Analyst Insight: Rapid Detection of Pandemics: Identifying the Unknown

10-Oct-2012 - United Kingdom

A Severe Acute Respiratory Syndrome (SARS)-like coronavirus is back in the headlines. A Qatari national, recently returned from a trip to Saudi Arabia, was struck down by a mystery respiratory illness. A lack of diagnostic capability led to the patient being transferred from Qatar to London for intensive care treatment and diagnosis. The UK Health Protection Agency (HPA) has confirmed that the patient had been infected, probably in Saudi Arabia or Qatar, with the same strain of a coronavirus determined by a Dutch team following the death of a Saudi male earlier this year. This is the third victim of the new coronavirus strain, all originating from the Arabian Peninsula. SARS first became known to the world in late 2002, originating in South China, but quickly spreading to other parts of Asia and North America, with an incidence count of over 8,000 people and morbidity of approximately 800.

Following the original SARS outbreak, are health authorities now better prepared to deal with the emergence and diagnosis of new infectious diseases? The answer is a cautious yes. Since 2003, the field of molecular diagnostics has grown to encompass new technological developments. However, while the laboratory diagnostic capability has improved immeasurably, the diagnostic capabilities at the point-of-care, including those of first responders (such as the emergency services) has been more hit and miss, with only relatively modest gains. The ability to correctly diagnose a disease early on (when a patient first presents themselves to their family doctor or in the emergency room) is critical in managing the spread of a disease.

Within a matter of days of the patient being admitted to hospital in London, the Health protection Agency (HPA) published a partial genomic sequence of this new variant of coronavirus, or ‘London1_novel_CoV_2012’, as it has been named. This revealed that the new virus is more closely related to a coronavirus associated with bats, unlike SARS, which is thought to originate in civet cats. At this moment, however, fears over a new major disease are being downplayed by the authorities due to the low incidence and transmission between humans.

The speed of this genomic sequencing work underlines both the improved technical capabilities of existing DNA sequencing instruments since 2003, and also the dramatic fall in the price of sequencing, even outstripping Moore’s law. According to research published by the National Human Genome Research Institute in 2011, the cost of sequencing one million base pairs has fallen from almost $10,000 in 2001, to around 10 cents in 2012. This rapid progress in being able to establish a clinical molecular test for the London coronavirus will greatly aid the future identification of affected individuals, and will go some way to helping develop more rapid point-of-care tests.

In the last 10 years, rapid advances have been made in genomic sequencing technology, which is the so-called gold standard of identifying emerging biological threats. For point-of-care or first responder testing, the progress is more mixed. While there have been advances in biosensing technologies, many of the existing fielded biological identification instruments are still based on technologies that would have been familiar 10 years ago, such as immunochemical techniques or the Polymerase Chain Reaction (PCR); although the techniques are much improved, they bring only modest improvements in performance or cost.

There is every prospect that the next major disease outbreak, or pandemic, will have its origins in a new and unknown disease. The nature of such a disease would be identified very quickly, thanks to the phenomenal step changes in nucleic acid sequencing technology – what is less certain is how healthcare systems will perform in the absence of targeted infectious disease screening tools suitable for use at the point-of-care or by the first responder. The Star Trek–style universal ‘Tricorder’ demanded by the first responder community is still some way from being a reality.

https://www.bionity.com/en/news/140048/analyst-insight-rapid-detection-of-pandemics-identifying-the-unknown.html