The unseen front line of Canada’s pandemic response
In early January 2020, a cluster of cases of ‘viral pneumonia of unknown cause’ was identified in Wuhan, China. On January 9th, the World Health Organization reported that Chinese authorities had determined that the outbreak was caused by a novel coronavirus.
On January 25, a man in his 50’s who had arrived in Toronto from Wuhan became the first presumptive case in Canada. After calling 911, the man was placed in isolation in Toronto’s Sunnybrook Hospital. Two days later, the National Microbiology Lab in Winnipeg, Manitoba, confirmed the diagnosis. Canada’s battle with COVID-19 had begun.
Canada’s Labs Begin to Respond
The SARS-CoV-2 virus sequence was first published by Chinese researchers the weekend of January 10, 2020. Once the National Microbiology Laboratory had access to the sequence, they began the process of refining tests.
The test itself requires specially trained medical laboratory technologists (MLTs) to extract viral RNA from a patient’s nasopharyngeal swab. The samples are put through an analyzer in a process called polymerase chain reaction, or PCR. This detects if a sample is positive or negative. The entire process is extremely manual and reliant on the skills and expertise of the MLT performing it.
A decentralized approach would be needed to meet the growing demand for testing across the country. Typically, this type of testing is done at public health laboratories, for epidemiological purposes and for data collection. However, as demand surged past public health laboratory capacity, the call went out for hospital labs to take on COVID-19 testing.
In Ontario, Mount Sinai Hospital was among the first to volunteer. Mount Sinai and seven other hospital facilities obtained their licenses for the COVID-19 testing. At first, the Mount Sinai team could perform 654 tests per day. By early December, the lab was able to perform 17,000 tests per day, and provincial capacity exceeded 76,000 tests per day.
A Scarce Resource
Prior to the pandemic, Canada already faced a shortage of MLTs. The demands of a prolonged nationwide pandemic have exacerbated this issue. As this marathon of testing continues and it is unclear when there will be a reprieve, Canadians should recognize the dedication and commitment this profession has shown.
The staffing shortages have challenged provincial governments across the country, causing them to look for ways to meet their HHR needs.
"While this unprecedented time calls for innovative and creative solutions, it's important that the right professionals are performing the right tasks," says Christine Nielsen, CSMLS's Chief Executive Officer. "Accuracy and reliability of test results must remain paramount. Canadians are best served when their tests are performed by certified regulated medical laboratory professionals, in accredited labs."
In some provinces, the use of non-medical laboratory personnel has been considered or implemented to various degrees. Deploying uncertified individuals should be done with great care, which means their roles be appropriate for their skills and training, and that they work under the direct supervision of a certified and licensed MLT.
The provinces have been well served by their existing regulatory framework, which includes a national certification process, entry-to-practice standards, and patient safety mechanisms. This is one of the reasons Canada's laboratory system is world class. During times of crisis, it is vital to lean on these systems, rather than creating ways around them.
"While the theoretical knowledge that BSc and MSc graduates have may be similar to that of an MLT, the application is worlds apart," says Nielsen. "When it comes to all laboratory testing, including COVID-19 testing, MLTs are the most qualified practitioners and we need to respect the knowledge and skills of this professional group."
Potential Solutions Hiding in Plain Sight
While MLT shortages abound, most provinces are fortunate to have an abundant supply of medical laboratory assistants. While not currently regulated, these professionals have a similar national certification process that mirrors the rigours of their MLT counterparts. Better use of certified medical laboratory assistants to their full scope can alleviate workload pressures in various testing phases and areas of the lab, which can allow more MLTs to be redeployed for COVID-19 testing.
Other professional groups within the laboratory profession, such as diagnostic cytologists and clinical genetics technologists, can also be called to help support the pandemic response. Retired MLTs and students finishing their MLT training programs would also represent a potential source of relief labour.
"Laboratory professionals have always been there servicing the needs of patients across the country," says Nielsen. "However they are often overlooked as key contributors to patient care. This pandemic has emphasized the importance of their role and we all owe a debt of gratitude to these unseen champions.”