Although the global COVID-19 pandemic is undeniably awful, a silver lining can be glimpsed through rapid innovation in medical technologies, underscoring the extent of human ingenuity when confronted with crisis.
El Paso health officials say that COVID-19 testing technology has expanded by leaps and bounds over the past several months, and that options for El Pasoans who want to get tested are improving dramatically both in accuracy and speed of results.
“Since we’ve been dealing with (COVID-19) we’ve seen a massive explosion of different ways to test, different modalities, all the vendors working to try to develop a test that’s accurate and make sure we get the correct results. I think the outlook is very positive,” said Greg Erickson, an administrator at University Medical Center.
Dr. Oscar Vega, chief medical officer for Las Palmas Medical Center, echoes the exponential growth of COVID-19 testing capability within El Paso.
“Just like the other treatment modalities around COVID, the testing has been an evolution. In the beginning the only way (to) get a test was by sending it to the Health Department, and then Labcorp and Quest. We were also sending tests out to San Antonio and Austin … on a plane twice a day, specifically so that we could get results out faster,” Vega said.
Now, local hospitals including University Medical Center, Las Palmas Medical Center, Del Sol Medical Center, and the Hospitals of Providence have the ability to do rapid testing in-house, sending a far lower percentage of tests out for analysis.
COVID-19 testing terminology
The two primary types of tests used to identify active COVID-19 cases are PCR tests and antigen tests. These two categories of tests differ in significant ways, and both are utilized by local hospitals. They should not be confused with antibody tests, which test for past infections with the virus.
A PCR test (polymerase chain reaction), also referred to as a molecular test, is the most common type of COVID-19 test administered, and the type that El Pasoans are most likely to currently encounter.
When a PCR test is administered, a sample is typically collected using a throat or nasal swab, and then analyzed for the virus’ genetic material. The length of time it takes to get results and the accuracy of the test itself varies from platform to platform.
PCR testing has encountered problems with supply-chain shortages as it has been introduced en masse to the public. In particular, sourcing adequate reagent has been an ongoing problem. A reagent is a chemical that is used to measure a particular substance (in this case, the presence of the COVID-19 virus within cells).
Erickson said that reagent shortages have had an impact on UMC’s testing capacity, even as testing platforms have been expanded. “A steady supply of reagents is the issue — we had the system but getting a consistent flow of reagent was tough,” he said.
Additionally, other small components to PCR testing have resulted in massive supply chain shortages around the world. For example, in July a shortage of “pipette tips,” a tiny plastic lab supply used to move liquids between vials, had an effect on hospitals in El Paso.
“it’s not even a reagent, it’s an ancillary supply that just carries fluid from one area to the other. But because it’s in such high demand, the whole world is running out of tips,” said UMC’s regional laboratory director, Roland Perea. “So you just never know what type of supply is going to start being depleted and you don’t have enough to do COVID-19 tests.”
An antigen test, meanwhile, identifies protein fragments of the virus. These tests tend to be cheaper, faster and somewhat less accurate. A recent FDA authorization for Abbott to distribute a new antigen test has made headlines as representing a bright and exciting future for widely accessible COVID-19 testing.
Designed for self-administered testing, these tests would be similar to an at-home pregnancy test and cost only $5 a pop. However, some have questioned the viability of mass implementation of this new form of test, noting the diminished sensitivity and potential for new supply-chain shortages.
Sometimes, multiple COVID-19 tests will be run on the same person in order to ensure the accuracy of the test results. This process is called reflex testing. For hospitals, reflex testing can be a useful technique for gaining confidence in test results, while prioritizing rapid testing (that lacks somewhat in accuracy) on patients for whom the hospital needs to know their COVID-19 status as soon as possible.
University Medical Center’s COVID-19 testing laboratory
The laboratory at UMC has incorporated cutting-edge technology and plans to continue implementing new innovations in COVID-19 as they become available, according to spokesperson Ryan Mielke, who led El Paso Matters on a tour of their lab facilities, introducing us to specialists along the way who spoke to the intricacies of COVID-19 testing.
UMC currently has three platforms that are used to test for COVID-19 based out of their laboratory facility: the Biofire, the Panther, and the Abbott ID Now.
Kaylee Vasquez, a medical tech in the microbiology department of UMC’s lab, brought us over to the Biofire first. Multi-colored figurines sat atop the red and gray machine that looked straight out of “Star Trek.” I asked Vasquez what the figurines were, and she said they were cartoon versions of viruses.
“This is the Biofire, you can run six tests at a time. The turnaround time is around an hour. And it also tests for 20 different respiratory viruses, so we can also test for the flu, RSV, and other coronaviruses that aren’t COVID-19,” Vasquez said.
Perea said this capacity to test for multiple viruses at once is significant. “During flu season this is going to be a game changer for us. We’ll be able to know, is it the flu, is it COVID-19? Is it another coronavirus? Is it just the regular common cold? You can test many viruses at one time. We didn’t have this before so now we do,” he said.
The Biofire is the platform that UMC typically uses when it admits a new patient to the hospital, Erickson said. Perea said this platform is among the fastest modalities for getting extremely accurate test results.
Vasquez next led us into a small room filled with racks of tiny test vials and a large black machine, which she identified as the Panther.
“(The Panther) has 100 percent sensitivity, so if the patient does have the virus, it’ll find it. No matter what,” said Vasquez.
Perea said test turnaround time on The Panther is four to five hours. He said the volume of test results the lab is able to process with the Panther is significantly greater than with the other platforms.
On the Biofire, the UMC lab can process 126 tests in a 24-hour period. On the Panther, it can process 500. And on the Abbott ID Now, the lab can process just 96 tests every 24 hours.
Vasquez led us around the corner to another small room, in which sits a sleek white device, the Abbott ID Now, the fastest of the platforms at UMC, and the only testing platform that is used by all of the major hospitals in El Paso.
“(The Abbott ID Now is) a point of care, and the idea behind that is you want to be able to put that in physician’s offices, it’s very portable,” said Perea, who clarified that test results are processed one at a time on that platform.
Vasquez demonstrated how it was used, noting that the machine heats up for about 10 minutes before inoculating the sample.
Perea said that although the Abbott platform is fast, it’s their least sensitive platform, sometimes necessitating reflex testing. “If it’s positive, you can trust it, but if it’s negative, you want to reflex it to a Biofire,” he said.
As of Aug. 31, UMC has processed 10,611 COVID-19 tests in its lab facility and hired five new full-time staff members to accommodate increased testing needs. The lab’s hours have increased to 24/7, and all COVID-19 test samples are walked to the lab (other tests are transported to the lab using a pneumatic tube system that runs throughout the hospital).
The state of testing in El Paso
Beyond the lab at UMC, new innovations in COVID-19 testing are being implemented by hospitals and city public health officials in an effort to improve and broaden local pandemic response.
Jorge Rodriguez, El Paso’s assistant fire chief and emergency management coordinator, described changes to test sample collection methodology by the city.
“(Tests) are collected either through a nasal swab, which has been an advancement because previously when we started they were doing a lot of the nasopharyngeal testing, the one that really gets in there. Those are then sent to a CLIA licensed lab that then does the molecular test and they get a very high (accuracy) rate,” Rodriguez said.
Two weeks ago I went to a city testing site and experienced exactly what Rodriguez described. Unlike my last time getting tested a month earlier in July, this recent testing experience involved a shorter q-tip which I was instructed to insert one inch into each nostril, rotating around the edge before handing back to the testing site technician. I received my results approximately 24 hours later — this was another significant change from my last city testing experience.
“Twenty-four hours is the gold standard (for testing),” said Rodriguez, adding that experiences like mine are becoming more common among El Pasoans who visit city COVID-19 testing sites. “A lot of our samples are sent out of El Paso to East Texas or other areas. We have to ship out, so you’re gonna have that inherent delay. Our goal is to get it between 24 and 72 hours.”
According to the EPSTRONG COVID-19 website, as of Sept. 7, the city of El Paso has performed 245,357 COVID-19 tests. Among tests administered in the past week, 65 percent of results were provided within 72 hours.
Las Palmas del Sol Healthcare also has implemented new testing technology at both of its hospitals in El Paso. Dr. Ogechika Alozie, chief medical officer for Del Sol Medical Center, said Del Sol has been using both PCR testing and antigen testing for patients.
“We use the testing for different types of people because of the test characteristics, the sensitivity. If a patient comes in and they’re sick, we use the Abbott ID Now. If we’re screening asymptomatic healthy people before a procedure, we use the Sofia antigen (test). And that’s really how the test should be used, ideally,” Alozie said.
I asked Alozie about the level of accuracy of the Abbott ID Now test, and whether Del Sol often uses reflex testing. Alozie, who is an infectious disease specialist, replied:
“A test is designed to work in a certain way and that’s how the characteristics are defined. We’ve always used it within the alignments that Abbott feels comfortable with. And so when we’ve looked at our internal data, we’re in the 93-98 percent sensitivity range, so we feel confident about it. Are there times when we send reflexes out to the health department or Quest labs? We’ve done it before, (but) it’s not our standard.”
Vega said that Las Palmas Medical Center is also using the Abbott ID Now and the Sofia platforms for COVID-19 testing.
The Hospitals of Providence utilize three different COVID-19 testing platforms, the Biofire and the Cepheid (both of which are PCR tests), and the Sofia platform for antigen testing, according to spokesperson Monique Poeissiger.
“The Hospitals of Providence uses all available testing resources for the diagnosing of COVID-19 to include in-house testing, reference labs and the city lab and drive-thru testing sites. Our hospitals continue to invest in resources to expand testing capabilities,” Poeissiger said.
Moving into flu season, some challenges for COVID-19 testing will increase, but El Paso health officials are confident that they are equipped to handle the need for rapid and accurate testing in the weeks and months to come.
“We know that in the future we’re going to have a lot more availability of different modalities to test. We know that testing will ramp up, we know that PPE is ramped up. I’m very optimistic with our numbers decreasing that we’ve got a bit of a handle on this, and we’re improving on a daily basis,” Vega said.
However, Vega and Alozie both warn the public to not become complacent as hospitalization rates decline, and emphasize the importance of going out and getting the flu vaccine, in addition to maintaining social distancing, universal masking, and frequent hand-washing.
“People have to remember, we can’t just let our foot off the gas here, especially as kids start to go back to school. This will throw a wrench into this process that we have, so we have to be vigilant,” Alozie said.
Cover photo: Samples waiting to be tested for COVID-19 in the Panther machine at the UMC laboratory. The Panther, which can run about 500 samples in 24 hours, can also test for other viral infections. Some elements in this photo have been digitally blurred to protect the privacy of patients. (Corrie Boudreaux/El Paso Matters)