The Covid-19 Chronicles: Time to prioritise rapid point-of-care testing


  • Science, She Wrote
  • Saturday, 21 Mar 2020

I THOUGHT I had Covid-19 last week.

Someone at work had been in contact with a person who was confirmed to have Covid-19.

By the time we found this out, our colleague was sick and being checked at the hospital. This was after he had been in contact with hundreds of people in the office, at seminars, and at meetings all week.

We wondered: Did he have Covid-19? Were we infected as well? Should we be going out and about? Are we passing the virus on to our families, our neighbours, and strangers at the mall?

We waited for his test results anxiously. It took 24 hours before we were informed his test result was negative. We breathed a sigh of relief.

Twenty-four hours may not seem like a long time. But if our co-worker was ill with Covid-19, and if only three* of us became ill with Covid-19, within those 24 hours of uncertainty and days earlier when we were completely unaware, we could have spread the disease to another nine people*, who then would have spread the disease to many more.

This is the danger of a viral disease like Covid-19 that is able to spread from person-to-person, not even showing signs of its presence until many days or even weeks later. Covid-19 is caused by a virus called the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), a virus that used to only infect animals but was recently able to make humans ill. This new contagious disease has spread across countries, closed down schools, major events and movie productions.

Although SARS-CoV-2 specifically causes Covid-19, the symptoms of Covid-19 are general flu-like symptoms, which may vary from person to person.

Like the flu, which is caused by the influenza virus, Covid-19 results in most people developing fever, needing rest and fluids for a few days. But in some people, especially the elderly and those with other chronic illnesses, the virus causes more severe illness such as breathing difficulties requiring hospitalisation, or worse, pneumonia and even death.

Unlike the flu, we have no vaccine to protect from this disease, and no specific drugs to provide a cure for Covid-19. The best we can do is control the spread of the virus so that fewer people are at risk of getting sick, and that hospitals are not overloaded with a sudden surge in patients needing care.

This overload of hospitals is dangerous not just because of Covid-19, but because it will cause preventable deaths from other diseases and injuries. If we do nothing and allow hundreds of thousands of people to contract Covid-19, our hospitals will simply not have enough people, space or resources to provide care for the community.

This is where diagnostics play a huge role in containing the spread of this disease. Diagnostic tests are used to confirm whether someone has a disease, beyond just their symptoms or history of exposure.

Currently, someone is diagnosed with Covid-19 based on detection of the viral RNA (the genetic material) of the SARS-CoV-2 in respiratory fluid samples of the patient, i.e. samples taken using a swab deep into the nose and mouth. Test results can vary based on how the patient is sampled and how the test is run, and the tests can only be performed in laboratories with the necessary (often expensive) equipment.

What we need urgently are simple, rapid, cheap and accurate diagnostic tests that can be used to screen and identify people who have been exposed or have already caught the virus as soon as possible. These rapid tests that can be administered at “point-of-care” or outside of the laboratory are often simple devices that look like a pregnancy strip or dipstick test, and they are designed to detect proteins from the virus or antibodies made against the virus.

Rapid point-of-care tests have changed the fate of millions of people who were infected with HIV living in areas without access to laboratories, because once they could be diagnosed, they could reduce their risk of disease progression by starting treatment, and take steps to reduce spreading the HIV to others.

Thanks in some part to these simple diagnostics, HIV has become a chronic disease instead of a cause of premature death. However, these simple diagnostics are not simple to develop, and they are often the least of priorities when it comes to research and funding.

While we still do not have a vaccine and specific treatment for Covid-19, there needs to be significant resources and investment in developing these. But at the same time, investing in development of a simple accurate diagnostic is also crucial.

Rapid point-of-care diagnostics can be used to screen individuals at risk of getting the disease can empower more healthcare providers, instead of relying solely on central hospitals with laboratories. Accessible rapid diagnostics allows more individuals to get care if needed, and coupled with appropriate counselling and guidance, these tools enable infected individuals to self-isolate in a timely manner, to reduce their risk of spreading the virus to others, and to slow down the rate at which new infections pop up in the community.

It is interesting that once we think we are at risk of catching a disease, we start feeling symptoms. When I thought I potentially had Covid-19, I suddenly developed a scratchy throat and a little cough. Usually, these are simply nuisances that I would endure to still show up at work or go shopping at the mall, passing on my bug to others. Many people would too. As they say, no one ever died of the sniffles.

But people are dying from Covid-19. And as this new virus spreads further into the community, more people need to know if their scratchy throat is actually an early sign that they have Covid-19. More people need to know if they need to stay away from others or to stay home, to protect others who are at higher risk of severe illness or even death.

* Based on the current R0 for SARS-CoV-2, which estimates that each person infected will spread the virus to two-three more people.

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Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own.

   

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