Use university labs to clear the testing bottleneck

The coronavirus has invaded every country across the world and paralysed social and economic activity. First-hand accounts from healthcare workers on the frontline describe warzone-like experiences with patients being subject to triage reminiscent of its historical context in the treatment of the battlefield wounded. These scenes of horror are reported daily in neighbouring countries like Italy.

However countries like South Korea are notable in being relatively successful in containing the virus with mortality rates 10 time less than some other countries. What is the secret? Contact tracing is essential but its success is dependent on extensive testing. South Korea tested early and often including those primary contacts that failed to display symptoms. Such testing captures the virus before it reveals itself and gives us a fighting chance to control the virus rather than chasing it. Scientific evidence shows that asymptomatic infected individuals, including children, spread coronavirus. It is vital to detect these silent spreaders as early as possible.

In Ireland there are many anecdotal reports of symptomatic individuals waiting over a week for testing. We are at risk of not only missing the virus before it shows itself but may even miss it after it has been cleared by the immune system.

So why is testing so slow when we hear every day in the media of many new testing centres being established across the country? These are not testing centres. They are sampling centres at which swab samples from the throat and nose are taken. These clinical samples must then be analysed in a laboratory for the presence of coronavirus. The samples are initially handled in a Biosafety Level 3 (BSL-3) laboratory to protect the technician from infective virus. The sample is quickly converted into an innocuous form that can be analysed in a BSL-2 laboratory. The analysis involves placing the processed samples into a PCR cycler that cycles many time between high and low temperatures to reveal the presence of 2 coronavirus genes if the samples are infected by virus.

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The whole laboratory process is completed in the matter of a small number of hours. So why the backlog and waiting for over a week on testing of samples? I have heard many reasons being cited and it is difficult to from the outside to be sure of where the bottlenecks are actually located:

We don’t have enough testing centres!

We don’t have enough laboratories at the appropriate biosafety level!

We don’t have enough technicians!

We have problems with supply chains providing enough kits to detect the virus!

Some or all of these may reflect the reality on the ground. Early testing in Ireland was established at the national Virus Reference Laboratory in UCD. This serviced has since been rolled out to testing centres in some regional hospitals and laboratories in state agencies.

However, there is a vast resource that remains untapped in our university sector. This resource is not only infrastructure but more importantly expertise from researches. Many of these researchers are international leaders in their research fields and use the above testing technology as a matter of routine in everyday laboratory research. Indeed every university and many institutes of technology have the facilities and expertise to carry out the analytical part of the testing. So let me propose the following scenario that may avoid the above bottlenecks and transform our capacity to test for coronavirus:

1. Establish regional testing centres in universities and Institutes of Technology

2. Carry out a national inventory of institutions that have Biosafety Level 3 (BSL-3) laboratories to identify main testing centres.

3. Identify institutions that lack BSL-3 laboratories but have BSL-2 laboratories and can act as satellite testing centres associated with the main testing centres.

4. Redeploy PhD students, postdoctoral fellows and technical staff to carry out testing in their host institutions.

5. Researchers to make components of kits if kits are not commercially available. Most labs should be able to circumvent kits and perform these tests using reagents produced in labs.

Under normal circumstances such sites would require accreditation. However many labs in the Irish universities are performing research at a world class level and would be eminently capable of satisfying required standards. Indeed I would argue that for a short period accreditation should be bypassed/expedited to achieve such large scale testing. Currently Ireland is testing approximately 2000 samples per way. With a co-ordinated approach across all universities 20,000 samples per day and more would be eminently achievable.

This would allow for testing times of 24 hours. All primary contacts, identified by contact tracing, could be immediately tested, irrespective of display or absence of symptoms.

Testing will help contain the spread of the virus. Testing will protect the most vulnerable. Testing will save lives. Lets use the resources and expertise that are ready in our research community.

Paul Moynagh is Professor of Immunology and Director of The Kathleen Lonsdale Institute for Human Health Research at Maynooth University