Dr. Fergall Magee and his team waited for another shipment that never came.
The provincial and clinical lead for integrated lab services with the Saskatchewan Health Authority and his colleagues were doing everything they could to get enough swabs, chemicals and equipment to test the people of Saskatchewan for the novel coronavirus.
The problem was that nearly every other jurisdiction in the world wanted the same thing. In this instance, Magee said the state of California had ordered millions of measures of the same chemical reagent.
Saskatchewan’s order was ignored.
“We began using the phrase ‘You don’t know what you don’t have until it doesn’t arrive,’ ” Magee said.
Each morning, Royal University Hospital clinical microbiology head Dr. Joseph Blondeau huddles with staff to determine how much of each supply is left.
It’s never been zero, but there have been near-shortages of everything from swabs to reagents to the tips used for pipettes.
“We’re always at the mercy of supply chains,” said Lenore Howey, executive director of laboratory medicine. “And we had some nervous days.”
CLIMBING THE MOUNTAIN
On March 12, when Saskatchewan reported its first case of COVID-19, Saskatchewan had to send COVID-19 tests to the National Microbiology Lab in Winnipeg just to confirm them.
Now, Magee said they can do as many as 1,900 a day, through the average is in the hundreds.
The force behind that effort is the 1,500-odd laboratory staff across the province. At any given hour of the day, there are people in laboratories in Regina or Saskatoon running tests for the novel coronavirus, said David McKinnon, director of lab medicine and pathology. It’s the core of the SHA’s “offensive strategy” to detect cases before they become outbreaks.
“The team really came together and rallied to provide that testing for the patients of Saskatchewan,” McKinnon said. “It was amazing.”
Setting up tests isn’t as simple as buying a specific kind of chemical, or plugging in a machine.
It’s like a recipe. You need ingredients — swabs, chemical reagents and specific equipment. You also need to train hundreds of people.
“With an outbreak like COVID-19, there’s a lot of planning that goes into how we run our operations,” Blondeau said.
“It’s not as simple as saying ‘here’s the problem, and here’s how we can start testing.’ ”
Unlike most recipes, ingredients aren’t interchangeable. Specific testing “platforms” require specific ingredients.
“I’ve been on phone calls to Japan, South Korea, Singapore and Hong Kong to get reagents at one phase, because it was so hard,” Magee said. “And you begin to realize there’s more than one way up the mountain, because they’re all using different tests than us.”
A PLATEAU
In a way, that’s what the SHA did to close the testing gap. Howey said the authority now has contacts with three vendors supplying three different platforms. Collectively, they’re enough to climb that mountain.
“We’re stable,” McKinnon said. “We do have quite a bit of reagents right now, but we’re really reliant on our vendors to continue bringing reagents so we don’t run out.”
Howey said the public’s adherence to health measures slowed the virus’s spread enough to give the authority time.
Blondeau said there might be another thing to thank: a false alarm about a potential case of ebola.
In 2014, a man who had recently travelled to Saskatoon from Liberia exhibited symptoms consistent with the deadly hemorrhagic virus. It led to a 96-hour scramble that highlighted the need for better infection control measures and testing protocols, Blondeau said.
“I think we were in a better position when we saw COVID-19 knocking on the door.”
The lab system has a new challenge: gradually resuming some of its suspended services in line with the SHA’s health services resumption plan while still testing for COVID-19. He said tasks may take twice as long as before, since lab technicians and the public have to adjust to new physical distancing measures that will restrict patient intake and work station capacity.
“Now we really have to ask for more people,” Magee said. “Because we can’t do all these things with our current human resources.”
Even as those services resume, they have to stay on their guard, Blondeau said.
“We have enough (supplies) to do thousands of tests,” he cautioned. “We don’t have enough to do tens of thousands of tests. “We really don’t know what to expect in the next weeks or months to see from COVID-19.”
