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Labs are experiencing slow volume during the COVID-19 pandemic and are calling for support during Medical Laboratory Professionals Week.
Like other businesses hit hard by stay-at-home orders and the subsequent economic crisis, many medical laboratories are losing revenue and facing reduced staffing hours.
Most other businesses, however, don't play a significant medical role in addressing the COVID-19 pandemic and finding a way back to normal through testing. Medical and public health labs are the only businesses that detect infections and viruses like SARS-CoV-2 for diagnostic purposes.
“We are always there to perform testing for detecting infections, cross matching blood for transfusion, performing chemistry and hematology testing, detecting cancerous diseases and so much more,” said Dr. Rodney E. Rohde, professor and chair of the Clinical Laboratory Science program at Texas State University. “The positions require technical expertise and professional judgment. During this pandemic another set of complex tests has been added to our arsenal. We are essential in determining whether you have the infection and that drives many subsequent medical decisions.”
Rohde said that because of the way governments have responded with delaying elective surgeries and other medical procedures, there is reduced testing to run in the labs. Patients aren’t going to their doctors for their routine cholesterol checks or STD screenings.
He urges government officials to support the professionals and the labs that run the tests to ensure they stay operational throughout the crisis.
“Though we may not realize it until we are in need of disease detection, diagnosis and treatment, laboratory testing plays a crucial role in our health-care system,” Gov. Greg Abbott said in his proclamation for Medical Laboratory Professionals week. “These dedicated men and women are invaluable members of medical teams across the Lone Star State, and their contributions are critical to meeting the health care needs of our state on not only a daily basis but also during public health emergencies, such as during the present coronavirus pandemic.”
As Medical Laboratory Scientist Megan Ledford pointed out earlier this month, There are about 310,000 medical lab professionals in the United States who have been through rigorous training and education to become credentialed and certified to serve 331 million people, equaling one lab professional for every 1,067 Americans. The results of the tests they perform enable educated decisions by physicians, nurses, policymakers, government officials and many others.
“When you hear about drive-thru COVID-19 testing centers, what you are really observing is the important first step in the testing process, the collection of a specimen,” Rohde said. “This is often performed by a physician, nurse or medical assistant. The testing itself occurs in hospital laboratories, reference laboratories and public health laboratories and is performed by medical laboratory scientists and technicians with the leadership and support from pathologists and our other medical laboratory professionals.”
Hays County has several test collection centers but fewer labs: Clinical Pathology Laboratories (CPL) is a designated lab for the county referred tests and Labcorps and Quest Diagnostics are each running tests collected from private collection sites. Labcorps and Quest Diagnostics are running 40,000-45,000 COVID-19 tests per day nationwide.
When talking about testing supply shortages, there is more to diagnosing COVID-19 than the reverse transcription polymerase chain reaction (RT-PCR) molecular test that most government officials and physicians are trying to get their hands on.
“What I’m hearing from laboratorians in the trenches is they may have plenty of lab tests, but the lab test is not the complete picture,” Rohde said. “Preanalytical material is a complete other supply chain issue. If you have a hospital lab with 1,000 test capability because you have 20 kits that each run 50 samples, but you only have 30 specimen swabs, you are only going to test 30.”
For every molecular test, used for diagnosing real time viral infection, there has to be a nasopharyngeal swab and viral transport media.
The swab is used to collect the viral material deep in the sinus cavity. Some clinics are forced to use other less effective swabs instead of the nasopharyngeal swab when supply runs low.
The nasopharyngeal swab is attached to a tube that contains the second piece; the viral transport media. The transport media preserves the delicate viral material and keeps it from getting damaged during transport from the collection site to the lab.
“You can have the greatest test kit that has high sensitivity and specificity but if you have a poor collection then it doesn’t matter, you can have a false negative,” Rohde said. “A bad specimen is one of the more typical troubleshooting issues. You have to ensure you are getting the right specimen and are getting it to the lab in an appropriate transport, time frame and temperature.”
Once the test is received at the lab, it is run through a kit that extracts the RNA. The COVID-19 test is looking for the specific RNA sequence of the SARS-CoV-2 virus. Once it finds the sequence, the virus begins to duplicate and can then be detected and diagnosed by a laboratory professional.
In a typical non-pandemic environment, lab directors look for the most accurate test and the most intuitive system and software and then validate it before purchasing. In a pressurized market, there are many automated and semi-automated test kits being developed and purchased in mass by labs and government officials. Laboratory professionals urge the government and others to purchase and support production of transport tubes, transport media and swabs as well. “If you don’t have that, your test is dead in the water,” Rohde said.
Hays County has purchased a number of molecular tests and is looking into serological tests, which would test a broader sample of the population to understand the penetration of the virus in the community.
“Medical lab professionals are screaming about the need to be consulted in these matters,” Rohde said. “Sometimes other healthcare professionals or a CEO with the exception of pathologists may not have the understanding of what goes into laboratory testing and all of the regulatory issues. When someone, even the government steps up with the funding, it needs to be done carefully, with some oversight. People spend millions of dollars abroad. on bogus tests.”
Community members and educational labs have been fast to donate personal protection equipment, masks, gowns and RNA extraction kits, but there is also a need for swabs and virus transport.
Environmental labs, veterinary diagnostic research labs, pharmaceutical companies and biotech companies likely have stashes of RNA extraction/testing kits and transport media that are vital for diagnosing more COVID-19 patients.
This story has been updated since its orginal publication to include appropriate citation to an article by Megan Ledford.
