Beating COVID-19: Better Tests and Slicker Labs

Good afternoon, everybody, and welcome to UTS Science in Focus, which is a public free lecture series showcasing the latest research from prominent UTS scientists and researchers. I'm Professor Bradley Williams, Associate Dean, external and international engagement and I'll be the moderator for today's event. Part of my role is to collect the audience's questions and pose them to our speakers at the end of the, at the end of the talks. Our Science in Focus talks provide an outstanding platform for UTS academics and public participants to meet for the sharing of ideas and to shine a spotlight on some of the top of the line work we're doing at the Faculty of Science at UTS. Not only are we pushing the boundaries of scientific knowledge by making new and substantial contributions to a fundamental understanding of the world around us, but we have a dedication and devotion to translate our work into real world impact. Today, we will hear from one of our UTS experts making major contributions to our knowledge and understanding of newer and easy, easy to use tests for SARS-CoV-2, the virus causing COVID 19. We will also learn about the rollercoaster ride of one of Australia's largest private pathology companies and how Covid affected them, too. Before I introduce our speakers for today, I'd like to acknowledge on behalf of everyone here present the Gadigal people of the Eora nation upon whose ancestral lands the UTS City campus now stands. I would also like to pay respects to the elders, both past and present, acknowledging, acknowledging them as the, the traditional custodians of knowledge for this land. I'd also like to recognise that the Cammeraygal people of the Guringai nation from which I joined today and the people and elders of the country from which you joined today.

Just a little housekeeping, and I will forward this slide. Before we get started, it is an online event and there have been some technical difficulties with Internet connectivity today. So if there are problems, please stay with us and we will resolve them as quickly as possible. If you have any questions during today's webinar, please use the Q&A function in the zoom and you'll find it as shown on the screen now. And you can then enter your question into that Q&A function. If you'd like, if you like a question that you've seen, you can always use the upvoting tool, which is the little thumbs up symbol next to the question itself. Now, this session will be recorded and it is recorded for our internal purposes, and it will be made available on the UTS website. We will not be recording any video or audio input from the audience. And you may contact us at the email address presented on this slide. If you have any concerns or questions about the recording. Our speakers today are Professor Dayong Jin of the School of Mathematical and Physical Sciences at UTS and Mr. Anthony Friedli, who's the chief operating officer and chief executive officer of Australian Clinical Labs. And I will introduce now Professor Dayong Jin. Distinguished professor Dayong Jin is an award winning scientist and technology developer who is driving the transformation of photonics and materials into an analytical diagnostic and imaging devices for disease detection through interdisciplinary research teams. These devices identify early, early signs of disease and toxins to enable rapid detection of target cells and of specific molecules. He has won many prizes in recognition for his outstanding work, including the Australian Museum Eureka Prize and the Australian Prime Minister's prize for the physical scientist of the year. Dayong, I now invite you to give us your presentation. Thank you.

So thank you for the nice introduction. And thank you for all the participants in the audience today for attending my lecture today. As you may notice, the title from my lecture, part two. Why is it part two? Because at the end of last year, I presented on the same topic at the New South Wales chief scientist at breakfast seminar series. So that, on that lecture, I presented the basics of this technology and because the time, the time limit today in my lecture today, I'll be only focusing on the updated part. So you're welcome to visit the New South Wales chief scientist website and to watch my first presentation on this similar topic. So the topic today, as I said, I'll pretty much will be focusing on the new variants and it's challenging in terms of demanding the increasing number of the herd immunity in the vaccination rate. And the focus today will be pretty much on the past, on the rapid test. There is a dilemma here between the detection speed and detection sensitivity. So I'll show you the principle, how, actually, each of the test that works and then I'll bring you to the basic principle, how our UTS science solution works and how to make the signal can be optical, optically amplified. And in terms of the developing of a single molecule probe, which can be sensitive enough to detect a single molecule from the virus. At the close of my lecture, I will discuss the broad range of opportunities, including the manufacturing opportunity in Australia and the development of rapid and, you know, non-invasive saliva test.

And of course, there are challenges ahead associated with the new variants and also the clinical translation and TGA approval process. So as I already present a very similar picture, last lecture, but this way is more simplified version to show you, you know, how difficult to handle, you know, to conquer this virus. At the beginning of the pandemic, I remember a lot of public, they got confused between the difference, you know, between the bacteria and the virus. If you compare the size, you know, the bacteria is at least one order magnitude larger than the virus in diameter. But if you compare to the volume, you can see the volume, the virus is a tenth is a thousand times at least a thousand times smaller than the size of the, the bacteria in volume. Ok, so this Covid, SARS-2, they are tiny. You know, they are around 100 nanometre smaller than the optical diffraction limit. So they are very, very difficult to detect. The size and the shape is pretty much closer to the size of the traditional influenza and also the HIV virus. And that's the first challenge why this is so difficult to detect. Most importantly, this virus has a very long period of incubation time inside the host people, you know, like people got infected. In the beginning of the infection because the number of virus load is still small enough, so in the first couple of days, we call it a latent period, the host person doesn't pass on the virus to the other, other people because the number of viruses are very low.

But this virus, they can duplicate themselves very quickly inside our human sell at a rate about, you know, three order magnitude virus in every 10 hours. So in the later couple of days, you know, the host, the people who get infected will become infectious. But there's a long window, this window, we call it incubation window, the time between the onset of the infectiousness and a time between and also the time till the patient get to, start to show their symptoms. So this window is a fairly long, you know, actually can last for several days and up to two weeks. And this window is pretty dangerous because the host people has no idea whether he or she got the infection and where and when they got infected. But they're already passing on the virus to people around him or her. More or less, the patient starts to show the symptom, we're traditionally using this, you know, conventional gold standard technology called PCR. But you understand you're only getting the results within like, you know, a day or two. So this has become quite slow. So the entire window for understanding and detecting this virus is fairly long, can take about a couple of weeks. Ok, so this is a very, very challenging problem for this virus. And because this is a long black window, we've got no idea, you know, who is the host, who got infected? Ok. And particular when the number the COVID case number is above 100 - you know, this is the particular truth in last, in the current pandemic lockdown in Sydney, in New South Wales. At the beginning, you know, even at around 100 new cases, daily new cases, there are about, you know, at least half of the people who have no idea when he got the infected and they're still spreading the virus in the community. But now, nowadays, you know, today I heard a number is above 900 cases. So more than 80 to 90 percent of the patients they got, they have no idea, you know. We don't, we don't, we couldn't trace these people so that because the cases, they never get linked. So this is a completely, you know, annoying problem to control the spreading of this virus. And the next challenge is, you know, the virus getting smarter. You know, they they genetically, you know, improve themselves and they become smarter. And you can see, you know, from the original strand to the Alpha, Beta and the Gamma, now this we are handling you know, we're coping with the Delta variant, and they are smarter and smarter.

So you can see each wave, at least where we got it, we are in the process of the third wave. And you can see, you know, each wave they could become stronger and stronger. And because they are smarter and that, the infection, they they become more contagious. And there's a scientific number called the reproductive number. It's a parameter to measure how infectious each new each new strain virus they are. So at the original strand, you can see the R is close to 1.1, that means, if somebody got infected, they can pass on by average for only one person. Ok, so the spreading rate is a slower. Right, but once we move to the R Alpha phase, you know, the Alpha variants, the number is close to two. So that means, one, people getting infected can quickly pass on two, two to four, four to eight. So this is a power of two. And that's that means it's very quick. And now, why the Delta variant is so contentious? Because the R number is close to 3.4. So that means if one people get infected, at least three people by average will be infected, you know, getting the virus passed on and then three to nine, nine to 27. And that will be quickly spreading through the whole, you know, community. So this is a pretty, you know, dangerous situation that we are facing.

And accordingly, you know, in the beginning of the pandemic, we are expecting the vaccine and now the vaccine is ready. And, you know, we are predicting, you know, if, you know, 60 percent of the population getting the two shot of the jabs, and we could develop a herd immunity so we could control the spreading of the virus within our community. But now everything changed because the new variants. And you can see, you know, the the higher number of R value getting associated with the new, you know, variants and the requirement for the vaccination rate is getting higher and higher. At this stage, we need at least 80 percent of the population get vaccination until we could stop the spreading of the virus through our community. And this is a new update I got from the website, and you can see, you know, at this stage, unfortunately, Australia in a way in, you know, leave behind, you know, compared to the other major economy countries, including the Canada, US, European countries and Asian countries. So hopefully there will be some good news in the next two to three months time for our population, get at least 80 percent of the vaccination by two jabs. So this is a you know, unfortunately, this is the reality.

And, you know, I'm sorry to share in all of this shocking and bad news to start with my lecture, but there is some good news. Ok, so this is the good news. Why, you know, the virus can be cured easily. So how the virus can be cured, you know, by washing our hand, because if we are using the soap molecule, they have the hydrophilic head and have hydrophobic tail, the hydrophobic tail can insert onto the membrane of this virus. So the virus can be broken down into molecules. Ok, so this is a way, that's why we encourage our population to regularly wash our hands each time with soap for 20 seconds, at least 20 seconds. So once the molecules, once the virus breaks down into molecules, we have ways to detect them. And when you look at the detail of the construction of this virus, you can quickly understand, you know, what's the, where is the strategy? How can we detect them? So there are basically two strategies and two approaches. One is to detecting the oligo molecules, which is the RNA molecule inside the virus. Each virus only have one RNA molecule, OK. The second approach is you can detect in the proteins. So we call antigens, OK, at least the spike protein, they are very specific to the SARS-CoV-2 and nuclear proteins, they are specific to the coronavirus.

Ok, so then you can focus our detection to detecting these proteins. At least you have 26 copies of the spike proteins per virus, and you have 35 copies of nucleo proteins from one single virus. And that's how you know, where we, we get the detection started. PCR technology these days is a very well known. And it's a gold standard because a PCR technology can amplify the number of the RNA molecules. So from one to two, two to four, four to eight, until you are getting, you know, 30 to 40 cycles, you're getting, you know, these target molecules amplified significantly until you get, you know, a trillion of molecules, you can detect them in the lab. But the downside, although, you know, this is a very sensitive technology, the downside we all know this is very slow. You have to operate this in the pathology labs for a couple of hours until you've got the results, which typically require overnight, you know, one day to get the results. Ok, so that's explaining why, you know, PCR is so sensitive, but but that's that's also slow. There's another, you know, sort of a good news from Channel Seven and also the public domain. You can see I'm sharing this short clip with a clip from,

COVID test results in just 15 minutes. That's the promise, as new rapid testing kits rolled out across the state. But they're not without their downsides. It looks kind of like a pregnancy test, but this plastic stick is to be the bearer of some other good or bad news. It's very simple to use that the technology inside is quite sophisticated. So the tests can be run almost anywhere. You know that it's not just the only solution, but it's part of our solution in fighting Covid.

So, you know, this is some video from the news media. And also, I got this screenshot yesterday from the Sydney Morning Herald website. Australia has been fairly slow compared to other nations to implement the rapid antigen test. But it's all changing in the face of the Covid Delta variant. But there's a reason, you know why why we are being so slow. You know, not not because we don't know this technology, but we we're concerned, we have a concern around this technology. I, you know, get this message is a testimony from the teacher website. Adrian's daughter, unfortunately, got the COVID 19 virus recently, and he shared the experience by, you know, testing using this a home based test to monitor the positive and sensitivity of this commercial kit. And he found, you know, the rapid LFT antigen test was still negative and until four days into her symptoms. So that means, you know, in the first couple of days, the antigen tests are still not so accurate. We are getting some samples, commercial kit samples from the market and we test it in our lab. We're getting the known concentration of the protein antigen and we test, we check the sensitivity. And this slide shows you the principle, the animation shows you the principle how this technology works. So at the present of this virus, you can see a virus protein, the fluorescent molecule, like a fluorescent nanoparticle, can salvage the antigen in the middle at the test, the testing line area.

So if there are about, you know, 10 millions of the virus in the sample, the some, the testing might start to show a positive signal. So this is the current reality, reality about the antigen test using the European technology is quick, you know, only five minutes you can get results. But you need to have the high concentration of the virus in the sample until you can detect anything positive. So this is a somewhat limitation. Our government and the TGA approve the COVID 19 antigen test recently but has the emphasis saying, you know, they are less accurate, they can only be used for a symptomatic patient, and if you've gotten negative results, you still need a PCR as the confirmation test. So no matter whether you got positive or negative, you still need the PCR test. So you can see this, you know, the reality. So if we come back to this chart, you will understand why the antigen test, current antigen test are not ideal. So we've got this black window, but this is where the antigen test sits. So they are not sensitive enough. And that's why we couldn't apply them to screen the people in early stages. Ok. The scientific challenge, the scientific challenge for this technology is if you want to detect the proteins, the number of the protein cannot be amplified.

Ok, so at the beginning of the pandemic, the researchers and the scientists and also our team at UTS Institute for Biomedical Materials and Devices, we work together to consider, you know, translating our existing technology to a couple with, this very difficult situation from the science perspective. And we, our test is basically built on this, a new science of discovery we made for the last couple of years and is called nanoscopic upconversion nanocrystals. So this material is very fascinating because you could combine the multiple low energy longer with less emissions and convert them into the visible emissions. So you could put a few thousands of meters per small nanocrystals. So we're using in this case, about 40 nanometre crystals, you can put a few thousands in meters. So that means you could first detect the signal free of the background because you use the, neuro fract, excitation. Second, you can amplify optically amplify the signal by the number of meters per nanocrystals so that you can amplify the number of the target and the lights. Ok. So the journey is actually a long journey. But I, I cut this long story short. We made this fundamental discovery in science about eight years ago, and we published these results together with a professor, Tanya Monro, at the University of Adelaide. We demonstrate this a single crystal is sensitive enough to improve the limit of detection by three order of magnitude compared with the quantum dot technology.

We could detect a single crystal using a piece of fibre, and we further studied this technology under a microscope. We found, you know, each single crystal can emit a few thousands of photons per 100 milliseconds. So our naked eye can see the crystal, you know, under a microscope together with the cell. So you can see the transport, you know, moving in and out of a single crystal inside and outside of the single cell. So they are a single molecule probes. And in parallel, a couple of years ago, we worked with Minomic International in Sydney, a cancer biomarker company. So we translate this technology for very sensitive detection of the prostate cancer biomarkers in urine. So my student, Dr Ho, he did a Ph.D. with us a couple of years ago. He engineered this little box so we could patch this box into in front of the smartphone and we could use this new natural flow IC test to simultaneously detecting two proteins on one strip. And since that, the pandemic we retain the reagents and now we are targeting one spike protein, you know, by using one colour and targeting the nuclear protein, using the other colour of the probe. So we could simultaneously detect the presence of the virus protein at the same same test.

So this is our latest results. We've been collaborating with researchers at the Sydney Centenary Institute and also the clinical doctors at the Prince of Wales Hospital by testing our technology using the inactivated COVID virus. And we found our technology now is sensitive enough to detect the presence of about thousands to 10 thousands of viral particles from 100 microlitre sample. And this means that we already push, the limits of detection by at least another two order of magnitude. Soonce you push the limit detection by two order of magnitude and you can see from this chart, you can extend your detectable window, you know, goes into these dark, undetectable window period. So we can use this technology for detecting the asymptomatic patient. Ok, so this is of course, there's a quite a large scope for that, for us to further improve the technology and to add a single molecule level. Another good news is, you know, our industry collaborator Alcolizer, they been funded by some federal government funding and they re-tailor their fibre fabrication labs and establish the fabrication, you know, facility at Perth. And they can buy the UTS technology with Alcolizer's hardware technology. And we start to do this, you know, manufacturer and commercialisation process. So this is some good news.

The other possibility is really started by a problem, like the non-invasive testing potentials. So last weekend, I was approached by Martin. He said he wanted to have a test, but he couldn't use any existing test in the testing centre because they need a nasal swab and he got to some allergy issues. He couldn't use this, you know, swap based test. He was asking whether our technology can be used. My answer was, I think this was their response to a lot of questions during my lecture. So I provided the answer beforehand. Technology works in the lab. But in order to push this technology into the Australian market, I think there are some, there are still quite a few steps. You know, between the, you know, the lab based technology and the commercial product, because the procedure to get through this in through the clinical stages and department approvals are a lot more complicated and sophisticated than we initially thought. And if you know that when we're pushing further, pushing down, this limited detection by order of magnitude, we found our technology could provide a potential to do this, you know, detection from the saliva. But the big challenge from the saliva detection is you can see from this clinical data that there is a big variation between the number, the virus load means, you know, sometimes the patients who got infected can provide a very high amount of virus in their sample by, you know, 100 million. But sometimes, they can only provide about a few of thousands of the viral particles.

So that means we need to continuously push the limit detection from nanograms per mil, which is a current antigen test, can do down to picogram per mil, which is what our technology can do now and further down to tens of femtogram per mil until we could completely capture all the possibilities from the patient's sample. And of course, this is a moving target. You know, once you've started the research direction, you've found more you know, you get more solutions, you know, a lot of excitement, good solutions, but you'll find more problems. And it's a moving target because the virus, they become smarter each step they modify their protein on the surface a little bit. Then you have to, you know, capture the latest latest development of the antibody technology like a lock and a key relationship. So you have to adopt new reagents and make sure, you know, the technology can detect the new variant strains. And this is the chart to show you our current plan to push the technology from the lab based to clinical based and to the market and through the government approval. We already, you know, completed all the preclinical test and showing very positive results. And now we are requesting, you know, to develop more partnerships with clinical labs and doctors to access the real patients sample. First of all, we need maybe 20 confirmed patient sample to start to understand to the variation, you know, how much virus we could detect from confirmed cases.

Then we upscale into 200 confirmed patients in the mix of the healthy patients to check the sensitivity and specificity. Then we could use this technology to unknown cases, like a larger population of unknown cases. Once you complete all of these datasets, you can provide all the documents to the government and for the like a CFD and TGA approvals. Ok. Finally, I'd like to thank my colleagues and my postdocs and their students. They are extremely, you know, efficient. And they're hardworking members at IBMD, particularly during the pandemic, they are still active and productive in the lab. They sacrificed a lot, you know, these days and try to push this, accelerate the development of the technology in the lab. I sincerely appreciate their efforts. As I said, this is a joint effort between different groups and between, you know, UTS and also industry partners and external partners from hospital. And of course, without funding, we couldn't do this research. I would like to acknowledge Australian Research Council for continuously funding our research from the fundamental discovery level to engineering level now to the translation towards the industry usage. In particular, we would like to thank the Innovative Manufacturers Cooperative Research Centre for funding, directly funding this research towards the commercialisation and industry prototype development. Thank you, everybody.

Thank you very much Dayong. I really appreciate your your talk today and also for highlighting some of the issues that we face. In particular, we in New South Wales every day hear from the Premier, and we hear the numbers of people infectious in the community. And of course, you've now explained why that is the case, even with the very best of testing. And there's certainly hope for these quicker tests. As you've as you've identified, which will hopefully bring back that window to enable much quicker testing of people who are pre symptomatic or early symptomatic. So thank you very much for that. And I'm now going to introduce Anthony Friedli, Mr Anthony Friedli from Australian Clinical Labs. And before I do so, I suppose the main point that I'd like to make is that notwithstanding any of these quick tests, when they come through, when they are positive, of course, we still need to submit the patient testing for testing at PCR lab, such as what Anthony will describe shortly. Of course, this is really important for the contact tracing and for the strain detection. So it's only really in the labs under those with the PCR technology that Dayong referred to where we can achieve the type of tracing and strain detection. So let me introduce Anthony. Thank you very much, Anthony, for joining us today. Anthony Friedli is chief operating officer and Victoria CEO of Australian Clinical Labs. And his responsibilities include leading the business transformation on a national basis and managing in total the Victorian operation. Anthony also oversees human resources, quality and risk and business improvement functions right across Australian Clinical Labs. Prior to joining ACL, Anthony was managing director of Australia and New Zealand for Kepner Tregoe, a management consulting company specialising in business transformation. And Anthony has also held management roles within the telecommunications, banking and manufacturing industries. Anthony, thank you so much for joining us today. And I invite you to give us your presentation.

Many people start a career with a particular end game in mind. Some people keep to that path, while others go off on tangents and explore new frontiers. Many of you have heard of some of those success stories of careers that seem to evolve rather than follow a plan or a path that's well-trodden. I believe, your degree not only, it just it does not define you. It actually enables you to do amazing things. Today, I'm going to take you on a journey of how a UTS engineering graduate found himself managing at the frontline of this global pandemic. I will talk about the roller coaster ride, that is pathology, that is pathology is been for the past year, as well as the predictions of the future of what the cost will be and what issues and potential health risks are there within the community. So back in 1996, I graduated with a bachelor's degree in electrical engineering, majoring in telecommunications. Throughout my time at UTS I had a cadetship with Westinghouse and worked my way through that organisation and eventually leaving and taking a role up in one of Australia's largest telecommunications companies, which was Optus. At this point you would suggest my logical career path have been achieved. What else would a telecommunications professional end up? And so then in 2015 my career was provided a tangent. And I found myself as the chief operating officer and Victoria CEO of Australian Clinical abs, a newly formed pathology company amalgamated Healthscope pathology and St John of God pathology and several other small players. An electrical engineer now running a pathology company, really? Pathology is a tough business. Only the top two private pathology companies actually make any money. All the rest, run at a loss. One payer, which is the government, 20 years of no fee increases on top of three major fee cuts means the industry is on its knees.

I was brought in to salvage a number of companies, and four years later, we managed to save these businesses from extinction and prevent the country from having another duopoly. The month was February 2020, my CEO calls me into her office and proclaims that when have successfully saved the organisation from closure and we will celebrate in March. We knew about coronavirus since November 2019, and then proactively worked up a test that would be able to be used if required. Little did we know, what was about to happen. I'd now like to take you on a journey of what Covid 19 looks like from the viewpoint of a pathology company. The way I'll portray this journey through the lens of work coming into our organisation. The axis on the left shows the percentage comparison of volume from previous years, the dark line across the graph is the zero percent line, which means that you're not making any money. Above the line, you're OK, below the line, you're losing. So what I have done is broken this story down into seven parts. February 2020 after four long years we have finally, the business was making a very meagre profit. It was enough to be invested back into the organisation and then organisation now could be sustained. 23rd of March 2020, disbelief. As our country was overcome by the fear of Covid and we plunged ourselves into lockdown, we watched as our organisation collapsed to give you relativity and use the boating analogy. Our business had minus 10 percent on this graph, starts to take on water, but at minus 40 percent, we've hit an iceberg. Work dries up coming into the lab. Patients abandon their doctors, private hospitals are ordered to close. Public hospitals are empty to make space for the anticipated patients that we saw in the US and UK. The world is confused that it stops, and so does our business. A quick calculation reveals that we have 45 days before we will like to close the doors. We will be out of business by mid-May. 30th April 2020, we are drowning. With work barely trickling in, and we have no way of paying our people. The government steps in and announces a jobkeeper for businesses that have slumped over 30 percent. We hurriedly apply and within two weeks, we have enough money to pay our people, not the full amount, but something. We decide not to lose any staff but reduce all pay. This lifeline does not save us, but it gives us another 20 days to survive. It's a deadline at the end of the tunnel, but it's a lot nonetheless. June 30, 2020, gasping for air. With pay rates, in some cases down 80 percent and staff down all over the country, Covid testing starts to rev up considerably. Then a new start, a new threat hits our organisation. One department is now functioning at levels, never seen, while the other nine scamper for work. As we retrain scientists we realise the biggest threat to our organisation and our existence, our supply chain.

Issues we now face. One: PPE to manage the collection of COVID is now in short supply and we are and we connected to a secret department in Canberra for supply. b.      Reagent for our, for our equipment is now cannot be produced fast enough. And we're a small market in Australia so fair allotment is difficult. We strategically decide not the one supplier, but to deal with four. The variation is tough on our people, but keeping supplies is key. Qualified staff become tough in short supply with borders closed and it is tough to find personnel willing to work the gruelling 24/7 shifts that now keep up with demand. Swabs become impossible to find and all sorts of fly-by-night suppliers pop up trying to make a profit in these dire circumstances. Again, the federal government steps in and provides us with critical supply. Masks now become difficult to source, and therefore slow down our operation. Our lab staff are allocated masks, that if we miss one shipment, we will be, we will have to stop the testing and that will put pressure on turnaround times back to the public. So we are walking on a tightrope. The 9th of August 2020, resilience. As New South Wales, South Australia, WA and Queensland as shown in the green line, start operating in a kind of normal state, Victoria and the hotel quarantine bungle sends out business into a spiral.

Our organisation is heavily skewed to Victoria and healthcare again plummets in state, dangerously low levels with hospitals and doctors surgeries closed. We now have been here before and we've got good processes, good supply chains, and the testing we're completing keeps us afloat. So what will be the true effect of this second lockdown? 15th of October, 2020, Hope. Our organisation is almost back to pre COVID levels. We are expecting a surge of testing from the consults that never happened over the past few months but those never come. Our standard tests return and hospitals come back online, theatre lists fill up and elective surgery starts to come back. COVID testing is now constant and the experts believe that it's here to stay. Our profits return and we repay our jobkeeper payments. Our business has survived, but what is the toll that is taken on our people? December 10 2020, how do we manage this environment. Pathology's now in the limelight. We are weary that we've not only survived, but we've thrived. We now have technology that aids to speed up testing. We have processes and reporting that can navigate the toughest situations. We have formed relationships and bonds that will help us into the future. The threat of the next outbreak is never far, but we are ready. We are ready and capable. The story is continued throughout this year from Victoria, moving into its sixth lockdown to New South Wales now suffering through the longest lockdown ever. I hope that fine line this one has dispelled some of the myths of the affluence and good times it must have been feeling.

I can honestly say that these were the scariest times of my life. This story has much more to unfold. What does the future hold? How long will COVID 19 testing play be a thing? What does anti-body testing look like? Covid 19 passports, what are they and how do they work? Next winter, how long is the vaccine going to be effective for - new strains, severity, new challenges? Will we ever travel again, and how will it look? Pathology has been a driving force in the management of the pandemic but what have been the costs. Dr. David Deam and Dr Simon Nazaretian from Australian Clinical Labs have written a compelling paper titled The True Impact of Australia's COVID 19 Lockdowns on critical health diagnoses. In this paper they analysed the delays to medical appointments, cancer screenings and pathology tests of chronic health conditions over the past five years, and the results are truly frightening. To give you some frame on this, cancer diagnoses across the country and especially Victoria are down 18.9%. But what does that mean? One thousand Victorians were not diagnosed with melanoma in the last period. 650 breast cancers and 600 bowel and 620 prostate cancers go undiagnosed. 140 lung cancers are undiagnosed. These are absolutely staggering omissions. Looking at the graph on the right hand side, showing the critical difference between New South Wales and Victoria, 16% of diabetic patients have gone undiagnosed and untreated in the past 12 months.

To put that into perspective, one percent equates to 17000 tests, 17 percent downturned, and cholesterol testing and delays in treatment and or unmanaged conditions have occurred over this period. However, there were some interesting upsides to the pandemic that occured. Prenatal testing is up to 200 percent. We have, we will have quite a number of COVID 19 babies on the way. That testing is actually up 300 percent. The purchase of COVID 19 puppies have gone through the roof. And finally, Zoom is now a thing. Our pathologists now easily dial into multidisciplinary meetings and provide expert advice, remotely, adding to critical care and increasing their efficiency to talk about critical cases throughout the country. So I guess in summary, please never limit yourself to what you want to achieve in life. Never believe you must follow the obvious path of your career and life. Make sure, however, to be an expert in something in your career that is valuable. Be that go to person for something. For me, I learned how to transform the businesses that were struggling. I'm not a scientist, but I play to my strength and partner with those that could support me on that journey. Believe me, you have an exemplary career ahead of you. And don't be afraid to take the path less travelled. It might take you to places that you never thought possible. Thank you for joining me today.

Thank you so much, Anthony. I really appreciate your presentation today. And certainly it exemplifies the rollercoaster ride that you and your company had followed and certainly dispels many of the myths that I guess would have been circulating in, in our community. So just for our for our participants today, we have really already received a large number of of questions in the Q&A. But just reminding you where you can insert your questions. We have some minutes to respond to the questions, and I'll pose those to our panelists today. So I'm going to stop sharing now. And just for our for our panelists, then I'll start off by asking a question that came in pre, pre today's session, that came from one of the attendees. What are the challenges identifying the Covid virus and how do you differentiate between Covid and other types of viruses? Either one of you. I'm happy for either one of you to to respond.

Anthony, do you want to go ahead?

Honestly that might be one for you.

OK. So as I explained through the lecture, there are two possibilities, two strategies. One, you using the oligo test, you can detect in sequence, you know, you know, which which virus it is. Second, you can recognise the structure of the protein, because each variant, they when they are mutating, they will also change the protein structure. So you can and you can test the protein structure as well. And in terms of the rapid test, you know, we're developing that detection to targeting both nuclear protein and spike protein. Spike proteins are more specific to the Cov-SARS-2. Ok, the nuclear protein is specific, broadly cover all the coronavirus like, you know, the HIV and and other Coronavirus. So, you know, the spike proteins are difficult to detect. But this is a where the technology will go.

Thank you very much, Dayong. Yes, indeed. It's by testing the genetic material or the protein material at the at the surface, that's excellent. Thank you. And then maybe another question for you Dayong, and then I'll go to some of the questions that our participants have have lodged today. Will the test, such as yours be sufficiently affordable to be made available to the public through pharmacies, for example, for use at work and home?

We still don't recommend this test, it will be used at home because as long as, you know we haven't proved the saliva test, you know, the nasal swab, you know, it's not comfortable. I don't think everybody can use the stick properly in their nose. But the cost of the technology is getting lower. And so the cartridge on my hands is the ones produced by Alcolizer in Perth. So the cost of this cartridge only cost one dollar. The reagents on this cartridge, it only cost a few dollars. So the overall cost of could be, you know, between 10 to 20 dollars at the customer hand. So potentially this test can be, you know, a few dollar test. But depends, you know, how sophisticated the government approval and how much more, you know, data will be needed. And that all will build into the into the cost, you know, of the of the technology department.

Yeah, indeed. Indeed. And I know from our own association, Dayong, that you do try to make tests that are called point of care test. In other words, you make them really easy to use for for general public, but of course, within a limited parameter, a specified for their use. All right. So I'm now going to go to a question that came through the online chat. And again, for either of you, is the original or alpha strain of the Covid virus still prevalent or does each strain become superseded by the next one that comes in?

It's a good question. I would say when we're testing, there's definitely, they definitely look at the genetic material to see the thread. So in our lab, we would, the predominant what we would be looking for in the volumes that we're looking for would be the Delta strain. So the actual strain it is, is probably immaterial to the time getting back to getting a negative or a positive result. But it's definitely a high proportion of that genetic link.

Yeah, indeed. And I do recall from the previous sessions that we had on Covid, so just for our participants today, this is this is the second in the series. And I invite you to to visit the UTS science website for the first in the series where we had the member from New South Wales health pathology as one of our panelists. And they indicated that the predominant strain that is currently being detected is, in fact, the Delta strain. All right. So another question that has come through is effectively will we have to really learn to live with with the coronavirus into the future, or will it be suppressed?

I can, I can give you a pathologist view, so. I was sitting on a pathologist meeting today and they were walking, they were walking through and pathologists, are very balanced individuals, and they were saying that this will be, this will be here for quite some time. They they talked about in what forums. But their belief is that if you're thinking, if we are thinking running an organisation that we are looking for, that this will move on and that will be something in the past, they were saying that you need to bolster your organisation and bolster life that this will be part of life.

Indeed, I've heard other experts make make similar comments that we just we're going to have to learn to live with coronavirus for some time into the future. All right, so another question and Dayong, you touched on this to some extent in your presentation. How effective is hand sanitiser, such as the type that's used in hospitals in destroying the virus and maybe in comparison to hand washing.

It's a similar effects, to my understanding. I'm not an expert in this, you know, how to cure the virus. But recently, one of our post-op members put together a review article and seeing how to physically, you know, different variety of different ways to cure the virus. But hand sensitiser, because they have a high concentration of alcohol, they also, you know, departed the virus. But the solve isn't cheap and dirty and easy, you know, wash our hands.

Yes, indeed. And another one for you Dayong is when you when you were explaining the upconversion particles, you were explaining that they have the ability to absorb infrared light and to then emit a visible light. That's why we can see it. So we shine a dark light on it, and we then have visible light. It's a little bit of a technical question, but is there a specific wavelength or band of infrared that we that we use or prefer to use?

Yeah. So at the moment we prefer to use the bandwidth around 980 nanometre, around one micron. So one micron, your infrared and you can check the green in 550 and also the blue in 470. You can also generate that red colour around 660. So they're they're very colourful, you know, materials been discovered and demonstrated in the past couple of years. It's very interesting science, you know, science, scientific material. And that's actually, the whole team of my research group got addicted to this area for the last two years.

Yeah, I can see why that would be the case. Anthony, I don't know if you would be able to answer this one. I hope that you can. What exactly does it take to get a clinical test approved by the TGA or other branches of the government?

Yes, there is, there's a set of working up of the test. So you sort of got to get the technology within the lab right. And then a set of tests, you then grab, you then get what they call reference material from a governing body. That reference material will be a will be a positive so, so to speak. So the biggest issue at the start of the pandemic is that there was, you could not get positive material. So until remember, at the start of the pandemic, we had very few positives and it was very difficult. And we were, what we would like, we would that was basically synthesising and trying to make it. But we would have paid thousands just to get a positive so that we could actually so. So when you get those positives, you actually then have to work up the test and correlate that to the positive. And as soon as you're within a set of bands and you run a predominant sample size, there is a governing body called NARTA within this country that actually will then certify not only the equipment, but the testing process that you've got. And then that can then be brought into other types. And so every time you introduce the new equipment, a new piece of equipment, you need to go through that process that's very rigorous in this country.

Yeah, indeed. I certainly believe that that's true. And I understand that the issues would have been relatively difficult at the beginning, difficult to manage at the beginning, when indeed you had no access to, to particular specimens.

Material, that's right.

Yeah. So to our panelists today, thank you both so much for your presentations. I really value the insights that you've brought to us and also to our audience today. Thank you so much for joining us. I hope that you have enjoyed the presentations and thank you for staying with us today. Enjoy the rest of your day.