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Winter is coming and with many European countries facing an imminent second wave of infections, it was reassuring to see how the research community has come together to accelerate progress and learn from each other. At the ECCVID conference, it became clear that we now understand a lot more about the SARS-CoV-2 virus and how experts are beginning to pull together an arsenal of potential solutions, including new treatments and vaccines. Diagnostics is also key in our battle against COVID-19. Here, there are many key developments that are likely to influence how well societies can deal with the second wave, which include:
1. Rapid point-of-care testing – the passport to normality?
The UK Government’s proposed “Operation Moonshot” aims to test 10 million people a day for COVID-19 by early 2021. This ambitious strategy will most likely rely on technologies including Endpoint PCR, isothermal amplification technologies and lateral flow antigen tests. The “pregnancy-style” lateral flow test could enable close to home testing with results being delivered in as little as 5-10 minutes. The hope is that these simple and low-cost tests could be used regularly and provide confidence that users are not infected or pose any risk to others.
Despite significant progress, there are clear challenges that remain in the use of these technologies, which relate to limitations insensitivity, the high variability between individual samples and the significant source of error that arises from at home sample collection. Whilst it remains unclear whether “Operation Moonshot” can be delivered on time, it was great to see the progress being made by researchers across the world in the development of these technologies and share strategies on how to continue to move forward.
2. Solutions for high volume testing
Many countries are continuing to increase their existing testing capacity, which mostly relies on PCR based methods. However, the increase in disease prevalence could threaten to reinstate the logistical challenges that delayed the implementation of large-scale testing at the beginning of the pandemic. For example, by depleting valuable reagents and resources, including kits for RNA extraction and nasopharyngeal swabs. At ECCVID, multiple speakers proposed alternative solutions to ensure these issues did not re-occur during the second wave. These included changing the choice of sample (for example, using gurgled pharyngeal samples instead of nasopharyngeal swabs), using computational methods to identify infected patients from pooled samples and direct lysis/extraction methods to avoid the need for RNA extraction.
3. Identifying COVID-19 patients amongst other circulating respiratory illnesses
Winter is already a challenging time for healthcare systems across the northern hemisphere, with many respiratory viruses, including influenza A and B, increasing in transmission during the colder months. An ongoing challenge is how we can quickly stratify COVID-19 patients from those with other respiratory illnesses, which often have similar and overlapping symptoms.
A single test that can diagnose infections caused by multiple viruses could offer a real advantage. For example, by allowing laboratories to process more tests in a shorter period of time, preserving reagents that are likely to be in limited supply and providing public health officials with the information they need to support their efforts to control COVID-19 and other circulating respiratory illnesses. Here, we have already seen the development of multi-panel tests that can detect several common respiratory diseases at the same time as COVID-19. For example, the Allplex™ SARS-CoV-2/FluA/FluB/RSV Assay from Seegene, which featured at the ECCVID Conference.
4. Overcoming challenges in existing testing methods
We now know that RNA from “dead” virus can continue to be shed from a patient’s cells for many weeks after symptom onset. As a result, many patients who are no longer infectious and have recovered from their illness will continue to test positive for COVID-19 using existing methods, despite posing no risk to others.
Multiple ongoing studies were presented at ECCVID that were correlating viral RNA levels (detected through PCR) with measures of infectivity (for example, by using viral culture methods). These studies are beginning to reach a consensus that patients are most infectious during the first week after symptom onset and that infectivity declines after the eighth day. There are exceptions, but this is an important discovery that will help to inform return to work policies for health care practitioners and other key workers.
5. Smarter shielding programs for those most at risk
One of the most striking features of what we know about COVID-19 so far, is the high variability in disease severity between individuals, even within the same age group. An important question is whether we might be able to predict an individual’s risk of falling into the critically ill category by utilising novel biomarkers. Multiple presentations at ECCVID highlighted the potential use of inflammatory bio markers (including IL-6 and D-Dimers), as potential predictors of disease severity. Identifying these predictors could help to develop much more informed shielding programs and avoid further economically challenging lockdowns and unethical herd immunity related strategies.
My take-home message from the ECCVID Conference was that there are many reasons to be optimistic. It was a true demonstration of the fantastic progress that can be made when multiple disciplines from across the world come together. Whilst the second wave will inevitably pose new challenges, it presents a real opportunity to develop impactful and innovative solutions. At CDP, we hope to utilise our broad expertise and experience in diagnostics, drug delivery and medical therapy to support many, diverse companies and institutions to rise to the challenge of COVID-19 and support the development of products and services that will have a positive impact on people worldwide.
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