SARATOGA SPRINGS — Abuzz with activity behind closed doors, medical laboratories are one of the most-important and least-seen parts of the battle against COVID-19.
At Saratoga Hospital, 140 people run a main lab, three satellite labs, seven collection points and multiple roving collection efforts. COVID tests alone account for more than 1,000 analyses per day and all the non-COVID ailments that the hospital sees add thousands more tests to the docket each day.
The Saratoga Hospital Main Laboratory runs around the clock, with patient names, specimen numbers and test details listed on an overhead monitor as the clinical scientists work amid the steady hum of numerous cooling fans and motors.
The job is as important as ever, 10 months after the first COVID cases were found in the community. In some ways the work was harder in the beginning, when materials were in short supply and the virus was an unknown substance, but the volume of testing is much greater now, and there are seasonal respiratory infections such as the flu added into the mix.
Administrative Director of Laboratory Services Rick Vandell discussed the lab and its work with The Daily Gazette on the next-to-last day of a year that has been like none other for the people who work there.
“The reason that my lab has been able to manage the pandemic successfully and also the hospital managed it successfully is that we went into this with a degree of preparation,” he said.
In January 2020, watching the rapid spread of the virus in China, department managers decided to assume it would reach the Capital Region and plan for a range of potential scenarios.
Even simple measures set the tone. The lab staff trained on the requirements of Category B shipping (infectious live organisms) and stockpiled shipping containers.
“I think that also helped us in the mindset of what to do if this thing really did explode,” Vandell said.
It did explode, and the national shortage of testing supplies affected Saratoga Hospital despite its preparations.
“That’s what caused us to be kind of innovative,” he said.
The lab staff found a company that was using 3-D printers to make test swabs and it found a recipe for homemade viral transport medium, both of which were in short supply.
“And we still use that media,” Vandell said.
The Saratoga Hospital lab was also an early adopter of pooled testing, in which samples from numerous patients deemed unlikely to be infected were combined in a single test, so as to conserve supplies. If the pool tested positive, everyone in it had to get tested individually.
That worked well — “we’ve been very successful at not having to do a lot of repeat testing,” Vandell said — until cold weather hit, and annual seasonal viruses (influenza A, influenza B and respiratory syncytial virus) began to show up in the pools.
So pool testing is over at least for now, but there’s no longer the shortage of test materials that made it necessary.
The lab staff is still looking for a way to test for COVID and the three big seasonal respiratory infections at once. That spirit of improvisation and teamwork has been critical through the pandemic, said Vandell, who recalls watching managers assembling the next day’s test kits during conference calls the way someone might doodle on a notepad.
“I can’t say enough about my team,” he said. “Everybody has just been doing double duty, working long hours.”
That includes Vandell, who has had a few long weekends but no vacations in almost a year. He has not, as yet, spent the night in his office rather than do the long, long commute home to Indian Lake.
“I tell you what, I’ve been tempted a few times,” he said.
Nor can he crash at his parents’ home in Saratoga Springs. Only one Saratoga Hospital lab employee has become infected this year, and the transmission was not in the lab itself, but Vandell’s parents are old enough that he doesn’t want to expose them to any risk of infection.
Vandell, 56, has spent most of his career in hospital and academic medical labs but never really was an infectious disease specialist. When COVID arrived, he had a broad-enough background that he could adapt to the situation.
Medical labs succeed through the simultaneous application of sophisticated equipment and the personal knowledge and experience of those who use it.
The standard COVID test, for example, entails amplifying the genetic material in the sample through a polymerase chain reaction until there’s enough to identify it as COVID. It’s done in an automated, self-contained unit and works on its own once set up properly.
Identifying what’s right or wrong with a blood smear on a microscope slide relies instead on the eye and judgment of the person looking at it.
“You have to be very good at pattern recognition,” Vandell said. “There’s both a fine skill that’s required but also being able to be very organized and detail-oriented … even if it’s on an automated piece of equipment.”
Being able to turn a vague complaint into a fairly certain diagnosis in a very short time — for example to tell an Emergency Department physician that their patient with fatigue and fever probably has leukemia — is one of the best parts of the job.
“That provides a great deal of satisfaction,” he said. “That’s the difference between admitting the patient and sending the patient home and telling the patient to go to their primary care.”
Knowing that they’re helping people who are suffering, not just analyzing computer-generated data, is also rewarding for the lab scientists, Vandell said, and something they must remind themselves about as they work in isolation from these patients.
The fear and expectation in the public health field is that January will bring a new surge in COVID cases, but the so-called second wave began in the Saratoga Hospital lab two months ago.
Vandell said the lab has a greater quantity of supplies and knowledge on hand for the second wave than it had for the first wave, when it was collecting a dozen test samples a day and first opened the outdoor testing tent.
“When we opened our tent on March 10, I look back to those days … we used a lot of our leadership team [in the tent] because we wanted to set an example for the staff and show that it was safe. But there was a lot of fear,” he said.
The problem today is more just sheer numbers.
At the end of December, he said “just managing the volume and the complexity of all the services that we’re offering is definitely our biggest challenge.”