Increasing COVID-19 detection through secondary distribution of self-tests

Researchers at the University of Pennsylvania looked at whether individuals might be motivated to self-test for COVID-19 and to distribute self-test kits, given the urgent need to increase testing and contact tracing. The question was, with the growing availability of COVID-19 self-testing kits, would at-risk or infected individuals distribute test kits to their social networks. Such a strategy has been successfully employed to increase HIV testing. Participants were provided information about self-tests and how they are used. The team then used a six-point scale (1 being “extremely unlikely” and 6 “extremely likely) to describe their level of motivation to distribute self-test kits to contacts if they tested positive, self-test if they received a kit from a potentially infected contact and order a free self-test if they were exposed to COVID-19. In each case, the motivation was high. Among 584 respondents, 90.1% said they would distribute kits to contacts, 86.1% would self-test if given a kit and 82.8% would order a kit if exposed to the virus. “Motivation is a prerequisite for voluntary behavior, and our findings suggest that the secondary distribution of COVID-19 self-test kits may be associated with increased test uptake and case detection,” the researchers wrote. “However, individuals with lower socioeconomic status reported lower motivation and may be less likely to distribute test kits and self-test; behavioral interventions may help increase motivation in this population. There work appeared online Jan. 20, 2021, in JAMA Network Open.

COVID-19 and breath analysis

Researchers in the U.K. and Germany examined the feasibility of using breath analysis to distinguish COVID-19 from other respiratory conditions with near-patient gas chromatography-ion mobility spectrometry (GC-IMS). Patients presenting at hospital with possible COVID-19 infection provided a single breath sample, which was analyzed for volatile organic compounds (VOCs) using GC-IMS. COVID-19 infection was identified by transcription polymerase chain reaction (RT-qPCR) or oral/nasal swabs and clinical review. After eliminating environmental contaminants, COVID-19 breath biomarkers were identified and a breath score based on the relative abundance of a panel of VOCs was proposed and tested. Of the 98 patients recruited, 63.6% in the Edinburgh, U.K., and 15.45 in Dortmund, Germany, had COVID-19. Other diagnoses included asthma, chronic obstructive pulmonary disease, bacterial pneumonia and cardiac problems. “Multivariate analysis identified aldehydes (ethanol, octanal), ketones (acetone, butanone), and methanol that discriminated COVID-19 from other conditions. An unidentified-feature with significant predictive power for severity/death was isolated in Edinburgh, while heptanal was identified in Dortmund,” the authors wrote. Accuracy in distinguishing COVID-19 patients vs non-COVID-19 patients was 80% in Edinburgh and 81.5% in Dortmund, demonstrating 82.4% sensitivity and 75% specificity. “These two studies independently indicate that patients with COVID-19 can be rapidly distinguished from patients with other conditions at first healthcare contact. … Development and validation of this approach may allow rapid diagnosis of COVID-19 in the coming endemic flu season,” they said. The research paper appeared in the December 2020 issue of in The Lancet EClinicalMedicine.

Saving lives from colorectal cancer

Researchers at the University of Exeter have shown that a simple, inexpensive test can help to identify individuals at risk of developing colorectal cancer (CRC), aiding in early diagnosis and improved outcomes. The team analyzed data from 3,890 patients at low risk for CRC who received the fecal immunochemical test (FIT) between June and December 2018. The test, which costs about £4 (US$5.50), can detect traces of blood in feces. Of those who took the test, 618 tested positive for blood in their stools, 43 of whom were diagnosed with CRC in the previous 12 months. Only eight patients who tested negative were diagnosed with CRC in the following year. “This is a major diagnostic advance: low-risk patients were previously either not investigated, and had more emergency admissions and worst survival, or were referred for colonoscopy,” the authors concluded. “The background rate of cancer of 1.3% in this population meant that 77 patients had to be offered colonoscopy to identify one cancer, potentially swamping endoscopy services, and putting patients at a small risk of complications.” The study was published in the Jan. 19, 2021, online issue of the British Journal of Cancer.

New classification scheme for glioblastomas

Researchers at Columbia University have developed a new subtyping scheme for glioblastoma multiforme (GBM) and used it to identify glioblastomas driven by mitochondrial hyperactivity. In contrast to many other tumor types, identifying individual driver mutations through genome and transcriptome analysis has not, to date, resulted in better clinical outcomes, prompting the Columbia team to take a pathway-based approach to classifying glioblastomas. They identified four subtypes, which they classified as proliferative/progenitor, neuronal, mitochondrial or glycolytic/plurimetabolic. Mitochondrial subtype tumors, which made up roughly 20% of all glioblastomas, used exclusively oxidative phosphorylation to fuel themselves, and “exhibited marked vulnerability to inhibitors of oxidative phosphorylation,” the authors wrote. Mitochondrial glioblastomas had a slightly better outlook than other subtypes, prompting the authors to conclude that “the pathway-based classification of GBM informs survival and enables precision targeting of cancer metabolism.” They published their findings in the Jan. 11, 2021, online issue of Nature Cancer.