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Multiplex Testing: What It Is and Why It’s Important in the COVID-19 Era



With COVID-19 cases again surging globally, Ron Chiarello, founder, CEO and chairman of Alveo Technologies, discusses multiplex testing


Despite some developed countries’ progress in vaccinating their citizens against COVID-19, recently surging case numbers across the world have brought into sharper focus the global need for multiplex home testing options. 

In one two-week period ending in early May, the World Health Organization recorded more COVID-19 cases than the entire first six months of the pandemic. At the time of this writing, global cases have increased for ten consecutive weeks, driven by surging infection rates in India and Brazil. 

As of early May, the US had reported the highest number of cases among all nations since the beginning of the pandemic at 32.1 million, followed by India at 20.2 million and Brazil at 14.7 million. While 30 per cent of the US population has been vaccinated, far less of the world has and it will likely be a long time before we even arrive at 30 per cent on a global basis. 

To continue to manage this pandemic on the global stage, we must lean into the reality that COVID-19 will not simply disappear any time soon. That means humanity needs to figure out how to best mitigate and manage the pandemic, and that’s where at-home multiplex testing enters the picture. 


The basics of multiplex tests

Molecular tests can simultaneously detect multiple targets from the same sample, and have traditionally been used in life science research, clinical diagnostics, and forensic laboratories. Molecular tests have many common uses including pathogen detection, forensic studies and food analysis, but their use for infectious disease testing is what can help lead us out of the COVID-19 pandemic. 

Compared with other testing options, multiplex molecular tests offer a host of advantages, including: more information with less sample, higher throughput, greater cost-effectiveness, time savings and greater accuracy of data normalization.

It’s important not to overlook the “multi” in “multiplex testing,” largely because there will be other pandemics in the future. Multiplex tests cater to consumer convenience by using the same sample and device to test, for example, for multiple conditions such as respiratory syncytial virus, influenza, COVID-19, urinary tract infections, sexually transmitted infections and theoretically any other new diseases that arise – depending on how the tests are engineered, of course. 

And new diseases inevitably will arise. COVID-19 represents humanity’s seventh zoonotic episode in roughly the past two decades – meaning a virus that jumps from part of the animal kingdom to humans. Given the frequency of the emergence of these types of infectious diseases in the past, it is a virtual certainty that we will see more in the future. 


The current and future state of at-home COVID-19 testing

For U.S. and UK consumers, the good news is that current options are available for at-home COVID-19 testing, and in the future at least some of those are likely to be multiplex tests that detect a wide array of infectious diseases. The US Food and Drug Administration recently authorized five over-the-counter COVID-19 tests, with some capable of delivering results at-home in just minutes.

Generally speaking, the tests work by collecting samples through nasal swabs that don’t require going too far up the nose, then are inserted into a device that performs an analysis on the spot, removing the need for the sample to be sent to a lab. Results are typically ready in a range of just a few minutes to about a half-hour. 

However, it should be noted that most of these approved diagnostics are antigen tests, which are good at quickly identifying people with larger amounts of the virus, but – importantly – far less sensitive than molecular tests and more likely to lead to false negatives, according to a report in Popular Science. Overall, most of the tests were easy-to-use and required only a small learning curve, according to the report. 

A future innovation to look out for is smartphone-based, battery-powered, at-home multiplex infectious disease testing, in which the device that analyzes the sample runs on batteries. This feature will prove valuable in many lower to middle income countries that suffer from frequent outages and intermittent, unpredictable power supplies. 

Similarly, a recent Frost & Sullivan report highlights the significant market potential for smartphone-based, point-of-care infectious disease testing technology, predicting three-fold growth between 2019 and 2024. The emergence of cost-effective lab-on-a-chip and smartphone-based point-of-care tests, in addition to increasing reliance on less-invasive testing methodologies, will propel the market, according to Frost & Sullivan.


A broader perspective

Given the surge in US vaccinations and innovations in at-home testing, the prospects of successfully managing the pandemic are looking up – and that is certainly worth celebrating. Nonetheless, an assessment based on global surveillance data tells us that things are considerably bleaker in much of the rest of the world.

We need look no further than India and Brazil for confirmation of that reality. The sooner we begin to distribute quick, accurate, battery-powered multiplex molecular tests around the globe, the sooner we’ll start to change today’s reality. 

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