Finding the positives

Fall 2020

The race to detect COVID-19 in our community

As COVID-19 began to emerge around the world in early 2020, all eyes were focused on the numbers - how many positive cases were being diagnosed? How many patients were filling intensive care units in local hospitals? How many people were dying from this devastating virus? The question became not if this virus would appear in Canada, but when.

While hospitals across the country prepared for the unknown, inside the Pathology and Laboratory Medicine department at LHSC’s Victoria Hospital, work was already underway to determine how, and at what rate, COVID-19 testing could be performed in the hospital labs, and what resources would be needed to increase testing capacity if it became necessary. Known as PaLM for short, the department is a joint venture between LHSC and St. Joseph’s Health Care London, providing a range of standard and specialized lab testing for patients within southwestern Ontario and beyond.

During influenza season, a busy day for PaLM’s microbiology program might see 30-35 lab samples processed for respiratory viral testing. Initial planning in March for COVID-19 suggested that at its peak, the lab might need to be capable of performing 200-250 COVID-19 tests per day by adding additional staff, supplies and equipment.

As the pandemic rapidly progressed, PaLM had to radically increase its response and as of August 15 had built capacity for 3,000 tests a day – a 1,000 per cent increase in volume – and by the end of this year, that number is anticipated to have reached 7,000 tests per day or more. “We recognized early that lab testing would be a critical part of our pandemic response,” says Dr Mike Kadour, PhD, Director of PaLM. “By rapidly bringing together regional system partners from across southwestern Ontario, we quickly established the testing needs of our community to help contain the pandemic. Once we had a handle on the initial needs of the community, we got to work on solutions.”

The solution to dramatically increase testing capacity wasn’t an easy one to achieve. It required an around-the-clock effort from every member of the PaLM team, and strong partnerships with local and provincial public health agencies as well as the vendors who would supply everything from testing reagents (which are added to the patient’s test sample to detect the virus) to the laboratory equipment which would be needed to expand the lab’s operations.

“When I think back to where we were before COVID-19 emerged and look at where we are now, we are completely transformed,” says Dr. Ana Cabrera, Clinical Microbiologist for PaLM. “Our entire team - medical microbiologists, clinical microbiologists, medical laboratory technologists, medical laboratory assistants and clerks – rose to the challenge before us, and as a result, we quickly became a leader in COVID-19 testing across the province, processing more tests per day than many other labs in the early days of the pandemic.”

As the need for broad testing was identified, assessment centres began to open including two in the city of London. These centres were created to allow for safe, easy, convenient testing of residents, while keeping the Emergency Department from being overwhelmed by people worried they might have been exposed to the virus.

At the regional table, it was recognized that there was a lack of testing availability for indigenous and other isolated communities in southwestern Ontario, and that there was a desire to provide testing close to home so that residents did not have to travel into larger cities, potentially risking exposure or delaying diagnosis. As COVID-19 assessment centres were set up in these communities, PaLM worked to develop an Ontario-first fully-digital solution to testing which would allow the entire testing process (minus the swabbing itself, of course) to be performed electronically, from the initial request for testing to the final results. “This end-to-end digital support is vital to early detection and identification of a positive COVID-19 patient,” says Kadour. “The sooner we can share results back to the community, the sooner contact tracing can begin, and the spread of the virus can be contained.”

As PaLM adapted to the increased volumes that this additional testing created, it was becoming apparent that there were other areas in need as well – dozens of local community hospitals and long-term care homes across southwestern Ontario all who had a need for fast and accurate test results.

“PaLM tries hard to be a champion for our communities, and we didn’t hesitate to offer support to our partners across the region,” says Kadour. “Southwestern Ontario has over two million people, and it was important that any and all cases of COVID-19 in the community could be identified quickly. We expanded our lab capacity and transportation links even further to ensure that we could still turn around high-quality test results within a tight timeframe – ideally, within 24 hours.”

For PaLM staff, this meant even more transformation as solutions were found for expansion and further automation of services. Not insignificant in all this transformation was the maintenance of ‘normal’ testing operations as well. “We were already a busy academic lab before COVID-19 hit,” says Cabrera. “We couldn’t just shut down other testing functions. We are an acute care hospital, and we needed to still ensure we were taking care of our patients in hospital as well. We were fortunate to have the right people on our team, who were willing and able to embrace all this change, while still maintaining the same quality that patients deserve.”

Kadour agrees, “There is no doubt that we could only have achieved the results we have with an amazing team of people behind the scenes performing highly innovative, incredibly complicated work day in and day out. Work that previously would have taken months was accomplished in a matter of weeks. The entire team including our lab partners across Southwestern Ontario should be very proud of the work they’ve done, and continue to do.”

As the COVID-19 pandemic continues to ebb and flow, work in the PaLM lab continues to ensure capacity is ready for any surges the region may see as we head into influenza season and beyond. Says Kadour, “there is no time to take the foot off the gas. Early detection is key to knocking this virus down, and we will continue to provide the high-quality diagnostic services that our community deserves and has come to expect.”

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Roxanne Wan, Medical Laboratory Assistant
Dr. Mike Kadour, Director of PaLM and Dr. Ana Cabrera, Clinical Microbiologist