Ramping up Nigeria’s testing capacity for COVID-19 with RDT

Ade Adebisi is a sickle cell disease (SCD) patient and advocate. The former professional rugby player is the brand ambassador for Sickle Scan, BioMedomics’ rapid disease diagnostic tool. Adebisi, who is currently vice chairman and general manager of the Nigeria Rugby League Association, represents what is touted as the world’s first rapid test to help diagnose both SCD and the sickle cell trait. Born in Nigeria, Adebisi is the only known athlete with sickle cell disease (SCD) to ever play rugby professionally. A former member of the British Rugby League Association, he played for the London Skolars, the London Broncos and other teams as a fullback or wing before retiring. He is now championing the use of BioMedomics COVID-19 IgM/IgG Rapid test to diagnose more Nigerians for the novel coronavirus (COVID-19). BioMedomics COVID-19 IgM/IgG Rapid test is one of the world’s first rapid point-of-care lateral flow immunoassays for the diagnosis of coronavirus infection. This Rapid Diagnostic Test (RDT) detects both IgM/IgG antibodies in human finger-prick or venous blood samples. It can also be used to test human serum or plasma samples. Adebisi in a chat with The Guardian gave reasons why the Federal Ministry of Health (FMoH), the Nigeria Centre for Disease Control (NCDC), States, hospitals and individuals should use the rapid test kit. He said this rapid test could be used to scale up testing for COVID-19 in Nigeria from about 50,000 to at least two million in days. CHUKWUMA MUANYA writes.

• Rapid test at point of care offers immediate answers critical for health workers, says Adebisi

Can the rapid test kit address the issue of low testing capacity in Nigeria?
Today, globally there are over five million confirmed cases, over 300,000 deaths and luckily nearly three million recoveries. Coronavirus is continuing its spread across the world, with more than 5.6 million confirmed cases in 188 countries. More than 350,000 people have lost their lives.

Let s take a step back here. The United Kingdom’s population is around 67 million with over 260,000 cases, Italy, just over 60 million with over 230,000 cases and Spain with 280,000 cases out of its nearly 50 million people. Although all these countries have approached coronavirus testing in different ways, one thing is consistent: they are taking a mass testing approach.

The World Health Organisation (WHO), as we know, stresses the need to aggressively test for COVID-19 mostly via Polymerase chain reaction (PCR) testing, antigen testing and now antibody testing using rapid test kits is the newer way forward. One issue is the up to 72-hour wait time for PCR results hence companies developed rapid tests, which are being adopted for mass testing and some of the ‘track and trace’ initiatives.

Nigeria is the most populous country in Africa and we are seriously playing catch up. The question is ‘why are we not adopting rapid tests to address the infection rate, location as well as antibodies to see the longer-term picture of who has had it and may have possibly developed a level of immunity?’

NCDC has advocated the use of PCR testing which is fairly reliable and acceptable, however, given the population of Nigeria, a dual solution using both PCR testing and antibody testing would be more effective. Rapid test at point of care offers immediate answers critical for health workers.

Utilise rapid tests, which are suitable for mass preliminary, or emergency screening for the presence of antibodies will let us know if one has been exposed to the virus and if one’s body has developed the blood proteins needed to fight the infection at point of care. This allows the individuals to respond appropriately regarding self-isolation, carrying on at work, which as we all know, will have a positive impact on the economy. It will help the Nigerian Government to understand the prevalence of the disease, offer a better understanding of the number of people who have been infected with the virus. In addition, outside Nigeria, use of this widespread rapid test screening is showing a significant number of people are positive but had no symptoms. This means they were able to carry the infection to others who maybe are not so lucky and succumb to the illness.

So, let us get the full picture – Use PCR to detect current infection and rapid tests to detect antibodies to the virus in the blood at the point of care – the two actually do go hand in hand.

How did you come about this rapid test for COVID-19?
BioMedomics, headquartered in the Research Triangle area of North Carolina in USA, is an ISO13485 registered company that develops innovative point-of-care diagnostic solutions for underserved diseases and populations around the world.

I am a BioMedomics Brand Ambassador in Africa and hence kept up to date with what they are doing that will impact my community. With the advent of COVID-19, I was made aware of the rapid test developed by BioMedomics

You said you are living with the sickle cell anaemia and the company has test kits for the condition?
One of the innovative point-of-care tests developed by BioMedomics is the Sickle Scan, which aids in the rapid diagnosis of sickle cell disorders. Before Sickle Scan, Sickle Cell diagnosis was only possible using complex lab equipment and with Sickle Scan, the test can be completed in less than five minutes giving real-time results.

Given my history with sickle cell and my passion for raising awareness of the disease, I am a proud Brand Ambassador for BioMedomics in Africa.

Are you not concerned, rapid test kits are not endorsed by the Federal Ministry of Health?
Of course, I am concerned. I completely understand that COVID 19 is ‘new’, there is so much we don’t know about this disease but we need to look at what other countries are doing, how they have battled it, how they continue to add new ways of doing so as scientists and researchers develop new tools.

Many of these tools are being made available in a quarter of the time this science usually takes. Yes, these new tests and tools may not be 100 per cent perfect but they are here now and with sensitivity and specificity results of over 90 per cent or over, we need to use them whilst the scientists continue to hone in and improve things.

Frankly, we appear a bit arrogant and less open than other nations if we wait for tools to be absolutely perfect. Yes, there are rapid testing options out there that are not really good enough so it’s important to work with companies who are experts in this field of work. I wouldn’t have agreed to be an Ambassador for BioMedomics if I was not convinced by their scientific principles and rigour that goes into developing the best that is possible to meet the needs of a health problem.

Your adventure with rugby
I was raised in East London, to parents that pretty much lived in fear of a disease that could take their children’s lives at any time. Sickle cell disease (SCD) is one of the most common genetic causes of illness and death in the world. A disease which would have your parents try to wrap you in cotton wool for the fear of one having a ‘crisis’ and ultimately, dying.

Sport was not an option and probably seen as a death wish.

The turning point in my life was having a role model who believed in me, my Physical Education (PE) teacher (Andy Hurst) who saw a talent in me, encouraged me to try out for his old rugby league club (The London Skolars).

I became a sportsman played for the Skolars and then the Broncos kept this as far away from my mother as possible (she had lost one child already). Sickle cell means you can’t take in enough oxygen, it means struggling with fitness levels, fatigue, pain and crisis.

Today, I am the only sufferer to have played rugby in the world so I decided to be an ‘Andy Hurst’ to sickle cell sufferers, to show that anything is possible, using what I knew best – sports, rugby!

I have worked hard to raise awareness of the disease, eradicate the stigma associated with sickle cell and be that person any young or old sickle cell sufferer can look up to.

I am a British – Nigerian rugby league player who played Rugby for the British Rugby League Association (BARLA), for the London Skolars, the London Broncos, Hull FC, Doncaster Lakers, Featherstone Rovers and Whitehaven. I am the only Rugby player to ever play professionally with a genetic blood disorder called sickle cell. This condition contributed to the shortening of my sports career.

Today, I am extremely passionate about healthcare and well being in Nigeria and helping bring this to the fore in a number of ways: through my Foundation – The Ade Adebisi Foundation; and through my Brand Ambassador role with BioMedomics in Africa.

WHO’s advice on the use of point-of-care immunodiagnostic tests for COVID-19
In response to the growing COVID-19 pandemic and shortages of laboratory-based molecular testing capacity and reagents, multiple diagnostic test manufacturers have developed and begun selling rapid and easy-to-use devices to facilitate testing outside of laboratory settings. These simple test kits are based either on detection of proteins from the COVID-19 virus in respiratory samples (example sputum, throat swab) or detection, in blood or serum, of human antibodies generated in response to infection.

WHO applauds the efforts of test developers to innovate and respond to the needs of the population.

However, before these tests can be recommended, they must be validated in the appropriate populations and settings. Inadequate tests may miss patients with active infection or falsely categorize patients as having the disease when they do not, further hampering disease control efforts. At present, based on current evidence, WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. They should not be used in any other setting, including for clinical decision-making, until evidence-supporting use for specific indications is available.

WHO continues to evaluate available immunodiagnostics tests for COVID-19 and will update this scientific brief when necessary.