COVID 19 test, but there are tests and tests!
by Philip Ingram MBE
Some see a perceived lack of testing as the latest stick to beat the government up with the current COVID-19 crisis. The perception that is being left with the general public and with healthcare workers is that testing will provide some magic solution to the crisis. The reality is, being blunt, it won’t; being more accurate, each test has its strengths and weaknesses and no one test is the complete answer, they will only help our understanding of the spread of the infection and help keep us safer.
The current test, which is the one being scaled up, is an ‘antigen’ test. Antigens are molecules capable of stimulating an immune response in the body and that immune response is the start of the production of antibodies.
The antigen test requires a swab to be taken, usually from the back of the throat. That swab then needs to be sent to a laboratory where the antigen is scientifically amplified and compared with a reference to see if it is what they are looking for. This test, called the Polymerase Chain Reaction (PCR), often referred to as real-time PCR (rt-PCR), or the quantitative PCR (qPCR) test, requires trained laboratory technicians, specialist equipment and time for each test, as well as an administrative burden matching tests to results and informing individuals of results.
The current PCR test is an excellent technology but leaves a window as it misses some early cases, at times not detecting infection until a period post symptoms, even though the person can be highly infectious during that time. The test is also manpower and equipment limited, needing people to take samples, technicians and scientists to process and interpret the tests and staff to deliver the results.
Of course, a negative test one day does not mean the individual could not become infected the next day, and this is why it is essential the complimentary Antibody test is further developed and rolled out to identify who has had the infection.
This is a much simpler test using a sample of blood taken from a finger pin prick and it is then put into a device like a pregnancy test kit, but the chemistry on the test stick is designed to look for antibody. Antibodies (sometimes called immunoglobins (IgM and IgG)) are proteins produced by the body over the course of a week or two in response to an infection and are there to fight the infection. Each antibody is designed to recognise a specific part of the cause of the infection (the antigen), lock onto it and stop it replicating thereby fighting the infection.
With the antibody test, a solution is added, and the blood sample moves up the test paper stick, interacting with the chemistry on the stick and giving an indicator that the antibody is present. This will tell someone that they have had the COVID-19 disease in some form and only takes a few minutes to carry out. It does not indicate early infection or necessarily that an individual currently has the infection.
There are other tests currently being offered to the fight against COVID-19 that will complement the PCR antigen and the antibody test. This test is similar in its physical form to the antibody test, but the chemistry is very different. It detects a key very early marker of the activation of the immune system in the body produced from the very early stages of the infection. This happens as the infection enters the body and is active as the body produces certain ‘help’ molecules. A marker that has been identified, following a great deal of research activity into HIV and earlier SARS infections is called neopterin.
The neopterin test does not specifically identify that an infection is COVID-19, but it does detect that someone is suffering from an activation of their immune system and, as such can detect infection at a much earlier stage in the disease than any of the other tests. It is a very simple to use and understand lateral flow test (as a pregnancy test) and can be used and interpreted by health workers and the general public, requiring no specialist support. It is projected to be non-invasive by using only a small sample of saliva, with the test results showing a positive result with a red line in a few minutes only if the individual is suffering a current viral infection.
This new test is not yet part of the governments offering but would complement the other two allowing the resource and time-consuming PCR test to be used only on those who have a positive indication of a viral infection and, critically, detecting those that are too early in the course of infection to be detected by the PCR or antibody test. It could also be used much more frequently as part of a wider screening programme as it can be self-administered, self-interpreted and produces rapid results and allow more informed self isolation, thereby reducing cross infection, potentially dramatically.
What is important is that the strengths and limitations of each type of test are known and understood and that a range of complimentary tests are available to maximise the collection of results that will rapidly let the health system and public understand the risks.
This article was written by Philip Ingram MBE with the some help from Professor Colin Self BSc, MB, BChir, PhD, DSc, FRSC, FRCPath who has developed the Neopterin test. Please use the contact us page if you want further details.
Related Article: https://www.providertech.com/covid-19-test-results-how-texting-makes-it-easy-for-patients-to-access-lab-results-from-epic/
Maintaining business proactivity
By Philip Ingram MBE
Travel is being restricted, people are being told to work from home, meeting cancelled, companies are desperately trying to take business online and remote, events are cancelled or postponed. The great British wartime spirit is being displayed by most as the few riot over toilet rolls, panic buy on a first come first served basis, forget our elderly, our sick, it’s me first; but one thing will be at the back of everyone’s mind; “what next?” This brings out the best in many if not most and the worst in some; a sad reflection on elements of our community. Businesses must be asking “how do I maintain my business proactivity?”
For businesses, many that can afford to are looking for ways to provide support to front line services. Only yesterday I was contacted by the investigation’s software company Altia-ABM asking for introductions to front line services who may benefit from their capabilities for free. We are seeing reports of major manufacturers like JCB and Dyson changing their production lines to make medical ventilators, we are hearing of distilleries switching to the production of alcohol-based hand gel (and not for internal use).
One thing is clear, the current COVID-19 pandemic is changing and will change the business landscape for some time to come if not make a permanent change. However, the first thing to recognise is that capabilities will still be needed, help provided, services delivered. The world is not stopping completely, so businesses that take a proactive approach are more likely to come out the other side of this crisis better than those that don’t. That is just simple logic.
So, what do I mean by a proactive approach in an environment with no meetings, increasingly restricted travel and no events? It is all about communicating, about informing, about contributing. It’s all about keeping a sense of perspective and as much of a sense of normality as possible. The crisis will pass, and a newer version of ‘normality’ will return so it is important that businesses don’t just disengage completely.
So how do you engage, what should you be doing?
First and foremost, inform, inform, inform. Keep your staff and customers up to date with what is happening. Ensure you have clear statements and contact details on the front of your websites if appropriate and in your telephone answering system. You know who your main customers are, make sure you or your team are talking to them throughout this crisis.
Secondly, secure, secure, secure. Threats to your data, your IP are not going to go away and will likely increase over the crisis period. GDPR fines will not be waived for careless data breaches so ensure your working practices for remote working are as secure as your practices in the office. Those that were a threat before COVID-19 hit are still a threat and will see this as an opportunity. Be on the lookout for phishing, malware, ransomware and people exploiting online social engineering opportunities.
Thirdly, engage, engage, engage. Don’t fall into the trap of isolating yourself, your business, your services. There are lots of ways to remain engaged. Talk to your suppliers and customers, keep them reassured. Publish articles, blogs, thought pieces, updates on your website and use email and social media to distribute them widely. Engage on social media, a perfect way to keep your followers confident that all is as normal as it can be. Finally look for different opportunities to communicate. I am doing PODCASTS and will likely start restart VLOGS as well. Webinars have long been an excellent way of delivering informed content and good debate. The key to getting and maintaining your audience is to provide good informative content.
With all of the social media enabled communications means almost enabling the building of a virtual world, this is a perfect opportunity to stand out from the rest and show how progressive you can be making the transition back to proper normality that much easier. So, don’t sit and wat for something to happen, take the initiative and be proactive that is the key to standing out in this crisis.
Note:: Grey Hare Media provides focused content – drop us a line or gave a call for a chat to see if we can help. It costs nothing to chat and could save or better your market position.
COVID and the criticality of informed trusted communication.
by Philip Ingram MBE
One thing is becoming apparent, the last true global crisis on the scale of the developing COVID-19 pandemic, was the Second World War. In any crisis it is only natural that people hunt for as much information as they can get to try and get a sense of security for themselves, their loved ones and if appropriate their businesses.
Information itself is of little help unless it can be used to accurately ‘paint’ a realistic picture of what is going on and the implications of various decisions. During the Second World War people got their information from 4 sources, the newspapers, the radio, newsreels in the cinemas and local gossip. For three of those sources the accuracy of the information could be at the very least influenced by the government for the common good.
The local gossip networks were also influenced heavily through campaigns around careless talk with posters like “Are you a Megaphone Mouth? Don’t Spread Rumours,” making talking out of turn socially unacceptable, as this was also linked to wider consequences for security with posters such as “Lose lips sink ships.”
Those providing the news, whether journalist for print or, as there was only one source of Radio, the BBC, and news reels from Pathé News, trusted commentators were recognised, and this brought with it a degree of confidence for those who consumed the information. The potential for misinformation or disinformation that was not formally planned, was low. The limited information was pushed to the population, was easy to absorb and on the whole accepted by the general public.
However, today this type of control and social conditioning is impossible outside dictatorial regimes. With social media enabling anyone to publish an opinion or comment about anything and possibly reach a huge audience for very little effort, the potential for misinformation and disinformation is extremely high. The volume of information that exists means individuals need to pull what they believe is relevant form a variety of sources.
That wouldn’t be an issue if there remained trusted sources of information that operated outwit the sensationalist click bait approaches shown not only by some celebrities, but also by politicians who seek opportunities for political point scoring on every issue. For example, Piers Morgan at the weekend said, “The government seems to be avoiding draconian ‘shutdown’ action now because we will all get too bored with it,” accurate? Helpful? Or flippant clickbait?
Individuals tend to pull information from sources they like and too often it is from known celebrities or from politicians of their own political persuasion. The number of sources ‘trusted’ by individuals is massive, that doesn’t mean that their information should be ‘trusted.’ That trust is not necessarily based on the accuracy of the information, it is too often based on the popularity or agenda of the individual.
The ability of those individuals to unduly influence rather than inform needs to be recognised by those who listen to them and the motivation behind what is being said must be questioned alongside the accuracy of what they are saying. The point is rapidly approaching if it hasn’t been reached already, where unreliable sources of information or individuals who are sensationalising for their own position, must be called out.
We are facing a threat at the level that is almost stimulating the need for a total war footing, we are seeing industry being asked to switch manufacturing from their normal goods to essential medical products and capabilities. We are seeing government initiating daily ministerial and expert briefings, we are seeing controls being imposed across the globe that six months ago would have been described as impossible. We need common sense to start to prevail in the information and communication sphere.
For those who fall into the category where they could say, “Could be. I’m a pretty dangerous dude when I’m cornered.” (Not a Nigel Farage quote)
Remember the next line was,
“Yeah,” said the voice from under the table, “you go to pieces so fast people get hit by the shrapnel.” ― Douglas Adams, The Restaurant at the End of the Universe
Don’t let the Nigel Farage’s, or Piers Morgan’s who stir up clickbait type comments kill you with their shrapnel as their opinions go to pieces. For once, it is probably time to trust government sources once again. To trust press outlets like the BBC or Sky or ITN and remember in ratio terms 2 ears and one mouth means that listening should be done more than speaking. By all means question what is being said but learn to accept informed assessment from proper sources you can trust.
COVID-19 an Intelligence assessment
by Philip Ingram MBE
One of the worst things a Prime Minister has to admit to his country is that, “many more families are going to lose loved ones before their time,” as Boris Johnson was forced to say in his press conference about what the UK was going to do about the COVID-19 pandemic. He, with the country’s chief scientist and the Chief Medical Officer for England and Wales, who had consulted got agreement with the Chief Medical Officers of Scotland and Northern Ireland, explained the current position with the COVID-19 pandemic and what the government’s response would be.
The general feeling after the briefing was it was considered, informative, measured and frightening all at the same time. However, this hasn’t stopped the armchair scientific and medical experts such as Nigel Farage and Piers Morgan from berating the response because it doesn’t match or go further than the responses of some other countries. Comments from influencers like Morgan, such as “The government seems to be avoiding draconian ‘shutdown’ action now because we will all get too bored with it,” display a shocking naivety that, from a journalist, is at the least unhelpful and is certainly unprofessional. Maybe now is the time to do a proper intelligence assessment of what we know.
The thing to realise about intelligence assessments, as intelligence is very often blamed after the fact for not seeing things that were not there at the time of writing. It is an assessment at a snapshot of time and as the situation develops and more information, or ‘unknowns’ be come known, then it is likely to change. No enemy on the battlefield follows your plan because it is in your intelligence assessment, no terrorist gets caught because you have assessed how small the threat is, no virus will do exactly what you predict.
What is a virus?
The microbiological society describes a virus as the smallest of all microbes. With some, they are so small that 500 million could fit on to the head of a pin. They are unique because they are only alive and able to multiply inside the cells of other living things. The cell they multiply in is called the host cell.
A virus is made up of a core of genetic material, either DNA or RNA, surrounded by a protective coat called a capsid which is made up of protein. Sometimes the capsid is surrounded by an additional spikey coat called the envelope.
Under a process called Lysis, virus particles burst out of the host cell into the extracellular space resulting in the death of the host cell. It is this that causes the damage to the host organism, and the symptoms experienced, when many cells are killed. Once the virus has escaped from the host cell it is ready to enter a new cell and multiply.
An organism, if exposed to the virus or a similar version may have a degree of immunity as it has the genetic pattern to develop antibodies to fight the viruses and restrict their spread. The danger is when a novel virus is discovered, as organisms will have no pre prepared defences to these.
The next question has to be, what is CoronaVirus and what is COVID-19?
According to the Centre for Disease Control and Prevention in the US (CDC), coronavirus is the name for a family of viruses that were first identified in the 1960’s. They are named for the crown-like spikes on their surface (envelope) and there are four main sub-groupings known as alpha, beta, gamma, and delta.
People around the world commonly get infected with some human coronaviruses and in recent years it has been identified that coronaviruses that infect animals can evolve and jump the species gap to humans. Three recent examples of this are; severe acute respiratory syndrome, or SARS (SARS-CoV-1), Middle East Respiratory Syndrome, or MERS which were both identified as beta viruses and now we have coronavirus disease 19 or COVID-19 which has been designated as a novel corona virus, i.e. it doesn’t fit into any already known category and therefore any immunity to other types of coronavirus that is present in a species can be bypassed by this strain. The name of the virus that causes COVID-19, the disease, is Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).
Comment: Much is already known about coronaviruses, about their protein makeup, their genetic coding, their transmission, their strengths and their weaknesses, there has been over 50 years research into them already and SARS and MERS have given recent impetus to the scientific community. SARS-COV-2 is closely related to SARS-COV-1 which emerged in 2002. Therefore, the scientific fight against COVID-19 disease is not from a standing start, it is from a position of many years research. Comment Ends.
Where did COVID-19 come from?
Here conspiracy theories abound, as the reality is the origin of SARS-CoV-2 is only a scientific assessment. However, based on over 50 years research into coronaviruses and that the international scientific community is quick at checking and commenting on all of the relevant works and studies in the scientific community, their current assessment is probably accurate; it is certainly extensively peer reviewed.
The World Health Organisation (WHO) situation report of 21st January 2020 said that on 31st December 2019, the World Health Organisation’s (WHO) China office heard the first reports of a previously unknown virus behind a number of pneumonia cases in Wuhan, a city in Eastern China.
On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.
In February nature magazine reported that, “Chinese scientists suggested, on the basis of genetic analyses the prime suspect was the scaly ant eating pangolin. However, it then went on to say that scientists have now examined that data and say that although the animal is still a contender, the mystery is far from solved.
Other animals that are known as host of various coronavirus strains are Bats and they, like the Pangolin, were sold live in the Wuhan market. MERS and SARS were originally corona viruses hosted on bats, so it is now thought that they are the most likely contender.
Apportionment of its source is made slightly more conspiratorial by the fact that Wuhan is the site of China’s only facility designated at Biosafety Level 4 (BSL-4) and is known as the Wuhan Centre for Disease Control (WHCDC). It was constructed in 2004 following the SARS emergency to conduct research into countering such viruses. Level 4 facilities are designed to stop the escape of even the smallest particles, so accidental escape is highly unlikely. Despite sensational speculation in some press circles, there is no evidence in the scientific community that the COVID-19 disease is a result of WHCDC activity.
Comment: Coronavirus species jumps have been identified in the past, bats were identified as the source of the SARS corona virus and given the initial reporting in the city of Wuhan, the focus around the seafood market, it is highly likely that the ground zero for the COVID-19 disease is Wuhan and the seafood market. However, it is possible that the exact source will never be identified and therefore likely that sensationalised speculation will continue. Comment Ends.
How dangerous is COVID-19?
COVID-19 is a new illness and as such no one will have any inherent immunity to the virus that causes it and an understanding of how the disease develops in humans is just being observed. This lack of inherent immunity means that the herd immunity principals that restrict the spread of known viruses and the peak of their impact in numbers, does not exist.
The main symptoms of COVID-19 are a cough, a high temperature and, in severe cases, shortness of breath.
According to NHS England, because COVID-19 is a new illness, exactly how it is spread from person to person is not fully understood. However, the WHO says, “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.”
It goes on to say, “Illness due to COVID-19 infection is generally mild, especially for children and young adults. However, it can cause serious illness: about 1 in every 5 people who catch it need hospital care. While we are still learning about how COVID-19 affects people, older persons and persons with pre-existing medical conditions (such as high blood pressure, heart disease, lung disease, cancer or diabetes) appear to develop serious illness more often than others.”
The UK Government says, “a minority of people who get COVID-19 will develop complications severe enough to require hospital care, most often pneumonia. In a small proportion of these, the illness may be severe enough to lead to death. The Prime Minister, Boris Johnson, confirmed this in his statement of 12th March 2020.
On 30 January 2020, the WHO declared the outbreak of COVID-19 a “Public Health Emergency of International Concern” (PHEIC). On 11 March 2020 the WHO formally declared COVID-19 as a pandemic and a pandemic is simply a new disease for which people do not have immunity that spreads around the world beyond expectations.
Exact death rates expressed as a percentage of infections is impossible to accurately state at this time as many who contract the disease will have very mild symptoms, are unlikely to be tested so formally diagnosed and recorded as having it but could still transmit it to others.
Comment: COVID-19 is extremely dangerous to certain parts of the community but will have little impact on most sufferers. However, as there is no herd immunity there is very real potential for the most vulnerable to require hospitalisation all at the same time, overwhelming medical facilities. Anyone with the disease, even with very mild symptoms, can transmit it.
Much has yet to be learned about this disease and its impact but the “So What?” is that it is critical that measures to reduce the number of severe cases and spread them over as long a time period as possible, to ensure medical facilities and staff are not overwhelmed, are taken. Those measure must be taken by all potential sufferers to have the best outcome.
People should take statistics in the press with an understanding of the reality that they are likely wrong and an over exaggeration of the risk if taken in isolation. Comment Ends.
What can and is being done about it?
Every county seems to be taking a slightly different approach to dealing with the COVID-19 pandemic, which is fuelling political opportunism, sensational headlines playing on the very real fears of the population, and in turn causing anxiety in the financial markets wiping billions of their value. One thing is clear, it will pass.
The UK has very robust, tried and tested processes and procedures for dealing with pandemics. This is nothing new and the WHO has been talking about the threat form a disease X scenario for some years. Understanding of the spread, measures to deal with it for theoretical diseases have been modelled and exercised frequently and the government has a series of plans to deal with these incidents ready to go.
On 03 March 2020 the Government published its Coronavirus (COVID-19) action plan based on its experience in dealing with other infectious diseases and its influenza pandemic preparedness work. The UK government and devolved administrations, including the health and social care system, have planned extensively over the years for an event like this. The UK is therefore well prepared to respond in a way that offers substantial protection to the public.
The plan confirms that, “The majority of people with COVID-19 have recovered without the need for any specific treatment, and it is expected that the vast majority of cases will best be managed at home.
The planning principles for the UK and Devolved administrations used are:
- Undertake dynamic risk assessments of potential health and other impacts, using the best available scientific advice and evidence to inform decision making.
- Minimise the potential health impact by slowing spread in the UK and overseas, and reducing infection, illness and death.
- Minimise the potential impact on society and the UK and global economy, including key public services.
- Maintain trust and confidence amongst the organisations and people who provide key public services, and those who use them.
- Ensure dignified treatment of all affected, including those who die.
- Be active global players – working with the World Health Organization (WHO), the Global Health Security Initiative (GHSI), the European Centre for Disease Prevention and Control (ECDC), and neighbouring countries, in supporting international efforts to detect the emergence of a pandemic and early assessment of the virus by sharing scientific information.
- Ensure that the agencies responsible for tackling the outbreak are properly resourced to do so, that they have the people, equipment and medicines they need, and that any necessary changes to legislation are taken forward as quickly as possible.
- Be guided by the evidence, and regularly review research and development needs, in collaboration with research partners, to enhance our pandemic preparedness and response.
The key is that they are evidence based, balanced, well planned and frequently modelled and lead to four phases:
- Contain: detect early cases, follow up close contacts, and prevent the disease taking hold in this country for as long as is reasonably possible
- Delay: slow the spread in this country, if it does take hold, lowering the peak impact and pushing it away from the winter season
- Research: better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care
- Mitigate: provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy.
The aim across the board is to delay the onset of rapid cross infection throughout the population and spread the peak and most severe cases out over a longer time period enabling current and surge medical capabilities to deal with the effects of the COVID-19 disease on those most affected.
However, a plan is only as good as those who adhere to it and the government advice to the general public needs the general public to follow that advice if there is a hope of the plan succeeding. Social distancing, seeking advice from the 111 website, handwashing are all examples of what the general public need to do to keep the government plan on track and to save as many of the most vulnerable and severe cases as possible.
Comment: The measures being outlined to deal with the COVID-19 epidemic are considered, modelled, progressive, well planned and thought through by every expert in the field. They are not made up ‘on the hoof’ and are designed to minimise the impact on sufferers, society, business and life in general. The measures do require a greater public understanding and cooperation, and this is one time when sensationalism and speculation is unhelpful at best, but more likely deadly. Comment Ends.
Why are other governments taking different actions?
Other governments may take different actions as they have different cultural norms, different scientists with differing opinions, they are likely to be at a different stage of the pandemic and all healthcare systems and social care system likely differ so strain and breaking points won’t be the same between countries. A final consideration is there is a possibility of different political considerations in decision making for example, France’s closing of schools and universities puts additional strain on adults, some of whom are key to the yellow vest processes, the banning of groups of 100 or more again could (and I emphasise could as I don’t believe this question has been asked), make it easier for President Macron to control anti Government sentiment such as the yellow vest protests which with greater pandemic spread could flare up more. In Ireland, the pressure from the closure will force the political parties to agree a new government more quickly. Unfortunately in this world one has to consider political actions as part of disaster consequence management.
The key is when you make drastic decisions such as closing schools, as you want to leave them as late as possible to reduce the social impact but take them as early as possible to reduce the spread – the Government is doing that and the scientists are watching for that point on a daily basis. Thank goodness it is an evidence based decision and not a politically expedient one or and emotionally based one. Things could be very different if we had a minority government in power and politics, not evidence based science, drove decision making.
Assessment: The current COVID-19 pandemic is a serious situation that will likely result in a number of deaths, that number will be a very small percentage of those who catch the disease as most people will recover, many without ever being formally diagnosed.
Critical to keeping the death toll to the lowest numbers possible is flattening out the peak number of severe cases at any one time in order to reduce the burden on medical facilities and personnel.
Current understanding of how pandemics spread is good, current planning for dealing with pandemics has been scrutinised by some of the best brains in the country and are generally well thought through. They rely on evidence-based assessments and have been modelled extensively.
COVID-19 will disrupt normal activities for a period of time and then society will recover. However, as ever, the success of any plan requires the support and cooperation of all involved, and in a pandemic scenario that means the general population. Recovery time for society will depend on cooperation and sticking to a well tested plan.
MERS, SARS, COVID-19 are just the latest in a series of viral infections, there will likely be more in the future and many will have a smaller impact but the potential remains for some with an even greater impact on society. Assessment Ends.
The best advice remains that on the front cover of Douglas Adam famous book, “The Hitch Hikers Guide to the Galaxy,” it says: “Don’t Panic.” The current continuously updated statistics for the pandemic can be followed here: https://www.worldometers.info/coronavirus/
This blog was written by Philip Ingram MBE a former senior Military Intelligence officer and specialist in CBRNE. He grew up in a family immersed in disease identification and control as his late father, Brian, ran a laboratory at the local hospital and his biomedical science journals were Philip’s youthful reading. He is always available for comment through the contact us page. You can always listen to this blog through our PODCAST site by clicking here: