Cambridge hospital becomes first to use rapid new coronavirus tests
NHS hospital in Cambridge becomes first in the UK to use rapid new viral coronavirus tests which take just 90 minutes to produce a result
- Portable devices, called Samba Two, used at Addenbrooke’s Hospital this week
- Machines give result in 90 minutes, compared to PCR tests which take days
- Samba’s creators say the tests have been validated by Public Health England
- Other NHS trusts expected to purchase the machines in the coming weeks
An NHS hospital in Cambridge has become the first in the UK to use coronavirus testing machines that give results in an hour-and-a-half.
Ten portable devices, called Samba Two, were this week deployed at the 1,000-bed Addenbrooke’s Hospital to test staff and patients.
The machines have shown to be almost 99 per cent accurate at analysing swabs and give a result in just 90 minutes, compared to current PCR tests which take up to two days.
Once nasal and throat swabs have been collected from patients, the samples are loaded into the devices, which look for tiny traces of the virus in their DNA.
The machines are used at point-of-care, as opposed to current tests which need to be sent off for analysis at a lab.
The tests do not look for antigens – parts of a virus that trigger the immune system’s response to fight the infection. The tests also do not look for antibodies – proteins made by the immune system in response to an infection.
Samba’s creators say the tests have been validated by Public Health England and are expected to be launched in hospitals across the country.
Cambridge University Hospitals NHS Foundation Trust was the first to get 10 of the gadgets, but other NHS trusts are expected to follow suit.
An NHS hospital in Cambridge has become the first in the UK to use rapid new PCR coronavirus testing machines for its staff and patients
Ten portable devices, called Samba Two, were deployed at the 1,000-bed Addenbrooke’s Hospital this week
Once nasal and throat swabs have been collected from patients, the samples are loaded into the devices, which look for tiny traces of the virus in their DNA
Samba Two was adapted from an HIV testing kit by the technology firm Diagnostics for the Real World, owned by the University of Cambridge.
Tests in 102 patient samples were shown the machines can spot the disease 98.7 per cent of the time.
Patients or staff provide a nasal and throat swab, which are then loaded into the Samba machine. The rest of the process is fully automated.
The device scours the sample for tiny genetic material of the virus and amplifies this billions of times to tell if someone is infected.
It is known as a PCR (polymerase chain reaction) test, which aims to pick up on viruses active in the bloodstream.
WHAT IS THE DIFFERENCE BETWEEN A PCR, ANTIBODY AND ANTIGEN TEST?
An antibody test is one which tests whether someone’s immune system is equipped to fight a specific disease or infection.
When someone gets infected with a virus their immune system must work out how to fight it off and produce substances called antibodies.
These are extremely specific and are usually only able to tackle one strain of one virus. They are produced in a way which makes them able to latch onto that specific virus and destroy it.
For example, if someone catches COVID-19, they will develop COVID-19 antibodies for their body to use to fight it off.
The body then stores versions of these antibodies in the immune system so that if it comes into contact with that same virus again it will be able to fight it off straight away and probably avoid someone feeling any symptoms at all.
To test for these antibodies, medics or scientists can take a fluid sample from someone – usually blood – and mix it with part of the virus to see if there is a reaction between the two.
If there is a reaction, it means someone has the antibodies and their body knows how to fight off the infection – they are immune. If there is no reaction it means they have not had it yet.
Antibody tests differ to a swab test, known as a PCR (polymerase chain reaction) test, which aims to pick up on active viruses currently in the bloodstream.
A PCR test works by a sample of someone’s genetic material – their RNA – being taken to lab and worked up in a full map of their DNA at the time of the test.
This DNA can then be scanned to find evidence of the virus’s DNA, which will be embroiled with the patient’s own if they are infected at the time.
The PCR test is more reliable but takes longer, while the antibody test is faster but more likely to produce an inaccurate result. It does not look for evidence of past infection.
Antigens are parts of a virus that trigger the immune system’s response to fight the infection, and can show up in blood before antibodies are made.
The key advantage of antigen tests is that it can take several days for the immune system to develop enough antibodies to be picked up by a test, whereas antigens can be seen almost immediately after infection.
Antigen tests are used to diagnose patients with flu, as well as malaria, strep A and HIV. They can also be done using swabs.
It works by a sample of someone’s genetic material – their RNA – which is worked into a full map of their DNA at the time of the test.
This DNA can then be scanned to find evidence of the virus’s DNA, which will be embroiled with the patient’s own if they are infected at the time.
At the moment, PCR tests are sent for analysis in centralised laboratories and this, compounded by the sheer number of samples that are having to be analysed, means that diagnosis can take around two days.
Samba Two is able to deliver results while the patient waits in less than an hour-and-a-half.
Professor Ravi Guptay, from the Cambridge Institute for Therapeutic Immunology and Infectious Disease, said: ‘Testing healthcare workers could help reduce the risk of infection in healthcare facilities themselves, which might in turn assist national control efforts.
‘It will also reduce the number of staff self-isolating for symptoms as we could use the test to determine who is actually infected. At present the lack of testing is resulting in severe staff shortages nationally.’
Billionaire philanthropist Sir Chris Hohn has donated £2.3million to buy 100 Samba Two machines for hospitals across the UK.
He said: ‘We urgently need rapid diagnostic tests to help the NHS and Public Health England manage the coronavirus outbreak and identify those patients at risk to themselves and to others.
‘I’m delighted to have supported this important research and now help begin the rollout of this cutting-edge technology across the NHS. This is a game changer.’
The Samba Two cannot reveal whether someone previously has suffered from COVID-19 and recovered. Only an antibody test can do this.
The Government says it has purchased 17.5million of these tests, which scour the blood for antibodies, produced by the body when coronavirus infects them.
Officials have still yet to approve any type of coronavirus antibody test, despite promises the DIY kits would be ready for use by mid-April. Health Secretary Matt Hancock first said the UK had bought antibody tests last Tuesday.
Other manufacturers of similar DIY kits have warned it could take up to six weeks for them to start supplying Britain because of the hold-up.
Yesterday it emerged the UK had bought two million coronavirus antibody tests from a Chinese manufacturer.
Half of the rapid fingerprick kits are being made by Guangzhou-based firm Wondfo and will arrive in Britain by the end of the week, ITV reports.
The other million, which are reportedly being held-up, are being made by AllTest, a diagnostics firm based in Hangzhou.
There was little activity at the Chessington coronavirus testing site which was set up as a drive-thru for NHS workers who need to get tested
Workers were seen sitting, standing around and stretching at the testing centre in Chessington, south-west London yesterday as the Government was blasted for a lack of testing, especially for NHS staff
Pictured: Stewards organise traffic at a Covid-19 test centre for NHS workers which has opened at Ikea’s store in Wembley, north-west London
MINISTERS TOLD TO GET A GRIP OF MASS TESTING IN BRITAIN
Ministers have been told to get a grip of mass testing after Britain endured its darkest day so far in the coronavirus epidemic yesterday.
The Government is under pressure for failing to ramp up its testing quickly enough – only 8,240 patients were tested in the last 24 hours.
One British firm which claims it could be supplying more tests to the NHS is selling them to 80 countries abroad, including India and the Middle East.
Novacyt – which has a subsidiary firm based in Southampton – suggested the reason it was unable to supply more kits was a shortage of lab space.
Separately a former director of the World Health Organisation, Professor Anthony Costello, said the Government’s health protection agency had been ‘slow and controlled’ over testing, claiming that 44 labs in the UK were underused.
Meanwhile, Number 10 admitted that the Government target of carrying out 25,000 tests a day may not now be hit until the end of next month.
Ministers had previously implied they would have reached this rate already, while NHS officials said it would be achievable within the next three weeks.
Last night, Michael Gove blamed the fiasco on a ‘critical shortage’ of chemical reagents, crucial substances in test which enable them to detect the virus.
However former health secretary Jeremy Hunt expressed disquiet at the Government’s strategy and called for mass-testing, or so-called ‘community testing’, to help Britain through the outbreak.
Both of the tests – which the Government has spent millions of pounds on – are said to have EU approval and can be used in hospitals in the UK immediately.
Countries have already had to send back defective coronavirus medical kits bought from China during the pandemic.
Spain returned tens of thousands of testing kits, while the Netherlands recalled half a million ‘defective’ face masks it brought from Beijing.
All UK testing so far has involved centralised PCR tests, which involve transport to a lab, processing by staff and a wait of up to 48 hours for a result.
But the Prime Minister is facing mounting fury over the failure to get anywhere near the levels being carried out in countries like Germany.
For reference, Germany carries out more than 90,000 coronavirus tests every day – nine times more than the UK’s 10,000.
Germany has also announced it will give 100,000 people coronavirus antibody tests in the next few weeks to get a firmer grip on its outbreak.
Berlin has also announced it is planning to bring in ‘immunity certificates’ as part of preparations for the country to cease its lockdown.
British health chiefs have said they could give out coronavirus ‘immunity’ certificates like Germany to allow millions of Britons out of isolation.
Otherwise, there is no official way of keeping track of who has already battled the virus and has developed some form of immunity.
Several manufacturers of coronavirus antibody tests are in discussions with Number 10 about scaling up production, if their kits pass stringent checks.
Despite repeated requests from MailOnline, the Department of Health has refused to confirm which businesses are in the running.
One of these firms includes Derby-based SureScreen, which has shipped its tests to be used in Germany and Spain, among other nations.
The company has sent hundreds of the tests to a Public Health England laboratory in Oxfordshire earlier this week but has yet to hear back.
Another of the firms is known to be BioSure, an Essex-based manufacturer which has been asked to get ready to ramp up production.
The company’s chief executive revealed earlier this week that it had chosen to hold off on scaling up production in case its tests fail.
Brigette Bard warned the delay in approval could mean it won’t have any kits ready for Britons to use in the comfort of their own home until mid-May.
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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