February 1, 2019 | “The USA is still not prepared for highly infectious diseases. Key is lack of community rapid response and resilience, which must be enhanced not via mechanisms distant, but instead by molecular diagnostics and point-of-care testing (POCT) directly at critical points of need.” So writes Gerald Kost, Director of the Point-of-Care Testing Center for Teaching and Research (POCT•CTR) and Emeritus Professor in the School of Medicine at University of California, Davis, in a paper published last year in Expert Review of Molecular Diagnostics (DOI: 10.1080/14737159.2018.1491793).
It’s a bold statement—one Kost thinks may come as a surprise to many. He emphasizes, “We should be asking ourselves why we have not reached out and teamed up with the public health profession in America to educate and get ready for outbreaks in our communities by enabling everyone with POCT.” Such partnerships, Kost believes, will change the paradigm of public health in this country. To this end, his 2019 Frontiers in Public Health paper provides public health schools, colleges, and programs with the teaching tools they will need (DOI: 10.3389/fpubh.2018.00385).
On behalf of Diagnostics World News, Kaitlin Kelleher, producer for the upcoming Point-of-Care Diagnostics conference, recently spoke to Dr. Kost about the future of POCT.
Editor’s Note: Kaitlin Kelleher, Conference Producer at Cambridge Healthtech Institute, is planning a conference dedicated to Point-of-Care Diagnostics next month at the Molecular Medicine TriConference, March 10-15 in San Francisco. Kost will be speaking on the program; their conversation has been edited for length and clarity.
Diagnostics World News: One of your current goals is to change the paradigm of public health in America, particularly surrounding POCT. In what ways would POCT change the way first responders provide care in emergencies, disasters, and outbreaks?
Gerald Kost: Our vision of future public health entails POCT-equipped practitioners moving to points of need with mobile diagnostic tools that will help stop outbreaks quickly, maintain isolation efficiently, and manage quarantine equitably. Mobile testing, rapid diagnosis, and rational triage will help thwart contagions not only in countries where they start, but also arriving in America from abroad. Public health practice in general will benefit from well-trained personnel capable of administering POCT both in the community and primary care, and as needed, during disasters, complex emergencies, and national crises.
What types of major innovation in technology and delivery do you see coming in the future?
Small, light-weight, and portable devices will be the key technology for POC. Some companies may underestimate the importance of specialized skills for molecular diagnostics. Some perhaps anticipate prematurely a future of extremely simplified “black-box” operation by creating a modular diagnostic that attaches to a smartphone. Nonetheless, these approaches, when combined with well-trained operators, will be cost-effective, connected, and impactful, and several are already in the commercial pipeline.
What guidelines for point-of-care diagnostics do you think are necessary to curb or stop epidemics?
Coordinated and integrated development and implementation of molecular diagnostics at points of need promote rapid response to stop outbreaks. Future sustainability seems unlikely without key elements and personnel in place, supported by national POCT policy and guidelines in individual settings or countries, such as in geographic regions of Africa and member nations of ASEAN. Expectations unite POC culture and standards of care to motivate the right design principles, specifications, and biosafety. Think globally and act globally while performing POCT in the context of local community culture, so that medical intervention is welcome.
What projects can we expect to see you working on next, and where do you suggest POC diagnostic researchers to head next?
There are three core applications that demonstrate our need for POC diagnostics and serve as a place for researchers to focus their resources: (a) to support critically ill patients suspected or diagnosed with highly infectious disease and placed in isolation, (b) to quickly detect and stop outbreaks where they start upstream on spatial care paths, the concept we use to assure the patient moves along the fastest route to definitive care, and (c) to improve the efficiency and effectiveness of quarantine and treatment centers worldwide. It’s so important that we collaborate on national POCT policy and guidelines while we maintain high standards (see figure) and work on gaining proper funding.