Lab Staff the Hidden Heroes of COVID-19 Response
The New York Times recently reported that the pandemic has created problems at laboratories across the country: staff who are burned out and fatigued, suffering repetitive stress injuries and frustrated by a shortage of testing supplies.
Labs are short staffed, with little time to do the comprehensive training and fulfill competency requirements needed to do COVID lab work. Some people just depart for less pressured jobs.
Here at Einstein Medical Center Philadelphia, Lisa Provost spent most of her workday in her administrative office. She went home on time. She cooked dinner for her family, which she loved to do. She baked regularly for her family and staff.
Then COVID struck.
These days, Provost, supervisor of the microbiology lab where testing is performed to identify COVID, stays late. She spends much of her time “on the bench,” doing hands-on lab work. After she completes that work, she needs to catch up on her administrative duties.
She gets home too late to cook dinner. Her husband cooks, but she misses doing it. She rarely has time to bake.
“One day COVID wasn’t there and the next day it was,” Provost says. During the second week of March 2020, the hospital went from having one patient sample to test for COVID to – literally – thousands a few weeks later.
“There’s such an increased workload and it’s very stressful,” Provost says. “The staff is doing tons of overtime. Everybody feels compelled to work as long as necessary to get the work done. The work is so important.”
The Philadelphia lab also does all the routine COVID testing for Einstein Medical Center Montgomery and Einstein Medical Center Elkins Park as well as several outreach locations.
Essential But Invisible
Provost and her colleagues are among the most pivotal and least visible of COVID warriors. The entire laboratory team works together using nasopharyngeal specimens to determine whether a patient has COVID or not. Central Processing logs in and delivers specimens to all areas of the laboratory. Along with Microbiology staff, lab workers constantly deal with phone calls from nurses and physicians requesting COVID results.
The other areas of the laboratory have seen an increase in testing used to monitor the status of COVID patients. Microbiology averages 8,000 COVID samples per month on top of their usual 5,000 samples. Their work is critical, but unheralded.
“Unfortunately, lab professionals aren’t really recognized because they don’t have a one-on-one patient interaction, like a nurse or physician,” says Sasha Voce, Einstein’s Administrative Director of Laboratories. “I don’t think people truly understand the impact the pandemic has had on the laboratory. It’s not that they don’t want to know, it’s just because the lab staff is invisible.”
Provost acknowledges it’s been frustrating for her and her colleagues as they labor behind the scenes, especially because they’ve been so slammed by the work. “People are just tired,” she says. “It’s tough. But I’m so proud of our staff. Everybody works from the minute they get in until the minute they leave. Some people are basically doing two jobs. They never complain.”
Early Delays, In-House Solution
In the early weeks of the pandemic, Einstein Philadelphia, along with most hospitals in the area, was sending out specimens to external commercial labs. The average turnaround time was five to seven days.
Seeing the need for in-house and community testing, Sasha Voce arranged for the purchase of an in-house analyzer. The instrument was delivered in early April 2020. Within a week, the instrument was installed and validated, and staff was fully trained to perform the necessary testing.
Shortly after testing began, the lab started experiencing shortages in testing supplies and specimen collection devices. David Mihalic, Director, Pharmacy Services at Einstein Medical Center Montgomery and David Young, Director, Pharmacy Services at Einstein Medical Center Philadelphia, stepped up and started manufacturing viral transport media according to a recipe from the CDC. Testing kits are made and distributed by various members of the laboratory staff.
The process to test for COVID is lengthy and time-consuming. The nasopharyngeal samples need to be transferred by pipette to a secondary tube, which must be labeled. Staff need to make the reagents that are then loaded onto the instrument.
“It takes a good hour and a half to get the specimens and the instrument ready for each run,” Provost says.
Lengthy, Complicated Process
The instrument is cleaned after each run – four times a day. The test usually runs at full capacity of 94 samples and it takes about eight hours to complete each run.
“When it’s running, it’s fantastic. But it has a lot of moving parts,” Provost says. “It’s very touchy. If the calibration is off by a millimeter, it won’t work.” The lab is expected to provide results within 24 hours.
The technician assigned to perform COVID testing on the analyzer works in full protective gear – gown, gloves, N-95. The fear of contracting COVID in the lab has also lessened.
“In the beginning, there was real fear about getting it, but no one has contracted the virus from processing patient samples,” Provost says. Still, lab staff members take precautions – removing clothes and showering when they get home to protect their families.
The emotional jolt from a positive sample isn’t as bad as it was in the beginning, either. “Back then, if someone was positive for COVID, it was much more likely they were going to die and you were very conscious of that,” Provost says. “That’s not the case anymore. As treatments have improved, everybody now has a fighting chance to survive the virus.”
Provost has been at Einstein for 10 years, in a career that fulfills her desire to help others through medical science, while allowing her to work within the confines of a laboratory where she is most comfortable. The silver lining for Provost is that COVID has forced her back to “the bench,” doing hands-on lab work, which she loves.
Through the madness the laboratory has continued to meet all challenges and respond to change quickly.
Now if Provost could only get home in time to make dinner, and bake.