The number of tests that laboratories in Monroe County can run for the novel coronavirus is slowly increasing.
Administrators at the University of Rochester Medical Center’s central laboratory said they have begun using automated testing that can process several times more samples than the manual tests the lab had been running.
The difference between manual and automated testing, said the lab’s microbiology director, Dr. Dwight Hardy, is like “making a cake from scratch, where you have to have all of the individual ingredients to make the cake, versus taking a Betty Crocker cake mix box off the shelf.”
The automation started last Friday, said operations director Melissa Allen. But a continued shortage of the reagent the lab uses to isolate the virus’s genetic material from everything else in a sample means the apparatus is running far below its capacity.
“That automated platform could churn hundreds and hundreds of tests out in a day, but we aren’t able to do that because we can’t get enough reagent,” Allen said.
A spokesperson for Rochester Regional Health said that company began some automated testing on Monday. Like URMC, Rochester Regional will continue with a mixture of manual and automated tests while reagent remains limited.
Testing supplies, including reagents, have been in short supply across the country.
The materials are distributed by Roche, a multinational health diagnostics company that also manufactures the machines that run Rochester Regional and URMC’s automated tests.
Three URMC lab administrators, including Allen and Hardy, said in an interview with WXXI News that they thought Roche’s process for allocating testing supplies was fair.
“Really, I think they’re doing the best they can, given the current situation,” Allen said. “The places with the most need are getting the most of the supplies.”
A spokesperson for Roche said the company has been working with government agencies "to achieve the broadest geographical reach and greatest patient impact" from its machinery and supplies.
Even without a fully automated process, Hardy said the URMC lab’s capacity has increased substantially. He said the number of results the lab can return in a day has more than doubled since it began testing last month.
Administrators at URMC said they can now keep up with the number of samples being submitted for testing. They no longer send samples to commercial labs with days-long turnaround times. Most tests at URMC are now completed in 24 hours, Hardy said.
Still, the lab’s ability to match the pace of incoming samples is only possible because of guidance from Monroe County to limit testing to select groups, including health care workers, first responders, and people who have been hospitalized with respiratory symptoms.
Eventually, Hardy said, he expects the lab’s capacity to increase further as testing supplies become more readily available.
From a treatment perspective, local hospital and government officials have said, the testing guidelines make sense: They prioritize results for situations where knowing whether a person is infected with the coronavirus would make a difference.
Everyone should be quarantining themselves if they have any respiratory symptoms at all, Monroe County Public Health Commissioner Dr. Michael Mendoza has said, so knowing whether those symptoms are the result of the coronavirus would not change the recommended course of action.
But for people who are hospitalized, the result of a coronavirus test determines whether the person needs to be isolated and staff need to burn through more personal protective equipment like masks and gloves when treating them. And for hospital staff, a negative test means they can return to work sooner and ease the stress on the health care system.
From an epidemiological perspective, however, restricting testing presents problems. Researchers cannot know how prevalent the virus is, or how quickly it’s spreading, without widespread testing for it.
At this point, though, Mendoza said, “we should all assume that we have been exposed to COVID-19, even if we do not have recognizable symptoms.”