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a dialog with Dr Richard Molenkamp from Erasmus MC’s Division of Viroscience

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Erasmus Medical Middle (Erasmus MC) in Rotterdam, the Netherlands, has an extended and proud historical past as a instructing hospital and analysis facility, with the world-renowned Division of Viroscience working to raised perceive viruses and the infections they trigger at molecular, affected person and inhabitants ranges.

It’s because of their work, and that of comparable facilities world wide, that severe illness threats might be quickly detected and contained. Certainly, their work entails learning and monitoring an entire vary of viruses, from these inflicting extreme acute respiratory syndrome (SARS) and Center East respiratory syndrome (MERS), to Ebola, HIV, influenza, herpes and measles.

Moreover recognized viruses, their work additionally helps determine new and rising pathogens that might pose threats to people, which resulting from many components – together with globalization, altering land use and local weather change – are showing increasingly ceaselessly. The continued COVID-19 pandemic, now coming into its fourth yr, and the more moderen mpox (monkeypox) public well being emergency of worldwide concern, are simply 2 latest examples, exhibiting the numerous affect that zoonotic illnesses (these originating in animals) can have in our interconnected world.

To higher perceive the work of the Division of Viroscience, significantly within the context of the COVID-19 pandemic, we spoke to Dr Richard Molenkamp, ​​a medical molecular virologist working there.

How lengthy have you ever labored at Erasmus MC and what’s your explicit function right here?

I have been working right here for 4 and a half years, and my function is targeted on molecular diagnostics – in different phrases, analyzing markers within the genome of viruses to diagnose and monitor illness, and to assist clinicians make choices on which therapies will work finest for his or her sufferers.

Alongside that, I additionally play a job within the reference facilities for quite a lot of viruses. Erasmus MC is the WHO Collaborating Middle for Arbovirus and Haemorrhagic Fever Reference and Analysis. Arboviruses are transmitted by mosquitoes, ticks and different arthropods. The work of the Collaborating Middle additionally contains coping with novel and rising infectious illnesses, corresponding to these brought on by coronaviruses. Moreover, the Division of Viroscience is accredited as one of many WHO European Area’s reference laboratories for measles and rubella, and is the Nationwide Reference Middle for Influenza and Rising Viral Infections within the Netherlands.

Are you able to give us a short overview of the aim and work of the Division of Viroscience?

We do fundamental analysis and diagnostics, in addition to every thing in between! Our goal with all our actions is for what we discover out to end in advantages to human well being. We’re a giant division, consisting of round 200 or 300 individuals, from medical medical doctors working straight with sufferers to scientists and technicians of all ranges truly performing the diagnostics and research.

How do you go about figuring out, characterizing and diagnosing viruses?

Relying on the particular diagnostic query, we attempt to detect the virus’s genomic materials utilizing polymerase chain response (PCR) to repeat, amplify and detect the ribonucleic acid (RNA) strands that kind the genomic code of the virus.

Moreover, we are able to perform sequencing to know the precise order of the genetic info contained within the RNA strands, which helps us determine and characterize the virus, as an example, to find out whether or not mutations within the virus might have an effect on antiviral remedy.

Alternatively, we are able to, by antibodies within the serum (serology) of sufferers, decide whether or not a affected person has beforehand been contaminated by a virus. Lastly, we use virus cultures in some instances to reply some very particular diagnostic questions we would have.

Are you able to inform us what function the Erasmus MC laboratories have performed in testing for SARS-CoV-2, the virus that causes COVID-19 illness?

From the early begin of the pandemic again in January 2020, we collaborated with different WHO collaborating facilities to validate a PCR take a look at, developed by the Charité laboratory in Berlin, Germany, that was to develop into an ordinary technique for diagnostic detection of SARS-CoV- 2 internationally.

Subsequently, we began testing for SARS-CoV-2 within the third week of January 2020. From that time on, and primarily nonetheless, we suggested and collaborated with WHO and different WHO collaborating facilities throughout the globe to share info on the virus and on laboratory strategies.

Within the Netherlands, we had been initially solely testing suspected instances that had a journey historical past to China, or afterward to Italy, however on the finish of February, we had our first optimistic COVID-19 case right here. From that time on, we started finishing up routine testing, working alongside RIVM (the Nationwide Institute for Public Well being and the Surroundings) to substantiate one another’s take a look at outcomes.

Because the pandemic took off and extra hospital laboratories turned concerned in testing, we had been the only real testing laboratory for the Rotterdam space, which lasted till August 2020, when it was realized that extra testing capability than we might present was wanted.

At current, we’re primarily concerned within the routine testing of newly admitted sufferers to our hospital, whereas persevering with to check our health-care workforce regularly to attempt to stop the unfold of COVID-19 an infection and to make sure enough availability of personnel for offering well being care.

Because the pandemic has gone on, we have seen new variants rising. Are you stunned how the virus has modified and developed over time?

Not likely. From our expertise and former research of coronaviruses and different viruses genetically shaped from RNA, I feel it’s no shock that there was a sure degree of variation and evolution within the make-up of SARS-CoV-2. What’s new on this pandemic, although, is that in comparison with different outbreaks we now have been capable of carefully observe how the virus has developed via the inhabitants, because of the highly effective methods which were developed for real-time sequencing. The quantity of genetic knowledge we now have for SARS-CoV-2 is unprecedented. This implies we now have been capable of significantly better detect new variants and observe in actual time how they’re spreading.

Has your testing routine modified on account of the variety of individuals affected by COVID-19?

Actually. Firstly of the pandemic, we had been splitting our samples with the RIVM laboratory to do joint testing and affirmation, utilizing handbook PCR techniques to give you mixed choices on the outcomes. This was all very effectively once we had been solely coping with a handful of instances, however because it took greater than 24 hours to get a confirmed end result, the method turned unsustainable as numbers rapidly elevated.

Due to the event and introduction of extra automated techniques, we are able to now do neighborhood assessments in round 12 hours and there are laboratories working across the clock to course of samples. If actually speedy solutions are wanted – as an example, if a hospital emergency division is overflowing with sufferers and a unfavorable take a look at is required to confess somebody to a normal ward – then we are able to use speedy molecular assays which may ship outcomes inside an hour. These assays are costly and solely appropriate for very small testing volumes, so we solely do this for significantly pressing instances.

How is your work contributing to controlling and ending the pandemic?

All through the pandemic, we now have supplied neighborhood testing for individuals with gentle signs as a method of controlling infections and ensuring the virus does not unfold additional via the inhabitants. As vaccines have develop into accessible, we have additionally carried out assessments on their effectiveness, particularly in view of latest variants, and put diagnostics in place to see how effectively they carry out.

Moreover, we additionally examine the effectiveness of antiviral compounds on rising variants, all of which is useful for the event of latest, extra focused vaccines and antiviral therapies.

Do you suppose the function of laboratories in illness analysis, surveillance and testing is absolutely appreciated by governments, well being authorities and the broader public? What must occur to raised talk what you do?

Laboratories typically play a behind-the-scenes function, which might be too simply taken as a right. Certainly, I typically suppose that the general public, policy-makers and even some clinicians regard them as some form of machine, the place you push a button and the outcomes will simply come out!

In actuality, it is far more refined than that. Laboratories solely perform effectively by repeatedly constructing experience. With out skilled laboratories and the funding wanted to take care of and develop them, we might have very restricted understanding of illnesses, the dynamics of an infection, and the perfect methods to forestall and deal with rising well being threats. This has been significantly evident throughout the COVID-19 pandemic, as lots of the response measures had been developed because of knowledge from skilled laboratories, corresponding to ours.

On the whole, laboratories attempt – and we actually do – talk their work in a number of methods, by publishing outcomes, speaking with the press and informing stakeholders. Nevertheless, science communication is an experience in itself and, in my view, must be extra built-in into the talent set of the subsequent era of laboratory scientists to enhance effectiveness.

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