epiLab: Coronavirus testing in the mobile safety laboratory

A key to preventing SARS-CoV-2 spread is frequent, comprehensive testing. This allows the early detection of infections and helps break the chain of infection. It always comes down to Coronavirus testing capacity. In Germany's southwest state of Saarland, the mobile epiLab (epidemiological laboratory) supports the search for infections lurking in nursing homes and long-term care facilities.

In this MEDICA-tradefair.com interview, Dr. Anja Germann and Markus Michel talk about the epiLab, explain its role during the Coronavirus pandemic, and describe pooled testing of large groups of samples.

Dr. Germann, Mr. Michel, could you briefly tell us what prompted the setup of the epiLab?

Markus Michel: We are a research and development center and often require a laboratory setup that goes beyond standard laboratory systems. Since our Institute was founded in 1992, we have amassed a high level of expertise pertaining to biological safety laboratories. We set up our first mobile laboratory in 2005 as part of a project in which we isolated stem cells from rare animal species living in captivity (zoos). Mobility was a key element to make this a reality as it enables quick sample collection on-site. That's why we started developing mobile units.

The current version of our epiLab is based on a semi-trailer, which we launched at the MEDICA trade fair in 2012. It is a Biosafety Level 2 (BSL-2) mobile laboratory and is typically used for epidemiological research. The German Environment Agency has tasked us with the investigation of environmental and human exposure to pollutants in four locations as a representative sample of Germany in support of the Federal Environmental Specimen Bank. Due to the Coronavirus pandemic, all assignments were cancelled for the remainder of 2020 after the first deployment was completed in January.

Dr. Anja Germann: We developed another mobile laboratory in 2009, which is also based on a specialty trailer. The Biosafety Level 3 (BSL-3) lab facilitates HIV testing in South Africa. The lab was able to reach residents of townships who have little or no access to medical services and health infrastructure. We performed the tests on-site. Residents who tested positive for HIV also received immediate counseling. Today, the South African government still uses the mobile BSL-3 lab to test for zoonotic diseases.

How do you use the laboratory to test for SARS-CoV-2, the virus that causes Covid-19?

Germann: We are collaborating on research conducted by the Institute of Virology at the Saarland University Hospital under the direction of Prof. Sigrun Smola. The aim is to perform comprehensive testing of staff members and residents in all nursing homes and long-term care facilities throughout the Saarland where there has been no official detection of the virus so far. Right now, this applies to 130 of approximately 150 facilities. The study is designed to spot hidden Coronavirus infections and outbreaks. Facilities with a high COVID-19 infection rate are monitored by the respective local health authorities.

Nearly 22,000 people have had nasopharyngeal swabs (swabbing into the cavity between the nose and mouth). The team of Prof. Smola has developed a new pool testing strategy: After collecting on-site samples, we combined the samples of five individuals in a single test tube in the epiLab and subsequently combined the pools of five into pools of twenty. We created a pooling workstation in the epiLab that comprises two sub-workstations. The samples are pooled at a sterile workbench, while barcodes are added to the individual samples at a registration workstation. We set up six additional pooling and registration workstations at the Fraunhofer Institute for Biomedical Engineering IBMT.

The combined samples of 20 individuals were subsequently examined at the Institute of Virology. If there is a positive test in the pool, the pools of five are then tested separately. Subsequently, the individual samples of the pool that tested positive are examined to identify the infected person or persons. Pool testing saves valuable testing resources, including time, staff, and available test kits.

How many tests have you completed so far?

Germann: We finished the first round of testing and did not detect any infections. We tested nearly 22,000 people in twelve business days. This includes all residents and staff members.

In the second round of testing we will retest about 12,000 staff members in nine business days. That’s because the nursing home and assisted living residents have lived in isolation for weeks, yet the personnel still has contact with the outside world of course.

Michel: Public discourse always focuses on testing capacities. The numbers that Ms. Germann mentioned reflect the entire testing process from start to finish. This literally means all processes from collecting samples on-site to providing the test results to the respective facilities. Needless to say, this is a challenge from a logistics, administrative, and infrastructure perspective that goes beyond the mere number of tests that laboratories can handle.

What are some other possible applications of the epiLab?

Germann: There will be more applications as we continue to loosen social distancing restrictions. If we develop rapid diagnostic tests, we could also test on-site in large companies and detect “silent carriers” in the workforce, thus preventing hidden hotspots of Coronavirus infection.

Earlier you mentioned your MEDICA trade fair participation. Could you see yourself collaborating with partners to manufacture mobile labs in series?

Germann: These labs are always custom-built and tailored to the needs of the users and the intended application. We are planning projects to build these types of mobile laboratories on a smaller scale with a modular interior. Users can then add the necessary equipment based on the respective needs and requirements of the application.

Michel: We are obviously not mobile lab manufacturers but we collaborate with many partners. In a way, you need "custom production line solutions" thanks to the complex requirements. It is a question of mastering the balancing act between series production as we know it from the automobile industry and custom-tailored solution. The market is still manageable, but the industry already has its eye on it. I believe there is definitely market potential.