Erasmus Medical Center (Erasmus MC) in Rotterdam, the Netherlands, has a long and proud history as a teaching hospital and research facility, with the world-renowned Department of Virology working on viruses and the infections they cause at the molecular, patient and population levels.
It is thanks to their work, and that of similar centers around the world, that serious disease threats can be quickly detected and contained. Indeed, their work involves studying and monitoring a whole range of viruses, from those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), to Ebola, HIV, influenza, herpes and measles.
In addition to known viruses, their work also helps identify new and emerging pathogens that may pose threats to humans, which are becoming more common due to many factors – including globalisation, changing land use and climate change. The ongoing COVID-19 pandemic, now entering its fourth year, and the more recent mpox (monkeypox) public health emergency of international concern are just 2 recent examples, showing the significant impact that zoonotic diseases (those originating in animals) can have in our interconnected world.
To better understand the work of the Department of Virology, especially in the context of the COVID-19 pandemic, we spoke with Dr. Richard Molenkamp, a clinical molecular virologist who works there.
How long have you been working at Erasmus MC and what is your specific role here?
I have been working here for 4 and a half years, and my role is focused on molecular diagnostics – in other words, the analysis of markers in the genome of viruses to diagnose and monitor diseases, and to help clinicians make decisions about which therapies will work best for their patients.
In addition, I also play a role in the referral centers for a number of viruses. Erasmus MC is the WHO collaborating center for arbovirus and hemorrhagic fever referral and research. Arboviruses are transmitted by mosquitoes, ticks and other arthropods. The work of the Collaborative Center also includes dealing with new and emerging infectious diseases, such as those caused by coronaviruses. In addition, the Department of Virology is accredited as one of the WHO European Region’s reference laboratories for measles and rubella, and is the National Reference Center for Influenza and Emerging Viral Infections in the Netherlands.
Can you give us a brief overview of the purpose and work of the Department of Virology?
We do basic research and diagnostics, as well as everything in between! Our goal in all our activities is that what we discover will result in benefits for human health. We are a large department, consisting of about 200 or 300 people, from clinical doctors who work directly with patients to scientists and technicians of all levels who actually perform the diagnostics and studies.
How do you go about identifying, characterizing and diagnosing viruses?
Depending on the specific diagnostic question, we try to detect the virus’s genomic material by using polymerase chain reaction (PCR) to copy, amplify and amplify the ribonucleic acid (RNA) strands that make up the genomic code of the virus to find.
In addition, we can perform sequencing to understand the exact sequence of the genetic information in the RNA strands, which helps us to identify and characterize the virus, for example to determine whether mutations in the virus can affect antiviral therapy.
Alternatively, by looking at antibodies in the serum (serology) of patients, we can determine whether a patient has been previously infected by a virus. Finally, we use viral cultures in some cases to answer some very specific diagnostic questions that we may have.
Can you tell us what role the Erasmus MC laboratories played in testing for SARS-CoV-2, the virus that causes COVID-19 disease?
From the early onset of the pandemic back in January 2020, we collaborated with other WHO Collaborating Centers to validate a PCR test, developed by the Charité laboratory in Berlin, Germany, which would become a standard method for diagnostic detection of SARS-CoV-2 around the world.
After that, we started testing for SARS-CoV-2 in the third week of January 2020. From that point on, and essentially still, we advised and collaborated with the WHO and other WHO collaborating centers around the world on information about the virus and laboratory methods.
In the Netherlands, we initially only tested suspected cases that had a travel history to China, or later to Italy, but at the end of February we had our first positive COVID-19 case here. From that point on, we started performing routine tests and working with RIVM (the National Institute for Public Health and Environment) to confirm each other’s test results.
As the pandemic took off and more hospital laboratories became involved in testing, we were the only testing laboratory for the Rotterdam area, which lasted until August 2020, when it was realized that more testing capacity was needed than we could provide.
Currently, we are primarily involved in the routine testing of newly admitted patients in our hospital, while we continue to test our healthcare workforce on a regular basis to try to prevent the spread of COVID-19 infection and to ensure adequate availability of staff to ensure the provision of health care.
As the pandemic continues, we have seen new variants emerge. Are you surprised how the virus has changed and evolved over time?
Not really. From our experience and previous studies of coronaviruses and other viruses that are genetically formed from RNA, I think it is no surprise that there has been a certain level of variation and evolution in the composition of SARS-CoV-2. However, what is new in this pandemic is that, compared to other outbreaks, we have been able to closely follow how the virus has evolved through the population, thanks to the powerful techniques developed for real-time sequencing. The amount of genetic data we have for SARS-CoV-2 is unprecedented. This means that we were much better able to detect new variants and track their spread in real time.
Has your testing regimen changed due to the number of people affected by COVID-19?
Certainly. At the beginning of the pandemic, we split our samples with the RIVM laboratory to do joint testing and confirmation, using manual PCR systems to come to combined decisions about the results. This was all very well when we were only dealing with a handful of cases, but as it took more than 24 hours to get a confirmed result, the process became unsustainable as numbers increased rapidly.
Thanks to the development and introduction of more automated systems, we can now do community tests in about 12 hours and there are laboratories working 24 hours a day to process samples. If really fast answers are needed – for example, if a hospital emergency department is overflowing with patients and a negative test is needed to admit someone to a general ward – then we can use rapid molecular tests that can provide results within an hour . These tests are expensive and only suitable for very small test volumes, so we only do them for particularly urgent cases.
How does your work contribute to controlling and ending the pandemic?
Throughout the pandemic, we have provided community testing for people with mild symptoms as a way to control infections and make sure the virus does not spread further through the population. As vaccines became available, we also tested their effectiveness, especially for new variants, and put diagnostics in place to see how well they performed.
Furthermore, we also study the effectiveness of antiviral compounds on emerging variants, all of which are useful for the development of new, more targeted vaccines and antiviral treatments.
Do you think the role of laboratories in disease research, surveillance and testing is fully appreciated by governments, health authorities and the wider public? What needs to happen to better communicate what you do?
Laboratories often play a behind-the-scenes role that can too easily be taken for granted. Indeed, I often think that the public, policy makers and even some clinicians view them as some kind of machine, where you push a button and the results will just come out!
In reality, it is much more sophisticated than that. Laboratories only function well by constantly building expertise. Without expert laboratories and the funding needed to maintain and grow them, we would have a very limited understanding of disease, the dynamics of infection, and the best ways to prevent and treat emerging health threats. This was particularly evident during the COVID-19 pandemic, as many of the response measures were developed thanks to data from expert laboratories, such as ours.
In general, laboratories – and we certainly do – try to communicate their work in various ways, by publishing results, talking to the press and informing stakeholders. However, science communication is an expertise in itself and in my opinion needs to be more integrated into the skill set of the next generation of laboratory scientists to improve efficiency.