Will the SARS-COV-2 virus keep mutating? How many variants are there? Can I get my results instantly? These are some of the burning questions which have cemented their place in the FAQs of healthcare pages. Understanding the biology of the virus and what makes it mutate and spread has helped healthcare professionals to mandate practices that can support curbing transmission. At Arab Health 2021, we sat down with Consultant Clinical Microbiologist and Infection Control Doctor, Dr Wael Faroug Mohamed Elamin, who broke down the virus’s genetic material and highlighted how technology is evolving to uncover our understanding of COVID-19’s future.
Has COVID-19 escalated the urgency of improved methods in infection diagnostics? What breakthroughs have we witnessed?
The acceleration of technology, research, and development has been unprecedented. Patients can receive results rapidly, in some instances within an hour or instantaneously. Innovations that we predicted being in use in the future within the industrial and clinical practice are now being implemented.
How have these innovations and technologies accelerated due to COVID-19?
COVID-19 saw a substantial increase in testing capacity, supported by governments worldwide. The need to test many people, at large volumes within short instances, gave developers the incentive to work rapidly and bring their products and prototypes to the market. There were trial stages to ensure these prototypes get tested and validated, to be fit for purpose. Therefore, there was a political, economical, and sociological benefit in developing these tests, which have in turn accelerated diagnostics.
What does the onset of new variants mean for diagnostics and the population?
Presently, there are variants of concern and nonvariants of concern. The question is, which one of them are worrisome enough to be considered? Evaluating the effectiveness of our tests, vaccines, and approach is key, however, weighing in the outcomes is crucial as well. Most of the tests that are used to diagnose SARS-COV-2, involve looking at pieces of the RNA of the virus. It's called the polymerase chain reaction or PCR, which is widely in use to analyse particular components of the virus. And to simplify it, it's like an adapter fitting into a socket – a fit indicates that you have the virus. If an individual may have a mutation, a diagnostic kit will be used to determine its presence, but it does not detect the virus per se. However, it does not cancel out the possibility of an individual having the virus completely, therefore, a very important question is who mandates further testing and running diagnostics to ensure that every trace of the virus has been searched for? Although the virus is mutating, it is likely that most kits would at least give an indication that the virus may exist.
Was the emergence of the mutation predicted?
SARS-CoV-2 is an RNA virus, and what RNA viruses lack is called the proofreading mechanism. While they replicate, they always make mistakes during replication and there is a lack of checking mechanisms during this process. Therefore, mutations in old viruses always exist in RNA viruses more so than DNA viruses. Hence, mutations are not only predictable but are expected. There can be several types of mutations, and some become anonymous, which causes a change in the actual property of the virus, or nonsynonymous, which may not cause an effect. If a mutation is causing a significant change, further study needs to analyse its consequences and severity. Nevertheless, mutations are a part of how viruses replicate, and they have their replication cycle.
What does the future hold for us?
There have been significant advances in diagnostics over the past 20 to 30 years, specifically in molecular testing. Sequencing 15 years ago would take four to five days to just receive a few kilobytes of data with a Sanger sequencer. Now with whole-genome sequencing or next-generation sequencing, gigabytes of data can be generated in a few days. With these advancements in technology escalating, it is unlikely that we will lack tools to diagnose developments in the biology of the virus in the future.