Pan-Family Assays for Rapid Viral Screening: Reducing Delays in Public Health Responses During Pandemics

Background Coronavirus disease 2019 has highlighted deficiencies in the testing capacity of many developed countries during the early stages of pandemics. Here we describe a strategy using pan-family viral assays to improve early accessibility of large-scale nucleic acid testing. Methods Coronaviruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were used as a case study for assessing utility of pan-family viral assays during the early stages of a novel pandemic. Specificity of a pan-coronavirus (Pan-CoV) assay for a novel pathogen was assessed using the frequency of common human coronavirus (HCoV) species in key populations. A reported Pan-CoV assay was assessed to determine sensitivity to 60 reference coronaviruses, including SARS-CoV-2. The resilience of the primer target regions of this assay to mutation was assessed in 8893 high-quality SARS-CoV-2 genomes to predict ongoing utility during pandemic progression. Results Because of common HCoV species, a Pan-CoV assay would return false positives for as few as 1% of asymptomatic adults, but up to 30% of immunocompromised patients with respiratory disease. One-half of reported Pan-CoV assays identify SARS-CoV-2 and with small adjustments can accommodate diverse variation observed in animal coronaviruses. The target region of 1 well-established Pan-CoV assay is highly resistant to mutation compared to species-specific SARS-CoV-2 reverse transcriptase-polymerase chain reaction assays. Conclusions Despite cross-reactivity with common pathogens, pan-family assays may greatly assist management of emerging pandemics through prioritization of high-resolution testing or isolation measures. Targeting highly conserved genomic regions make pan-family assays robust and resilient to mutation. A strategic stockpile of pan-family assays may improve containment of novel diseases before the availability of species-specific assays.