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I have a vague knowledge of MS - used it as a student over 50 years ago. Which tells you all you need to know!
Assuming an appropriate mix of affimers was selected, would it be possible to pick up and distinguish between all three of the current CV-19 variants - Chinese, UK (Kent) and South African? Thus would it be possible in a single BAMS assay to identify in an infected patient which variant was present?
As an aside it seems a bit rich - as happened in the Boris press conference yesterday - that it has become common practice to refer to the UK variant, or to the South African variant, but never to refer to the original CV-19 virus as the Chinese virus.
DTel today:-
The Army to be deployed in the biggest ever peacetime operation in the UK to help roll out vaccines and testing. A further 800 soldiers have been sent to Greater Manchester in order to provide community testing support across all 10 local authority areas.
Troops will carry out targeted asymptomatic testing of specific populations that may be at a higher risk of infection including social care staff, key workers, public facing occupations such as bus drivers, and those in high risk environments such care homes and shared accommodation for the homeless.
The new addition of soldiers means more than 5,000 Armed Forces personnel are currently deployed to support the response to Covid across the UK... "more than at any previous point in the pandemic and the biggest homeland operation the UK has ever seen in peacetime".
... Manchester to be an important contribution to protecting the highest risk groups as the city seeks to recover.
It comes after 1,500 troops were put on standby last week to run testing in schools and colleges as ministers battle to get pupils back into the classroom. Their duties include providing support and phone advice to institutions needing guidance on the testing process, as well as setting up testing facilities. RAF personnel to support Covid testing in Merthyr Tydfil, Wales
To date, the MoD has deployed 10 military planners to assist the Vaccine Task Force, with over 150 personnel deployed across the UK to support organisational and logistical components of the deployment programme.
... from Monday personnel will be trained up as part of the Vaccine Quick Reaction Force. This will initially be 21 teams of 6 personnel assigned to the seven NHS England regions, able to provide surge support to the vaccine roll-out if required by local health authorities.
In addition to community testing, 515 personnel remain on-task testing hauliers in Dover and helping to establish 10 new testing sites to improve the flow of traffic across the Channel.
Lt Gen Sir Tyrone Urch CBE, Standing Joint Commander UK, said: "In recent weeks, our amazing staff have deployed at short notice to set up and staff community testing centres across the country in support of the NHS, DHSC, devolved nations and local communities.
And any sampling process which has children gagging in front of teachers, volunteers or whoever schools bring in won't survive for long.
I don't like weighing into this too much but I do think AP may be interpreting this new tender about right. Surely a "product offering which can only use a nasopharyngeal specimen shall not be permitted " does rather sound as though they will only consider or at least would certainly prefer non-invasive tests? AP's posts suggesting most of AVCT's competitors are likely to struggle to comply with this seems to be reasonable to me?
Well if nothing else did, at least the article in Forbes hat ES23 posted earlier got me thinking!
"The Trouble With Herd Immunity And Covid-19 Vaccines" 11th December
One of the unknowns is "... the duration of protection—in other words, how long the protection conferred by a vaccine will last. Several studies, though not all, suggest that natural immunity to the Covid-19 virus is quick to fade. Vaccine-induced immunity might do nature one better, but that isn’t always the case. The immune response precipitated by the influenza vaccine, for instance, dwindles in four to six months. Only time will tell whether our protection against Covid-19 is as short-lived."
Makes you wonder whether our upcoming vaccination programme - January through to May say - is poorly timed. What if it turns out the immunity conferred by these Covid vaccines has faded by next autumn / winter? I hope they are preparing for an annual autumn top as per the flu vaccines. So what might fading immunity from vaccination mean long term - perhaps regular booster jabs plus a continuing role for testing?
Pigster, Doorstop what you are describing is the reality of what AVCT are having to deliver - something with very good S&S, capable of but limited to detecting contagion and at various rates of prevalence, and meeting lots of use cases. I don't want to reignite the anguish caused by the antigen test update of 23 Nov but maybe these complexities were what was behind it - the talk of several coronavirus tests and use cases, etc:
"... significant progress in the development of a highly scalable manufacturing process for a lateral flow SARS-CoV-2 antigen test being carried out with BBI Solutions, and that the lateral flow test has very good analytical sensitivity with laboratory samples.
Avacta is developing several coronavirus tests using Affimer binders that are highly specific to the SARS-CoV-2 virus spike protein.
The development of an Affimer-based lateral flow antigen test that can be manufactured at scale being carried out in partnership with BBI Solutions has made substantial progress.
A highly scalable test device using readily available components and routine manufacturing processes has now been shown to have a sensitivity for coronavirus spike protein in laboratory samples better than 300 pg/ml which is in the range expected for spike protein in clinical samples.
In preparation for clinical validation of the lateral flow test Avacta is working on both saliva and anterior nasal swab samples.
... Avacta and its partners will continue to develop both sampling methods in parallel in order to bring high performance COVID-19 tests to market quickly to suit a range of use cases."
In the more recent 21 Dec RNS the message was about progress with the LF "rapid antigen test programme."
Its going to be interesting to see what they come up with! A single test? Multiple tests?
Make that three - I wouldn't have a clue either
This is what AS actually said on the subject in the interims follow up Q&A
Q23: What are the requirements, if any, for Avacta to have suitable technology (a smartphone app of some sort) alongside the LFT that records the results of the tests? If so, does this impact the rollout plan for the test?
There is no formal requirement at this time for the LFD test to have a reader or an associated smartphone app for it to work; the intention is that the test will be read by eye. However, there is likely to be additional benefit to the test working in conjunction with a smartphone app so that the result can be read objectively, communicated for track and trace purposes and so that a “passport” can be provided for a few days for those with a negative result, collectively creating an audit trail linking the test result generated by a certain test to a specific individual at a specific point in time. Avacta is working with partners and aims to have a smartphone app available at the time of launch to provide this additional functionality.
From the horses mouth - well actually WeedyIan
Amazing what Unit built in the late 40s through to the early 60s - Kirkby, Speke, Skem, etc. - what we now call social housing - a phenomenal output year after year - and at the end there were the high rise Unit Camus 22 storey tower blocks.
Speke Boulevard brings back memories - anyone remember Unit Construction?
They do not eliminate risk entirely, which is why visitors to care homes must still be symptom-free, wear masks and wash their hands. Their chance of spreading the virus given all these precautions is far, far below one per cent.
Why, then, are we making the perfect the enemy of the good? Why focus only on the risk of missing 30 per cent of cases who would probably never have been tested anyway, when we should be thinking about how to mitigate the devastating cost of lockdowns, pub closures, cancelled weddings, online-only universities and care home residents cut off from their families for months?
It’s time we stopped focusing only on how to shut things down and thought about how to open them up. If rapid tests can help us achieve that faster, they are well worth a try.
Secondly, no one is suggesting that these tests replace PCR tests in high-risk situations. In hospitals, for example, it is essential to know if a healthcare worker or a patient has Covid. Likewise, if a person has symptoms, they are much more likely to have Covid and be infectious than if they are asymptomatic, so isolation and a PCR test are merited. Rapid tests are not a substitute here. They are an added extra, a screening tool for use in situations where it would never be economical or practical to do the full works.
They do, after all, have two advantages over the PCR. They are much, much cheaper and much, much quicker. Whereas a PCR can cost $40 (£30) a go, a rapid test costs just $3-7. And whereas it usually takes at least a day to get a PCR result back, rapid tests give a result in 30 minutes. In fact, as a surveillance tool to find out what is going on across a population and isolate cases, their rapidity makes these tests far superior to the clunky process we use now. That’s because these tests are convenient enough that, as Dr Mutreja points out, “you’re reaching many times more people”.
One study led by a team at Harvard and Colorado looked at exactly this question. If you imagine a particular population, whether it’s a school or a whole country, and decide to subject everyone to a testing regime to reduce transmission, there are three factors that really matter. The first is how well your test picks up a person’s infectiousness. The second is how often you test people. The third is how quickly you can get the test results back.
On the first of these metrics, rapid tests perform nearly as well as PCRs and mainly miss people who aren’t actually infectious. On the second two metrics, a good rapid test wins hands down. It simply isn’t practical, from a cost, capacity and convenience point of view, to test whole populations every three days or every week unless you use rapid tests. And since the results come back while you wait, you can isolate infectious people immediately, rather than having asymptomatic spreaders going about their business.
The overall point is that public health policy is about balancing priorities. Would it theoretically be better for virus control to roll out 100 per cent accurate tests to everyone all the time and have them all sit at home while they await the results? Sure, but the cost to society would be devastating.
Rapid tests offer an alternative, a potential way to cut transmission by 70 per cent across a much wider swathe of the population than our current testing programme could ever manage.
continued ...
A slightly cut down version ...
“Experts” are calling on the Government to rethink. The ambulance-chasing lawyers are readying a lawsuit.
This time, it’s the plan for lateral flow testing that has people raging. In his Facebook Q&A Boris Johnson made clear that the vaccine programme is only part of the plan for reopening
society in the next few months.
The other, he suggested, is the roll-out of mass testing, the “moonshot” programme. These tests will, he hopes, enable some normality like weddings and conferences to return even before Easter, the informal deadline for vaccinating most vulnerable people. Given the worries already emerging about a vaccine supply crunch, having a backup plan makes sense.
Yet something about this plan is driving people crazy. A few scientists have already gone nuclear, calling it “totally unsafe” or “really worrying”, and their views are being wrongly reported as a consensus. The Good Law Project is attempting to get a judicial review going, even before there is anything to review.
They are missing the point. “Moonshot” is about reducing transmission and risk, not eliminating it. It is not perfect, but it might be a damn sight better than the status quo.
The main gripe about rapid tests is that they are not as accurate or as sensitive as the gold-standard PCR tests. Whereas a PCR test will essentially pick up over 99 per cent of Covid cases in a batch, rapid tests have been known to miss six per cent even in a lab. Used in a school, the Oxford/Public Health England study found that they missed almost 17 per cent.
The UK’s biggest trial so far in Liverpool suggests they perform even worse out in the field. As usual, the Government damaged its own cause by not being open about this. On Monday, it invited localities to apply for mass testing with a long page of information. Buried in an annex, it revealed that the Liverpool trial suggests the rapid tests may be missing 50 per cent of all positive cases. Cue rage and panic.
It isn’t actually that bad, however. Firstly, the annex also stated that the tests are capturing 70 per cent of those with high viral loads – those likely to be the infectious ones. This is the relevant figure and is exactly the level of field performance one should expect from these sorts of tests, according to Ankur Mutreja, A Cambridge infectious disease. Michael Mina, of Harvard agrees: “These are transmission detecting tests. They detect you when you’re high enough to transmit.” They might miss people carrying extremely low levels of coronavirus, but who cares?
(As an aside, as someone who was given a PCR test to take in my car and, in retrospect, almost certainly did not shove the swab far enough down my throat, I wonder what their true field performance is.)
continued ...
Whose name will be on the tender, assuming ‘we’ are tendering in this round? Could it be that of BBI? They are the end manufacturer, they will be delivering the product, doing the logistics. And as AS said Cytiva and Avacta (just!) supply the raw materials.
So was the real purpose of the RNS of Monday 23rd November to soften the market up for a couple of things – swab not spit and BBI Solutions being awarded a contract to supply, without mention of Avacta (How many mobile phones mention the crucial enabler - ARM Holdings?).
As to why no mention of Abingdon? Well maybe their involvement is conditional on confirmation of government purchasing a first batch of BBI/Avatca/Cytiva LFTs. Maybe they are waiting to do their fund raise until they see this happen?
Just some more speculation following Monday’s RNS, why it was issued, how to interpret it, what it has to do with the recent request to tender, etc.
First why no mention of Cytiva? It’s been suggested BBI have in some way taken over their role. But go back to the Q&A after the September Interims. The fact AS chose this as the first thing to answer surely tells us Cytiva has a key role. This is how he explained it all fitting together:
Q1: "... please give an explanation of Cytiva’s role in the manufacture of the rapid antigen test.”
Answer: “That’s a good question, which allows me to clarify… So Cytiva are a materials company, they manufacture the materials to make the strip … they supply the finished nitrocellulose strip, not the finished IVD. So the manufacturers who supply the finished IVD are the likes of BBI Solutions and Abingdon Health… It’s really a process of raw materials from Cytiva and Avacta… So we have partners who do the strip manufacturing, and partners who do what’s called the kitting, who put the kits together and then obviously the logistics of shipping those out”
Cytiva seemed to get singled out by some as the culprit in the switch from spit to swab. I am not sure. Equally it could all go back to the mad panic March onwards when PPE, reagents, face masks, swabs and all the rest of it were virtually unobtainable. Then remember the five pillars - the fifth, research, included building up a sovereign diagnostics capability. So Avacta come up with a super spike binding very specific affimer reagent and partner with Cytiva who suggest or are persuaded the use of saliva is doable rather than the use of swabs, sourcing of which being from overseas would at that time have been problematic?
Through into late summer there is a reluctance to regard PCR as anything other than the gold standard. Dr Mina and others helped change that and the diagnostics powers that be (Porton Down, Prof Bell, etc.) decide LFTs could be OK but that spitting into a pot is unhygienic, saliva is subject to cheeseburger contamination, etc. (All conjecture on my part – which is what these threads are about?)
So by now swabs are becoming more readily available maybe now we can make them in the UK - like it seems we may now be making quantities of face masks. In his video on Monday AS says the issue with swabs has been simply sourcing but now he says “ we have done extensive work and we have more than one source – high volume source – in place”
So surely the government is just as likely behind the switch to swab as Cytiva. Also from the governments point of view the uniformity of messaging - education as to modality of use - that comes with using swabs in both Avacta’s and in the Innova test may also be an attraction?
But why was BBI singled out in last Mondays RNS and no mention made of Abingdon? Well for one BBI are the lead manufacturer. But is there something else? continued...
Very good article, though a few weeks old. It deals well with the strategies that will be necessary for vaccination and re the need for testing in the longer term, about which it starts by saying this this:
You need low case numbers to track and quarantine everyone infected, and UK numbers are currently too high. But vaccination should drive case numbers down to where containment becomes practicable. “We need to all become South Korea as quickly as possible,” says Joshua Gans of the University of Toronto, author of Economics in the Age of Covid-19.
Bodes well for building up delivery throughout next year of a gold standard LFT!
Dogs80... To me it was a strange RNS to put out, I felt like a lot was being held back and it was only put out for a reason, I don’t think spit is over, I think there more to it than it just didn’t work out.
There is one clear reason for the saliva to anterior nasal swab switch RNS yesterday. Who knows whether we are in the running in this current £512m tender, but if we are awarded something 16th Dec it would come as a shock on the day to find out we were being awarded a swab contract when everyone believed we were about to launch a unique saliva test. Without yesterday's announcement we could not be in contention.
A key point well made by Michael Mina in this tweet:
This paper also does not look at symptomatic vs asymptomatic use... But WHY??
Because the test DOES NOT CARE about symptoms. Clinical medicine cares. A public health test for contagiousness ONLY CARES ABOUT VIRUS presence
I wish @US_FDA could understand this
Sir John Bell said they have found about 6 LFTs with usable S & S with his validation being published tomorrow. He does not say clinical validation . I cannot see why pre BBI pilot samples e.g. produced by Cytiva, cannot have been included in his assessment, done maybe by Porton Down?
If such work has been going on I cannot believe AS would want to pre-empt Sir Johns statement and make mention of it in todays tweet, which they were clearly forced to put out by yesterday's sp drop. In fact a pedantic reading of AVCT's tweet today seems to leave wide open that possibility that Sir john has included the Avacta LFT in his validation work. AVCT's tweet refers to preparing for "the first clinical evaluation of the rapid antigen test", which clearly does not preclude some preceding S & S validation.
Poundcake - you say next up, the bid stats contract for Avacta.
This is something that I have always wondered about? Rather than being a massive order for Avacta, since they will not be supplying the end product - the LFD test kit - will not it rather be several massive orders for BBI, Abingdon and whoever else? Avacta will then obviously get a huge junk of revenue on the back of these orders. Clearly though Avacta will get all the kudos - ideally each LFD should be stamped 'Avacta Affimers Inside' ;-)