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Inside the BCCDC: The front lines of B.C.’s quest to conquer COVID-19
VANCOUVER -- The machines whirr and cycle test tubes around what looks like a futuristic version of a conveyer belt.
Lab technicians open and close hatches, type with precision on touchscreen monitors, and occasionally hunt for a thick black binder.
It’s both old school and high-tech, and it’s here, on the ground floor of the B.C. Centre for Disease Control’s Public Health Lab in Vancouver, where the experts may need both approaches to crack the COVID-19 code.
And according to Dr. Muhammed Morshed, a clinical microbiologist who heads up research efforts around antibody testing at the BCCDC, immunity is the “million dollar question.”
Because in his 30-plus years of experience, Morshed has never seen a virus like COVID-19.
“Personally, I’m very nervous, because a good vaccine takes years and years,” Morshed says.
But what is more heartening than frightening, for Morshed, is that he’s also never seen such a powerful response.
“I’ve never seen a single virus (with) more than 100 vaccine (companies) working on producing a vaccine,” Morshed says.
So in the meantime, the doctor, one of whose specialties before COVID-19 was the Zika virus, leads a team working to help British Columbians answer the questions of whether they’ve been infected with the novel coronavirus, and more significantly, what that means.
“That’s a question that can only be answered by following people to see whether they are in fact protected,” says Dr. Mel Krajden, the medical director of the BCCDC’s Public Health Lab.
Krajden cautions we are nowhere near ready for so-called “immunity passports.”
In search of the perfect antibody test
It starts with a blood sample, an antibody testing kit, and technology.
Dr. Morshed walks me over to a machine that looks like an oversize photocopier. Lab technicians buzz around it – inserting tubes of blood, along with test kits full of bright pink and blue liquids.
This is the DiaSorin LIASON, Italian-made and the first antibody test officially approved by Health Canada.
The BCCDC has had two of the machines for a couple of years. But the COVID-19-specific test kits have just arrived, and the goal right now is to make sure they work – a process called validation.
By taking blood samples from patients who are known-positives and samples from those who believe they haven’t been exposed or tested positive, the team can essentially calibrate the machine and the test itself, making sure it’s giving the results they expect.
The BCCDC experts liken it to making sure all the parts inside a new car are functioning and, critically, work together as intended.
I ask how accurate it is, and Dr. Morshed and the BCCDC team politely, but promptly correct me.
The key words when it comes to antibody testing are “sensitive” and “specific.”
A highly-sensitive test means it gives off few false negatives. A highly-specific test means there are few false positives.
Or, put another way, when a test is highly-sensitive, it’s good at detecting COVID-19 antibodies. When it’s highly-specific, it doesn’t show a person has antibodies, when they don’t.
And when it comes to the search for the y-shaped proteins that show evidence of a coronavirus infection, and could potentially prevent reinfection, both are highly valued.
Morshed says the plan is to finish the validation process by the end of the month, or if not, by the first couple weeks of June. The more tests they perform, he explains, the more confidence they will have in the procedure and the results.
And then he asks me to volunteer to get tested.
The future of antibody testing in B.C.
In the Zoonotic Disease and Emerging Pathogens Lab a few floors up, I catch my first glimpse of what could be in many British Columbians’ futures: a tiny white piece of plastic, about the size of a cookie or cracker.
It turns out the lab is working on validating dozens of antibody tests, including nine different varieties of a portable “point-of-care” test that could one day be given anywhere in the province, and scaled up for industries like farming, mining, and beyond.
“It’s good for B.C. because it can be done in any remote situation,” Morshed says.
Before I agree to the test, I clarify that it won’t set anyone who’s waiting for his or her test results further behind in the queue. I also make sure that the decision won’t keep anyone who needs care from getting it.
“All these test kits we got are for research use only,” Morshed reassures me. “So we are not jeopardizing any patient or anybody.”
(I later learn the BCCDC is also using staff members to validate new COVID-19 testing kits as it works to expand its repertoire of tools available for a potential second surge.)
Lab tech Fred Burgess cleans the tip of my ring finger with an alcohol wipe, and before I know it, he’s pricked it.
I watch as he carefully places a couple drops into the white “cassette” labeled with my name. Then he adds a couple drops of buffer solution and sets a timer for 15 minutes.
Before I know it, the clock beeps, and Dr. Morshed inspects the test.
It looks something like a pregnancy test: a line next to the letter C (control) means the individual cassette is working, or valid.
But next to the numbers 1 and 2, there’s nothing.
“You don’t have anything,” Morshed declares.
He briefly mentions how an antibody called IgM is the first type the body makes in in response to an infection. IgG is produced slowly, he says, and eventually becomes the major antibody present.
The test looked for both, and it shows I don’t have either.
It’s what I expected, but because the test is still in the validation stage, there’s a catch.
“We really don’t know if you have it or not,” Morshed says, though given my medical history, he tells me he doesn’t believe it’s a false negative.
Once the experts are confidence the test kit is both sensitive and specific, it’s quite possible that thousands of people across BC will be getting their fingers pricked or having their tubes of blood sampled by the Diasorin LIAISON.
In fact, the province has already asked for volunteers for antibody, or serology, testing as part of its COVID-19 survey.
And like with testing for COVID-19, it will be up to provincail health officer Dr. Bonnie Henry and her team, including those at the BCCDC to come up with the antibody testing strategy that provides them with the critical data they’re looking for.
Morshed tells me he’s confident that will happen within the next month or so.
But as for understanding what the presence of COVID-19 may mean for immunity, local experts agree it will likely be into the fall before we learn more, with both the research and the science an intense work-in-progress, both in the BCCDC lab, and beyond.
“People should definitely be on guard and (only time) will tell how long we will have that protection,” Morshed says.