Alberta laboratories had two advantages when the COVID-19 pandemic hit, allowing them to ramp up early and perform more tests per capita than almost any other jurisdiction in Canada.
One had to do with timing and the other with organization.
"One advantage is that we are at the tail end of the pandemic time curve (behind China and Europe), so we had access to a lot of epidemiological information from other jurisdictions," said Michael Mengel, chair of laboratory medicine and pathology at the University of Alberta and north sector medical director for Alberta Precision Laboratories (APL).
"The second advantage is we have strong public health leadership and an integrated health-care system," he said. "The decision to hand over the control and command to our chief medical officer early in this was a good one."
Alberta had tested 77,316 people for COVID-19 as of April 12-about 20 per cent of the 422,200 tests carried out across Canada to date.
As of this week, testing is now available to anyone in Alberta with symptoms of COVID-19 including cough, fever, shortness of breath, runny nose or sore throat. Patients can access testing by completing an online self-assessment at the Alberta Health Services website.
Mengel said testing has been critical to Alberta's pandemic response because it has allowed public health officials to track the spread, refine isolation measures and work toward "bending the curve" of infections to minimize the strain on the health-care system.
One Alberta-wide system
When Alberta's first COVID-19 case was announced on March 6, the labs were already doing dozens of tests a day for the virus.
The test involves taking a swab from the nose or back of the throat of a patient and then examining the sample in the laboratory for molecular signs of the virus. At peak capacity, Alberta's two provincial public health labs in Calgary and Edmonton are now running almost 24/7 (6 a.m. to 2 a.m.), and anyone with skills in molecular diagnostics, such as cancer and genetic screening, has been redeployed to hunt down COVID-19.
With more than 2,000 laboratory staff in northern Alberta under APL, and a similar capacity in the south, Mengel said Alberta now has the capacity to do almost 8,000 tests per day.
Ramping up to that level required a monumental co-ordination of staff, equipment and supplies, which APL was able to do in part because over the past year and a half, it consolidated labs from different organizations into one Alberta-wide system.
"One of the key principles in emergency or disaster situations is that you need a clear governance and communication structure so that you have the ability to redeploy resources that are under pressure from one area to another," Mengel said. "That is a lot easier when you are one entity.
"The pandemic hit us as our first major test," he said, "(and) it showed after the first couple of weeks that we were very well prepared just by the sake of being one integrated organization."
To reach and sustain the high volume of testing in the province, Mengel said the universities of Alberta, Calgary and Lethbridge have collaborated with APL to share critical lab supplies.
"Our university colleagues have been super helpful in this," he said.
Specialized tests
Beyond the diagnostic test for COVID-19, APL also had to expand capacity for specialized tests that are unique to the pandemic.
For example, some patients who are very sick with COVID-19 develop a "cytokine storm," an extreme immune response that is rarely seen with other illnesses. The test for such patients used to be carried out at just one lab in Alberta; now it has become available across the province as part of clinical treatment studies.
"This is critical because there are experimental drugs out there, which have been used against other diseases, that can be applied to truncate that cytokine storm," Mengel explained. "In order for patients in Alberta to be enrolled in those clinical trials, they require this specialized testing."
Another example is a trial looking at the possible benefits of transfusing blood from recovered patients into those with active disease.
"You need to have special testing and quality assurance around preparing to receive and treat patients with this convalescent serum," Mengel said.
Mengel said APL is also supporting a large clinical research project to examine questions such as how long people who have recovered from COVID-19 are infectious, how long their antibodies last and whether they can get sick again.
"The testing for antibodies is technically not that complicated and there is capacity to do it in a large volume," Mengel said. "The bigger challenge is to understand what the test results mean.
"It's a high priority to work this out."
Mengel also explained that other diagnostic tests that can be delayed without harm to patients have been put on hold. For example, age-related screening for people with no risk factors for colon cancer can be held off for a year. Patients considered to have a high risk will continue to be screened on schedule.
Keeping spirits up by sharing information
Mengel said lab staff are working flat-out to maintain COVID testing levels and it can be exhausting.
"There are no weekends and no time off-everybody is working extra hours."
The staff hold daily huddles, and there is regular communication from Alberta Health Services CEO Verna Yiu and Alberta chief medical officer of health Deena Hinshaw.
"We want to let the staff know where the system stands, what is new, allowing them to understand why they are doing this and what the progress is," he said.
Mengel said the day will come when the infection rate curve in Alberta will flatten, at least for a while, and he is confident the province's labs will be ready if a next wave of infectious disease arrives.
"It's about designing a health-care system that is adaptable enough to address these challenges as they emerge. The redeployment of staff, the governance around this, the supply chain-they are all part of our response."