Unresolved Covid Questions, WSU's MDL is Researching Answers

Sara Nickel (Photo courtesy of Wichita State University Molecular Diagnostics Laboratory)

Unmasking the testing process

Now playing in the world’s various echo chambers: Mask on, mask off, mask on . . . vaccinated? Why? Why not? Do I need a vaccine passport to enter? What do you mean I need a third shot this fall? What is a variant?

In the world of viral epidemiology, it seems reasonable to expect these questions. Covid-19 is certainly not the world’s first pandemic, yet it is presenting unique challenges. It is questionable, however, to expect quick, decisive answers. To be definitively determined: What are the pathways, contacts, and methods of transmission of a particular virus, and which interventions will stem the tide of pandemic spread? Many years of charting human responses to a virus, and its subsequent vaccine, are required to pinpoint those answers, but our impatience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its nasty offspring, the Delta variant, have accelerated expectations. Tired of playing Fauci Says, or wondering if you’re an existential threat to all around you? Perhaps local experts can provide clarity.

Sarah Nickel, and the staff at Wichita State University’s Molecular Diagnostic Lab (MLD), are providing genomic sequencing expertise to the Covid-19 process which will allow results to accurately reflect viral load, and whether you are likely at the beginning, or the end, of the illness; are you in need of simple social distancing and masking, or are you a Covid Mary who needs to isolate until the load safely decreases?

Nickel, a Medical Laboratory Specialist, who is the Technical Director of WSU’s MDL, and an Assistant Professor, Medical Laboratory Sciences at WSU, believes that testing has, and will continue to have, a major impact in the Wichita Area, and worldwide, as efforts to minimize the devastating effect of the Covid pandemic. Planning, building, and establishing the process for operations proved a daunting task, with many naysayers and roadblocks along the way.  

Given that many virologists are labeling Covid-19 perennial, and that Delta variant numbers are rising while testing numbers are down from previous months, what do you expect testing participation to be from your Community Partners, and others, this fall, and beyond?

I feel like this past year has been nothing but unpredictable for me. Based on all 15 years I have worked in clinical virology, I thought Influenza A was going to be terrible and we never saw it, but I am always happy to share my thoughts. Testing numbers have been decreasing greatly over the summer, but as of this last few weeks, our testing numbers are now going up. We have performed more tests in July than we did in June and we still have another week of this month. Within just our lab, we have also seen our positive rate almost double since last month. The Delta variant is spreading through our community and is directly related to our increased testing and positive rate. While it is hard to completely predict, we anticipate that test orders will continue to increase into the beginning of August.  Past August, I am still completely unsure what to expect. I feel like we can plan to need to test for at least the following year and anticipate the need for testing will come in waves as new variants continue to break out. I am really worried to see how this particular virus will continue to mutate and how long this might go on in such full force. I am also worried and wondering about other viruses like Influenza this year. We are living in a very unpredictable situation. I just hope that funding will continue to empower people to test so that they can isolate and notify contacts to try and keep the spread down while we all try to live a somewhat normal life. I believe our partners will continue to lean in as needed for testing and I anticipate some could begin proactive screening again as the numbers begin to rise. We also have signed on several new partners recently, and that is something that had stalled for quite some time.

From what you've experienced, what are the major inhibitors exhibited in the Wichita Area with regard to Covid testing?

 In the Wichita area, I feel the major inhibitors to testing have really diminished over the course of the year. In the beginning it was lack of supplies, funding, and collection sites. Additionally, people needed a doctor’s order to test. I think not all people that needed a test could get an appointment and if they could, knowing that results would take so many days to come back was a huge inhibitor. With the addition of so many community testing partners and our huge expansion of the PCR testing capacity in the county, I feel now that really isn’t as big of an issue. I really feel we have eliminated large inhibitors to testing by the state funding and standing order form Dr. Norman for anyone that needs a test. Additionally, by adding saliva as an optional specimen type, we have truly been able to bring testing right to the need even in underserved populations. I do feel we are seeing less desire in the community to test, but that is gradually changing as we see more and more cases. Symptomatic people still appear to be seeking testing as appropriate which is very encouraging to me. I feel like honestly we have really overcome inhibitors to testing. Now we are just working on making sure the community knows that testing is still available free of charge. If the state no longer funds testing, I anticipate we will see great decreases in testing as the cost is so high and unaffordable for many.

What are some of your insights regarding the impact your lab has provided to this community, and what, if anything, has surprised you?

The impact in the community has beyond surpassed anything I could have predicted. We have over 500 testing partners now. Several of which are also registered with the state of Kansas to allow for collections on anyone in the community that wants to test. To be able to test and consistently get a result within 24 hours (usually less than 12) allows people to be empowered to help stop the spread or know that it is at least safe in the moment to hug their mother or grandfather. We have met our turn-around time promise over 99.5% of the time. I knew we would be able to help with testing. I really thought we would be doing it by helping already existing healthcare clinics/hospitals. What I didn’t anticipate was our ability to empower organizations to help their own employees, families, and volunteers. The endless thank you’ s we still receive truly warm my heart. Saliva testing has been huge (given the more invasive alternatives). We have provided results for over 160,000 tests since late October 2020 and if the need had been there, we could have done so many more. We had nowhere near that capacity in this county before our lab started. I was actually working PRN in the microbiology lab at a local large hospital facilitating these tests one at time and just so frustrated with the process and the methods that we were using because I knew there were better ways. The administration just didn’t have enough workforce to bring in more molecular testing that wasn’t performed easily on an instrument. Something else that has surprised me is that I have been teaching at WSU for 4 years now and I have taught over 120 MLS students, but this lab provided me an opportunity to teach in a completely different way. I never thought about my ability to impact the community by teaching those that weren’t in my field. I have led presentations, explained PCR (Polymerase Chain Reaction) to people from the governor to all types of students all on different educational paths. I have had opportunities to make known a profession to people who had never heard of medical lab scientists. Also, I just feel it solidified my belief in our university. From the beginning, the first day we began planning this lab in April of 2020, there was no way that I truly felt we could pull off something this huge in such a short amount of time, but I knew I could do the testing and others could pull off the rest. However, in a time when things were so hard and we only wanted to make things better, to see so many people fight against what we were doing was shocking. Overall, though, there is support, so much support. It just came from those out there that felt so helpless before. It came from all the small businesses and non-profits and athletic programs that were so grateful that we pushed through. No matter how many people tried to push us down, there were so many awesome powerful people at WSU to lift me and the team back up. We as people have an opportunity to support and drive each other and WSU, especially the leadership and innovation campus, have really opened my eyes to teach more than just my students and to believe in things that sound impossible. WSU partnering with the community and faculty knowledge has huge power to drive positive change. I have now taught over 15 other Medical Lab Specialists how to conduct this type of complex molecular virology testing. That increased our community’s lab knowledge in molecular infectious disease testing to larger than it has ever been. We need lab scientists that truly know how to conduct molecular testing, and this pandemic has proven that to me. I can’t wait to continue to meet this challenge and the next as we try to think outside of the healthcare box and drive more change. I wish it would be easier, but if we can do this I know we can do a lot more too!