Microbiologist Marisa Egorov prepares a KingFisher extraction
plate. Photo: Washington PHL
The problems with the initial CDC test
have since been well documented.
With pressure building across
the country to expand testing
capabilities, APHL lobbied the Food
and Drug Administration (FDA) to
allow public health laboratories to
develop their own tests.
to finally receive the CDC testing kit on a
Friday in early February.
“My staff came in on Saturday to start the
validation,” recalled laboratory director
Megan Crumpler, PhD, HCLD, “and I can
still remember—I was at my son’s baseball
practice—getting the phone call from my
molecular supervisor saying, ‘Something
just doesn’t look right.’”
The problems with the initial CDC test
have since been well documented. With
pressure building across the country to
expand testing capabilities, APHL lobbied
the US Food and Drug Administration
(FDA) to allow public health laboratories
to develop their own tests. At the end of
February, those efforts were successful
and CLIA-certified laboratories were
able to begin testing in-house, greatly
expanding testing capabilities.
Building Capacity
As testing got underway, however, it
quickly became clear that existing
capacity was insufficient to meet
the need. “Demand started to grow
exponentially,” Gautom said. Washington
added higher throughput equipment and
stood up several teams for each step in
the process, from accessioning through
extraction and PCR to releasing results.
From 15 specimens on their first day of
testing, they quickly ramped up to 400
specimens per day.
In Orange County, COVID-19 testing needs
translated into an all-hands-on-deck
approach, as they shifted all possible
instruments to extraction and PCR and
cross-trained all available staff with
even slightly relevant microbiological or
technical expertise. With hundreds of
samples arriving each day—800 on the
peak day—they hired temporary staff and
expanded the laboratory’s active hours,
opening early and rotating through two
staggered shifts to help accommodate the
testing volume.
The Washington team knew from past
outbreaks that data handling could pose
a large stumbling block. From the earliest
days of their response, they were building
a specimen dashboard to facilitate data
entry and result reporting for specimens
coming into their lab.
“The system largely eliminated the need
for manual communication between
the laboratory and epidemiology staff,”
Gautom said.
Crumpler noted that other routine
testing needs dropped, with fewer people
going into clinics for non-COVID-related
reasons. “That worked to our advantage
because our other departments were
slower. I think it was our saving grace,”
she said.
The South Dakota Public Health
Laboratory has also seen non-COVID-19
testing drop, especially for sexually
transmitted diseases. The lower volume
has been helpful for managing the crisis,
said laboratory director Tim Southern,
PhD. But he’s concerned about what these
“disturbing trends” mean for the future.
“We’re trying to find ways to support our
provider community so that we don’t
create other public health issues in the
future by not providing care that our
populations need,” Southern said.
Many laboratories worked to build
regional and statewide capacity in
parallel with their own. In Washington,
laboratory staff devoted significant time
and effort to develop testing capacity at
clinical, private, academic and veterinary
laboratories throughout the state, helping
laboratories obtain CLIA certification
and validate their methods. The state
had around 20 active testing sites by
late March and more than 40 in June,
bringing statewide capacity to around
25,000 to 30,000 samples a day, of which
only around 1,000 are handled at the state
public health laboratory.
With a relatively small team of seven
medical microbiologists, South Dakota
prioritized enhancing a robust statewide
infrastructure encompassing public and
clinical laboratories, biomedical supply
manufacturers, healthcare providers,
tribal organizations, government
agencies and other partners. Public
health laboratory staff helped two of the
principal healthcare systems in the state
develop their own RT-PCR capabilities
and assisted clinical laboratories with
acquiring collection supplies. A strong
partnership with Hologic helped them get
an instrument to provide high throughput
6 LAB MATTERS Summer 2020
PublicHealthLabs
@APHL APHL.org