COVID-19: 60,000 tests carried out at HMR

Doctors Lambert Busque and Annie-Claude Labbé take the time to pose in the Maisonneuve-Rosemont Hospital laboratory.

On May 30, the Hôpital Maisonneuve-Rosemont (HMR) laboratory team surpassed 60,000 tests for the detection of CoV-2 SARS (Covid-19). We look back on this success story with Dr. Lambert Busque and Dr. Annie-Claude Labbé.

What types of tests do you perform and how do you proceed?

Lambert Busque and Annie-Claude Labbé: Currently, more than 40 laboratories in Quebec perform nucleic acid amplification tests (NAATs). After two months of activity, the HMR laboratory has carried out a record number of 60,000 tests, accounting for 10% of the tests performed in the province.

Tests are conducted in the Molecular Diagnostics Laboratory and the Microbiology Laboratory. Unlike serological tests (blood samples), which detect antibodies developed as a result of infection, we detect the presence of the virus directly, in the secretions of the throat and nasopharynx of the infected person.

This is the same technology used for human genetic testing but targeting the coronavirus genome. The PCR (Polymerase Chain Reaction) technique is used, a kind of virus replicator that can detect very small amounts of virus. This technique is very accurate, but not foolproof: You need a good sample to be successful!

Several complementary methodologies are available in our laboratories. This allows us to meet the demand and prevent supply problems: With the pandemic, all laboratories order the same reagents! We are constantly planning for alternatives to possible stock shortages, as we work seven days a week.

Who are you testing?

L.B. and A.-C. L.: Our mission is to serve the population of the eastern part of the city. So, we test:

• Patients who:
  • Come to the emergency room;
  • Are hospitalized in the CIUSSS de l’Est-de-l’Île-de-Montréal (CEMTL) facilities.
• People living in seniors’ residences, intermediate resources and rehabilitation centres;
• CEMTL employees;
• People who present themselves at the various screening sites, according to the priorities established by the Ministère de la Santé et des Services sociaux and the Direction de santé publique.

This prioritization evolves with the pandemic, in accordance with public health guidelines. We are also adapting to the needs of the institutions that the laboratory serves.

How do you operate?

L.B. and A.-C. L.: A large part of the volume received is collected by the Chauveau Clinic team (including the mobile clinics) who does a great job, day after day.

Some employees who had to undergo testing there many times have told us that, although swabbing the nasopharynx is very unpleasant, the staff on site is friendly and efficient! Daily communication between the laboratory staff and the managers of this team is essential to ensure the fluidity of the analyses and the quality of the results.

The speed with which samples are transported, and the accuracy of the information transmitted are essential elements of the process.

What are the challenges encountered?

L.B. and A.-C. L.: Some of the challenges we have to overcome include the availability of swabs and of the equipment (liquid and tube) for transporting these swabs. We worked with the procurement team to find and validate solutions for alternative swabs in record time.

For example, in terms of transport media, we used to rely on those from the company COPAN for respiratory virus testing. However, this Italian company is unable to meet the demand. As a result, the microbiology laboratory staff prepares more than a thousand tubes containing saline solution every day, in which the swabs can be stored and transported to the laboratory.

We also had to overcome enormous challenges in terms of logistics and the organisation of activities. Coronavirus testing had to be integrated with other diagnostic activities that never stopped despite the pandemic. This was possible thanks to the dedication of the teams in place who accepted that their routine would be completely disrupted.

You were up and running very quickly. How do you explain that?

L.B. and A.-C. L.: The Molecular Diagnostic Laboratory at HMR being one of the largest in the province, thanks in part to the support of the HMR Foundation, we knew we were capable of meeting this challenge, the biggest since the laboratory’s inception in 1994.

Realizing that space, personnel and equipment would not allow us to achieve the desired volume of tests, we called upon several partners:

• With the help of the HMR Research Centre, two laboratories were adapted to allow COVID testing to be carried out safely.
• With the help of managers and medical technologists, and the mobilization of the HMR scientific community, newly hired staff was trained quickly.
• Close co-operation with the purchasing department made it possible to order and receive the new equipment in record time: Once installed and validated, it allowed us to double our capacity in less than two weeks.

How would you sum up the last few weeks?

L.B. and A.-C. L.: These exceptional achievements would never have happened without the commitment and dedication of the entire team, and the collaboration of our partners. Such mobilization, whose ultimate goal is to preserve the health of the population, is a source of motivation to go even further, to do even better, by acquiring and developing, with the support of the Foundation and its donors, innovative technologies.

How many people work there? What is the focus of your work?

L.B. and A.-C. L.: It’s a big team! From receiving samples to entering requests and validating results, about 50 people are involved: Medical technologists, specialists, scientists, managers, receptionists, clerks and physicians.

Our team has quickly developed a scientific expertise on COVID. In fact, we plan to work on a project to identify and characterize the different strains of SARS-CoV-2. This will be very important in understanding the evolution of the virus over the next few months. However, we will need to implement new high-throughput sequencing technology to do so. The Together for the HMR Fund, just created by the HMR Foundation, will allow us to acquire this technology.

Lambert Busque, MD, FRCPC
Hematologist
Head of Molecular Diagnostics,
OPTILAB-CHUM, HMR site

Annie-Claude Labbé, MD, FRCPC
Microbiologist
OPTILAB -CHUM, HMR site