Dr Mark Howard contributes to LENS article on Covid point-of-care diagnostics

ACES Ethics, Policy and Public Engagement (EPPE) Research Fellow Dr Mark Howard has contributed to a recent Monash University LENS piece, which looks at the case for accurate and quick mobile point-of-care COVID testing.

Dr Mark Howard.

The collaborative article features input from a number of Monash researchers, analysing the current model for testing against COVID-19, and how a true point-of-care (POC) could be a solution and a more effective model.

Dr Howard was joined by Prof Patrick Kwan, A/Prof Zanfina Ademi, James McMahon and Tuncay Alan for the piece, each contributing with their area of expertise – those ranging from public health and preventative medicine to neuroscience.

Lens is a Monash online publication that aims to highlight the work and global impact of researchers and academics at the university.

To find out more and the article, how it came about, and its future implications, we caught up with Dr Howard for the chat below.

Could you tell us about your area of research?

I specialise in political philosophy, applied ethics and social informatics, with a research focus on the social, political, and ethical implications of emerging technology in healthcare, transportation and agriculture. I am currently investigating distributive justice issues associated with the market in innovative diagnostic technologies (especially point-of-care testing) for the developing world and in response to the COVID 19 pandemic in high-income countries.

You recently contributed to a Monash LENS article on accurate point-of-care COVID testing. How did it come about?

Prof Patrick Kwan of the Monash Neuroscience department was aware of my research with ACES EPPE that considered the social and ethical impacts of innovative diagnostic technologies. Prof Kwan had also recently worked with a group at Monash University looking at a potential Microfluidic-based diagnostic test for COVID 19. He invited me to look at their research and provide feedback, and this led to a discussion of how a ‘true’ point-of-care test for COVID-19 in Australia could radically change the health and social response, both to the current outbreak and long term.

Our group also includes a virologist, health economist and engineer. We all believe the failure to invest in decentralised COVID-19 testing is a public policy failure.

What is the main point the article tries to get across?

The article highlights that testing is the first line of defence against COVID-19. However, the current centralised testing model has been exposed as a deficient public health response to the pandemic due to long wait times for testing and the delay in returning results.

The current laboratory-based testing regime also has significant costs in terms of lost productivity and social impacts, especially amongst vulnerable and marginalised populations. We argue it’s likely that a true point-of-care (POC) test can be part of a larger solution to these issues. Benefits of a POC test may result from fast test turnaround times and greater accessibility, with the potential sites for testing expanding to include, for example, pharmacies, GP offices, nursing homes, rural and mobile health clinics and workplaces.

You have suggested how microfluidic diagnostics could be an ideal solution for this type of diagnostic. Could you expand on that a little bit?

In high-income countries with developed healthcare systems ‘high throughput’ laboratory testing is typically considered the most effective way to provide diagnostic services to the population. However, the COVID-19 pandemic has revealed we need to be more agile in our response to novel public health concerns. A true POC test is portable, simple to use, and provides a rapid ‘sample-in-answer-out’ solution, and can complement centralised testing.

In the current situation, the COVID-19 POC diagnostic also needs to have comparable accuracy to that of the gold standard lab test. There are many antibodies or antigen based POC tests that provide rapid detection, but they cannot match the sensitivity of laboratory based nucleic acid amplification tests.

Microfluidic based diagnostics, which manipulate fluids in a controlled manner in microenvironments, are making rapid advances and have the potential to deliver unmatched sensitivity in POC testing and have the capacity to incorporate and automate all the fundamental technical aspects of nucleic acid testing in a single device — effectively a “lab on a chip”. Moreover, with simple modifications microfluidic based POC tests have demonstrated the potential to detect multiple pathogens (and their mutations). This currently isn’t possible with antibody or antigen tests.

So, what’s next for this kind of research?

Hopefully, the work I have been undertaking with my colleagues can raise the profile of microfluidic POC testing in Australia, where we have all the relevant infrastructure, industrial, and research expertise to achieve this goal.

What is required now is the political will and public and private investment to transition the research from academic settings to real-world solutions. This requires effectively presenting the case from a social and economic perspective in favour of development and deployment of an Australian-made COVID-19 POC microfluidic diagnostic, which we believe we have started to do in our article.

You can read the LENS article here.