At Montefiore Health System’s Moses campus, hundreds of orders for COVID-19 lab tests pour in daily. Some are for healthcare workers. Others are for people in intensive care. Still others are for women in labor and delivery.
Though the cases have different levels of urgency, each person who has had a COVID-19 test anxiously awaits the results. To meet the surge in demand, several Einstein M.D./Ph.D. students are stepping up to help. Some have volunteered as triage coordinators, speeding up lab turnaround times, while others are running samples in the Montefiore virology lab under the guidance of lab technicians and physicians. Their efforts are helping to dramatically increase test capacity, which leads to quicker clinical decisions and improved patient care.
“They are using the skills they have learned from working in the labs and their clinical rotations,” said Wendy Szymczak, Ph.D., assistant professor of pathology at Einstein, director of clinical microbiology at Montefiore, and a member of the new COVID-19 lab operation, along with Pathology Chair Michael Prystowsky, M.D., Ph.D., Amy Fox, M.D., M.S., Sean Campbell, Ph.D., Evan Cadoff, M.D. M.B.A., and Lucia Wolgast, M.D.
Volunteering for eight-hour shifts five or six days a week, the students “are developing protocols and workflows right along with us. It has been a rapidly changing process. Every 12 to 24 hours we're giving them changes, and they are adapting to them and doing a great job,” she said.
Triage Coordinators, Virology Volunteers
In mid-March, when the need for increased COVID-19 testing became apparent, the Einstein M.D./Ph.D. student volunteers were asked to come to a room-turned-triage-center at Montefiore that came to be known as the “COVID Command Center.” Dr. Szymczak said the group had to learn infection control procedures and how to use the lab computer system, which ordinarily can take a day and a half. “We had them on the ground working within two hours,” she said. “They picked up the system very, very quickly. They were adaptable and flexible.”
During the first few weeks of testing students had to prioritize which respiratory specimens to test in-house and which would have to be sent to an outside commercial lab, but now most of the testing is being done at Montefiore. “For all specimens that come in, they're looking at the priority of the patients,” Dr. Szymczak said. “They are deciding when to escalate testing. They interact with clinicians on the phones, they troubleshoot, they look at specimens to make sure everything is where it’s supposed to be.”
One of the student volunteers, new M.D./Ph.D. graduate Kieran Seay, said when a test order comes in there are a series of questions the clinician has to answer. “Based off of their answers, we triage and determine where the sample should be run,” Dr. Seay said, “so that the clinicians can get the results as soon as possible.” Other Einstein M.D./Ph.D. students working in the COVID Command Center include Raven Diacou, Maxim Maron, Marika Osterbur-Badhey, Cary Weiss, and Michael Willcockson.
In addition, two Einstein students have been volunteering in the Montefiore virology lab, doing everything from pre-pipetting samples to sending positive results to New York State, said Yitzchak Goldstein, M.D., assistant professor of pathology and associate director of the virology lab. The two, Farid (“Freddy”) Tadros, a third-year medical student, and Karin Skalina, an M.D./Ph.D. candidate, “have been an immense amount of help. Everything they do saves our technologists time.”
As an example, Dr. Goldstein noted that when the COVID Command Center started processing lab samples in mid-March, he was able to get through about 60 tests a day. Just a week after the students arrived, they were able to quadruple that output daily. “That’s really a testament to the streamlining and all the work that the students are doing,” he said.
They [Einstein students] have stepped up in a way that no one could have envisioned. The word amazing doesn't come close.
Amy Fox, M.D., M.S.
Mr. Tadros said the environment can sometimes be tense, “because there are a lot of samples coming in, and everyone knows that each one is tied to a person. And we are keeping track of the outcomes.” Still, he noted that everyone “has been very welcoming and incredibly kind, and Dr. Goldstein has done a great job of expressing how grateful he is. He tells us, ‘You’re helping to save lives.’ There’s no subtlety about it. That’s a striking thing to be greeted with, but that’s the situation.”
A Virus Never Encountered Before
Dr. Fox, a professor of pathology and of pediatrics at Einstein and director of the virology lab at Montefiore, said at the end of February the U.S. Food and Drug Administration issued a new policy to help expedite the availability of diagnostic testing for COVID-19. (Testing was initially only offered through an assay developed by the U.S. Centers for Disease Control and Prevention.) That allowed Montefiore to develop a test and submit it for approval.
“We explored all the options available to us, and this was really the way we had to go. Though we developed our own test, we were limited by the reagents available to us, limited by the instruments we could put the test on, and limited by the technical staff who could actually perform the test,” she explained.
As additional platforms from other industry partners became available, along with the work of the student volunteers in the labs, “we were able to significantly boost testing output,” Dr. Fox said. Some test results now can be in hand in as little as 60 minutes, with the remainder turned around in merely a few hours.
What the Einstein students have done is “inspiring to all of us. They have stepped up in a way that no one could have envisioned,” Dr. Fox said. “The word amazing doesn't come close.”
Posted on: Wednesday, April 22, 2020