ASCLS Today Volume 34, Number 4

Learning from the Past and De-Weaponizing Disease

Miles Tompkins, MLT(ASCP)^CM, ASCLS-Oklahoma President, ASCLS Diversity Advocacy Council Chair

“I won’t come to your funeral when you die from AIDS.”

Despite being almost 25 years since I came out as a gay man, those words are still emblazoned in my memory as if they were spoken to me yesterday. Even in the pre-internet and social media world, divisions were drawn based on religious, political, geographic, and socioeconomic associations. Headlines with the words “gay plague” or “junkie pneumonia” were commonplace in the period from when doctors first saw cases of GRID (Gay-related immune deficiency), a term never condoned by the scientific community, to what we now know and understand to be HIV/AIDS.

Now, with the advent and adolescence of our understanding of SARS-CoV-2, and the disease it is more commonly referred to—COVID-19—it is vitally important that we as laboratory scientists take a stand against those who would weaponize the tragedy and ignorance of others for their own gain. While it is practically impossible to make a comprehensive guide on how to combat the malicious or even sometimes unintended language used, as someone who has been on the receiving end, here are my personal recommendations on how we can re-educate the public and promote the diversity in which ASCLS, our field, and a successful society thrives.

1. See something, YOU say something. Just like with any human rights struggle, progress is never made solely by those affected by change. It takes allies of all kinds. Just because you are not of Asian descent, it does not exclude you from being part of the solution when you see the words “China virus” or someone being treated differently because of their appearance. Ignorance cannot be fought by ignoring.
2. Have a conversation. Don’t allow yourself to fight with memes or 280 characters but have a genuine personal connection. Peoples’ minds are changed by discussion, not by someone shouting through a megaphone on the street.
3. Educate yourself. One of the things I am most proud of about ASCLS is our welcoming of all educational levels and the desire to raise the bar on our collective knowledge. It is with that in mind that we should push ourselves and each other to learn as much as possible, not only the specifics of COVID-19, but the proper language we should use with each other.
4. Have empathy. Unlearning a behavior or breaking a habit can be one of the most jarring moments some people have. While it certainly does not compare to the destructive consequences of vitriol and hate, it still requires empathy and understanding to unlearn prejudices.
5. See your own flaws and be part of the solution. One of the most difficult parts of fighting prejudicial behaviors is recognizing them in ourselves. Words and actions that to you may seem benign, to someone else can be physically and emotionally detrimental. Take time to contemplate your cognitive behavior and take appropriate action to isolate and eliminate anything that is fallacious.

The history of how humankind has reacted to previous pandemics is wrought with unfounded prejudice and predatory moments. We, as a scientific community, are fortunate to have the methodical and critical thinking skills already in our wheelhouse of knowledge. It is through our behavior now that the lens of time will show how we communicated during the COVID-19 pandemic, and how it imprinted on the memories of those most affected. I challenge all of us, myself included, to project and communicate in a way that will make people, even 25 years from now, proud of who we were and are, in some of the most difficult of circumstances.

Miles Tompkins is a Medical Technologist for DLO at Integris Baptist Medical Center in Oklahoma City, Oklahoma.

Karrie Hovis, MHS, MLS(ASCP)^CM, CQIA

Author Karrie Hovis was redeployed to the molecular laboratory to perform the SARS-CoV-2 assay.

Monday, March 9, 2020, started like any other weekday. Kids went to school while parents reported to the office. However, the citizens of New Orleans and surrounding areas were not prepared for what the next five days would bring.

On that same day, Ochsner Medical Center-New Orleans admitted its first COVID-19 patient. March 11 would bring several COVID-19 declarations: the World Health Organization declared a global pandemic, Louisiana Governor John Bel Edwards declared a statewide public health emergency, and Mayor LaToya Cantrell did the same for the city of New Orleans. By Friday, March 13, President Trump declared a national emergency for the United States. In just five days, our lives had drastically changed.¹ Schools were closed, and festivals were canceled. It felt as though we were at war, and the enemy was a large-sized virus, approximately 120 nm in diameter, otherwise known as SARS-CoV-2.²

Just two weeks prior, New Orleanians were celebrating their world-famous carnival season, commencing with Mardi Gras Day on February 25. New Orleans is home to one of the world’s largest Mardi Gras celebrations. Each year, over one million people from all over the globe descend upon our city to celebrate the final day before Ash Wednesday.³ Therefore, it was no surprise that New Orleans quickly emerged as a hot spot for COVID-19 cases roughly two weeks following Mardi Gras.⁴

Government officials and hospital executive teams acted immediately. The leaders at Ochsner Health moved quickly to implement in-house SARS-CoV-2 RT-qPCR testing at Ochsner Medical Center. As a result, we were the first hospital in Louisiana to insource diagnostic testing for SARS-CoV-2.

I was fortunate to be in a position for redeployment to the molecular laboratory. I was immediately trained to perform the SARS-CoV-2 assay and subsequently assisted with training additional staff, which was needed for the influx of samples. Despite challenges and high-test volumes, we never lowered our standards and maintained strict work processes to ensure accurate and timely results. Patient safety was always first.

By April 15, my job was complete. The redeployed staff were trained and competent. Therefore, I resumed my position as laboratory education coordinator. The following day, I discovered that my mother and sister had tested positive for SARS-CoV-2. Although neither was critically ill, they needed additional care. I was redeployed again; this time it was of a personal nature to take care of my mother. By day 12, my mother was showing no symptoms. I returned home, only to discover that my husband, daughter, and mother-in-law were now positive for SARS-CoV-2. Thankfully, no one was critically ill and did not require hospitalization due to complications of the virus.

Five weeks later, I can proudly report that all five family members are negative for the virus and at least two are positive for the antibody. Face masks are always within reach. We have several cans of Lysol® and hand sanitizer throughout the house. Social distancing has become second nature and communicating with friends and family via FaceTime and Skype are the new norms.

I never imagined that one virus could invade my personal life as well as my work life. As a medical laboratory professional, I have spent my career developing skills that would enable me to handle the technical aspect of a pandemic. As a daughter, sister, wife, and mother, I was unprepared for the emotional toll. In the end, we persevered. To all fellow laboratory professionals on the front line, keep up the good fight. We are winning the war against COVID-19!

References

1. Mayor’s Office: Executive Orders https://nola.gov/mayor/executive-orders/ [Accessed May 25, 2020]
2. Encyclopaedia Britannica: Coronavirus https://www.britannica.com/science/coronavirus-virus-group [Accessed May 25, 2020]
3. Trip Savvy: The Best Cities for Celebrating Mardi Gras in the U.S. https://www.tripsavvy.com/mardi-gras-us-4157793 [Accessed May 25, 2020]
4. NBC News: New Orleans is a center of coronavirus. Mardi Gras could be to blame, doctors say. https://www.nbcnews.com/news/us-news/new-orleans-epicenter-coronavirus-mardi-gras-could-be-blame-doctors-n1167741 [Accessed May 25, 2020].

Karrie Hovis is Lab Education Coordinator at Ochsner Health in New Orleans, Louisiana.

Conversations from Twitter

Kathryn Golab, MLS(ASCP)^CM

This past February, the American Journal for Clinical Pathology released the results of a study completed by the ASCP Institute for Science, Technology, and Public Policy about workforce job satisfaction, well-being, and burnout among laboratory professionals. Not surprisingly, the study found that 85.3 percent of survey respondents had experienced burnout because of their job stress, and a majority of those surveyed had a little or a lot of stress because of their job.¹ Now the laboratory is in the national spotlight with the latest novel virus outbreak, SARS-CoV-2, about testing turnaround, accuracy, and availability. One has to wonder what kind of stressors this is now putting on an already burned out workforce. Add in wage and hour cuts due to low census, and increased job hazards … this is a recipe for disaster.

“Mental illness among healthcare workers will increase, and we need to anticipate this fourth wave that is approaching after this pandemic subsides.”

On Friday, April 3, I talked with my dad about how work was going for both of us, my concerns about how I was going to make up wages lost due to low census, and when we hoped we could finally sit down for a family dinner again. He posed this question to me: “Do you realize how many in healthcare are going to leave when this is all over? Quit their jobs and get out of healthcare forever because of the stress?” After thinking over this question for a couple of hours, I put out a short thread on my Twitter page (@KgolabMLS). Three days later, it had more than 23,000 likes, and has been seen by more than 1.7 million people.

Along with the number of likes, retweets, and views, it also sparked a number of interesting conversations with people both in and out of healthcare. Conversations about burnout, whether or not it is deemed acceptable for people to walk away because of something like this, and mental illness considerations we need to make now for our frontline providers. These are my observations about what people thought about those in healthcare on the frontlines. I did not look into what the folks did for a living, or whether they lived in the United States or a country with a nationally run healthcare system.

Long-Term Effects

One thing that seemed to be an overwhelming theme was that people had not thought to ask the questions that my dad posed, and now wondered what would happen in the long term. This began to be referred to as the fourth wave.

The first wave is occurring now; the second wave will happen with people who have critical conditions and put off healthcare due to COVID-19 fears; the third wave is the delay of care for patients with chronic health conditions; and the fourth wave is the burnout and loss of healthcare providers due to treatment during the pandemic. This is something that needs to be thought about and prepared for going forward.

Physicians and healthcare providers already have an increased risk of mental health issues and normally do not seek out treatment for these conditions due to stigma in healthcare.² Now that these frontline providers are participating in what both media and healthcare are referring to as a warzone, the concern for increased anxiety, depression, suicide, and PTSD is high. There was already a study out of Wuhan, China, that showed frontline providers experienced a significant increase in mental health conditions after the first wave of this pandemic in their region.³

Current Conditions

Another common theme discussed was how frontline workers are being treated, and this covered a number of topics. Many people commented on how it is atrocious that our healthcare systems were cutting wages, hours, and benefits during a pandemic. And how many were doing so while still not having enough personal protective equipment (PPE) to keep workers who were treating COVID-19 patients safe. One person responded to these comments in a very pointed way: “This country punishes passionate commitment. Unfortunately, passion only goes so far.”

Did We Sign Up for This?

One topic, however, stuck out the most, and we would not leave it. These comments did not come from healthcare employees. The common theme that came from these comments was that this is something we signed up for, and hard times should not be pushing us out of our jobs, because everyone goes through tough times. A number of people responded to those comments, and I will try to sum up the responses here.

Healthcare workers go into healthcare because they have a passion. They have a passion for helping heal and care for others. But they go into healthcare with the expectation that while they are caring for some of the sickest patients, they will have the equipment they need to do their jobs. They do not go into healthcare to become martyrs. They do not go into healthcare to watch their friends and colleagues get sick and die from a disease that would be prevented by appropriate PPE. Nurses and doctors go through physical and emotional abuse every day on the job, they do not sign up for the mental abuse this crisis would inflict upon them. Some will leave because of it.

While working in the background of healthcare, some of these issues might not be hitting laboratorians as hard as others. But the pressures and stresses get to all of us anyway. Mental illness among healthcare workers will increase, and we need to anticipate this fourth wave that is approaching after this pandemic subsides. A simple question has sparked a bigger discussion. Hopefully, one that will continue about how we can better care for our healthcare providers.

References

1. Garcia E, Kundu I, Kelly M, Soles R, Mulder L, Talmon G. The American Society for Clinical Pathology’s Job Satisfaction, Well-Being, and Burnout Survey of Laboratory Professionals. Am J Clin Pathol. 2020;153(4):470-486. doi:10.1093/ajcp/aqaa008
2. Dutheil F, Aubert C, Pereira B et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS ONE. 2019;14(12):e0226361. doi:10.1371/journal.pone.0226361
3. Lai J, Ma S, Wang Y et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.

Kathryn Golab is a Level 2 Technologist at Wisconsin Diagnostic Laboratories and a Second-Year DCLS Student at Rutgers School of Health Professions.

Navigating the SARS-CoV-2 Pandemic in North Dakota

Christie Massen PhD, MS, MLS(ASCP)^CM

The North Dakota Public Health Laboratory staff before the SARS-CoV-2 pandemic. The laboratory capacity expanded during the pandemic through many critical partnerships.

Being the laboratory director at the North Dakota Department of Health during the SARS-CoV-2 has been rewarding, and the lab has seen plenty of successes and challenges. The laboratory looks very different today than it did at the end of March.

Pre-COVID-19, the North Dakota Public Health Laboratory (NDPHL) would perform an average of 200 tests per day. In mid-May, the laboratory was reporting an average of 2,000 tests per day for SARS-CoV-2 PCR alone, and we are aiming to run over 5,000 tests per day in June. The only way this is possible is through the partnerships that have been created along the way.

In the beginning, like most public health laboratories, we struggled to obtain reagents and consumables to perform SARS-CoV-2 PCR tests. Supply shortages are common in public health laboratories. This was different. For the first time in my laboratory career, I felt the magnitude of a global supply need. During the first few weeks after the virus was identified in the United States, we only had enough reagents to test about 200 people total. We were forced to be very strategic in our criteria for physicians. It quickly became clear that increasing test capacity and reducing turnaround time was critical to effectively respond to the virus.

It was a challenge; we were drowning. We didn’t have adequate resources. Our people worked themselves into exhaustion in an infinite cycle of long days with no rest in sight. We needed help. But, so did everybody else. We did not know how to send out the SOS signal. Even if we did send the request, could it be answered? Then, the tides turned.

Send in the Reinforcements

We received a call from Major Waylon Tomac with the North Dakota National Guard’s 81st Civil Support Team (CST) offering assistance. He reached out to us during one of the most difficult times, and we were relieved to get help. Our previous relationship with the CST, through the Bioterrorism program, allowed us to work quickly and efficiently together. We did not have to waste valuable time getting to know one another; we were able to jump in headfirst and hit the ground running.

The first CST member to show up was Major Aaron Noragaard. Within hours he was here entering demographics. We quickly realized we needed significant reinforcements if we were to mount a sizable defense against the COVID-19 pandemic for our citizens. The formal request was sent up.

First Sergeant Robert Ferderer and other members of the ND National Guard, Army, and Air Force came and helped us immediately. They assisted with processing specimens, identifying resources such as additional laboratory space, facilitating supply orders, building sample collection kits, and solving a multitude of old and new problems. It was this initial partnership and immediate support that allowed us to come up for air and start focusing on the future.

“In mid-May, the laboratory was reporting an average of 2,000 tests per day for SARS-CoV-2 PCR alone, and we are aiming to run over 5,000 tests per day in June. The only way this is possible is through the partnerships that have been created along the way.”

Public Health Lab Coordination

While the National Guard was a pivotal partner, they, like everyone, did not have a secret stash of extraction reagents and consumables tucked away at their warehouse. So, we needed to reach out to another resource—the Northern Plains Consortium (NPC). The NPC is a group of public health laboratory directors and leaders in the upper Midwest. This amazing support system includes North Dakota, South Dakota, Montana, Wyoming, and Idaho. We meet regularly to discuss issues that are affecting our states. Since our state public health laboratories tend to deal with laboratory tests of low volume but of important public health significance, we also share time, resources, and services. For example, the ND Public Health Laboratory offers HIV confirmatory tests to the other states. Other NPC laboratories have assisted North Dakota with sequencing particularly difficult bacterial isolates to help us when our biothreat laboratory needed decontamination. These relationships with other laboratory personnel gave a solid support of resources in times of need.

During one period of time, our operation was coming to a standstill because of a lack of nasopharyngeal swabs. One of our laboratorians reached out to the South Dakota Public Health Laboratory (SDPHL) and discovered that they had extra swabs but didn’t have any extraction kits, so we swapped supplies. This transaction helped move both the NDPHL and the SDPHL forward. We were able to keep collecting samples, and they were able to continue to perform laboratory tests.

Not too long after that, our largest throughput extractor failed, and we needed a replacement immediately. Working with our state’s government leaders, Dr. Tim Southern at the SDPHL was gracious and allowed us to borrow one of their extractors. That night, the CST drove through the night to Pierre, South Dakota, and picked up the extractor. Again, SDPHL and the CST saved the day for us! Unfortunately, that was not the last time we would need an extractor to maintain test capacity.

Sharing Local Resources

As technologies shifted rapidly and new platforms became available, we decided to validate a new assay with higher and more efficient throughput. We had the right analyzer; however, we did not have the correct extractor. Dr. Brett Webb at the North Dakota State University (NDSU) Veterinary Diagnostic Laboratory (VDL) agreed to lend us one of its extractors without hesitation; even going as far as delivering the instruments to us
with consumables. In true professionalism, he trained our team on how to use it onsite! This partnership was critical to ensure our advancement of technologies. In addition, they agreed to perform all rabies tests in North Dakota to help reduce our workload.

With new instruments and increased capacity at our disposal, we turned our sights to increasing laboratory personnel to match our newfound instrument capacity. This is when the next great partnership was formed. Northern Plains Laboratory, a local hospital laboratory, was experiencing decreased test volumes while our test demand was climbing. A contract was established, and the local laboratory started to schedule laboratorians to work shifts within our facility. In addition, laboratorians from all over the state have started working with us to help respond to the crisis. This influx of staff moved the lab to a 24/7 operation.These individuals provided much needed relief for the original laboratory team and continue to aid us in sustaining our test capacity.

With capacity increasing and time running short to complete non-COVID-19 tests, we reached out to the University of North Dakota’s (UND) Medical Laboratory Science (MLS) program to brainstorm some options. Dr. Brooke Solberg agreed to bring equipment into their student laboratory and transform it into a high-complexity CLIA laboratory to help us perform Chlamydia and Gonorrhea Nucleic Acid Amplification tests along with Hepatitis C RNA tests. But, as with everything in this pandemic, we had to shift focus again. They graciously agreed to start performing SARS-CoV-2 PCR for overflow capacity. At this time, we are working to establish this assay in their laboratory and look forward to their continued support in the future.

Future Plans

As we settle into our new normal, we are continually reassessing our operations. The ND National Guard, Army, and Air Force federal emergency orders are expiring soon, and we are working to establish long-term plans. We reached out to Bismarck State College’s Medical Laboratory Technician (MLT) program director, Mari Volk for help. Their students are interested in helping with the pandemic and will assist us with creating collection kits and specimen processing. It is a unique experience to be part of a public health laboratory during a pandemic. We are extremely grateful for the willingness of these future laboratory professionals to step up and engage during a time of crisis. It is a rare opportunity for these students to get to experience the laboratory during a pandemic before they have even entered the workforce!

The vision of our future is expansive. We hope to place North Dakota in a position to better prepare and monitor for novel respiratory viruses. We intend to bring on even more advanced technologies, better laboratory facilities, increased Biosafety level 3 space, and ultimately Biosafety level 4 capabilities. As we look to our future and set our sights high, we are excited to foster even more partnerships and great relationships!

I am incredibly proud of and grateful to all the laboratory professionals I have worked with. They stepped up, worked extensive overtime, and united to provide critical laboratory data for physicians to better diagnose and treat their patients. Their passion for science and herculean efforts have moved North Dakota to second in the nation for tests per capita. We are forever grateful to the individuals who have consistently helped us reach our ever-changing goals again and again.

Christie Massen is Microbiology Director at the North Dakota Department of Health Division of Microbiology in Bismarck.