Shining a LAMP on Covid-19 testing

The regular Covid-19 briefings are compelling viewing because of the economic and welfare consequences of the decision government takes. The lockdown was an inevitable tool the government had to use in the early phase of the pandemic. But two certainties about lockdown are that it cannot be indefinite, and the end comes with risks of a second wave.

We will need to pay attention to the recent upsurge in positive tests among truck drivers who are a high risk by the nature of their trade. We need to focus on testing every clinical suspect and contacts traced of known cases. The turnaround time required to clear truck drivers at the borders has policy implications.

The diagnostic test for Covid-19 is the polymerase chain reaction (PCR) method. It detects the presence of unique sequences of genetic material found in Covid-19. It is performed in laboratories with advanced equipment to switch temperatures over several cycles and skilled staff who are experienced in the methodology including analysis of the data.

However, the turnaround time for often centralised testing, even in the developed countries, can be from several hours to a few days, depending on the resources allocated. The reagents are not cheap and increasingly becoming scarce due to high demand.

In 2000, a Japanese group described a new method for detecting unique genetic sequences which has several advantages over PCR, especially in a resource poor setting. Unlike PCR, the new method, Loop Mediated Isothermal Amplification (LAMP) uses a constant temperature of around 60 degrees Celsius, can be completed in one test-tube in less than an hour and the result can be visualised by naked eye.

The test can therefore be performed in a water bath. This will give you a yes or no answer in the setting of a point of care diagnosis or research field work.

These attributes made LAMP very popular to researchers in the developing countries and in the mid to late 2000s, my colleagues in the Department of Biochemistry and the School of Veterinary Medicine at Makerere University were working on LAMP for the detection of trypanosomiasis.

More recently, LAMP has been used in testing for Zika virus during the outbreak in Brazil. Taking inspiration from my years as a lecturer at Makerere University, I saw the opportunity LAMP offers in the current pandemic.

At the Griffin Institute here in London, I am working with colleagues on developing a LAMP based approach in the management of Covid-19. This confidence in LAMP has been boosted this past week when a UK hospital started a six-week trial of LAMP for rapid Covid-19 testing. It is being trialled in A&E as the 20min lab-free test because results can be obtained without sending swab samples to a laboratory. If this is successful, it will have major implications for public health policy and the management of acute care in the current pandemic.

For those who know the history of Uganda Virus Research Institute, we stand at the crossroads of a vast knowledge base in the study of diseases including Zika, West Nile and Semliki viruses which were all isolated in Uganda. Our health system has been further strengthened through the response of the MOH to epidemics including HIV and Ebola.

There is both self-interest and a duty of service in investing in our research talents both in the long established institutions and the new universities that have the opportunity to develop research and teaching programmes of our time, harnessing both information technology and cell biology approaches in answering the healthcare challenges of the day.

Dr Lali is a Senior Research Fellow, The Griffin Institute, Harrow London (UK).
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