Prosaic Problems Dog Testing For COVID-19

A two-inch plastic tube used to transfer fluids in testing devices turns out to be one underappreciated obstacle to getting timely testing for suspected COVID-19 patients, researchers at the 2020 virtual meeting of the College of American Pathologists (CAP) suggested.

"This wasn't even on our radar," said Christina M. Wojewoda, MD, director of microbiology, pathology, and laboratory medicine at the University of Vermont Medical Center, Burlington. But, lacking the pipettes for 3 days in July meant the whole team had to scramble to get testing done for the patients during the pandemic.

At a CAP press conference, Wojewoda and other researchers recounted some of the roadblocks that pathologists and laboratorians have run into when struggling to deliver testing to determine whether patients who are coughing and wheezing -- or just need a room to await an elective procedure -- need to be isolated.

In the case of the missing pipettes, "when that happened, we had to shift to use of another instrument to perform the tests, but our supply of reagents for that device was very limited," she told MedPage Today. "So we held those tests for symptomatic patients in the hospital and everything else had to get sent out to a commercial laboratory during that time frame. So it did delay patient care."

Lab workers use the disposable pipettes to deposit patient samples and reagents into the test well. "It is a precise device that can't be readily 3-D printed," Wojewoda said. "Everything stops if we don't have these pipettes. It wasn't even on our radar that this could be a problem."

But there are all kinds of other problems, she said. Patients wonder why it takes 7 days to get a response, she noted, but sometimes the delays have nothing to do with the time to do the test, but everything to do with logistics.

"An issue that we ran into in Vermont was that our samples were being driven from Burlington to Boston, getting loaded on a plane in Boston, but because people weren't flying, the flights were canceled and our samples were sitting in a plane on the tarmac at Logan airport waiting to go to Rochester, Minnesota," she said.

"When we figured that out, we got an Angel Flight to take our samples to Rochester to alleviate that problem."

In the 8 months since the pandemic began, multiple challenges face pathologists and people who work in the testing laboratories, said Benjamin Pinsky, MD, PhD, medical director of the clinical and virology laboratory at Stanford Health Care in Palo Alto, California.

"We have seen enormous problems when it comes to supply chain, specimen types, and a lot of other things we laboratorians have had to overcome in order to provide the best possible testing for our patients," he said at the press conference. "Most laboratories are actually struggling to get the actual tips that transfer the liquids for the various reactions. That had been sort of a week-by-week process to see if we are going to get our allocation."

Such struggles have forced labs to triage patients for fast versus delayed testing. "We have a tiered process based on the patient characteristics in order to determine the speed we need to turn around the testing," Pinsky said.

Press conference moderator and CAP President Patrick Godbey, MD, of Southeastern Pathology Associates in Brunswick, Georgia, said he uses a similar system. "We have a meeting where we discuss which patients are Tier 1 and are treated in-house and which patients are Tier 2 – and those samples can be sent out to a commercial laboratory," Godbey said. "It is a conversation of how ill the patient is, what is our supply of personal protective equipment, and if we can wait a little bit longer for some tests and the downstream effects of what goes wrong if we don't have a fast test."

"Everything for SARS-CoV-2 testing has been in short supply," said Pinsky. "Everything from the supplies we need to collect samples from patients – those swabs, to the tubes that contain the transport media, the test kits themselves. More recently we are seeing non-COVID-19 supplies that are being backordered which are bread-and-butter to a laboratory such as the plates we use to grow bacteria – they are in short supply. Nucleic acid amplification tests not related to COVID-19 are in short supply, so we have had to go from a fast test in some cases to a culture-based [assay], which is not as fast and doesn't pick up the organism as well."

And, he continued, "I think the biggest one and which is seen across the country is a short supply of the tests for gonorrhea and chlamydia. We are really focused on this one huge health issue right now that is COVID-19, but if we are not testing people for sexually-transmitted diseases, we could have another health issue on our hands," he said.

Government involvement might not help with the supply train. "We are pretty much behind the 8-ball," Wojewoda said. "If there is a magic supply of plastic someplace that we could divert into making the tips, that would be tremendously helpful."

And while testing is the heart and soul of the laboratory, Wojewoda suggested it isn't the whole answer to ending the pandemic. "Testing is just one part of how we can fight this pandemic, and while testing is my life, I really feel it should almost take a back seat to social distancing, mask wearing, and hand-washing."

"If you have symptoms, you need a test. If you are going to be intubated for a procedure, you need a test. If you have been exposed to people who have COVID-19, you need a test. But not everyone needs a test," she said.

"Once people are tested [positive], the transmission has occurred," she said. "We want to stop transmission from even occurring. Testing can tell us if a patient is positive for COVID-19 but in a perfect world, appropriate precautions could stop that infection from occurring," Wojewoda said.