Feds delayed UPMC from creating its own test for COVID-19 sooner
UPMC said Saturday that it was ready to begin testing patients for COVID-19 using an in-house test based on the federal Centers for Disease Control and Prevention test, just 10 days after round-theclock work to develop it began.
But Dr. Alan Wells, medical director of UPMC’s clinical laboratories, said the hospital’s virology team could have created the test much earlier if the federal government had not insisted it could handle testing on its own.
“We definitely had wished we were starting [to develop a test] sooner,” he said Saturday during a news conference at UPMC Montefiore Hospital in Oakland.
He said before March 3, when UPMC started work on the test, “we had considered developing a test but had been in communication with the CDC and [the Food and Drug Administration] and had been told that the federal and state authorities would be able to handle everything.”
Dr. Donald M. Yealy, chief of emergency medicine for UPMC, acknowledged that delay wasn’t just a local concern.
“As we’re all aware, the testing capabilities for the COVID-19 illness in the United States were both delayed and limited,” he said. “That created a lot of anxiety for people who were concerned about their own status: Are they infected now? And it also hampered public health capabilities and our response.”
“It’s hard to craft an efficient plan when we don’t really know who has an infection and who doesn’t,” he said.
As important as getting a local test up and running because the outbreak is just beginning, UPMC’s testing for COVID-19 will be limited to a specific segment of the population — at least until it is able to expand its testing from about 20 patient tests a day to a hoped-for 100 patients a day by the end of the week, Dr. Wells said.
“We’ll increase the capacity of the test,” Dr. Yealy said. “But it’s not infinite right now. So we still have to use some judgment, some careful selection about who gets tested.”
Starting Tuesday, UPMC will test patients if they meet the CDC’s current, narrow criteria that they are showing symptoms of the disease and that they have traveled to an affected area or possibly come in contact with an infected person. UPMC is requiring that they have a doctor’s order requesting the test, and they have to be interviewed by a UPMC infection prevention staffer, who will ask them about their travel and contact.
At the UPMC news conference earlier Saturday, Dr. Wells left open the possibility that other health systems could have patients tested through UPMC’s lab “on an as-needed basis for critical patients.”
But later Saturday at a news conference called by Allegheny
County to announce the first two positive COVID-19 tests in the county, Dr. Yealy said they are not restricting testing through UPMC’s lab to just UPMC patients.
“There is no restriction on which type of physician makes the original request,” Dr. Yealy said.
Dr. Brian Parker, Allegheny Health Network’s chief quality officer, who also attended the county news conference, said of the two rival health systems: “I think we want to cooperate.”
“As everyone ramps up their testing capability, whoever can deliver it the quickest with the largest volume and capacity, I think it’s important for us to work together to make sure we can deliver it to the community,” Dr. Parker said. “Because, otherwise, we don’t want to leave anyone in the community — insured, uninsured — without the potential … to be tested.”
Coincidentally on Saturday, the two dominant, rival health systems in Cleveland — University Hospitals and Cleveland Clinic — jointly announced an agreement to do drive-thru testing for COVID-19 for either system’s patients.
The test can be done with just a doctor’s order — no evaluation by an infectious disease expert — using the testing system that Cleveland Clinic bought from a vendor and put into use Thursday.
Seven-days-a-week testing began Saturday for Cleveland Clinic patients and will expand Monday to include University Hospital patients, with testing being done in a garage the two health systems jointly own.
Neither at its in-person news conference Saturday nor in the news release about the testing did UPMC make it clear that its test would be open to non-UPMC patients. Dr. Yealy only made that clear after being asked about the Cleveland hospitals’ cooperation.
Asked if UPMC and AHN were cooperating like the Cleveland hospitals during this crisis, Dr. Yealy said Saturday afternoon: “I think that level of cooperation actually already exists, and I expect it to grow even further. [AHN’s chair of emergency medicine] Dr. [Thomas] Campbell and I have known each other for 36 years here in Pittsburgh delivering emergency care, so we have a long and pretty healthy relationship.”
But he then cited the fact that both hospitals have access to both the state laboratory — which takes up to two days to return test results — and commercial laboratories, which can take even longer.
The advantage of being able to test in its own laboratory, Dr. Wells said, is that test results will come back much more quickly. The type of test UPMC is using — one developed by the CDC — can take just four to six hours to get a result for a test.
“We will be able to diagnose patients within 24 hours rather than days or even weeks like we currently face with outside labs,” Dr. Wells said earlier Saturday.
For example, the two Pittsburgh residents who were announced Saturday as the first two positive COVID-19 cases in Allegheny County were tested by a commercial lab earlier in the week, and it took until late Friday night to learn the outcome of their test, county officials said.
Both Dr. Yealy and Dr. Parker said that drive-thru testing is something both systems have contemplated, though Dr. Yealy said, “It will take time to marshal all the capacity” that would allow such ease-of-testing as a drive-thru.
In addition, he said, UPMC has concerns about making the testing procedure safe for the health care workers who are taking the swab from each patient.
To try to ensure that it is safe, UPMC is directing any patient who qualifies for a test — they have a doctor’s order and have been approved by a UPMC infection prevention specialist — to the former UPMC South Side hospital to have a nasal swab taken for testing.
The collection site is not available for walk-up testing, Dr. Yealy said, and “is not open to the general public.”
Nine rooms in the former hospital’s emergency room have been repurposed into negative pressure rooms, which don’t allow any particles to leave the building until the air in the room has been filtered twice through a fine HEPA filter to remove any infectious droplets.
The staff — who will wear a gown, gloves and either a mask or respirator — will perform the nasal swab in the rooms, and the patient will be directed to return home and self-isolate until the test result is known. Once a sample is taken, it will be tested at UPMC’s lab in Oakland.
Using a site isolated away from other patients and designed just for COVID-19 patients helps ensure “it’s not only safe for [the patients] but safe for the person acquiring the specimen,” Dr. Yealy said.