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COVID-19
COVID-19 Testing: WHERE TO FROM HERE

A Local Lab’s Experience

that our platform could indeed run up to thousands of tests per day.
By Kelly Elterman, MD and Steven Goodman, MD
At that time, testing was still very limited in San Antonio so we knew
that if we could provide testing on such a scale it would significantly
Introduction help the patients and fellow physicians in our community. Without
With the arrival of COVID-19, physicians in San Antonio and hesitation, we unanimously agreed that we needed to do whatever we
around the world found themselves suddenly facing circumstances could to make this a reality. We may not have been able to help in the
never faced before: a novel virus, a potentially deadly disease course, emergency rooms, but we would do all we could to make accurate
no definitive treatment, anxious patients and loved ones, and growing testing widely available in San Antonio as soon as possible.
uncertainty as stay-at-home orders brought nearly all aspects of daily It turned out that performing COVID-19 testing meant making
life to a halt. As the numbers of infections and deaths in the United significant changes to our lab. We quickly learned that we would need
States began rising, against a backdrop of international public health to enlarge our space, buy a new hood, obtain more personal protec-
crises and economic devastation in other parts of the world, many tive equipment for our staff and expand our courier services, all of
physicians started asking, “How can we help?” Some fled to the front- which would require much time and financial investment. We could
lines to provide direct patient care, others to legislators to demand not know at the time if we would even be able to obtain enough
proper personal protective equipment for those on the frontlines. testing kits to be able to run the tests, but we forged ahead with the
For many physician practices, both on the frontlines and not, the changes all the same. The chance of being able to help our commu-
risks of COVID-19 and the resultant decrease in clinic visits and sur- nity if we succeeded was worth the risk of loss if we failed.
gical procedures necessitated almost immediate practice changes. We remodeled a conference room into additional lab space and
Many clinic-based physicians adapted by switching to telehealth serv- set up two new hoods within a week. We obtained sufficient personal
ices. Emergency physicians and anesthesiologists offered to help in protective equipment for our lab technicians, educated them and re-
intensive care units. Even with these changes in place, physicians structured our staff to be able to run the tests seven days a week. By
across all specialties faced decreased workloads and increased anxiety mid-April, all we needed was the actual test kits. When the kits ar-
about the future of their practices. rived in the first week of May, we validated our platform immediately
Pathology, as a hospital and laboratory-based specialty, was not and began testing patients within days. Initially, we ran 20 tests a day.
immune to these factors driving drastic practice changes. As surgical With an increase in the availability of test kits nationally, and the will-
volume decreased, so too did the volume of surgical specimens re- ingness of our technicians to work around the clock, that number
quiring a pathologic diagnosis. Some pathology practices panicked. has steadily increased to nearly 300 tests daily from over 30 different
Some of these practices furloughed physicians and staff and in oth- sites within San Antonio and the surrounding area.
ers even permanently reduced their employed physicians, while oth-
ers sought ways to contribute to the crisis. Looking forward
With the known exception of Italian pathologists recently being As physicians, we are all interconnected across our individual spe-
asked to manage ventilators in the intensive care unit due to an over- cialties. Whether we see patients in a clinic, on a computer screen, in
whelming number of patients along with an insufficient number of the operating room, or in a laboratory, we all have an obligation to
available intensivists, pathologists are not typically on the frontlines serve our patients to the best of our abilities and to safeguard our
of clinical care. Despite this, as COVID-19 descended upon San An- community. Unfortunately, it is likely that COVID-19 will be with
tonio, in a similar manner to the way the clinicians offered to provide us at least for the foreseeable future, if not forever, as a regular sea-
care in emergency rooms and intensive care units, we too at Pathology sonal guest. As SARS-CoV-2 is highly virulent, frequently asympto-
Reference Laboratory (PRL) asked ourselves, “How can we help?” matic, and can have devastating medical consequences, adequate
PCR testing is crucial to our success against the spread of this dis-
The realization and the process ease. At Pathology Reference Laboratory, we are proud to help our
As normal specimen volume slowed, our molecular testing plat- colleagues and our community navigate these challenging times.
form, typically used to perform high volume PCR testing for various
infectious pathogens of gynecologic specimens, stood empty. This Kelly Elterman, MD is an anesthesiologist and an independent contractor at
question of how could we help kept spinning in our minds until one Lackland AFB, involved with preop COVID-19 testing; Steven Goodman,
day we spoke with the platform vendor, Hologic, who mentioned that MD, a pathologist at Pathology Reference Laboratory, is director of their
they were working to develop SARS-CoV-2 testing. They confirmed COVID-19 testing efforts.

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