Dr. Dylan Pillai, diagnostics and microbiology professor at University of Calgary
Dylan Pillai
Professor & Expert in Medical Microbiology and Infectious Diseases

COVID-19 Point-of-Care Testing & Canada's Ongoing Research Priorities

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Takeaways

  1. Domestic innovation needs to be promoted so that Canada is not relying on the international community for developments in diagnostic testing.
  2. Canada needs its own solutions for pandemic preparedness so that we do not need to rely on the international community for diagnostics, vaccines and therapeutics.
  3. Information and access to data is critical, and genetic information should be open sourced across global jurisdictions.

Action

Industry, including venture capital, should work with the research community to develop an impactful research strategy. It is in everybody’s best interest to work together, and private-public partnerships are valuable in leveraging research funding.


Canada’s Response to the COVID-19 Crisis So Far  

I think the research and health policy response has been positive. Very early on there was a call for proposals for rapid research funding which my group was very fortunate to be successful in. This has enabled us to respond very quickly to urgent needs in our area, which is diagnostic testing for COVID-19.  

In terms of health policy, this has been challenging for policymakers because it is an evolving process—so one has to be nimble and ready to adapt quickly. Generally speaking, across the country there has been a positive response.  

I feel like we have done a good job of mitigating worst case scenarios. If you look south of the border and to countries like Italy, Spain and perhaps even France, you see huge numbers of people infected and the mortality rate is quite high. If you map out our current epidemic curves, fatality rates, hospitalization rates, and ICU rates, it is currently in a holding pattern that is fairly steady. Having said that, there are parts of the country that are sustaining more cases than other parts. 

If you map out our current epidemic curves, fatality rates, hospitalization rates, and ICU rates, it is currently in a holding pattern that is fairly steady.

We have seen in Quebec, for example, there are higher rates of infection than in other parts of the country. It is not homogenous across the country. There are areas, especially around urban centres where there is more community transmission, that there is more risk of these fires getting out of control. I think we have to be vigilant around these urban centres especially. 


What Are the Next Chapters of the Unfolding Crisis? 

We have seen that it is essential to protect our elderly in nursing homes and long-term care facilities. They have been extremely vulnerable, and we have to protect the vulnerable—that’s an important thing moving forward here. My own feeling is that we are now in the midst of this pandemic, we are sort of hitting the peak spot. I feel like by June or July we will be on the other side of this mountain, and then important questions will have to be asked about how we turn the tap on again in terms of de-quarantining, or de-self-isolating, letting people go back to work and letting kids go back to school. In the summer we will be asking those questions and relying on policymakers to provide that guidance so that we can go back safely.  

I feel like by June or July we will be on the other side of this mountain, and then important questions will have to be asked about how we turn the tap on again.

 If we move too fast, there is a risk of a second wave emerging because we do not, as a society, have herd immunity. Herd immunity is this concept that if enough people were infected, we will be protected as a society or community. We will not be at that spot by the summer—so if you open up too fast, you can get a second wave. And we have to protect our intensive care units—we only have so many beds, so many ventilators—and that is the other issue. This flattening of the curve is the way to go, but the big question is when to return to these activities without triggering a second wave. 


What Are the First Steps in Approaching a Disease Like Covid-19 from the Research Community’s Perspective?  

From a medical-scientific perspective where I come from, it is really about understanding this infectious disease. How transmissible is it from person to person? That would be one of the first questions. How virulent or dangerous is this virus for human beings? That’s another question. How is it spreading from country to country, and what key counter measures can we do to contain it? These are essential public health questions. 

From a diagnostic point of view, testing became so critical early on in this pandemic. Do we have the tools in our toolbox to be able to test this virus in high volumes, so we can quickly identify who is infected and then make sure they are quarantined or self-isolated? That became, and it still is, a very important question.  

In hospitals, it is about understanding how to manage patients with COVID-19. One of the interventions we can do to prevent mortality is determining who are the highest risk individuals for mortality.  That is a very important question. Do we have any medications that work already in our arsenal that we could use? And of course, the ultimate question is the vaccine. How quickly can we deploy a vaccine to curtail the spread of the virus? And that is just the beginning. There are so many questions and we can get into the societal impacts of isolation, the psychological impacts of isolation, impacts on the economy—but for the research community, those are our priority issues.  

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The Approach to Covid-19 Funding by Government and Partners Such as Genome Canada  

I was a recipient of funding that came via the Canadian Institutes for Health Research and Genome Canada and Genome Alberta. I am very fortunate to say that we are putting these funds to work right away, and it has been really remarkable how quickly the peer-review proposals took place—in a matter of days, which is unprecedented. Volunteers across the country were able to review this in a very rigorous process, and awards went out. There were second, perhaps third waves of awards that have been made available as well. I think this has been great, it is unprecedented, and this is one of the positive elements that has come out of this. 

It has been really remarkable how quickly the peer-review proposals took place—in a matter of days, which is unprecedented.

Having said that, how much is enough? And that is a big question here. Have we put enough funds into this to make it truly something that can have impact? How do we also rally around industry partners? It would be prudent to have industry, venture capital perhaps, also contributing to this research strategy. We know the entire economy is essentially at a standstill situation—so it is in everyone’s best interest to work together, and some public-private partnerships may be valuable to really leverage the funding.  

It would be prudent to have industry, venture capital perhaps, also contributing to this research strategy. 


What Role Does Genomics Play in Helping Us Understand and Fight the Virus?  

We need to know what this animal is. Is it related to bats? Is it related to SARS previously in 2002? There was the Middle East Respiratory Syndrome (MERS) coronavirus that emerged in the Middle East. There are also existing circulating coronaviruses that already are human coronaviruses that we see every season. Understanding the interplay and relationships between these families of coronaviruses will help us. Getting back to precision medicine, we need to be specifically targeting this particular pandemic virus from a vaccine or diagnostic or therapeutic point of view. Genomics plays into that, because the genome sequence is the source of truth of the identity of the virus and we need to know the source of truth. That is absolutely critical.  

Access to data and information is critical. Information is power and I think it has to be openly available.

I’m a big proponent of open-source genetic information. I think that this should be freely available across jurisdictions. I realize this is a political environment in which we operate, and fingers are pointing at other countries and what they did or did not do. But for me, as a medical-scientific person, access to data and information is critical. Information is power and I think it has to be openly available. 


What iYour COVID-19 Research Focused On?  

Our main interest is diagnostics.  

Over the last decade or so, I’ve been working in resource-limited settings—in Africa for example—trying to develop low-cost tools that provide ultrasensitive, highly accurate diagnostic tests. I call it precision diagnostics. Traditionally, we relied on methods like culturing an organism, bringing it to life so to speak, and these are relatively insensitive methods that are sometimes necessary to do. But now we are seeing testing and infectious disease moving towards detecting DNA, RNA and genetic material. Those tests are currently cost prohibitive, highly sophisticated and require equipment that needs preventive maintenance and it is inaccessible in some low-middle income countries.  

We have been looking at a specific technology called isothermal application. That means, in layman’s terms, essentially detecting that genetic material in a way that does not need sophisticated equipment and laboratories.

Now we are focusing on bringing that technology to the bedside and making it more accessible and available. And we have been looking at a specific technology called isothermal application. That means, in layman’s terms, essentially detecting that genetic material in a way that does not need sophisticated equipment and laboratories. We can actually detect genetic material at the bedside. That has been our real emphasis, and that is what we wanted to do with COVID-19 as well— build on the experience working in resource-limited settings and seeing if we can use that technology to detect COVID-19 in the community. That is what we are trying to do.  

Point-of-care tools are essential because, in my view, you are taking the test to the patient’s bedside, house, or port of entry so that you can act on the test result in a more rapid fashion. The time needed for a result and the time to act is reduced, and that early intervention may prevent further spread in the case of COVID-19. Ideally, you do not want individuals who are infected coming into the waiting rooms of hospitals and spreading that infection to others. That is one of the reasons point-of-care testing is valuable.  

Local domestic innovation has to be promoted so we are not relying on international sources for things we need.

In terms of how close we are, there are already commercially available options that have been developed by large diagnostic companies. The issue around that is access to them. As you can imagine, everybody wants one of those instruments or tests. This goes back to my earlier point, where local domestic innovation has to be promoted so we are not relying on international sources for things we need. We need domestic options. This has been highlighted in the pandemic. We may not be the first in the queue if everybody wants something that is available internationally. 


What Role Does Sequencing of RNA and DNA Play in Fighting COVID-19 and Developing a Vaccine for It?  

COVID-19 is an RNA virus, so determining the genomic sequence of that virus is essential. We need to know how much variability it has—is it just one clone, or are there many clones that are circulating? That may inform us in terms of how a vaccine might work. Some vaccines are specific to certain clones, and so if there are multiple clones this may inform us as to whether we need to develop a vaccine that can target several clones that would be universally useful. Absolutely, sequencing DNA or RNA is essential. We saw that with this pandemic—very early on Chinese scientists made available sequences of COVID-19 that allowed international laboratories to quickly develop a diagnostic tool to target the virus. It is really quite amazing how things have changed and how fast we can get information. In a matter of days, an entire sequence of a genome of a virus is available to develop diagnostic tools or vaccines. 


What Priority Research Areas Must We Focus on and Invest in as the Pandemic Evolves?  

It is hard to argue against the importance of a vaccine. Vaccines, as a public health intervention for infectious diseases, have always been paramount. It really is a powerful tool, and I would argue that in this instance time is of the essence—we need to push forward and develop a vaccine. 

Diagnostics has also been very important. We have seen that, again, having diagnostic supply chains of free agents and commercial options in the country is absolutely essential for ramping up testing so that we can offer tests to as many people early on as possible in the pandemic. Research into that technology is important. And I would argue that the DNA and RNA sequencing that we alluded to in the previous question is part of that process. The epidemiology of the COVID-19 outbreak—understanding it, what are the Canadian strains, is it mutating, is it changing behaviour—is important.   

Finally, there is drug development. We need tools in our toolkit to try and prevent deaths. Right now, there are no good randomized clinical trials demonstrating the importance of a particular drug—and that is the goal. Understanding the impact of the drug in a randomized clinical trial is something we need to prioritize in terms of the clinical research that is available to us.  


What Policy Lessons Must Canada Learn from This Crisis?  

A big theme is innovation and self-sufficiency. Having our own solutions to pandemic preparedness in terms of diagnostics, vaccines, and therapeutics is important so that we are not handcuffed in terms of what we can do to save lives. And I think this may be one of the emerging themes from the pandemic and one of the lessons learned: our domestic capacity for innovation should be there.  

This may be one of the emerging themes from the pandemic and one of the lessons learned: our domestic capacity for innovation should be there.

In terms of policy, I think one lesson here is that there is no one-size-fits-all—we saw different patterns of spread and transmission in different countries. We have seen that play out in countries like Italy, Spain, and the US—where they have been really significant cases—and you contrast that with Germany, where there  has been a lot of cases but not as many deaths.  

I think there are some lessons to learn here in terms of policy. Does self-isolation work? How long can it go on for? And when and how do you slowly turn on the tap, so that the economy can recharge? These are really important health policy questions, and I hope that—although this is not my area—there is a lot of research into that as well, so that we can better forecast and model these kinds of events, and so that we are not on chasing our tail making policy changes week to week. I think this modelling aspect is important, and we must understand that health policy impact. 


Will We See Another Epidemic? If So, How Must We Prepare?  

We will definitely see another epidemic of this proportion. The question is when not if—and we have to be prepared. I spoke about short-term memory; I think there need to be dedicated individuals whose daily activity is monitoring and planning for such events and ensuring that there is good information coming back so that we know how to prepare. It is a lot easier to put out a fire before it starts. And so, the internationalization of this process is important as well. I do not think we can operate in a silo here and prepare for something that is starting in a different continent. We need good information flow about what is happening.  

My hope is that organizations like the World Health Organization can play a very critical role here in gathering data and providing that information so the governments can respond in a timely fashion. 


How Are You Managing Life and Work in the Crisis? 

Thank you for that question. It is stressful. I sit on the fence—I’m a researcher, but I also provide services in the healthcare system, so I see both sides of the equation: the need for innovation and research, but also the need for provision of services and safety for healthcare workers. Providing laboratory testing in a timely fashion is stressful because it is non-stop. There’s no time off, no weekends, no evenings—it is just going on and on.  

In fact, I was just talking with my colleagues down the hall today, and we decided that is actually better to split us apart because if one of us gets infected with COVID-19 and we spread it down the hall, we are all out. The whole department is gone. One of the things we are doing is splitting us up—some will stay home and work from home, others will stay in this office area, and some staff are moving to a third area so there is not a risk of losing an entire division in our healthcare system. All these are stressful things, and they change how we operate day to day. And of course, there are family considerations—home-schooling, pressures that occur at home—so it about trying to balance both being at work and dealing with that.   

Dr Dylan Pillai University of Calgary Professor of microbiology infectious diseases and diagnostics
Dylan Pillai
Professor & Expert in Medical Microbiology and Infectious Diseases

Bio: Dr. Dylan Pillai is a Professor of Pathology and Laboratory Medicine, Medicine, and Microbiology, Immunology and Infectious Diseases at the University of Calgary. His research interests are in diagnostics and improving point-of-care testing effectiveness and outcomes. Dr. Pillai leads the medical team that received $1.6 million in federal funding to mitigate the outbreak of COVID-19. 

 

Organization ProfileThe Cumming School of Medicine is a research-intensive medical school that is a national research leader in brain and mental health, chronic diseases, and cardiovascular sciences. It is one of two medical schools in Alberta and is linked to hospitals in Alberta Health Services