Webinar on COVID-19 laboratory routine tests and biosafety protection

A webinar titled “COVID-19 Laboratory Routine Tests and Biosafety Protection” was co-organised by College of Pathologists of Academy of Medicine Malaysia and Mindray on 14 May 2020. The webinar was hosted on Zoom.

Dr Ngeow introducing the speakers

Introducing and kick-starting the webinar was Organising Chairperson Senior Prof Dr Ngeow Yun Fong. She is also the Chairperson of UTAR’s Centre for Research on Communicable Diseases. Speaking at the webinar were Prof Sergio Bernardini and Prof Ma Lijuan.

Dr Sergio explaining the role of laboratory tests

With the first to speak, Prof Sergio spoke on “The Value of Laboratory Medicine during the COVID-19 Outbreak”. He explained the role of laboratory tests as well as the Human Alpha Coronavirus and Human Beta Coronavirus. There were two types of Human Alpha Coronaviruses identified. The first type, HCoV-NL63, saw patients displaying symptoms such as cold, Laryngotracheitis (CRUP) and sometimes severe LRT infections among children and the elderly.  The HCoV-229E, on the other hand, saw patients displaying cold symptoms and sometimes severe LRT infection among children and the elderly.

Under the Human Beta Coronavirus category, the HCoV-OC43 saw patients displaying cold and severe LRT infections among children and the elderly, and the same was found in HCoV-HKU1 patients. Other viruses identified included Severe Acute Respiratory Syndrome 2004 (SARS-CoV), Middle East Respiratory Syndrome 2012 (MERS-CoV), and Severe Acute Respiratory Syndrome 2019 (SARS-CoV-2).

He said, “Availability of protein structural information is an essential prerequisite for the interpretation of biological phenomena. Now, only nsp5 protease is available, although it is expected that many other structures will come soon. In the meantime, homology modelling could provide preliminary structural clues.”

He continued by explaining the tools used for testing, which included microbiology tools, serology and others. He also mentioned, “Samples should be obtained by using a flocked swab, if available, to enhance the collection and release of cellular material. Swabs that contain calcium alginate, wood, or cotton should be avoided because they may contain substances that inhibit PCR testing. Ideally, swabs should be transferred into a universal transport medium immediately after sample collection to preserve the viral nucleic acid. Early-morning posterior oropharyngeal saliva samples (coughed up by clearing the throat) have also been assured as useful specimen types and would not require the use of a swab.”

He went on to speak on the types of methods used, namely Clusters of Regularly Interspaced Short Palindromic Repeats (CRISPRs), Specific High Sensitivity Enzyme Reporter Unlocking (SHERLOCK), DNA Endonuclease Targeted CRISPR Trans Reporter (DETECTR), and Heating Unextracted Diagnostic Samples to Obliterate Nuclease (HUDSON). Using medical samples from blood, urine and stool, the release to protect target nucleic acids are done with HUDSON. RNA and DNA amplification is done using recombinase polymerase amplification and/or in vitro transcription, while target nucleic acids detection and signal amplification are done using SHERLOCK, SHERLOCK V2 and DETECTR.

He explained, “Nabs elicit their protective activities in three main steps; firstly in preventing the attachment of the virion to its receptors on targeted cells; causing aggregation of virus particles; lastly inducing viruses lysis through the constant (C) region of the antibody-mediated opsonisation or complement activation.”

Towards the end of the session, Prof Sergio advised for the utilisation of Artificial Intelligence (AI) tools to handle pandemic in the future. He also saw the benefits of telemedicine and how it should be considered further as a strategy and operational plan guiding health care providers to switch to outpatient teleconsultations and increase tele-expertise and remote patient monitoring. He also noted that telemedicine could facilitate data-sharing mechanism to integrate telemedicine providers’ data with epidemiological surveillance. He also shared ways on overcoming the lockdown and advised everyone to stay safe.

Prof Ma explaining he common test conducted in laboratory testing

The next to speak was Prof Ma. She spoke on “Blood Routine Test and Laboratory Safety Precautions”. Her talk was divided into two parts; the first part saw common test conducted in laboratory testing including blood routine test and C-reaction Protein Test (CRP) while the second part saw laboratory bio-safety protection during epidemic setting in term of personnel and laboratory prevention.

Prof Ma explained the application of Blood Routine Test & CRP for infected diseases and COVID-19 diseases. “We need to use the correct application for blood routine test. According to the epidemic review by the World Health Organization (WHO), these infected diseases are ranked Top 4 around the globe and it will cause death. Lower respiratory tract infection is the fourth leading cause of death in the world and nearly 13 million children die every year due to infectious disease, making it number one cause of death among children in developed and developing countries,” said Prof Ma.

She continued sharing the clinical application of CRP test where it is used for bacterial infection, virus infection and mycoplasma infection. Prof Ma then explained the treatment plan recommendation for COVID-19. She briefly explained the Chinese Guideline of Diagnosis and Treatment of COVID-19 that involved the process of laboratory examination, therapeutic monitoring and early clinical warning.

Prof Ma also emphasised, “COVID-19 also causes severe illness to children with 73 reported cases in New York with symptoms similar to Kawasaki disease and toxic shock–like syndrome. Children would suddenly suffer from a rare and fatal disease with symptoms like having rashes, carditis, and artery swelling. Some even experienced death. And they were all tested positive for COVID-19 test.”

She later explained how COVID-19 is transmitted. The transmission includes direct transmission, aerosol transmission and contact transmission. Aerosol transmission poses the highest risk for laboratory personnel due to the mix of droplets in the air. This could cause infection once inhaled. She added, “Laboratory personnel usually come in contact with blood, urine, faeces and other samples which could potentially produce aerosols. In the process of blood collection, syringe, centrifugation, uncapping, sample adding, automatic instrument and equipment operation, aerosol can be generated.”

Prof Ma showing participants the layout of biosafety laboratory during the epidemic

Towards the end of the session, Prof Ma shared the importance of having laboratory biosafety equipment and facilities to prevent aerosol splashing and reduce diffusion. Laboratory biosafety equipment and facilities included biosafety cabinet, autoclave, ultraviolet lamp, emergency shower equipment and personal protective equipment such as face mask, medical cap, goggles, shoes cover and isolation gown.

Staff technical training, biosafety training and assessment for the safety of laboratory personnel

The webinar was adjourned by a Q&A session between the speakers and the participants.