If there is one red line visible next to the "C" in the KnowNow device test results window, and no line at all next to the "T", then the test result is negative. This indicates that no SARS-CoV-2 antigen has been detected in the sample.
If there is one red line visible next to the "C" in the KnowNowᵀᴹ device test results window, and any line at all, no matter how faint, appears next to the "T", then the test result is positive. This indicates that the SARS-CoV-2 antigen has been detected in the sample.
Following a positive result, current government guidance on matters including self-isolation and reporting the result should be followed.
The Limit of Detection (LoD) is the smallest amount of virus in a sample that a given device can consistently detect.
The Liverpool School of Tropical Medicine carried out an analytical study of the KnowNowᵀᴹ test, which determined that the LoD is 500 plaque-forming units per millilitre (PFU/ml). Based on accepted models of viral load in disease progression, this very low LoD suggests that the KnowNow test can detect infected people as early as day 3 to 4 of infection. This is before they become highly infectious, and a day or two earlier than most tests available.
In the absence of a single study that compares the LoD of KnowNowᵀᴹ to that of other tests, it is not possible to do a like-for-like comparison of the LoDs of different lateral flow tests determined by different studies. This is because there wouldn't be parity across cell cultures and strains of the virus used in the different studies. Additionally, it's important to consider that what the KnowNowᵀᴹ test detects is fundamentally different from other tests. KnowNowᵀᴹ is a true infectivity test which looks exclusively for the spike protein only present on active SARS-CoV-2 viruses. Whereas other lateral flow tests detect the nucleocapsid protein encapsulated in the centre of the virus, which can be present whether the virus is active or not.
The PFU/ml measure, as used in the Liverpool School of Tropical Medicine KnowNowᵀᴹ analytical study, is a measure of only the number of virus particles capable of forming plaques in a given sample - viral particles that are defective or which fail to infect their target cell will not produce a plaque and so are not counted by this measure. No inference can be made about the relationship of PFU to the overall number of viral particles in the sample, since this will differ from sample to sample.
Since the KnowNow test specifically detects infectious viral particles only, an LoD measured in PFU/ml is an informative and appropriate measure. However, for other lateral flow tests which indiscriminately detect active and inactive viral particles, an LoD referencing PFU/ml is not particularly informative or comparable to the KnowNowᵀᴹ LoD. For example, the sample used to determine LoD may have had a very low PFU/ml, but many inactive viral particles which were detected by the test. Ultimately, other lateral flow tests are not true tests for COVID infectivity, they do not detect only infectious virus like the KnowNowᵀᴹ test does.
If you'd like to read more about this subject, we recommend reading this paper. It argues that the "Limit of Detection matters and directly impacts efforts to identify, control, and contain outbreaks during this pandemic" since "higher LoD are likely to miss nonnegligible fractions of infected individuals." It also makes the case that LoD values for tests should be benchmarked against a universal standard and readily available in the public domain to enable like-for-like comparison of SARS-CoV-2 detection methods.
The KnowNowᵀᴹ Test is unique to other lateral flow antigen tests in 3 key areas.
The first key difference is that the KnowNow test needs only a saliva sample, which can be taken easily and comfortably from the mouth. Other lateral flow antigen tests usually need a nasopharyngeal, anterior nasal or tonsil sample, all of which are painful and unpleasant for the individual being tested and more challenging to collect effectively for the clinical professional administering the test. No one wants to be made to cry or gag, or make someone else cry or gag, on a regular basis!
The second is that the KnowNowᵀᴹ Test looks specifically for live virus which would cause the individual tested to be able to infect others. Although other lateral flow antigen tests are often said to test whether an individual is infectious, this is because they have a higher Limit of Detection and can only detect the virus when there are more viral particles present in the sample. As a result, they offer a proxy measure for infectivity, rather than directly testing whether there is live virus in the sample. The KnowNowᵀᴹ Test on the other hand is a true infectiousness test, which uses a unique patented mechanism which detects a completely different part of the virus.
Finally, the KnowNowᵀᴹ Test is also more sensitive than other rapid antigen tests available, as it is able to pick up the presence of the virus even when there is much less of it present in the sample. Our Limit of Detection is between 50,000 and 200,000 viral copies per mL, whilst the Abbott BinaxNow test, for example, needs 1,000,000 viral copies per mL in order to get a positive signal.
The KnowNowᵀᴹ Test is the UK's only on-the-spot COVID-19 test that uses just your saliva to tell you if you are currently able to infect someone else with COVID-19.
Unlike other tests, the KnowNowᵀᴹ Test won't give you a positive result if you have been exposed to the SARS-CoV-2 virus in the past, but are no longer able to infect other people.
Receiving a negative result means that the individual tested does not have any live virus in the sample provided and is not currently infectious to others. However, it's important to be aware that they could still be exposed to the SARS-CoV-2 virus following the test. It could also be possible that the individual tested has already been exposed to the virus 1 or 2 days ago, and they have not yet become infectious to others.
As a result, we recommend that individuals are tested as regularly as possible to keep workplaces and communities safe. Depending on the scenario, we would recommend testing is repeated every 1 to 3 days.
At the moment, KnowNowᵀᴹ Tests are for professional use only, meaning that they need to be administered by a trained healthcare professional. This means that we can take orders from organisations that have in-house or outsourced healthcare professionals who can perform the tests, or testing service providers.
However, since the KnowNowᵀᴹ Test needs just a saliva sample, it is much easier to administer effectively than other similar tests, and still return highly sensitive results. So we are investigating whether specially-trained, competent individuals could be approved to administer KnowNow tests as well.
We are also in the process of trialling and seeking approval for a variation of the KnowNow test which could be administered by individuals themselves.
Although vaccine rollout is progressing extremely quickly in the UK, the government expects that it will be the end of July 2021 before every adult in the UK has been offered their first dose of a COVID-19 vaccine. Second doses should be received around 12 weeks after the first, and so it is likely to be the end of October 2021 before every adult has received both doses.
In the meantime, whilst we await full vaccine rollout, regular rapid antigen testing offers a way to enable the re-opening of society.
Beyond this, it is also important to consider that no vaccine is 100% effective even after 2 doses, that not everyone will accept or be able to have the vaccine, and that there is uncertainty as to whether the vaccines will work effectively against current or future mutations of the virus. We should also consider the fact that the UK is very much ahead of other countries around the world in progressing its vaccine rollout, and that it will still be some time before the vast majority of people globally will be vaccinated.
With these factors in mind, regular testing is likely to play a role in keeping societies safe and open for some time to come.
KnowNowᵀᴹ offers two key benefits over polymerase chain reaction (PCR) tests.
The first benefit is that the KnowNowᵀᴹ test needs only a saliva sample, which can be taken easily and comfortably from the mouth. PCR tests usually need a nasopharyngeal, anterior nasal or tonsil sample, all of which are painful and unpleasant for the individual being tested and more challenging to collect effectively for the clinical professional administering the test. No one wants to be made to cry or gag, or make someone else cry or gag, on a regular basis!
The second benefit is that the KnowNow test uses its unique detection mechanism to determine whether an individual is actually infectious, whereas PCR tests identify whether SARS-CoV-2 viral matter is present in an individual's body, regardless of whether it is already inactive.
Although PCR tests have been seen as the "gold standard" test for the SARS-CoV-2 virus, they do have a number of drawbacks. Laboratory processing is required, meaning that there is a delay before results can be returned, and the associated costs are relatively high. Also the detection mechanism does not specifically identify whether individuals are infectious. In fact, PCR tests detect the virus long after the infectious period, and individuals can continue to test positive for a mean of 17 days after they have stopped being able to infect others (source). This means that people who are not infectious are unnecessarily quarantined as a result of a positive PCR test.
Vatic was founded in October 2019 by Alex Sheppard and Dr. Mona Kab Omir.
When the first wave of COVID-19 started in the UK in early 2020, our team immediately saw an opportunity to contribute to global efforts to tackle the pandemic, and leveraged work already underway on antigen testing to quickly start developing the KnowNowᵀᴹ Test.
The mechanism underpinning the KnowNowᵀᴹ test mimics the means through which the virus interacts with the surface of a human cell in order to detect it. As a result, we expect that it will continue to identify the SARS-CoV-2 virus even in the face of further potential mutation in the future, unlike tests based on antibodies.
We have modelled the difference between the Wuhan and 501Y mutations in a recombinant protein model to give us initial analytical evidence that the KnowNow test reacts to these variations of concern. And we are currently carrying out a study on live samples of these and other mutations to gather practical evidence of this.
In fact, we predict that the KnowNowᵀᴹ test may potentially become even more sensitive as the virus mutates to become more infectious. And we will continue to carry out further analyses and studies to support this prediction, and confirm that KnowNow continues to function on newer mutations as they arise.