot quickly to combat COVID-19. The government was quick to close its borders, implement mandatory mask wearing and social distancing, and introduced the Trace Together app in March 2020, which people must use to enter stores, hospitals, and even taxis, in order to keep track of where someone has been if they should contract the virus. The government also made good use of buildings that were standing empty. Exhibition centres were turned into community isolation facilities and empty hotel rooms were used for Stay At Home notices to quarantine incoming visitors for two weeks. Dr Lim Hui Ling and her husband The virus started to spread during Chinese New Year of last year. The country went into lockdown from April 7 to June 1. The government announced that the country would go through three phases, and they moved into phase three on December 28 after new infection rates had already been low for months. “All shops, restaurants, and beauty salons are now open and people can also go to the movie theatre. Parks stayed open during the pandemic so that everyone had somewhere to exercise. We still have to socially distance and wear masks, but we can now meet in groups of up to eight people,” she says. The people played a big part “Most people have been acting very responsibly and trust in the regulations we're asked to follow. The ministers who run the COVID-19 task force are good communicators, so there's been no confusion and everyone is clear about which phase we're in and what we need to do. “Everyone wears a mask, apart from one or two people who make the papers when they don't. And everyone does their best to socially distance and most people stick to the rules about not gathering in large groups. Thanks to Singapore's control of the outbreak, this year we'll be able to visit our parents for Chinese New Year. “I feel fortunate to live in this surreal little bubble, where most people I know care about working together towards a communal goal. And when the borders reopen, I can't wait to start traveling again.” This article first appeared on the World Economic Forum. #### Tips for staying healthy during Ramadan During the month of Ramadan, observant Muslims fast from sunrise to sundown. This is a complete fast, meaning that people abstain from both food and drink. Fasting during Ramadan teaches people to practice self-discipline, self-control and empathy for those who are less fortunate. It is also a time for self-reflection and self-improvement, which means it is a great time to pay attention to your health and what kinds of foods you put into your body. Because fasting means a reduced intake of calories and sugars, it could be a good time to take note of and take control of your blood sugar levels. If you are pre-diabetic or diabetic, consult your Qualitas doctor before and during fasting to ensure that your levels remain stable. Fasting is safe for people who are healthy overall. It is always a good idea to consult your usual doctor or a nutritionist before fasting and discuss what are the right ways to fast to ensure you still get enough nutrition and are able to function throughout the day. It is not advisable for young children to fast. However, if your older child is learning to fast, consult your Qualitas family doctor about the best way to go about it. Here are some tips on how to stay healthy while fasting during Ramadan. 1. Stay hydrated Drink plenty of water or unsweetened juices before the start of fasting hours. Drink a cup of water or juice every hour until fasting starts. If you drink one jug of water all at once, you your body will end up passing most of it out almost immediately. Adults need about 2-3 litres of water each day Caffeine in coffee, tea and sodas causes increased urination, which will leave you more dehydrated.   2. Don’t avoid sahur Missing the pre-dawn meal will leave your feeling extremely hungry throughout the day, which will also make you feel tired. Focus on foods that digest slowly and release energy over time – whole grains, fruits and vegetables. Sahur should be a balanced diet. Divide your plate into quarter protein, quarter complex carbohydrates, and half vegetables or fruits. For sahur, this could mean some bread, eggs and some fruit. Or a plate of nasi lemak with some rice, ikan bilis or fish, and some vegetables. Add a cup of milk, unsweetened juice or water.   3. Don’t eat salty, sugary or overly spicy food Salty foods will make you feel thirstier during the day. Sugary foods are not good for your health and cause you to put on weight over the month. Spicy food will irritate an empty stomach.   4. Eat in moderation – don’t binge! There is always a temptation to binge when breaking your fast because you are feeling hungry. Binging will spike your insulin levels (even if you are not diabetic) and will strain your body and make you feel tired later. Eat slowly until you feel full and then stop. Every meal should follow the suku-suku-separuh (quarter-quarter-half) rule. Your plate should contain quarter protein, quarter complex carbohydrates, and half vegetables and/or fruits. Notice that sugary foods and sweets do not have a space on your suku-suku-separuh plate. Of course, you may indulge once in a while during Ramadan but cakes, kuih and other sweets are treats that should not be eaten at every meal.   5. Don’t forget to rehydrate After not consuming any fluids during the day, you will feel thirsty. The best drink is of course water. Drink a few cups during the night instead of a whole jug at once so that your body can retain and use the water. Avoid carbonated and sugary drinks. Again, these will spike your insulin levels and leave you tired. And, of course, sugar drinks are unhealthy and will cause you to put on weight. There are no nutrients in colourful drinks, so avoid them.   6. Rest and exercise strategically It may seem counter-intuitive to exercise while you are fasting but staying active is important no matter what you are doing. Find time to take a slow walk with your family after sundown or do some gentle stretching. If you are feeling more energetic, you can do more vigorous exercises but be aware of your hydration levels. Rest if also important when you are fasting, so make sure you get enough sleep if you are going to be waking up extra early for sahur.   Ramadan Kareem from Qualitas Health! #### Travel requirements for Malaysia-Singapore travellers As people get ready to travel to meet family and friends for Chinese New Year and return to hometowns they have not visited for almost two years, health and safety must still be a top concern. Some countries have conditionally opened borders to fully vaccinated travellers with precautionary and control measures that are intended to prevent and curb the spread of COVID-19, especially the latest Omicron variant. Fully vaccinated travellers (people who have completed two doses of their primary series of vaccination) travelling between Malaysia and Singapore may do so through three travel schemes and must adhere to certain COVID-19 testing requirements. Fully-vaccinated travellers using any of these travel schemes must undergo additional COVID-19 tests before and for six days after arriving in Malaysia: Vaccinated Travel Lane (VTL) by air and land Langkawi International Travel Bubble (LITB) One Stop Centre (OSC) for short-term business visitors Travellers are not required to quarantine. However, you are encouraged to stay home or in your hotel as much as possible until the six days are over and you have not tested positive for COVID-19. What tests should I take? Two days before departure: VTL Air travellers – RT-PCR test VTL Land travellers – RTK-Ag (professional) test at Larkin Sentral Bus Terminal Johor Baru Over the course of the six days: Day 1 (upon arrival) For asymptomatic travellers – RT-PCR Travellers with mild symptoms – RTK-Ag or RT-PCR COVID1-9 test Day 2 Self-administered RTK-Ag test (at-home saliva test) Day 3 Professionally administered or verified RTK-Ag test Day 4 Self-administered RTK-Ag test (at-home saliva test) Day 5 Professionally administered or verified RTK-Ag test Day 6 Self-administered RTK-Ag test (at-home saliva test)   The professionally administered or verified tests will be uploaded into SIMKA (Sistem Informasi Makmal Kesihatan Awam) – the national public health information system. Some clinics that are equipped with telemedicine facilities allow patients to administer the test themselves while being observed by a doctor online. The doctor will then verify the test results and upload the relevant data into SIMKA. All results must also be reported through Malaysia’s COVID-19 tracing app MySejahtera. While meeting friends and family after a long separation will be a wonderful and exciting experience, you should be mindful of your own safety and the safety of your loved ones. Most people will be fully vaccinated but children under 12 years old and immunocompromised people will not have been vaccinated and be vulnerable to the virus. Elderly people who are fully vaccinated and who have received their boosters must still take precautions to not expose themselves to the virus. 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