The role of clinical laboratories in patient care often has taken a back seat to glossier areas of medicine. But in the fight against COVID-19, their efforts are at the forefront as they work to implement and develop new diagnostic tests that ultimately may determine the future course of treatment for this disease.
Omai B. Garner, PhD, associate professor of pathology & laboratory medicine and director of UCLA Health’s clinical microbiology laboratory, and Lee H. Hilborne, MD, professor of pathology & laboratory medicine and medical director of care coordination for UCLA Health, are used to being behind the scenes. The work that they and their laboratory colleagues do rarely is seen by the public, but it is essential to diagnose disease and deliver the appropriate treatment for patients. In today’s fight against COVID-19, these once-unsung heroes are on the frontline of the battle.
Drs. Garner and Hilborne talk about the growing importance of testing in this ever-evolving situation and how UCLA Health is leading the charge.
What follows is their responses to some of today’s most pressing questions.
What efforts have been taking place in the UCLA Health clinical laboratory since this outbreak began?
Dr. Garner: We were one of the early labs to think about having a test in-house. Early in this outbreak, when it was decided that people flying directly to Los Angeles from Wuhan, China, would be screened for the novel coronavirus at LAX, you had to send the sample to the Centers for Disease Control and Prevention (CDC) in Atlanta and get the result back from them, which took five or six days. Then it was approved that these tests could be performed by the Los Angeles County Department of Public Health, and so samples would be sent there, with a one- or two-day turnaround. At the end of February, the Food and Drug Administration (FDA) made it possible for clinical hospital laboratories to do their own testing and to perform either the CDC test or to develop their own laboratory-developed test. That’s when our lab moved as quickly as we could to begin with the CDC test, and we went live on that test 11 days later, on March 10, offering about 30 tests per day.
How was your lab able to get up and running so quickly?
Dr. Garner: A challenge of the CDC test was that it had to be run on a very specific viral-extraction platform. If a laboratory didn’t have this specific piece of equipment, it could not perform the test. We actually had two of these platforms that were used primarily for clinical research. Because our hospital system has supported our Department of Pathology to do clinical research, we had them, and we were able to pivot very quickly to using those platforms for testing. That is why we were one of the first hospital laboratories in the country to be able to perform the CDC test in-house. Then a new test for COVID-19 from a company that we use for a lot of other viral diagnostics received FDA approval, and we were able to use that test to supplement the CDC test.
What will be the future direction of testing for this disease?
Dr. Hilborne: Clearly, there currently is not enough testing, not enough supply to meet the demand. We need there to be sufficient testing, in the long term, to be able to understand where this disease is in the population, who has it and at what point someone is no longer at risk for transmitting it and can safely reengage in the community. We don’t completely understand all those issues right now, but they’re being worked on with new blood-based antibody tests.
Going forward, we will be doing more of that kind of serology testing to determine if someone has developed antibodies to the virus.
We don’t yet know for sure, but my sense is that it will convey immunity. We don’t know how long that immunity will last, but there is reason to believe that, in fact, those individuals who have developed antibodies should be resistant to reinfection, at least for the foreseeable future. And I think we’ll see more population-based testing, and that information will give us a better handle on the strength of the community’s immunity to the disease.
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