Rare look inside Toronto’s COVID-19 laboratory reveals equipment shortages and delays


Lajomee knows better than most how the COVID-19 testing process works. In the past six weeks, she has been tested five times for the new coronavirus and each result has remained the same: positive.

“It’s always the same thing over and over again. Everyone in the hospital knows who I am now, “she said.

“I was scared, to be honest with you, because I have my mother-in-law and my children at home. And I was confused because I thought I had done my best to be safe. “

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The 35-year-old mother of four works in a disability care home in Toronto and needs a negative test result before she can return to work. She suspects that she was infected at her workplace and recalled the time last month when she suddenly lost her sense of smell.

“My mother-in-law once fried fish and you know how the fish smells; I couldn’t feel it, ”she said.

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“And then, when I tried to eat, I couldn’t taste it. I had no cold at the time and it lasted a long time. It was then that I knew something was clearly wrong. “

On April 11, Lajomee (who did not want to disclose his last name due to his work) visited his local hospital, where staff identified his lost sense of smell as a possible symptom of COVID-19. They did a test – a nasal swab that Lajome described as “uncomfortable but tolerable”.

The test itself took less than 30 seconds and it would only have taken a few hours to process the sample and determine if it was still infected. However, the facility did not have the capacity to process the test on site.

Instead, his sample – like the vast majority – had to be placed in a cooler bag, picked up by a courier and taken to another laboratory elsewhere in the city, where they joined the queue.

“Not all laboratories have the capacity to process large volumes of samples, which could affect the delay in results,” said Ruben Rodriguez, director of a COVID-19 testing center in Toronto, noting that their average wait time for a COVID-19 test result is around four days.

“I have seen a huge improvement,” he said. “Before, we needed something like 12 days. “

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Global News followed a COVID-19 test in Toronto from start to finish – from initial swabs to delivery of the final result – and witnessed a system grappling with logistical challenges and equipment shortages. Ontario is facing calls to urgently increase its testing capacity as businesses reopen and restrictions are lifted.

Place a cartridge with a COVID-19 test sample in an analyzer machine.

Place a cartridge with a COVID-19 test sample in an analyzer machine.
Jeff Semple, Global News

“Testing is essential to understanding when new cases arise so that we can overwhelm them with overwhelming force and prevent these few cases from becoming an epidemic,” said Dr. Raywat Deonandan, epidemiologist and deputy director of the Interdisciplinary School of Health Sciences. at the University of Ottawa.

“For a time in Ontario, only public health labs performed capacity testing,” he said. “But we had to relax these criteria to commercial laboratories and university laboratories. It’s a “everyone on the deck” scenario. “

Ontario’s COVOD-19 analysis system currently includes 26 laboratories: six run by public health, four private community laboratories and 16 hospital laboratories.

One of these, the medical laboratory at Toronto’s Humber River Hospital, is a new, state-of-the-art facility that operates 24 hours a day, 7 days a week and performs more than 2,000 tests per day looking for a range of diseases and conditions, from cancer to cholesterol.

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But the laboratory’s COVID-19 test system is a much smaller operation, currently able to process only 30 tests per day.

“I wish we had more tests and more capabilities so that we could be better informed about our decision-making,” said Dr. William Dubinski, chief pathologist and director of the hospital’s medical laboratory.

The COVID-19 test samples from the laboratory are transported to a separate area, through three sets of doors and negative pressure chambers. Staff put on additional personal protective equipment and carefully transfer the swab sample from the test tube to a small cartridge, which is then placed in a specialized machine – a rectangular box that vaguely resembles a photocopier with slits on it. its front panel to insert the cartridges containing COVID-19 test samples.

The machine, from the American manufacturer Cepheid, analyzes the DNA of a sample for two genes connected to COVID-19, using a technique known as polymerase chain reaction (PCR) which amplifies the genetic material of the virus in order to that it can be detected.

It takes less than an hour to produce a positive or negative result. But the laboratory is limited to a single machine and can only process 16 cartridges simultaneously. And the test itself is rare.

“Before this year, no one was developing this test. So every company that is currently developing this test has had to increase production, ”said Dubinski. “There are supply chain issues and there is a huge demand for testing. It’s that simple. “

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Dubinski said the lab is about to add a new test to its arsenal: an Italian-made serological test, just approved by Health Canada, that checks a patient’s blood for antibodies to determine he was infected with COVID-19. The laboratory hopes to start serological testing by the end of the month.

“It tells you how many people have been exposed and hopefully have partial or full immunity. And it helps you more in making public policy decisions, ”said Dubinski.

Serological and surveillance tests are particularly critical since many cases are mild or even symptomless. Several provinces have extended COVID-19 tests for those who have no symptoms, including asymptomatic healthcare workers in Ontario.

“We have to try to get a measure of the part of the iceberg that is underwater, these asymptomatic cases. We have to do it before we open, “said Colin Furness, an epidemiologist at the University of Toronto.

“We look at where the risk is going to be the highest and we check there. I would test the grocery clerks every week and test them all. “

Lejomee’s test was prioritized because she works in a care home and received her result in about three days. Despite a positive test for the fifth time, his only symptoms – lost smell and taste – disappeared after two weeks.

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Doctors told her that she was probably carrying genetic material from a “dead virus” and was no longer contagious. It is unknown how long it will take before his immune system removes all traces of the virus.

“I’m just waiting for this negative point to be able to return to work,” she said. ” I like what I do. I have so much passion and that’s why I want to come back. So fingers crossed. “

© 2020 Global News, a division of Corus Entertainment Inc.


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