We need a new Manhattan Project: Biomarker testing to screen for and stop the next virus

Hubby is reading The Making of the Atomic Bomb by Richard Rhodes, a brilliant and comprehensive history of the origin and execution of the Manhattan Project. This leads me to think we need to mobilize a new scientific project, with the resolve of the Manhattan Project or Apollo missions, to prepare for the next potential pandemic virus.

Because SARS-CoV-2 won’t be the last one.

New, disease-causing viruses are jumping from animals into humans at an unprecedented rate. These zoonotic infections have the potential to cause global epidemics because our collective immunity against them is nonexistent; nobody is immune. According to an article this month in the Wall Street Journal, viral scares used to occur about three times every century. Since 2000, we have seen at least seven (SARS, H1N1 flu, MERS, Ebola, Zika, Dengue, and SARS-CoV-2).

(If you’re interested, the article describes three primary reasons for the increasing rate of emerging viruses: urbanization, globalization, and increased human consumption of animal proteins.)

The list of actions our society should take for pandemic preparedness is long, but most of them are not “rocket science.” We should stockpile more stuff; we should improve our administrative management and leadership. One item on the wish list, however, is beyond our technical ability at present. I believe that with enough resources, we could definitely accomplish it.

That action/item is a universal screening test for viral infection that meets the following criteria:

• Fast: result available within minutes
• Scalable and cheap: must be able to deploy the test for millions of people at a very low cost per person
• Sensitive: the test must detect nearly 100% of all infected people

The third point is critical. We already have tests that meet the first two criteria (for example, taking people’s temperature to screen for fever). The test I envision would probably look at a panel of biomarkers that change when a virus invades a few cells of a person’s body.

(Aside: Specificity would be less important than sensitivity for this screening test. Most important not to miss anyone; false positives could be identified by a more specific, more expensive or slower secondary test.)

We already know of many such biomarkers. I mentioned fever. Others include an elevated white blood cell count, and production of inflammatory molecules such as interleukins. No currently known biomarker of infection, by itself, would work. We need to make a massive scientific effort to identify more biomarkers that indicate infection by a virus in the earliest stage possible, before any symptoms.

I have no doubt that such biomarkers exist. When a cell is invaded by a virus, it reacts. It turns on and turns off certain genes. It changes the proteins on its surface. It sends signals to neighboring cells. It alerts the immune system. We need to study this process in great detail. No one marker is going to be sensitive and specific enough, but a group or panel of them together might.

In parallel with finding the right set of biomarkers to test for, we need to develop Star Trek-worthy analytic tests to do it. They have to be fast, scalable, and cheap. Wave a tricorder, or a swab, and get an answer. That sounds like magic, or fantasy. But consider tests we already have, that looked like magic not long ago. Rapid strep tests can diagnose strep throat in minutes. MRI scans reveal silent aneurysms in the brain. A fingertip clip measures the amount of oxygen in your blood in real time. A urine strip from the grocery store can tell you if you’re pregnant. DNA- and RNA-based tests can do almost anything and the costs have decreased by something like 100,000 times since 2001 {based on cost of whole genome sequencing}.

We can do this.

The screening test I envision would detect people in the very early stages of a viral infection–the first hours or one day. In a potential pandemic scenario, this would be an extraordinary power. It would allow us to send those people for further testing, and put them in isolation for observation, without necessitating the blanket lockdowns that are crippling our economy at present.

The first US federal bailout of pandemic-related losses just passed to the tune of 2 trillion dollars. We could invent my screening test for a whole lot less than that.

The beauty of this universal screening test is it could be used to detect infection by a variety of viruses. It wouldn’t have to be designed from scratch for each new agent. That means the test might be useful in peacetime, and when a new virus emerges, we would already have a preliminary screening test on hand. As we are all learning now, the earlier you begin isolating the infected, the easier it is to stop an outbreak.

Scientists have started down this path already {for example, this 2018 study on a panel of three biomarkers to predict the onset of bacterial sepsis}. After the COVID-19 crisis has passed, we should go all-in to invent this test for the next time.

Learn more about Amy Rogers and her books, including a free ebook on the scientific backstory of SARS-CoV-2 and emerging infections, at AmyRogers.com.

Do you have a question you’d like Amy to address? Amy@AmyRogers.com

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