Erasmus Medical Centre (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 Viroscience working to better understand viruses and the infections
they cause at molecular, patient and population levels.
It is thanks to their work, and that of similar centres around the world, that serious disease threats can be rapidly detected and contained. Indeed, their work involves studying and monitoring a whole range of viruses, from those causing severe acute
respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), to Ebola, HIV, influenza, herpes and measles.
Besides known viruses, their work also helps identify new and emerging pathogens that could pose threats to humans, which due to many factors – including globalization, changing land use and climate change – are appearing more and more
frequently. 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 Viroscience, particularly in the context of the COVID-19 pandemic, we spoke to Dr Richard Molenkamp, a clinical molecular virologist working there.
How long have you worked at Erasmus MC and what is your particular role here?
I’ve been working here for 4 and a half years, and my role is focused on molecular diagnostics – in other words, analysing markers in the genome of viruses to diagnose and monitor disease, and to help clinicians make decisions on which therapies
will work best for their patients.
Alongside that, I also play a role in the reference centres for a number of viruses. Erasmus MC is the WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research. Arboviruses are transmitted by mosquitoes, ticks and other
arthropods. The work of the Collaborating Centre also includes dealing with novel and emerging infectious diseases, such as those caused by coronaviruses. Additionally, the Department of Viroscience is accredited as one of the WHO European Region’s
reference laboratories for measles and rubella, and is the National Reference Centre 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 Viroscience?
We do basic research and diagnostics, as well as everything in between! Our aim with all our activities is for what we find out to result in benefits to human health. We’re a big department, consisting of around 200 or 300 people, from clinical
doctors working directly with patients to scientists and technicians of all levels actually performing 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 using polymerase chain reaction (PCR) to copy, amplify and detect the ribonucleic acid (RNA) strands that form the genomic code of the virus.
Additionally, we can carry out sequencing to understand the exact order of the genetic information contained in the RNA strands, which helps us identify and characterize the virus, for instance, to determine whether mutations in the virus could affect
antiviral therapy.
Alternatively, we can, by looking at antibodies in the serum (serology) of patients, determine whether a patient has previously been infected by a virus. Finally, we use virus cultures in some cases to answer some very specific diagnostic questions
we might have.
Can you tell us what role the Erasmus MC laboratories have played in testing for SARS-CoV-2, the virus that causes COVID-19 disease?
From the early start of the pandemic back in January 2020, we collaborated with other WHO collaborating centres to validate a PCR test, developed by the Charité laboratory in Berlin, Germany, that was to become a standard method for diagnostic
detection of SARS-CoV-2 across the world.
Subsequently, 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 WHO and other WHO collaborating centres across the globe to share information on the virus
and on laboratory methods.
In the Netherlands, we were initially only testing suspected cases that had a travel history to China, or later on to Italy, but at the end of February, we had our first positive COVID-19 case here. From that point on, we began carrying out routine
testing, working alongside RIVM (the National Institute for Public Health and the Environment) to confirm each other’s test results.
As the pandemic took off and more hospital laboratories became involved in testing, we were the sole testing laboratory for the Rotterdam area, which lasted until August 2020, when it was realized that more testing capacity than we could provide was
needed.
At present, we are mainly involved in the routine testing of newly admitted patients to our hospital, while continuing to test our health-care workforce on a regular basis to try to prevent the spread of COVID-19 infection and to ensure sufficient
availability of personnel for providing health care.
As the pandemic has gone on, we’ve seen new variants emerging. 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 genetically formed of RNA, I think it is no surprise that there has been a certain level of variation and evolution in the makeup of SARS-CoV-2. What is new in
this pandemic, though, 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 that have been developed for real-time sequencing. The amount of
genetic data we have for SARS-CoV-2 is unprecedented. This means we have been able to much better detect new variants and track in real time how they are spreading.
Has your testing regime changed as a result of the number of people affected by COVID-19?
Certainly. At the beginning of the pandemic, we were splitting our samples with the RIVM laboratory to do joint testing and confirmation, using manual PCR systems to come up with combined decisions on 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 quickly increased.
Thanks to the development and introduction of more automated systems, we can now do community tests in around 12 hours and there are laboratories working around the clock to process samples. If really rapid answers are needed – for instance,
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 assays which can deliver results within an hour. These assays are expensive
and only suitable for very small testing volumes, so we only do that for particularly urgent cases.
How is your work contributing to controlling and ending the pandemic?
Throughout the pandemic, we have provided community testing for people with mild symptoms as a means of controlling infections and making sure the virus doesn’t spread further through the population. As vaccines have become available, we’ve
also carried out tests on their effectiveness, especially in view of new variants, and put diagnostics in place to see how well they perform.
Furthermore, we also study the effectiveness of antiviral compounds on emerging variants, all of which is helpful 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, which can be too easily taken for granted. Indeed, I often think that the public, policy-makers and even some clinicians regard them as some sort of machine, where you push a button and the results
will just come out!
In reality, it’s much more sophisticated than that. Laboratories only function well by continuously building expertise. Without expert laboratories and the funding needed to maintain and grow them, we would have very limited understanding of
diseases, the dynamics of infection, and the best ways to prevent and treat emerging health threats. This has been 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 try – and we certainly do – communicate their work in multiple ways, by publishing results, talking with 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 effectiveness.
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