The Laboratory & COVID-19

behind the scenes in the pathology laboratory

What is happening during the COVID-19 pandemic?

When I left the pathology world as a scientist early in 2018 I never thought I would be back in the lab helping my colleagues out in a busy environment made even busier with COVID-19.

COVID-19 requires scientists based in pathology laboratories to analyse the large number of test samples being collected. Given the limited numbers of experienced scientists in regional areas a call out was made asking for scientists to help out during this crisis.  With the support of the Department of Rural Health I offered to help. I must admit I was also fascinated about what was going on behind the scenes in the workplace. In recent times this situation is unprecedented.  In my nearly 30 years as a scientist I had never experienced anything like it. Going back to the lab gave me an opportunity to contribute in the fight against this virus.  

It gave me an insight into some of the problems being faced by my colleagues. It also highlighted some of the positives of working in a regional pathology laboratory. I have listed a series of Q & A’s, some of which I wanted to know and some of which you might also be wanting to know.

What instrument is being used in the laboratory for testing?

The instrument used in the laboratory is a Point of Care SARS-CoV-2 PCR. This instrument detects genetic material from SARS-CoV-2, the virus that causes COVID-19. It uses Polymerase Chain Reaction (PCR) technology. This technology amplifies the genes so that they can be detected. Whilst the testing is quick at just under an hour, there are a limited number of tests that can be performed at the same time.

Any positive result is then sent to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for confirmation using a different testing platform.

For further information see the link here.

 

What can cause the delay in testing (and receiving results)?

Each pathology laboratory is allocated a certain number of testing kits so each request is sorted into urgency with the most urgent being tested on site.

The less urgent samples are sent away to be tested, usually to Melbourne, but some have recently been sent interstate due to the high demand for testing in Victoria.

Testing is performed in batches. The number of batches were limited in the early stage of the pandemic because of the shortage of PPE at the time and the number of available scientists.

Transport times and the sheer number of samples are the cause of most delays in receiving results. Results that are positive in the first instance also have the added delay of confirmation testing.

 

What is unique about the scientists working in a regional laboratory and why does this help in times like these?

Scientists working in regional laboratories need to be multi-skilled. We are often the sole scientist on night shifts and weekend shifts, and need to be able perform testing in microbiology, haematology, biochemistry and transfusion. With increased pressure on microbiology scientists at the moment (as viruses, such as the COVID-19 virus, fall within microbiology), multi-skilled scientists from within regional laboratories have been able to help out because of their broader skill base.

 

What changes have occurred in the laboratory since COVID-19?

  • Increased specimen reception staffing to cope with the increase numbers of samples. This required back-filling by staff recruited from non-clinical areas to help out eg IT staff
  • Changes in shift times to reduce the number of staff working together within the one time period
  • Recruitment of more scientists and laboratory technicians
  • Increased number of phone calls
  • Increased data entry
  • All staff helping with the entering of COVID-19 results
  • Initially many extra hours worked to enable testing to be performed – evaluation of new testing methods, procedures manuals written, specialist PPE training, rewriting of rosters

My colleague Asha (on the right) and myself in the laboratory.

As well as working long hours in the laboratory Asha was recently in the extremely sad situation of not being able to travel to be with her family in India after her father passed away. In her own words “I would have never imagined not being able to attend my own father’s funeral”.

What pathology abnormalities are seen in patients with COVID19 infection?

An interesting report has been published by Wang et al (2020). They examined laboratory parameters throughout 19 days of hospital admission in 138 patients with COVID-19 infection (33 with severe disease), five of whom died during their hospital stay.  Several significant differences were noted between patients who needed admission to the intensive care unit (ICU) and those who did not.

  • Increased white blood cell count     
  • Increased neutrophil count
  • Decreased lymphocyte count                               
  • Decreased albumin
  • Increased lactate dehydrogenase (LDH)           
  • Increased alanine aminotransferase (ALT)
  • Increased aspartate aminotransferase (AST) 
  • Increased total bilirubin
  • Increased creatinine     
  • Increased cardiac troponin
  • Increased D-dimer 
  • Increased activated partial-thromboplastin (APTT)
  • Increased procalcitonin            
  • Increased C-reactive protein (CRP)

The increase in cardiac troponin over time – from hospital admission onward – has been shown in early studies to correlate with COVID-19 disease severity, requirement for intensive care, and patient prognosis. This trend has been seen in patients with and without pre-existing heart conditions.

All these tests are indicators of how the virus can attack anything in the body with devastating consequences.  The above test result changes indicate COVID-19 can cause kidney damage, cardiac damage, liver damage, increased clot formation, inflammation and sepsis.

 

Something to think about?

A former colleague shared the below image from a Norwegian medical journal.  The image on the left shows a blood smear with normal neutrophil granulocytes (a kind of white blood cell) taken from a COVID-19 patient on the day of admission. The image on the right was taken 5 days later and shows a blue coloured protuberance from the cytoplasm which then disappeared a couple of days later. We both commented on how we have never seen anything like this before – and we wondered: is this real or could it be an artefact?

 

The world is on a learning curve with this virus and every day presents us with new questions.

References:

Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J. & Peng, Z. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
JAMA (2020), DOI: 10.1001/jama.2020.1585
 

Lippi, G., Plebani M. (2020). Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 58:(7), pp 1131-1134.

Tveit, I. A. & Nielsen, H. Z. (2020). Morphologically abnormal neutrophil granulocytes in COVID-19 cases. Published: 3 August 2020. The Journal of the Norwegian Medical Association. DOI: 10.4045/tidsskr.20.0484   (available here)

 

Cathy O’Brien

Associate Lecturer, Rural Placement Education

Going Rural Health Shepparton

Medical Scientist

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