FEATURE
testing capability for the western half of
the state, where such capacity had not
existed.
“We have built in South Dakota a level
of relationship, communication and
partnership with our clinical laboratories
that I’ve never seen before,” Southern
noted. “We’ve got lasting relationships
and partnerships that I think we’re going
to be able to leverage in the future, not
just for COVID but for other things.”
Linking New Supply Chains
Those relationships helped when South
Dakota faced one of the most defining
challenges of the COVID-19 response:
limited availability of critical supplies.
Despite planning ahead, there were
issues acquiring supplies from vendors
and manufacturers. The entire US public
health infrastructure was vying for the
same supplies with all of the laboratories
around the globe—at the exact same
time. “We could see that they were doing
all that they could,” Southern said. “The
market couldn’t bear it any longer.”
At one point, after exhausting its supplies
of extraction reagents, South Dakota was
forced to halt testing. Staff raised alarms
about the fragility of their supply chains
with manufacturers, state leaders and
federal officials. Southern credits South
Dakota Governor Kristi Noem and APHL
staff with advocating at the highest
levels of the federal response team. The
laboratory was able to resume testing
after a shutdown of about 48 hours.
“Almost every item needed for testing
has been a limiting factor at one
point,” Gautom agreed, noting that the
Washington state laboratory was within
hours of running out of supplies on more
than one occasion. And in Orange County,
Crumpler said there were several times
when the laboratory gave out their last
nasopharyngeal swab specimen collection
kit without knowing exactly where the
next supply would come from.
“We have resorted to making our own
viral transport media and saline. That’s
been really helpful. But, you know, that’s
more staff work,” she said.
For extraction, the Orange County
team ping-ponged between different
manufacturers and platforms to cobble
together whatever capacity they could
manage. That diversification—and
communications with APHL and a
network of colleagues to track down
information and supplies—allowed them
to keep going, Crumpler said, but “it is
really difficult to plan when you don’t
have a steady supply of reagents.”
Pinch Hitters
Many laboratories found help through
partnerships, some familiar and others
unexpected: regional laboratory networks,
companies, government entities,
universities and foundations.
“There was overwhelming support
from several local companies as they
stepped up to provide resources,”
Gautom said, ranging from swabs
and personal protective equipment to
technical assistance with streamlining
methods. The University of Washington
provided testing capacity. The state patrol
even helped shuttle supplies between
laboratories. Washington, because of its
location in Seattle, is fortunate to have so
many tech companies and other giants
in the area. The Bill and Melinda Gates
Foundation helped secure supplies,
and Microsoft worked with the state
laboratory to build a specimen submission
portal that standardized and automated
data entry for samples sent to the lab,
reducing staff work and errors.
Orange County found a powerful ally
in a National Guard civil support team
(CST) based in southern California. The
laboratory has maintained a relationship
with the team since a bioterrorism
testing exercise two years ago. When the
pandemic hit the area, one of the CST
members reached out to offer aid. Since
then, they have been invaluable partners,
Crumpler said. Both team members
already met federal CLIA requirements
for laboratory testing, so they trained in
extraction and PCR and each took on two
shifts a week in the lab. But perhaps even
more important has been their ability to
obtain testing kits and reagents. “I’ve been
able to connect them with laboratories in
California that were having trouble getting
Cepheid GeneXpert kits, and the National
Guard has been able to supply them,”
she said. “We’re able to get some—not all
that we need, but at least it’s a consistent
shipment of kits.”
The Washington state laboratory helped
validate members of its local National
Guard CST to take on-site laboratory
testing capability into more rural areas
of the state, such as agricultural and
meatpacking operations where clusters
of cases may occur far from a testing
facility. The mobile laboratory can submit
Washington staff assemble COVID-19 specimen collection kits for distribution to county health departments. The training lab was
converted to a space for kit prep and eventually supply storage. Photo: Washington PHL
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Summer 2020 LAB MATTERS 7