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01

18/12/2021

08.45 am

Welcome Address

Mr Elias Woodrow Elias
Vice President, Singapore Association for Medical Laboratory Sciences (SAMLS)

02

18/12/2021

08.50 am

Opening Remarks

Dr Eddie Ang
Chairman, Asia Association of Medical Laboratory Scientists (AAMLS)

03

18/12/2021

09.00 am

COVID-19 Infection - The Role of Iron

Dr Ina S Timan
Faculty of Medicine of Indonesia, Indonesia

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) pandemic has spread through all continents, causing high mortality rate. Although most of the patient had mild or moderate severity, around 20% had severe infection. In the grave ill the patient had hyper-inflammatory state involving a cytokine storm causing high mortality rate. The Angiotensin-converting enzyme 2 (ACE 2) in many organs became the entry points for the virus. It was observed that there was ferritinemia in severe cases with multiorgan failure and this hyperferritinemia is link to higher mortality risk. Although its strong assoociation with mortality, it was still not yet clear if hyper-ferritinemia in COVID-19 pattients is merely a marker of the disease progression or a key modulator in the disease pathogenesis. Ferritin is an acute phase reactant, increased in inflammation and infection, and there was also release of iron from porphyrin due to the virus invation to red blood cells. There was also evidence that many organ damage were caused by high free iron in circulation which produce reactive oxygen species (ROS) and damaged the cells through ferroptosis.

04

18/12/2021

09.30 am

COVID-19 Testing: PAST to Present

Dr Ekawat Pasomsub
Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Thailand

05

18/12/2021

10.00 am

SARS-CoV-2 Virus Infections and Laboratory Diagnosis in Taiwan

Dr Chuan-Liang KAO
School of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taiwan

On December 2019, a novel coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was detected in Wuhan, China and then spread throughout the country and to the rest of the world rapidly. As of November 28, 2021, there were more than 260 million confirmed cases worldwide, more than 5 million deaths, the case fatality rate is 2 %; Taiwan is a small and populous island which is geographically very close to China. Social interaction between China and Taiwan is frequent, thus leading to a high risk of virus transmission.

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Central Epidemic Command Center (CECC) was assembled to combat the COVID- 19 pandemic in Taiwan on 20 January, 2020. The CECC executed several strategies to reduce disease transmission and its government guided strategies may have contributed to mitigating the disease’s spread. Taiwan’s first confirmed case was detected on 21 January 2020, and by mid-March there were 49 cases. With the last reported locally transmitted case on 12 April by 21 November 2020, Taiwan has marked its 222nd consecutive day without a locally transmitted case. During these past 7 months, 148 new confirmed imported cases but no indigenous case was reported in Taiwan. However, there are several hospital cluster infections and community outbreaks in 2021. Based the data reported by CECC, a total of 16,588 cases were reported during the period from 2020 to November 28, 2021. Of the 16,588 confirmed cases, 1,944 are imported; 14,590 are indigenous cases; 36 are naval crew members aboard the Panshi fast combat support ship; 3 are infections on an aircraft; 1 case has unknown sources of infection; 14 cases' sources of infection are being investigated. There has been a cumulative total of 848 COVID-19 deaths since 2020; of the 848 deaths, 836 are from indigenous cases and the other 12 are from imported cases.

At the early of 2020, the LDT real time RT-PCR method for diagnosis of SARS-CoV-2 infection was first established by the National Laboratory located at the Centers for Disease Control (CDC), Taiwan. In order to reduce the capacity of work load and turnaround time, CDC delivered the reagents to the 8 contracted clinical virology laboratory in medical centers. After obtained good proficiency results, CDC authorized these 8 contracted laboratories to receive the clinical samples for running the nucleic acid test (NAT) of SARS-CoV-2 virus. As the end of November 2021, total number of authorized laboratories for doing NAT test are 247.

In addition to NAT, the virus isolation, rapid antigen test and antibody detection are also established in many clinical laboratories. In order to accelerate the performance of laboratory diagnosis, as the end of October 2021, the numbers of imported EUA (TFDA) for COVID-19 NAT, antigen detection and antibody detection reagents are 53, 40 and 33 respectively and the domestic manufacture diagnostic reagents (EUA, TFDA) for COV-19 NAT, antigen and antibody tests are 21, 23 and 13 respectively. Regarding virus culture, it is only allowed to perform in the laboratory with BSL-3 facility.

The harmonization and proficiency test of laboratory diagnosis of COVID-19 should be established in future.

06

18/12/2021

10.30am

Whole-genome Sequencing of COVID-19 Cases in Hong Kong: Development of a Geophylognetic Database and Characterisation of SARS-CoV2 Variants Circulating in the Community

Dr Gilman Sit Hang SIU
Department of Health Technology and Informatics PolyU, Hong Kong

In spite of stringent public health measures, Hong Kong experienced four epidemic waves of COVID-19, resulting in 12,348 infected cases and 213 deaths as of October 2021. Our team established Nanopore GridION and Illumina Miseq platform for whole-genome sequencing of SARS-CoV-2 at the early stage of the pandemic (in February 2020).

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Objective: We aim to develop a phylogenomic database coupled with geospatial information system to unveil the transmission linkage of COVID-19 cases in Hong Kong.

Result: Phylogenomic analysis enabled us to identify an asymptomatic patient as the source of the first superspreading event of COVID-19 (Buddhist worship hall cluster) happened in late February 2020.After months of relative quiescence, a large COVID-19 outbreak (third wave) occurred in Hong Kong in July 2020. The phylogeny of some early cases indicated that the outbreak was attributed to a single lineage B.1.1.63, which was identical to viral genomes isolated from marine crew and aircrew who were exempted from mandatory quarantine.

In early October 2020, before the onset of the fourth wave, we identified a novel viral genome (lineage B.1.36.27) among local cases, which was most closely related to imported cases from Nepal. We highlighted flaws in hotel quarantine arrangements, under which travellers could still receive visitors. The Government later implemented the policy that inbound travellers should be quarantined at designated hotels and not be allowed visitors.

In December 2020, the United Christian Hospital experienced a large outbreak of SARS-CoV-2 in a palliative care and medicine ward. Later in January 2021, two healthcare workers from North District Hospital tested positive after taking care of COVID-19 patients. In both cases, we conducted phylogenomic analysis, enabling the hospitals to trace the transmission chain and prevent further cases.

In April 2021, we used rapid phylogenomic analysis to identify the transmission link between Filipino domestic helpers and an Indian businessman who had travelled from Dubai and tested positive for a SARS-CoV-2 VOC Beta. The genomic data enabled us to trace the entire transmission chain and their close contacts. Eventually, we identified an inbound traveller, who had stayed in the adjacent hotel room to the Indian businessman during quarantine, was the source of the transmission.

Recently we developed a phylogeographical information system which integrated the genomic, epidemiological, spatial and temporal information of COVID-19 cases in Hong Kong. Data visualizations are combined with the cartographic display to yield a clear view of the genomic diversity of SARS-CoV-2 variants and their distributions across Hong Kong districts, with a focus on the clustering of cases based on phylogenetic proximity.

Conclusion: Continued genomic surveillance of the imported cases is pivotal in detecting novel lineages that enters Hong Kong.

07

18/12/2021

11.00 am

Questions and Answers

08

18/12/2021

11.15 am

Break

09

18/12/2021

11.30 am

Comparative Analysis of the Immune Responses in COVID-19 Patients

Dr Nayoung HA
Biomedical Research Institute, Chung-Nam National University Hospital, Dae-jeon, Republic of Korea

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and resulting in severe pneumonia. Despite the worldwide effect of the COVID-19 pandemic, the underlying mechanisms of the fatal viral pneumonia remain elusive. In this study, we investigated the kinetics of immune responses in respiratory specimens with varying degrees of disease severity. Immune components, including various cytokines, chemokines and antibody responses in the respiratory specimens revealed that severe COVID-19 is associated with delayed but enhanced eosinophilic inflammation, when compared to those in mild cases.

In addition, analysis of single-cell RNA seq data set from mononuclear phagocytes showed significantly higher scores for FcγR signaling and complement activation in severe patient group. Indeed, we observed formation of MAC (Membrane attack complexs) in lung airway and microvasculatures from a fatal case. Here, we aim to provide insights and scientific evidence regarding the pathogenesis of COVID-19 and therapeutic strategies targeting this disease.
10

18/12/2021

12.00 pm

Antibody/Antigen Testing for COVID-19

Dr Michael Lau
Department of Laboratory Medicine, Changi General Hospital, Singapore

Several SARS-CoV-2 antibody (spike, nucleocapsid and neutralizing) and antigen assays are now available both in the central laboratory and point-of-care settings. It is essential to understand how to interpret and best utilize these tests in the current pandemic. Antibody assays are most sensitive 2 weeks after disease onset, and would benefit from lower, optimized limits of reactivity to improve sensitivity. Antigen assays are best utilized within the first week of disease onset, and when used twice a week, can be comparable in sensitivity of RT-PCR assays. Both antibody and antigen tests are still not standardized, and results are not transferable. When used in population screening in low prevalence areas, using two tests in an orthogonal testing can improve the positive predictive value of results.

11

18/12/2021

12.30 pm

COVID-19: post-vaccination serologic response

Prof Tar-Choon AW
Department of Laboratory Medicine, Changi General Hospital, Singapore

Subjects with previous COVID‐19 have augmented post‐vaccination responses. However, the antibody response after the Pfizer mRNA vaccine (BNT162b2) in COVID‐naïve subjects from Southeast Asia is not well known.

We tested COVID‐naïve vaccinees (n=77) with a full panel of spike antibodies (total [T‐Ab], IgG, IgM) and neutralizing antibodies (N‐Ab) pre‐vaccination, 10 days after dose 1, and 20/40/60/90/120/150/180 days after dose 2.

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Ten days after dose 1, 67.6% (48/71)/69.0% (49/71) were T‐Ab/IgG positive; only 15.5% (11/71)/14.1% (10/71) were N‐Ab/IgM positive. While all (100%) subjects had brisk T‐Ab, IgG and N‐Ab antibody responses 20 days after complete vaccination, only 79.1% (53/67) were IgM positive. At 180 days (n = 8), T‐Ab/IgG/N‐Ab were still reactive (lowest T‐Ab 186 U/mL, IgG 617 AU/mL, N‐Ab 0.39 μg/mL), but IgM was negative in all samples. Spike antibody thresholds of T‐Ab 74.1 U/mL (r = 0.95) and IgG 916 AU/mL (r = 0.95) corresponded to N‐Ab reactivity (>0.3 μg/mL).

Post-vaccination spike IgM responses are less robust than that of spike total and IgG antibodies and sero-reversion occurs earlier. There is good correlation between spike antibodies (T-Ab, IgG) and N-Ab (r=0.95) suggesting that spike Ab may be a good surrogate for N-Ab. While the spike antibody (T‐Ab & IgG ) and N‐Ab responses remain detectable at 180 days, its durability and levels needed to confer sufficient protection is not known. One of our subjects with a spike T-Ab of 600 U/mL and N-Ab of 0.6 ug/mL (@ 6 months post-vaccination) experienced a re-infection 3 weeks thereafter; this suggests that N-Ab levels higher than 0.6 ug/mL is required for protection. Emerging data from Israel noted that a spike T-Ab (Roche) of 930 was not sufficient to forestall a breakthrough infection.

Clearly needed are larger studies on correlates of protection against CoVID and durability of these protective antibodies.

12

18/12/2021

1.00 pm

Questions and Answers

13

18/12/2021

1.15 pm

Webinar Ends

Moderator:
Ms Siti Thuraiya Binte Abdul Latiff
Secretary, Singapore Asociation for Medical Laboratory Sciences (SAMLS)