Part 2
The race to test
2019
December 31: Cases of pneumonia detected in Wuhan, China, are first reported to the WHO.
2020
January 5: China announces that the unknown pneumonia cases in Wuhan are not SARS or MERS.
January 7: Chinese authorities confirm that they have identified the virus as a novel coronavirus, initially named 2019-nCoV by the WHO.
January 11: The sequenced genome is posted on open-source site virological.org.
The Wuhan Municipal Health Commission announces the first death caused by the coronavirus.
Berlin scientist Olfert Landt and his team send their test kit to Hong Kong and Taiwan.
January 12: Chinese authorities share the sequence on January 12.
January 16: Hong Kong University scientists submit their kit to the World Health Organization.
January 17: A top health official says the US Centers for Disease Control and Prevention has made its own test, without using the protocols published by the WHO.
February 11: The WHO names the coronavirus Covid-19.
All this is taking place on a tiny scale – in test tubes, within a diagnostic machine. The diagnostic machine measures the level of light, and compares it with the positive control – usually a sample of the virus. If the positive control doesn’t test positive, then scientists will know that the test isn’t working.
Developing a test is not difficult, according to Nathan Grubaugh, an assistant professor of epidemiology at Yale School of Medicine. The trick is making sure it doesn’t pick up other viruses, too.
Within six days of getting the sequence, Poon had a working test.
Like Landt’s kit, Poon’s test can pick up SARS and Covid-19. Poon says that isn’t an issue, as there isn’t currently a SARS outbreak.
In the months since, Poon has sent tests for free to more than 40 countries all over the world, including Egypt and Cambodia. Each country only gets one kit, which costs between 4,000 to 5,000 Hong Kong dollars ($515 to $644) and can be used to test 100 samples. Some countries, like Nepal, have sent their samples to Hong Kong University to test. The idea is to “buy some time” for countries, so they have a test while mobilizing resources to create their own.
But while companies like TIB Molbiol are making money from their kits, Poon and his team have reallocated funding from other projects to their Covid-19 test kits, and are essentially working for free.
“We don’t have money, we have zero resources,” said Poon. “We are just distributing it from our good will.”
Others, too, having been giving away vital information for free. The WHO lists seven protocols on its website – they are essentially how-to guides for scientists hoping to make their own test kit. Both Landt and Poon’s tests are laid out in detail.
“The (intellectual property) issue is not what we care about in this public health crisis,” Poon said. “What drives us to do this work is to try to react to these emerging infections so we can save more lives.”
To make a new test – or to use a preexisting one
In mid-January, in Gisborne, a sunny city on the coast of New Zealand, John Mackay got a request from the government’s National Reference Laboratory – he needed to buy materials to detect the coronavirus.
Mackay, the technical director of diagnostics lab Dnature, emailed Landt. “Olfret, if this is playing out like SARS, I’m guessing you have the kits sitting on the shelf ready to go immediately,” he recalls writing that afternoon.
Within half an hour, there was a reply from Landt, despite it being early morning, Berlin time. “Yes, do you want some?”
“The guy is a complete workaholic,” Mackay said of Landt. “He’s a phenomenal guy.”
The kits were sent to New Zealand, and around a month before the country would have its first case, the authorities were ready to test.
It was a similar situation in Australia. Like New Zealand, they had no samples of the virus, so they referred to tests developed overseas, according to William Rawlinson, the director of Serology, Virology and OTDS Laboratories, which leads much of the testing in the Australian state of New South Wales. Even before Australia had its first case, it had kits.
Other countries decided to go it alone.
One of the earliest tests was developed in mainland China by the country’s Center for Disease Control. By January 24, its protocol had been posted on the WHO website.
But as the outbreak raged in mainland China in early February, a number of people tested negative, only to later test positive. In a report in Chinese state newspaper China Daily, Gao Zhancheng, head of the respiratory and critical care department at Peking University’s People’s Hospital, said a number of factors could have impacted testing besides the test itself, including the way doctors took the sample, and the circumstances at laboratories.
Initially, China also appeared to struggle with a shortage of PCR test kits – so much so that China’s Ministry of Science and Technology called for research into other types of tests, according to state media Xinhua. Some people were forced to wait to be tested as China’s health care system was stretched by the outbreak.
In the United States, there were also problems.
On January 17 – the same day that the WHO published Landt’s protocol – a top health official said the US Centers for Disease Control and Prevention had made its own test, without using the protocols published by the WHO.
The agency announced on February 5 that it would begin shipping kits. Soon after, some labs reported that the tests were not working, meaning some had to be re-manufactured. It’s not clear how the defect happened.
Why the world needs multiple test kits
It’s easy to see how Landt and Poon’s early work helped other countries buy time and prepare for an outbreak. But neither Landt nor Poon have the capacity to make enough tests for the whole world.
And there are other also reasons why the world needs multiple test kits.
For one, scientists don’t know for sure at first that their test will work. In the US, for instance, the manufacturing defect created a lag in testing – if everyone in the world had been reliant on that one test, that would have created an even bigger problem.
Another issue is that the virus could potentially mutate in such a way that one kit no longer works. If a test targets Covid-19’s “N” gene, for instance, and the virus mutates so that gene no longer exists, then the kit will not pick up the virus.
Another consideration is that a test that works in one country might not work in another, said Rawlinson. If, hypothetically, the presence of dengue fever caused a test not to work, and a country had a large rate of dengue fever, then there might be a high rate of false negative, he said.
Having a range of tests also puts less pressure on one manufacturer or supply chain, as different suppliers may use different materials.
In the US, for instance, medical officials have said they are short of test supplies, including swaps, reagents, and pipettes – the tools for transporting liquids. The shortage forced Minnesota and Ohio to limit testing to the most vulnerable patients. Japanese test distributor Kurabo, which makes a different type of tests that looks for antibodies, claims its test only takes 15 minutes to give a result – and use blood samples rather than swabbed specimens.
Test supplier Roche Diagnostics Corporation says it is distributing 400,000 tests per week to labs in the United States, but that isn’t enough to keep pace with demand. “At the height of any global health emergency, demand will outweigh supply,” said company spokesman Michael Weist.
Ferran said testing could have changed the US’s infection rate.
“If we had better testing early on, we could have really changed the rate of infection. But we can’t go back,” she said. “We just have to go forward and learn from this and have this not happen again.”