By Diagnostics World Staff
May 8, 2020 | The diagnostics community continues to work hard to provide solutions and new data for diagnosing COVID-19 and SARS-CoV-2 infections. Accumen launches a COVID-19 test routing network, researchers in Spain launch a diagnostic network, University of Washington researchers find similarities between COVID-19 and high altitude pulmonary edema, and more. We round up the week’s research and industry news for COVID-19.
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In the Annals of the American Thoracic Society, clinicians from the University of Washington warn of the dangers of equating COVID-19 with high altitude pulmonary edema (HAPE). There are indeed similarities—in terms of very low oxygen levels in the blood, significant difficulty breathing, the degree to which there is stiffness in the lungs, and abnormal findings on chest CT scans. But there are also fundamental differences. HAPE develops when people ascend to high altitude and results in excessive vasoconstriction and far too great a rise in pulmonary artery pressure. This causes fluid to leak out of the blood vessels into the lung tissue, but this occurs with no inflammation. With COVID-19, the virus attacks the cells that make up the air sacs of the lungs and fluid leaks out of blood vessels even under much lower pressures, causing the alveoli to collapse and making the lungs stiffer and harder to expand than normal. Treatment with oxygen alone can resolve HAPE symptoms, but not the lung injury associated with COVID-19. Two medications used to treat altitude sickness (nifedpine and acetazolamide) can also have dangerous consequences in COVID-19 patients. DOI: 10.1513/AnnalsATS.202004-327FR
A study led by clinician scientists at RCSI University of Medicine and Health Sciences has found that Irish patients admitted to hospital with severe COVID-19 infection are experiencing abnormal blood clotting that causes micro-clots within the lungs, contributing to death in some patients. This scenario is not seen with other types of lung infection and explains why blood oxygen levels can fall dramatically in COVID-19 patients. An additional finding was that patients with higher levels of blood clotting activity had a significantly worse prognosis and were more likely to require ICU admission. How the micro-clots are being formed remains a mystery, and further studies will be required to investigate whether different blood thinning treatments may have a role in selected high-risk patients. Emerging evidence shows that the abnormal blood-clotting problem in COVID-19 results in a significantly increased risk of heart attacks and strokes. Results published in the British Journal of Haematology. DOI: 10.1111/bjh.16749
The American Gastroenterological Association (AGA) has published seven new evidence-based recommendations citing that GI symptoms are not as common in COVID-19 as previously estimated. The guidance was published in Gastroenterology. The AGS notes that the overall prevalence of GI symptoms is 7.7% for diarrhea, 7.8% for nausea/vomiting and 3.6% for abdominal pain; in outpatients, the pooled prevalence of diarrhea is even lower (4.0%). However, COVID-19 can present atypically with diarrhea as an initial symptom—sometimes before the development of upper respiratory infection symptoms—with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Recommendations include monitoring patients with new diarrhea, nausea or vomiting for other COVID-19 symptoms. Abnormalities in liver function tests should also prompt thorough evaluation, since they’ve been seen in approximately 15% of COVID-19 patients), although available data suggests these abnormalities are more commonly attributable to secondary effects from severe disease. DOI: 10.1053/j.gastro.2020.03.072
An international team of researchers has found a very high level of a protein known as suPAR in the blood of patients with COVID-19 may be a predictor of severe respiratory failure, making it a potential predictor for which patients will need to be put on a ventilator. Since suPAR (soluble urokinase plasminogen activator receptor) is a reactant of the innate immune system, it's an indicator of disease severity. The research, published in Critical Care Medicine, involved testing suPAR levels in 15 patients at Rush University Medical Center and another 57 at the University of Athens (Greece) when they were admitted or tested for COVID-19 and then following their time to intubation. Plasma suPAR levels provide a window into the course of the disease and if measured as part of diagnosing COVID-19 may indicate whom to watch more and whom to send home, researchers say. SuPAR has repeatedly been shown to harm the kidneys and an increasing number of patients with severe COVID-19 also develop kidney problems, suggesting a connection. DOI: 10.1186/s13054-020-02897-4
Avacta Group and Adeptrix are collaborating to develop a high throughput COVID-19 antigen test using Adeptrix’s proprietary bead-assisted mass spectrometry (BAMS) platform. Avacta and Adeptrix will collaborate to develop and manufacture an Affimer-based BAMS coronavirus antigen test that will provide clinicians with a significant expansion of the available testing capacity for COVID-19 infection in hospitals. Adeptrix’s novel BAMS platform combines enrichment of the sample to improve sensitivity with the power of mass-spectrometry to improve specificity. Hundreds of samples per day can be analyzed by a single technician using BAMS, exceeding the capacity of single PCR machine, making BAMS a very attractive high throughput technique for COVID-19 screening in the clinical setting. The diagnostic test will allow hospitals around the world to utilize their existing installed base of mass spectrometers that are not currently used for COVID-19 testing, thus contributing significantly to the increase in global testing capacity. Press release.
Halfpenny Technologies, a wholly owned subsidiary of Accumen, has launched the COVID-19 Test Capacity and Routing Network. The Network addresses three critical areas of need identified by hospitals and health systems throughout the current healthcare crisis: real-time availability of hospital and labs testing capacity, order entry and routing, and delivery of results to all appropriate parties. This level of connectivity in turn delivers faster turnaround times for these vitally important tests and results. Each regional Network hub receives COVID-19 test orders from EHR systems in local physician practices, hospitals, temporary hospitals and drive-thru testing facilities. Those orders are then routed to the closest regional lab with capacity. The orders are submitted in the required format, together with the necessary information to ensure proper laboratory billing, in advance of the specimens’ arrival. Press release.
Researchers at Cima Universidad de Navarra (Spain) have developed a large-scale, highly sensitive COVID-19 diagnostic platform more efficient than commercial PCR test kits currently available. It consists of an RNA extraction method that allows large quantities of samples to be processed in parallel, independent of extraction test kits, and offers more than 95% sensitivity to detect asymptomatic cases. RNA extraction is done on 96-well plate samples using magnetic beads that bind RNA, allowing researchers to use a magnet to draw the beads to the side of the tube and quickly purifies the RNA from many samples automatically. Quantitative PCR reaction (aka RT-qPCR) is then used to detect the presence of viral RNA and the approximate viral load present in the sample. Using a PerkinElmer instrument to automate the process, 384 samples can be processed in less than two hours by a team of four scientists and the number can be scaled with more PCR machines and staff. A Bravo multichannel robot from the Agilent will fully automate the process and nearly double the sample processing capacity with minimal personnel intervention. Less reagent is also required relative to usual COVID detection protocols. The platform has been made available to the scientific community for free online. Standard PCR protocols depend on RNA extraction as the first step, which has been one of the main bottlenecks in the detection process. Press release.