This article is part of Harvard Medical School’s continuing coverage of medicine, biomedical research, medical education and policy related to the SARS-CoV-2 pandemic and the disease COVID-19.
Since he was a student at Harvard Medical School three decades ago, Paul Farmer, the Kolokotrones University Professor and head of the Department of Global Health and Social Medicine in the Blavatnik Institute at HMS, has worked with his colleagues to confront epidemics, including AIDS, Ebola, cholera and drug-resistant tuberculosis.
“The world must wake up to the threat the coronavirus poses, and the possibilities for effective and humane action this pandemic presents,” wrote Farmer in a March 19 Boston Globe opinion piece.
“In order most effectively to address the threat, we need to trace and to treat, and to do that we need to test,” wrote Farmer, co-founder and chief strategist of Partners In Health (PIH), an organization dedicated to bringing quality health care to the most vulnerable around the world.
Unfortunately, the standard PCR test in widest use in the U.S. relies on sophisticated laboratory techniques to identify the presence of the virus’s unique chemical signature, making it difficult to use in places where there is limited or nonexistent laboratory capacity.
K.J. Seung, HMS assistant professor of medicine at Brigham and Women’s Hospital, has been fighting epidemics with Partners In Health since 2001. He is also a co-leader of the expand new drugs for TB partnership, or endTB, which spans 17 countries.
“In a lot of the countries where PIH works, there is only one national laboratory in the entire country that can do that test,” Seung said. “Some of our countries don’t have any laboratories that can do that test. So, we’re going to have to think of something different. We’re going to have to think outside the box.”
Rapid tests
That means the use of rapid tests, like those deployed widely in countries such as China, Seung said.
PIH ordered 100,000 of those tests last week. Seung said that PIH is procuring a range of products from multiple suppliers, which share a common mode of operation. The rapid tests detect coronavirus antibodies and can be done at a patient’s bedside, providing an answer in as little as 15 minutes.
While questions remain about the best ways to use the rapid tests, Seung said time is not a luxury that responders around the world have.
“The countries need something right now,” Seung said. “We’re going to distribute these to eight countries and work really closely with their ministries of health to figure out how best to detect the coronavirus, see how far it’s spreading, and respond to it.”
PIH teams plan to implement the rapid tests as soon as possible, potentially within the next two weeks.
“We’re working like crazy to figure out the best way to implement them in the [given] country, and get people trained up, get nurses trained up, and community health workers who will have to do the mobilization and the contact tracing, the community education,” Seung said. “Everybody in the health care system, from the very top to the very bottom, is going to have to be involved in this coronavirus response.”
In combating infectious disease outbreaks for more than 30 years, PIH has developed a methodology that builds strong partnership with national governments and local community members and combines screening and prevention efforts with the best available treatment for each targeted disease.
This comprehensive model for care delivery, combined with long-term collaboration at the community and national level, also creates a platform for performing crucial research to develop and test new care-delivery models, diagnostic tools and treatment regimens for a broad swath of illnesses.
In 2015, PIH used a similar strategy to study the effectiveness of a novel, commercially developed rapid, point-of-care test for Ebola virus disease, working with collaborators at HMS and Boston Children’s Hospital.
Seung said that, in spite of nearly two decades of experience dealing with deadly epidemics in some of the world’s most challenging conditions, the current outbreak is unlike anything he has seen.
“This is really unprecedented—so we’re planning an unprecedented response,” Seung said. “It’s going to take mobilization of everybody to try to prevent this virus from spreading.”
Adapted from an article in the Partners In Health news section.
