Molecular testing in travel medicine

Fleet Street has been the traditional home of British journalism since the 16th century. It’s from this storied strip that many journalists have been dispatched by their news agencies to report from countries around the world. That made it a natural place for Dr. Richard Dawood, a travel medicine specialist, and his wife, optometrist Dr. Gillian Whitby, to launch the Fleet Street Clinic, their travel medicine practice, in 1995.

Dawood has been fascinated by travel since childhood, but it was a trip he took as a young medical student in the 1970s that set him on a course for travel medicine. One particular event stuck with him, and that was a harrowing stay in a hotel in Kabul, Afghanistan. A group of travelers were stranded there, far too sick with amoebic dysentery to leave the country. Luckily, he didn’t catch dysentery himself (though he would in the future, along with typhoid, malaria, skin parasites, and other conditions).

“When I approached the rest of my medical training, it was slightly through that lens,” Dawood says. As he continued to travel widely throughout Africa and Latin America, “I saw things that were deeply fascinating to me but my medical training left unexplained because they didn't happen in London, Paris or New York. They happened in Ouagadougou or Kabul.” Dawood’s experience is what set the trajectory to open a clinic specialized for travelers.

From journalists to COVID-19

Today, Fleet Street Clinic looks after a wide variety of patients. Many travel to dangerous parts of the world, and some have complex travel-related health needs. Musicians and film set crews often tap their expertise, for example. Dawood and members of his staff frequently go on tour with bands across the world or spend weeks on location on film sets, tending to crews that can number in the hundreds. With lockdowns easing and everyone wanting to get back to work, the demand for PCR tests has exploded. “We started looking for an instrument that had a much higher throughput, able to cope with perhaps hundreds of tests that might need to be done over a period of time, and for solutions that would allow us to have testing under our own direct control,” he says.

That’s when he ordered a NeuMoDx 96. “Because it's so self-contained, it seemed a good choice. Now we're all trained up on its day-to-day use. It was actually fairly straightforward [to learn]. The beauty of having our own equipment means that we can actually deliver test results on the same day.”

Getting film crews back to work

Beyond being capable of handling the testing demand at the clinic, the NeuMoDx was also essential for allowing some of Fleet Street Clinic’s business clients to get back to work as the pandemic ebbed in the warmer months and UK’s lockdown eased. “The creative industries were very much in the front of the queue to get back to work, and so It was logical that we started to adapt this [molecular testing] service to their needs.”

“One of the issues that arises on a film set is that you have many people working together in close proximity. You can't really socially distance people who are appearing in a movie, and you really need a very rapid turnaround of results. And that was where the NeuMoDx really began to help. We could bring samples back, put them on the instrument, and get immediate results—and be able to reassure the people involved in the film production that all was well.”

As a scalable solution, the NeuMoDx 96 Molecular System can run medium to large numbers of patient samples – ideal not only for busy film sets, but also for reference labs, hospitals and academic institutions. Within its easy 3-step workflow, the system automatically extracts and isolates nucleic acids from multiple specimen types. The result is accurate diagnostic answers to help make quick clinical decisions.

A new era of molecular testing

In fall 2019, Dawood began using the QIAstat-Dx Respiratory Panel to rapidly diagnose patients. Winter was coming. Some Londoners were planning their winter holidays for warmer climes, and others were returning from trips abroad. And some of them were sick. Getting same-day results about which pathogen ailed them allowed the clinic to begin targeted treatment almost immediately. The clinic reserves the QIAstat-Dx system for what they suspect are non-Covid-19 cases in individuals so that they can quickly identify the pathogen that actually is responsible and begin treatment immediately.

Currently, the clinic is running about 100 COVID-19 tests per day, though that number sometimes spikes as high as 200 depending on lockdowns or time of year. So far, the clinic has used the NeuMoDx only for COVID-19. “However,” Dawood says, “we are very interested in its potential use for other pathogens. I’d love to see molecular diagnostics for the full range of intestinal parasites, and for things like Zika.”

The pandemic may have ushered in a new era of point-of-care molecular testing, he says. “I'm hoping that could be one of the longer term benefits of the massive surge of molecular testing. I think the world's eyes have been opened to the possibilities. The value of fast, accurate diagnosis has really become clear. ”