The science behind a county’s tests
Scientists testing at a new lab in Mullingar are leading the fight to combat Covid-19, writes Wayne O’Connor
AN innocuous-looking prefab on the grounds of Mullingar Regional Hospital is arguably the most important building in Co Westmeath.
It is brighter, shinier and newer than other buildings nearby with its sliding glass door and metallic panelling. Inside is a new lab uncovering Covid-19 cases in the county. Appropriately is has a futuristic name — welcome to the IsoPod.
It arrived six weeks ago and was initially acquired to swab suspected Covid-19 carriers. However, it was deemed too small because anyone coming to get a sample taken from their nose and throat would have been unable to practice social distancing with others coming in and out.
Instead, its three negative pressure rooms are being used as a laboratory to test swabs and identify positive cases. Each room is numbered.
Room Three is where the scientists first gown-up and don the necessary protective clothing.
In Room One, the swabs are tested. Next door, in Room Two, they are analysed.
It takes roughly an hour to test each swab, because the work is highly technical.
They average more than 30 tests per day and on their best day they analysed 58 samples here. All the tests are being turned around inside 24 hours. There is no backlog in the IsoPod.
“The pod is physically separated from the hospital building, so that reduced the risk to any of the other staff in the laboratory,” senior medical scientist at Mullingar Regional Hospital Mark McKeon explained.
“Because of the negative pressure, there are no aerosols in the room that might cause harm to any of the scientists, so they are totally safe when going about their work.
“We have been broken into teams and work different shifts so that if someone was to get infected, the virus wouldn’t spread between teams. That means we can keep testing up and running, even if someone gets sick.”
Mark is part of a team that keeps the lab running 12 hours per day, seven days a week, at the centre of Westmeath’s battle against the virus. They are on-call outside of these hours for urgent cases. Currently, they are exploring how the lab can be kept running 24 hours per day once demand increases.
A chemical reaction helps to identify positive strands of Covid-19 in the samples, but this process takes 60 minutes. The scientists’ work is highly technical and time-consuming but the team can test more swabs while they await chemical reactions to take place in other samples.
Still, it is hard to see where the extra capacity will come from to increase the number of tests analysed here.
Last week, the Sunday Independent revealed how thorough testing means Westmeath
is among the counties with the highest number of Covid-19 cases per head of population. It has a rate of 350 cases per 100,000 people. Some have been linked to pubs, Cheltenham and breakouts in care settings. A majority of these cases have come through this lab.
Mark explained further: “The figures coming in for Westmeath are more reflective of our current status, whereas because of backlogs the numbers coming in from elsewhere in the country are more representative of where they were five days ago.
“There has definitely been a positive knock-on effect here, in terms of being able to get the testing done.”
Some of the busiest labs around the country are forced to leave boxes filled with swabs in corridors while they wait to be analysed. There are boxes in the IsoPod’s corridor too, but these are filled with unused testing kits recently delivered from Shanghai.
Colin Murtagh, another senior medical scientist working in the lab, said these will be verified to make sure they meet quality control standards as the lab gets busier in the weeks ahead.
“The work we do directly informs patient care,” he added. Supplies to carry out the tests have been in high demand worldwide. Reagent, a crucial chemical ingredient used to detect the presence of Covid-19 in swabs, has been difficult to source but other unexpected issues have also popped up.
The IsoPod lab ran low on pipette tips and had to source these from a new supplier. As testing kits ran low earlier in the crisis, the team fashioned its own swabs by getting the various parts needed from different suppliers and bringing them together before sending the makeshift kits out to doctors for testing in the community.
“We have managed to keep ourselves above water because of our resourcefulness,” Mark added.
This modus operandi will have to continue as the lab expects to become inundated with more tests from nearby nursing homes and community test centres in the coming weeks.
More than 10,000 tests have been carried out by the Ireland East Hospital Group (IEHG), of which Mullingar Regional Hospital is a member, since the crisis began. At least 600 of these were done in the IsoPod but IEHG consultant pathologist Conor O’Keane, who is based at the Mater Hospital, said labs are already at capacity.
“How much do we expect labs to do and where do nursing homes fit in to that context?” he asked.
“We are at capacity and under pressure already. Eventually these settings will need support.”
In recent weeks that coincided with an increase in positive cases. When a run includes several positive cases, it can be deflating, Mark said.
“When you see a positive, or a run with a lot of positives you just think, ‘yeah, we are not out of this’.
“We need to get the results out as quickly as possible to the doctors, who are going to look after these patients.
“This is the priority and the quicker we get our results out, the quicker the doctors and medical teams can intervene.
“There is quite a bit of pressure, because the work we do is linked to patient care. We are part of a holy trinity of patient care really; doctors, nurses and scientists.”