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Fellow caregivers:
Testing has been an essential part of our recovery
from the COVID-19 pandemic.
Today, I will take you on a visit
to our Pathology and Laboratory Medicine Institute
to observe the testing process.
We will see how our lab caregivers do this important work,
and why tests are such a precious resource.
Let's take a look.
Well, I'm joined here today with Dr. Brian Rubin.
Brian, you and I had so many conversations
at the beginning of pandemic about the testing.
Could you please share with us what were the challenges
to develop testing in the first place
and then to ramp it up over the past several months?
Well, I think the biggest challenge has been time.
Time has been our enemy during the entire pandemic.
And so we had to launch an entirely new test very quickly
and we took on that challenge
and we actually did that in about 10 days.
And that required mobilizing quite a few people,
getting instrumentation in line, developing the assay,
validating, and then officially launching it.
How were you able to move so quickly?
Because we were one of the first academic medical centers
in the United States to bring testing to our patients.
What was the secret of our success?
So we were able to take our expertise, we were able
to take some people off of the main microbiology lines
and dedicate them to developing the test.
And that was really our strength,
is having this very, very strong scientific community
here within the Cleveland Clinic and being able
to mount a test that no one else could do as quickly.
So bring us now to this day.
How many tests can we do?
Where did we start, and how many tests can we do today?
We started at 500.
We then jumped to about 1500.
And now we're at approximately 2500 tests per day.
I will say we've done 250,000 total tests now
as of just earlier this week.
So that was a major landmark,
a major milestone for us that we achieved.
With all the advances that we've made
we've been able to create a lot of capacity.
Yet the capacity for testing is still finite.
So how do we use these resources responsibly, judiciously?
When we have finite resources
we have to prioritize how we use them.
We start with the sickest patients.
Those would be the patients in the ICU
who have a respiratory illness.
We want to know whether they have COVID or not.
And then from there, treating, looking at high risk patients,
so patients who are immunocompromised,
those who might be sick or elderly patients, very young patients.
And as we've rolled out capacity,
we've been able to open up testing to other groups,
most recently we now are able to test patients
who have a respiratory illness but are average risk.
Can you speak a little bit
about the actual process of testing?
What happens when we come for COVID testing?
Well it all starts with a swab.
So as most people probably know, the swab looks like a Q-tip.
We basically access the virus
by sticking that Q-tip in the nose where the virus lives.
Then that swab comes out and it's covered
essentially with mucus and virus.
And then it's going to move to the lab.
Now, to explain the last couple of steps,
you're going to go visit the laboratory
and talk to a couple of my colleagues
who will explain that process in detail.
So we're now in the preanalytics area of our laboratory
and I'm joined here by Deena Allen.
Deena could you tell us a little bit more
about what happens here every day?
What are the processes when it comes to testing
that are being conducted in a preanalytics?
The couriers will pick up at our collection sites
across the enterprise and they'll bring them in
the back door here, and drop them at the counter.
Then our techs here in this building
will accession those in, and they will triage them,
whether they're here for stat or expedited testing.
They'll stay on this floor
if they are for routine COVID testing,
they'll go upstairs to molecular micro.
So how many tests do you handle daily?
For COVID we could handle 2000, 2500,
we've had as much as almost 2800 a day.
But COVID testing is not the only type of testing
that takes place here.
No it's not.
We're back to almost our regular volumes with our other tests.
So these folks are accesioning everything
that comes through these back doors.
So how many caregivers participate in this process?
On each shift we could have as many as 20, 25 people
over here, 90 overall we have on our staff.
So when the COVID pandemic started,
how did you need to adapt
to the new requirements of new testing?
That is the one thing about this team
they have been phenomenal with adjusting to change.
We have change every day, sometimes multiple times in a shift.
So they've been very adaptable to that.
we have utilized staff from some of our other areas.
We've brought them over, we've quickly trained them
and they're over here to help out with the COVID volume.
And with all of that,
with an experience that you have now accumulated
over the past several months.
What are the learnings from the process?
Communication between us and the testing departments
has really improved.
We're really working on that piece.
As well as, we've different methods for triaging,
we're using a color coded system based on patient type.
So we've learned a lot during this process.
The team has done a wonderful job.
And not only by being able to process so many tests
but also by doing it in a way that was safe.
So thank you very much for what you do.
Thank you. And this is only phase two.
You'll see the next phase upstairs
with Tricia in molecular micro.
We're now on the second floor of our laboratory.
We're here in the molecular lab
and I'm joined by Tricia Johnson. Tricia how are you?
I'm good. How are you?
Tricia could you please tell us a little bit
about what happens in this part of our laboratory?
We just came back from a pre-analytics area
where the samples are being collected.
But what happens here?
So we at the Clinic,
we're able to do two different pathways of testing.
There is a manual method
which is completely reliant on teamwork,
and then we have automated pathways.
Going from the manual method,
so we extract the genetic material from the swabs.
Going from the extractors,
we have to combine it with our master mix.
We have a sterile clean room where all our master mix is done.
It has probes and primers,
everything to make our reactions work to test for the COVID.
So we have our master mix, which is our recipe for COVID,
plus our pure extracts from the patients.
We combine that together, and that's our assembly portion.
So when we assemble with those two parts,
we're able to put it onto a plate, we go on to the PCR room.
PCR is basically a genetic microphone.
It's going to amplify whatever's in your body
and letting us know, 'hey there's a presence of a virus,'
and then after an hour or so, we'll be able to get our results.
So we spoke a lot about the manual process
which is very labor intensive,
requires people with a specialized background
so that they can actually do it.
But we also do have parts of that process
that are highly automated.
And we have some new technology that we acquired recently.
Can you speak about the automated system?
So the automation systems that we have for COVID testing
is basically the game changer in this whole pandemic.
Whereas we have a team of people doing the extractors,
doing the assembly,
doing the analysis of the manual methods that we have.
One or two people can basically do hundreds of samples
by operating an instrument.
In a perfect world,
we want to have an entire automation line.
By offering all these different platforms and methods
to do testing, we're able to stay on top of the game
and just stay ahead of the whole situation.
And you have been staying ahead of the whole situation
thanks to your hard, hard work.
We're doing our best!
So we cannot thank you enough. Thank you very much.
Thanks!
Brian I really enjoyed meeting the members of your team
and learning more about an extraordinary work that they're doing
on behalf of the Cleveland Clinic for our patients.
But as we were wrapping up, could you please inform us
a little bit about the upcoming flu season
and how we're preparing for the flu season.
We've been preparing for flu season now
for about two to three months.
And we're rolling out a strategy
where we can simultaneously detect flu A and B,
respiratory syncytial virus, and COVID all in the same test.
We think that's going to be necessary
because we want to know during that season
what kind of, what disease a patient has.
Those are the four major respiratory pathogens
that we're expecting to see.
So we have one test, one swab,
and it'll test for all of those at the same time.
Brian, thank you very much.
And thank you and your team, for everything that that you have done
and continues to do for us every single day.
Thanks so much.
Much appreciated. Thank you.
As we approach cold and flu season,
the need for COVID-19 testing will be even greater.
Our team is working hard to increase the amount of tests
we can perform on a daily basis.
I am proud of how hard all of you are working
to serve our patients and communities
during this challenging time.
Thank you for your dedication.
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