Anne Barker – Indonesian scientists have developed a simple breathalyser test that they say can electronically "smell' coronavirus and detect infection in under two minutes.
The GeNose C-19 device uses artificial intelligence – in the form of an electronic nose – to analyse a breath sample and identify elements that are unique to COVID-19.
The Indonesian Government last week granted a distribution permit for GeNose and hopes to roll out thousands of the devices by February.
The aim is that this will increase mass testing of coronavirus at hospitals, airports, seaports and other public places in the world's fourth most populous country.
"We need faster screening to prevent people getting infected," Indonesia's Minister for Research and Technology Bambang Brodjonegoro said.
"This will accelerate the detection process and mitigate the risk of the pandemic spreading."
Sensors read pattern of COVID-19 from your breath
Professor Kuwat Triyana, who led the GeNose research project, said a single test takes barely a minute and a half to produce a result, compared to the two days or longer for the standard PCR nasal swab test.
"The workflow is very easy," he said. "The breath is taken from your mouth, put into a bag, sealed, then plugged into the machine whose software interprets it, all within about 80 seconds."
The breathalyser was developed by scientists at Gadjah Mada University in Jogjakarta, in Central Java, where three hospitals are already using it to screen patients for COVID-19.
So far he says the device has proven to be more than 90 per cent accurate. "The breath is sucked by a mini pump into sensors which can read the 'pattern' of COVID-19," he said.
"The pattern of COVID positive and negative can easily be differentiated, as long as we can create the artificial intelligence to read it. Coronavirus would be different from say influenza, tuberculosis or pneumonia."
Powerful filters and a suction process would then remove all COVID-19 droplets or particles, to sterilise the device for the next test. So far more than 2,000 people have been tested with the device.
How reliable is it?
While Professor Kuwat says the breathalyser's accuracy will only improve as it is used more widely, he acknowledges the breathalyser is less reliable than the existing PCR test, which is seen as the gold standard for detecting COVID-19 around the world.
"With this [device] we can screen people and set aside those who are negative," he said. "The rest can then be sent to do a PCR test."
Professor Catherine Bennett, chair of Epidemiology at Australia's Deakin University, said existing evidence from before the pandemic supports the feasibility of devices like the GeNose C-19 breathalyser.
"The science is there," she said. "You can pick up signatures of virus infections." She says the test is akin to a "sniffer dog".
"They're able to detect volatile compounds – that's how they use them to test for explosives, and they've already trialled them, testing for COVID-19 as well," she said.
"The question is whether it's distinctive enough for COVID, to be able to tell the difference between someone with a common cold and COVID."
Rest of the world also looking to breathalyser technology
Professor Kuwat said the Indonesian Government had already asked for 30,000 GeNose devices.
"In the right place, 10,000 GeNose units can test 1.2 million people a day," he said. "That is the highest testing rate in the world."
It comes as police in Surabaya last week detained three men accused of forging rapid test results for passengers travelling domestically from the nearby Tanjung Perak Port.
The suspects allegedly told police they had charged passengers 100,000 Indonesian rupiah (about $10) for a result showing they had tested negative for COVID-19, without undergoing any test.
One of the men had worked at a local health clinic, while another owned a travel agency. Indonesian media reports said similar fake documents had been sold in Jakarta and in Kalimantan.
Police said the crime was all the more alarming since many passengers with false negative results might well be carrying the virus and could spread it to other parts of Indonesia.
Yet Indonesia is hoping the GeNose C-19 device could help authorities rein in the alarming surge in local infections, by massively boosting the country's testing rates.
How to test a nation of 270 million people
As of this week, more than 735,000 people have been infected with COVID-19 since the pandemic began in March.
Around 22,000 people have died – the highest death toll in South-East Asia. In recent days the country has averaged about 8,000 new daily infections.
As a result, Taiwan has cracked down on Indonesians entering the country, because most of the recent cases of COVID-19 in Taiwan have been from Indonesian migrant workers.
There are also suspicions that several had fake test results to show they were negative, but then spread the virus into Taiwan.
Indonesia has one of the lowest testing rates in the world, meaning the true number of cases and deaths in the country is undoubtedly far higher.
The country has struggled to meet the World Health Organization's minimum recommendation of one test for every 1,000 people per week – or 270,000 people in a population of 270 million.
"Hopefully this device can help to solve the COVID crisis in Indonesia," Professor Kuwat said. "We can cut this chain of COVID relatively quickly, in one or two months."
Professor Bennett agrees that even with a lower accuracy rate than the PCR test, the GeNose device could make a big difference in Indonesia.
"If you've got people who aren't testing, and this is a way of grabbing them when they're at work or at shopping centres and doing a very rapid test, it's not as accurate but it will give you a group of people that you can then direct to more formal testing," she said.
"It won't capture everyone. You're still going to miss 10 per cent of the true cases that are out there.
"But you going to pick up 90 per cent of them. And you're not doing that at the moment if these are people who aren't testing. So rapid testing does make a difference."
Though Professor Bennett also warns that vaccinations could undermine the efficacy of rapid tests, because it isn't known "whether you could still be detected if you were carrying the virus but not actively infected by it and didn't have symptoms".
Of course, Indonesia is not the only country to develop such a device.
Researchers and private companies in Singapore, Britain, France and even Australia are developing breathalysers using similar or slightly different technology.
A Melbourne-based company, GreyScan – working with the University of Tasmania – is developing a device that would take its own technology used for detecting explosives, and apply it to finding COVID-19 in a breath sample.
And a Singapore company Breathonix hopes to get regulatory approval next year for its own device that in early clinical trials, involving 180 people, showed accuracy of about 90 per cent.