COVID-19

Impacting Citizens of the World

We, at GSE, are committed to doing our part in providing access to COVID-19 tests for early detection and prompt infection control measures.

World Health Organisation

"Every loss of life is a tragedy. It’s also motivation to double down and do everything we can to stop transmission and save lives. "

 

—  WHO Director-General

Real-Time PCR SOLUTIONS
WHO Recommendation
Point of Care SOLUTIONS

On 23 March 2020, the daily new confirmed COVID-19 deaths worldwide reported is at 1,660 new cases.[1]

Globally, the death numbers for COVID-19 doubled every 6 days. [2] WHO has reported over 332 930 confirmed and 14 510 deaths.[1]

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.[3,4]

Risk of infection with COVID-19 is higher for people who are close contacts of someone known to have COVID-19, for example, healthcare workers, or household members. Other people at higher risk for infection are those who live in or have recently been in an area with an ongoing spread of COVID-19.[4]

The “incubation period” refers to the time between catching the virus and starting to have symptoms of the disease. Most estimates of the incubation period for COVID-19 range from 1-14 day.[3] In an early study in Wuhan, the mean incubation period for COVID-19 was 5.2 days among 425 cases, though it varies widely between individuals.[5] Studies have suggested that most affected individuals with COVID-19 will start to see symptoms within 5 days.[3,5]

Countries should prepare to respond to different public health scenarios, recognizing that there is no one-size-fits-all approach to managing cases and outbreaks of COVID-19.[5]

Recognizing that the global spread of COVID-19 has dramatically increased the number of suspected cases and the geographic area where laboratory testing needed to be implemented, intensified COVID-19 molecular testing has led to shortages of molecular testing reagents globally for COVID-19 and for other molecular diagnostics. Beyond supply issues, there are significant limitations of absorption capacity in many regions, especially in low- and middle-income countries.[5]

According to World Health Organisation, diagnostic testing for COVID-19 is critical to track the virus, understanding epidemiology, informing case management, and to suppressing transmission. [6]

With reference to WHO recommendation on 19 March 2020, the suspected cases should be screened for the virus with nucleic acid amplification tests (NAAT), such as RT-PCR. PCR testing of asymptomatic or mildly symptomatic contacts can be considered in the assessment of individuals who had contact with a COVID-19 case. [7]

For patients with suspected infection, the following procedures have been suggested for diagnosis: performing real-time fluorescence (RT-PCR) to detect the positive nucleic acid of SARS-CoV-2 in sputum, throat swabs, and secretions of the lower respiratory tract samples. [8]

The current standard molecular technique that is now being used to detect COVID-19 is the realtime reverse transcription-polymerase chain reaction (rRT-PCR). This protocol has been documented and available online on the WHO website since 17 January 2020. [9]

Routine confirmation of cases of COVID-19 is based on detection of unique sequences of virus RNA by NAAT such as real-time reversetranscription polymerase chain reaction (rRT-PCR) with confirmation by nucleic acid sequencing when necessary. The viral genes targeted so far include the N, E, S and RdRP genes. Examples of protocols used may be found here. RNA extraction should be done in a biosafety cabinet in a BSL-2 or equivalent facility. [12]

When testing facilities are limited, available facilities tend to be located in or near a capital city, making timely access to testing difficult for people living in other parts of the country. Consider the possibility of mobile laboratories or, if available, automated integrated NAAT systems that can be operated in remote regions and by staff with minimal training. [5]

Faced with community transmission over large areas of the country, laboratories will need to be prepared for the significant increase in the number of specimens that need to be tested for COVID-19. Testing constraints should be anticipated, and prioritization will be required to assure the highest public health impact of reducing transmission using available resources. Planning should include the preservation of critical laboratory testing for other diseases and essential surveillance activities.[5]

Testing must be rationalized in areas with community transmission and where testing capacity cannot meet needs. Priority should be given to the detection and protection of vulnerable patients and health care workers. Focused testing in health care facilities assures infection prevention and control measures can be correctly implemented and vulnerable non-COVID-19 patients are protected from nosocomial COVID-19 infection.[5]

For diagnosis of acute infections, there is a lag period as antibodies specifically targeting the COVID-19 virus would normally appear between 7-14 days after the illness onset. However, serological tests can be used to assess both active and historical infection within the community. Serological tests using immunoassay test strips can also provide rapid point-of-care qualitative detection of antibodies for better screening before further confirmatory tests. [10]

A point-of-care device (i.e., a rapid, robust, and cost-efficient device that can be used onsite and in the field, and which does not necessarily require a trained technician to operate is crucial and urgently needed for the detection of COVID-19. [9]

Rapid and simple point‐of‐care lateral flow immunoassay which can detect IgM and IgG antibodies simultaneously against COVID-19 virus in human blood within several minutes which can detect patients at different infection stages. Testing of specific antibodies of COVID-19 in patient blood is a good choice for rapid, simple, highly sensitive diagnosis of COVID-19. [11]

 

It is widely accepted that IgM provides the first line of defence during viral infections, prior to the generation of adaptive, high-affinity IgG responses that are important for long term immunity and immunological memory. It was reported that after COVID-19 infection, IgM antibody could be detected in patient blood after 3 - 6 days. [11]

 

IgG could be detected after 8 days. Furthermore, detection of IgM antibodies tends to indicate recent exposure to COVID-19, whereas detection of COVID-19 IgG antibodies indicates virus exposure some time ago. [11]

More Independent Reading Resources on COVID-19 Tests:

  • FIND 28 APRIL 2020 SARS-COV-2 Molecular Assay Evaluation Results

  • Developing a National Strategy for Serology (Antibody Testing) in the United States

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References:

[1] Coronavirus Disease (COVID-19) – Statistics and Research

Accessed on 23 March 2020 : https://ourworldindata.org/coronavirus

[2] WHO Coronavirus disease 2019 (COVID-19) Situation Report – 62. 21 March 2020

Accessed on 23 March 2020: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200322-sitrep-62-covid-19.pdf?sfvrsn=f7764c46_2

[3] WHO Q&A on coronaviruses (COVID-19) – 9 March 2020. Accessed on https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

[4] CDC -What you need to know about coronavirus disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

[5] WHO Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Interim guidance 2 March 2020

[6]  WHO Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans. Accessed on 23 March 2020: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance

[7] WHO Interim guidance Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases - 19 March 2020 Version. Accessed on 23 March 2020: https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117

[8]Adhikari, S., Meng, S., Wu, Y. et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 9, 29 (2020). https://doi.org/10.1186/s40249-020-00646-x .Accessed on 23 March 2020: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00646-x

[9]Trieu Nguyen et al. 2019 Novel Coronavirus Disease (COVID-19): Paving the Road for Rapid Detection and Point-of-Care Diagnostics. Micromachines 14 March 2020, 11, 306; doi:10.3390/mi11030306

[10] COVID-19 Science Report: Diagnostics.  NUS Saw Swee Hock School of Public Health. Published on 12 Mar 2020. DOI: 10.25540/e3y2-aqye

[11]Zhengtu Li (2020) et al, Development and Clinical Application of A Rapid IgM‐IgG Combined Antibody Test for SARS‐CoV‐2 Infection Diagnosis. Accessed on 23 March 2020: https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.25727

[12]  WHO Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Interim guidance 2 March 2020

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