Interviews

We're so far into this pandemic we can discuss multiple waves and surges. Here's how Winchester Medical Center, Virginia, coped with the challenges of the first year of the COVID19 crisis.

Three Waves of SARS-COV-2 with Winchester Medical Center

February 2021
Joe Litten, PhD
with Sten Westgard, MS

Winchester Medical Center, a 445-bed regional referral center, serves the 400,000 residents of the Northern Shenandoah Valley of Virginia and the Eastern Panhandle of West Virginia and western Maryland. As of the moment of this writing, the laboratory is averaging around 550 COVID19 test requests per day, of which around 400 per day are handled in-house spread across three different instrument systems.

In the past year, our laboratory has faced three separate waves of the COVID19 pandemic. This has placed a tremendous demand on the lab. The workload has been nonstop, every day, many staff working 12 hour days.

See even more stories about COVID-19 Laboratory Challenges...

The first surge occurred in April and May (2020) as the first wave of the virus spread out over the country. The second surge hit in the late summer, quite possibly fueled by the returning of students back to college. The third, much, much larger surge, slammed the laboratory in November and December. This last surge dwarfed the previous surges.

n some ways, because the Valley is just a little bit withdrawn from the major population centers, we had time to learn from New York and those cities struck hard by the very first wave of the virus. While those areas learned by trial and error what worked in treatment and what didn’t, we were able to use their hard-won wisdom when the wave finally hit our community.

The start of the pandemic for us was early March, when we began to receive requests for the SARS-CoV-2 on a daily basis. The only place to get this testing done was sending it to the State Health Department. The State was very particular about who could get tested. Each patient request had to qualify for testing before we sent it out to the State lab. The turnaround time was around 1 to 2 days. The reference labs began testing around two weeks later with fewer restrictions. Early on, we had great turnaround times of 2 days from the reference labs, but that quickly changed to over 7 days within the first week. Around mid-April we began performing testing in-house on a Cepheid instrument to alleviate these result delays. However, we only had enough reagent to run around 10 tests per day, so we decided to conserve those tests for the patients that needed quick turnaround time. One of the main drivers for testing was the lack of PPE's; we had a very limited supply of masks and gowns for our employees taking care of the Covid patients. It was imperative that we not waste PPE's on patients who weren't infected.

By May, we were getting over 100 requests per day. This was putting a real strain on the ability of the health system to determine which patients were Covid positive and which were not. On June 12th, we began testing Covid specimens on the Hologic Panther instrument. Again, we were limited on the number of tests we could perform each day, but we were able to take care of all patients coming into the hospital. This really helped in the use of PPE and also knowing which patients were Covid positive.

Both Cepheid and the Panther are good instruments, but supplies are on allocation. Having the instruments without enough reagent or kits didn’t alleviate the testing problem.

Our volumes continued to increase over the summer and fall, so in early November, we set up a high complexity PCR method using the PerkinElmer system. We hired a molecular specialists to set up the method, along with we purchased new equipment. We had the equipment paid off in 3 weeks and in less than two months, we have performed over 7,000 tests on this system. We have performed over 30,000 tests on the Hologic Panther and over 2,000 tests on the Cepheid. We have also sent out over 30,000 tests to Quest. We find that the tests we can manage in-house are about a quarter of the cost that Quest charges.

The supply shortages were the biggest and most immediate crisis, particularly in PPE and pipettes. In the worst part of the early pandemic, we were down to less than a weeks supply of PPE. At one point, we had PPE supplies flown into Kennedy airport, only to have much of them stolen. Another time, we were so desperate for a particular brand of pipette tips, we resorted to searching on eBay to purchase them (we got them).

It’s not talked about very much in the mainstream press, but the financial punch of the first wave of the pandemic hit hard. Because there was essentially a shutdown of elective surgeries and other care, the hospitals lost their lifeblood, and subsequently asked for layoffs across the board, even in the laboratory. I was lucky in that I was able to move several of our staff over to a Covid Lab Team, a special task force that provided 24/7 answers to questions, and most importantly, that was funded by the government. Thus, we were able to shift our resources and prevent any layoffs, while still enhancing our capability to cope with the pandemic.

Now that we’re through our first year of COVID19, the rest of the normal hospital testing volume has returned, which helps the finances of the hospital system. However, for the laboratory, that means we have all the normal workload, plus the additional heavy workload of the COVID19 testing. So everyone is overworked. It does mean we don’t have as much time to do all our usual laboratory activities.

But overall we have been blessed and fortunate. We found a specialist among our ranks who was able to set up our in-house PCR testing. Our administration has been supportive in our efforts to get new instruments, reagents and supplies.

With a strong pace of vaccinations in our area, we predict a steady reduction in testing volume for COVID19, barring any new surprises with variants. Thankfully, we have had the partnership of Chandler University, and they have been sequencing randomly selected patient samples, so we have a slight grasp on the prevalence of variants within our region.

About the Author:

Joe Litten is the Corporate Director of Laboratory Services at Valley Health system in Winchester, Virginia. He received his Ph.D. from the Medical College of Virginia (Virginia Commonwealth University). He was an Assistant Professor in the Pathology Department at the University of East Carolina School of Medicine for several years before accepting a position at Western Maryland Health System (WMHS) in Cumberland, MD. He was responsible for the chemistry department and point of care testing at WMHS.

In 2006, he became the Technical Director for Piedmont Medical Laboratory in Winchester, Virginia. In 2008, Piedmont Medical Laboratory became the first laboratory in the U.S. to receive ISO 15189 accreditation from the College of American Pathologists.

He has spoken on Six Sigma Quality Control on numerous occasions and has several publications on the subject.