Lab Matters Spring 2022 | Page 23

INFORMATICS

By Rachel Shepherd , specialist , Informatics

At the onset of the COVID-19 pandemic , laboratories had to quickly strategize methods to broaden their testing capacity . One innovation that many laboratories adopted was the advancement of mobile testing . The ability to test in the field rather than exclusively in the laboratory enabled public health laboratories to deliver immediate results , reducing the spread in those instances and leading to better health outcomes for vulnerable populations . The expansion of mobile testing continues to play a critical role in this pandemic , and ideally the benefits gained now can be leveraged to address future crises .

Prior to the pandemic , the District of Columbia ’ s Department of Forensic Sciences Public Health Laboratory Division had never conducted mobile testing . However , through the US Centers for Disease Control and Prevention ’ s ( CDC ’ s ) National Health and Nutrition Examination Survey ( NHANES ), the laboratory was given the opportunity to use a truck stored at the US Food and Drug Administration ( FDA ) in Maryland and no longer in use . Matthew McCarroll , chief of laboratory operations for the DC laboratory , says that it was an immediate game changer .

“ It was especially helpful in dealing with new submitters who hadn ’ t reported to us before , particularly small ones — longterm care facilities , shelters for people without housing and nursing homes ,” said McCarroll . “ Suddenly we could go directly to the site to perform testing , give those results in real-time , and anyone who needed to isolate knew to do so immediately .” People in close-contact group settings and in at-risk populations received actionable information right away , instead of waiting 24-36 hours for results , and in the meantime , exposing others .

McCarroll alludes to one case in particular that showed just how life-saving mobile testing and early detection can be . Early in the pandemic , the laboratory was alerted to a small congregate of nuns caring for individuals without homes with terminal illnesses . Despite the fact that it was an isolated setting — and because it was isolated , COVID-19 precautions like mask-wearing and social distancing were not in place — some of the nuns began to feel sick . The laboratory was able to send the truck and test everyone at once . In the end , half of the group tested positive and began isolating right away , and the other half of the group never got sick . Had everyone been exposed for an additional two days while awaiting results , the infection rate could have been significantly higher , with potentially devastating consequences in such a vulnerable population .

The District also hosted several Health Resource Days , beginning in summer 2020 . These events featured community resources — doctor referrals , preventative screening , children ’ s activities — and the truck was onsite providing COVID-19 testing . In addition to identifying positive cases and providing guidance to limit exposure and spread , this sort of community involvement had the added benefit of visibility for the laboratory , educating DC residents about the role of the laboratory and public health .

Until recently , mobile testing has meant that the technicians had to print out results in the truck , enter the information into a spreadsheet , then enter data into the laboratory information management system ( LIMS ) retroactively . While the benefits were great , the process was inherently inefficient . However , DC recently upgraded their LIMS and McCarroll is optimistic that the addition of a patient portal remotely connected to their LIMS will streamline and improve processes .

“ The ideal scenario is to use a patient portal where the tester can scan QR codes on ( pre-labeled ) test kits , enter in minimal patient demographics in the field and then , when scanned again on the truck , all of the information captured is linked and logged into the LIMS from that point .”

DC ’ s patient portal is currently in beta testing and doing well . The laboratory hopes to launch it in the coming weeks for use in the city ’ s hypothermia centers for residents without housing . As residents are taken to the centers , they would be tested upon entry . Anyone testing positive would be redirected and taken to a hospital for treatment and isolation , eliminating potential exposure .

Looking to the future , the hope is the truck will not just be used for COVID-19 testing in perpetuity , but pivot to other needs over time . It could be particularly useful for onsite sexually-transmitted disease ( STD ) testing , including STD health days at schools , or at similar carefacilities that have benefited from onsite COVID-19 testing .

The continued enhancement of mobile testing capabilities could be one of the most effective investments public health laboratories make . The ability to provide critical and actionable information in real time is vital to mitigate infections and prevent further spread . •