COVID-19 is (still) dominating news globally, and clinical chemistry labs have been thrust into the spotlight as the world's media takes a previously unprecedented interest in bioanalytical science. Here, we speak with Peter Kissinger and Rolf Halden to gain expert insight into two very distinct approaches to coronavirus monitoring
Matthew Hallam | | Longer Read
The COVID-19 pandemic is showing no sign of letting up. As countries consider relaxing their various states of lockdown, secondary outbreaks represent a real (and, in some cases, realized) threat to those attempting to return to normality. The only way we can follow the extent of the issue is by implementing effective testing regimes. And the only way to beat it? A treatment or vaccine – both of which remain elusive.
In the world’s mission to identify the virus and treat those infected, analytical scientists are a secret weapon – turning samples into answers, exploring new targets, and optimizing drug discovery efforts.
We spoke to Peter Kissinger and Rolf Halden, two scientists involved in these crucial activities, to explore the challenges we face – and what to expect in the months (and years) ahead…
Tracing Individual Exposure
Bioanalytical guru Peter Kissinger provides an overview of the current status and future prospects of clinical COVID-19 testing
How are we testing for SARS-CoV-2?
Reverse-transcription PCR (RT-PCR) based on viral RNA sequence is the key qualitative tool for SARS-CoV-2 detection. These tests act primarily as a tool to prevent further transmission, but , being new as they are, many are yet to be validated with statistical rigor. The current situation, however, allowed for Emergency Use Authorization (EUA), meaning we have taken a shortcut, and statistical rigor will be accounted for later in time. But this must not be ignored for long.
A second approach is to detect a viral surface antigen via an antibody. Antigen tests could be conducted more simply and faster than typical PCR methods, but more data are needed to fully understand their utility. A third method then promises viral detection via CRISPR technology – developers say this can be accomplished quickly and at low cost, with the potential for home use based on nasal swabs or saliva.
Serological antibody measurement can indicate ongoing or previous infection. These can be applied in homes and instrument-free public health settings, and one from Roche was recently approved for use in the UK, but we are still not sure if reinfection remains possible despite the presence of antibodies. If not, for how long is this the case? This would be useful to know, especially given the potential for the virus to alter and overcome immune defences over time, but – from my reading at least – we have no definitive answer yet.
Sampling is also very important. Should we use a nasopharyngeal swab, a nasal swab, saliva, sputum, or blood? The first of these is closer to the action for a respiratory disease, but swabs are not without some “art” and luck. This topic has been a source of worry, and has added cost due to the need to employ experienced and (PPE) protected individuals. Home collection has recently begun, saving costly labour and travel expenses, but adding the risk of a poor collection.
The direction that disease-identifying tests are following is excellent – we just need to ensure they’re accurate – and fast. Movement towards testing for specific biomarkers to track infection and treatment response will also be essential for us to account for the wide range of ways in which patients respond to the virus, and improved cytokine measurements will help us understand these responses. Labs were overwhelmed early in the outbreak due to backlogs and the lack of supplies, but we are now seeing this situation begin to stabilize.
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