Caixin
Feb 26, 2020 08:04 PM
SOCIETY & CULTURE

Q&A: Renowned U.S. Epidemiologist Is Making a Better Test for Coronavirus

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A renowned epidemiologist said new testing kits that his team are developing could make testing for Covid-19 cases faster and more accurate.

In an interview Monday with Yang Lan, a special correspondent for Caixin, American epidemiologist Walter Ian Lipkin said his team is trying to transfer sequencing capture technology to make the tests cheaper, faster and more sensitive. Lipkin is the director of the Center for Infection and Immunity at Columbia University.

Lipkin said the new test will soon be sent to China.

That might be a good news for China’s battle against the novel coronavirus, as frontline doctors have been worried that laboratory tests sometimes fail to diagnose patients correctly by producing negative results in people who are later found to be infected. Under current criteria, the diagnosis of Covid-19, the disease caused by the new coronavirus, needs to be confirmed by lab tests, specifically nucleic acid tests conducted by swabbing a patient’s respiratory tract or blood.

Lipkin said the new testing kits would allow lab staff to find other infectious agents that might be present even if they don’t find the coronavirus. That would allow for diagnoses of other diseases, such as the flu, when someone displayed symptoms that could also be Covid-19, he added.

“If you don’t have some sort of backup diagnosis, you may be looking at a false negative. But if you don’t find this and you find influenza, you’re much more confident that (the) individual has influenza instead of the new coronavirus,” he said.

 Read more 
Caixin’s coverage of the new coronavirus

Nonetheless, Lipkin refused to predict exactly how accurate the new tests will be. He said he wouldn’t know the accuracy until the tests are used on patients. The state-owned China News Service reported (link in Chinese) at least 200 testing kits that Lipkin developed will be sent to China this week. “I have cautious optimism, otherwise I wouldn’t be doing this,” he told Caixin.

Addressing the epidemic itself, Lipkin said the coronavirus is likely to live with humans, reoccurring on a yearly basis, just like flu, unless there is a vaccine. As the temperature goes up, the virus could gradually become less active and less deadly, but it could come back next winter. “Only the next few years will tell us how this plays out,” he said.

He strongly suggested authorities invest in vaccine development. He believes that Covid-19 would not be a difficult virus to create a vaccine for because it is more stable than some viruses, like the ones that cause AIDS and influenza.

Medical experts now hold different views on how the outbreak will develop as it is now spreading rapidly beyond China’s borders. Some reckon that the virus could be around for a long time, like the flu. But Zhong Nanshan, a respected Chinese epidemiologist, said in an interview (link in Chinese) with state broadcaster CCTV that the likelihood the virus will live on in the human community is low.

The following are some of the highlights of Caixin’s interview with Lipkin. It has been edited for length and clarity.

Yang Lan: We were taken by such surprise this time with the speed and the scale of this outbreak. Why so? What are some of the epidemiological and clinical features of this novel coronavirus that we didn’t know?

Lipkin: This seems to be much more infectious, certainly than MERS. This is really an unprecedented challenge for mankind, and it won’t be the last. As we’ve been talking about over the past few days, starting with HIV, we have SARS and … MERS and this new coronavirus and Dengue and Zika. All these emerging infectious diseases essentially come from wildlife and then move into people and adapt to people, and then become capable of either direct or indirect human to human transmission.

So these are the things that we need to address going forward. One of the problems with epidemics like this one is that when it’s over, everybody relaxes and goes back to business as usual. And then five years later, you have something else that comes up, which is another public health threat. So one of the things that I’m trying to do this time is to emphasize what can we do to prevent this from ever recurring. So I heard today from somebody (who has) been writing me, she’s a famous judge in China.

And she asked me what you could do. And I said, close the wild animal market. She says, that’s not my business, but I will talk to people. And then I heard today that there was a decision made to close the wildlife markets.

It’s going through the legislation.

I think it’s terrific. This is something that is urgently needed. It’s something that we talked about in 2003. It’s not unique to China and their wildlife markets, but to many parts of the world including Africa, South America, as well as Asia.

The other thing we need to do is we need data sharing. There is no such thing as the New York City virus or the Wuhan virus. We need to approach them as a global community.

How important is this diagnostic test kit? Because we know that many people have been quarantined or there are many cases of false negative?

I think false negative is the right (way) to put it. So the question is, can you come up with a test that can be more accurate, more sensitive, more specific? The first test (that) comes out in an outbreak is rarely the final test. Sometimes it is, but not most of the time. There are modifications that you can make based upon the way you see it perform in the situation where you need to use it.

So I don't view it as critical of some other tests or anything else. It's just a continuous evolution of technology. So that was one thing that we were asked to do. The other thing is we're trying to come up — we're trying to transfer this sequencing capture technology. The advantage to this is that it's more sensitive, it’s cheaper, (and) requires less time to process. So we're going to move that forward. And then the last thing was an antibody test, because we don't really know everyone who's been infected.

We have some false negatives. Sometimes people don't come to medical attention. So how do you see whether or not somebody's been infected, but never had symptoms? So the antibody tests will give you that information. I predict that when we have that information, we’re going to find that many more people are infected than we know about.

How many more? What's your estimation?

At least tenfold more than we know about. But there's a way of looking at that as a good insight.

So if the majority of people infected with this virus don't develop disease, which means the mortality rate is lower than people think it is. So now, for predicting a mortality rate of 2%, we find out that many more people are infected. But the idea is to get as much (information) as we can into how to diagnose people early. Where are they got infected? For how long have they been infected? Are there are things in the environment that are infectious, because you can use all of those for risk reduction.

When we go back a little bit to the diagnostic tests, we learned that according to the initial nucleic acid test, the accuracy rate was around 30% of 50% or could be less. So how would you rate the accuracy of this new test that you are developing?

I hope it's going to be better. I think it's going to be better.

How much better? 100%?

I don't know until we start testing it on patients. But the way we will test this is that we will work in Guangzhou and in Beijing. And perhaps other provinces or in other cities. And the idea is that we will test people with the existing acid or the new acid and compare the two unbiased. The data will tell us what is true and what is not. And then we follow those people.

And if these people ultimately become infected and they are tested positive with this test, but not that test. Then we know that this test is more sensitive. So that's why I prefer not to speculate, but rather to see what comes out.

But rather to see what the eye can see. You have a confidence of increased accuracy.

I have cautious optimism, otherwise I wouldn't be doing this.

But that caused people other concerns. For example, with those tens of thousands people who have been released from hospital thinking they have been cured. So we don't quite know how infectious they still are or how safe the community is with these people coming back to our life?

Yes, I appreciate that concern. My feeling is that once somebody is infected and they get admitted to a hospital or a clinic, and then their symptoms recede. (Then) if they've been tested at that end, after they've recovered and tested no virus, that's probably good. The issue primarily is what happens at the front end?

The most frightening thing for me is to take somebody who's well and to put them into isolation next to people who are sick. And then somebody was initially well then becomes sick.

That is a tragedy, right? So we hope to be able to prevent those kinds of consequences.

How sure are you that the virus was from wildlife and not from human manipulations, because as you have known, there is speculation that it could be a result of genetic editing or manipulation by some bio-lab. Do you think that’s a possibility?

It was clear that if you look at the sequence of the virus, that there are some changes here that suggested it was not deliberately man-made.

Why do we say this? People have been studying this since 2003, trying to understand how they can become infectious for humans. There are some well-established frameworks which would allow you to take this and put it into that, just like putting in a record or a cassette or a tape. And they didn’t use those convenient sort of tools.

What my colleagues and I think happened was that this virus was existing in a bat, probably came into contact with an animal, perhaps in a wild animal market, perhaps an infected human.

We don’t think there’s any evidence that this virus was created in the Wuhan Institute of Virology or released accidentally. We think it emerged in nature. It’s a natural problem. And we need to address it as a naturally occurring virus.

We have also heard the director general of the WHO saying that the window for tackling this global crisis is actually closing. And we have people like Bill Gates saying that in the future, epidemics are a bigger threat than even nuclear weapons. So what are we facing as human society nowadays with this battle against this invisible enemy?

I agree. Actually the first person I heard saying that the virus is the last sort of enemy on the planet, was the late Noble laureate Joshua Lederberg, who used that specific phrase we said about viruses, the biggest risk to humans on the planet.

So many people feel that way. The other thing that we need to be certain is that as we conquer this one particular problem, we bear in mind that there is a continued threat, and there will be more of these epidemics. We need to do a better job of identifying them early and responding to them in appropriate ways. We need to find faster ways to build and test and validate vaccines and drugs to treat these infectious agents. And we need to move together in a global partnership to promote the containment of these infections.

You know the xenophobia is a side effect of an epidemic such as this novel coronavirus outbreak. When people are afraid, fear may provoke irrational and even hurtful behaviors such as stigmatizing people from a certain region or certain country. What are your comments on that? Because that’s also a part of the threat that we have to deal with as a globe community.

This is accurate; this is nothing new.

Whether they are a professor at Columbia University, like me, or a Chinese son who’s returning to school, it’s the same, and it has nothing to do with whether you’re white or Chinese, or Asian or black. It’s a virus, and it infects all of us equally. And the xenophobia is inappropriate because what it does is it put barriers in front of finding real solutions to real problems. 

This story has been updated with additional information.

Contact reporter Guo Yingzhe (yingzheguo@caixin.com) and editor Michael Bellart (michaelbellart@caixin.com)

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