Although vaccine rollout is progressing extremely quickly in the UK, the government expects that it will be the end of July 2021 before every adult in the UK has been offered their first dose of a COVID-19 vaccine. Second doses should be received around 12 weeks after the first, and so it is likely to be the end of October 2021 before every adult has received both doses.
In the meantime, whilst we await full vaccine rollout, regular rapid antigen testing offers a way to enable the re-opening of society.
Beyond this, it is also important to consider that no vaccine is 100% effective even after 2 doses, that not everyone will accept or be able to have the vaccine, and that there is uncertainty as to whether the vaccines will work effectively against current or future mutations of the virus. We should also consider the fact that the UK is very much ahead of other countries around the world in progressing its vaccine rollout, and that it will still be some time before the vast majority of people globally will be vaccinated.
With these factors in mind, regular testing is likely to play a role in keeping societies safe and open for some time to come.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the name given by the International Committee on Taxonomy of Viruses (ICTV) to the virus responsible for causing the disease, COVID-19.
COVID-19 test accuracy is typically determined by ‘specificity’ and ‘sensitivity’.
Specificity is about the extent to which you can eliminate false positives; sensitivity is how much virus needs to be present before a test picks it up. So there is always a need to strike a balance, when testing, between trying to pick up the virus as early as possible, versus accidentally delivering a positive test result for someone who is not actually infected.
The specificity of the KnowNowᵀᴹ Test is 100%. In more than 700 negative patient saliva samples, we haven’t had a single false positive.
What’s important when it comes to sensitivity is how much virus needs to be present in the patient sample for the test to give a positive signal. This is known as the 'Limit of Detection', and we measure this rather than clinical sensitivity as it is much more informative. Our Limit of Detection is between 50,000 and 200,000 viral copies per mL, making our test more sensitive than other rapid antigen tests available. The Abbott BinaxNow test, for example, needs 1,000,000 viral copies per mL in order to get a positive signal. The KnowNowᵀᴹ Test's very low Limit of Detection means it can detect infected people as early as day 3 to 4 of infection. This is before they become highly infectious, and a day or two earlier than most tests available (based on models of viral load in disease progression).
If you'd like to read more about this subject, we recommend this paper. It argues that the "Limit of Detection matters and directly impacts efforts to identify, control, and contain outbreaks during this pandemic" since "higher LoD are likely to miss nonnegligible fractions of infected individuals." It also makes the case that Limit of Detection values for tests using universal standard metrics should be readily available in the public domain to enable like-for-like comparison.
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If there is one red line visible next to the "C" in the KnowNowᵀᴹ device test results window, and any line at all, no matter how faint, appears next to the "T", then the test result is positive. This indicates that the SARS-CoV-2 antigen has been detected in the sample.
Following a positive result, current government guidance on matters including self-isolation and reporting the result should be followed.
So that the KnowNowᵀᴹ Test is used as effectively as possible, it currently needs to be administered by a trained healthcare professional.
A trained healthcare professional is defined by the Medicines and Healthcare products Regulatory Agency (MHRA) in the Target Product Profile for Point of Care SARS-CoV-2 Detection Tests as a professional belonging to one of the 10 health and social care professional bodies that are overseen by the Professional Standards Authority. You can find a list of these professions here.
However, since the KnowNowᵀᴹ Test needs just a saliva sample, it is much easier to administer effectively than other similar tests, and still return highly sensitive results. So we are investigating whether other specially-trained, competent individuals could be approved to administer KnowNow tests as well.
We are also in the process of trialling and seeking approval for a variation of the KnowNowᵀᴹ Test which could be administered by individuals themselves.
Used tests, swabs and buffer dropper tubes should be disposed of as potentially hazardous clinical waste.
It should not be necessary to perform more than one test on a given individual at a single point in time, unless the KnowNowᵀᴹ device test results window displays no lines at all, meaning that the test has failed, or unless it was not possible to read the test results within 15 to 60 minutes of applying the mixed saliva and buffer solution to the KnowNowᵀᴹ device.
However, receiving a negative result does not mean that the individual tested can't be exposed to the SARS-CoV-2 virus following the test. So we do recommend that individuals are tested regularly to keep workplaces and communities safe. Depending on the scenario, we would recommend testing is repeated every 1 to 3 days.
We recommend that individuals are tested as regularly as possible to keep workplaces, venues and communities safe.
It is important to remember that individuals can still go on to be exposed to the virus following a negative test result. Additionally, a high proportion of infectious people show no symptoms at all, and so regular testing is key to breaking the chain of transmission.
Depending on the scenario, we would recommend that testing is performed every 2-3 days, or daily, depending on the scenario.
The mechanism underpinning the KnowNowᵀᴹ test mimics the means through which the virus interacts with the surface of a human cell in order to detect it. As a result, we expect that it will continue to identify the SARS-CoV-2 virus even in the face of further potential mutation in the future, unlike tests based on antibodies.
We have modelled the difference between the Wuhan and 501Y mutations in a recombinant protein model to give us initial analytical evidence that the KnowNow test reacts to these variations of concern. And we are currently carrying out a study on live samples of these and other mutations to gather practical evidence of this.
In fact, we predict that the KnowNowᵀᴹ test may potentially become even more sensitive as the virus mutates to become more infectious. And we will continue to carry out further analyses and studies to support this prediction, and confirm that KnowNow continues to function on newer mutations as they arise.
So that we adhere to the strict rules around lateral flow tests, we have to make sure that anyone activating a sample pack is doing so purely to learn more about KnowNow Testing, and not as means of administering a clinical test.