As coronavirus takes hold in Nevada and across the globe, the Nevada State Public Health Laboratory housed at the University of Nevada, Reno is taking an important role in the response.
A public health laboratory tests and surveils for infectious disease across the state, including COVID-19. They also perform other health-related services such as newborn screening, water and dairy testing and testing for agents of bioterrorism.
The Nevada Independent sat down with the lab’s director, Dr. Mark Pandori, to discuss developments related to the novel coronavirus in the state and to clear up some questions about the testing process.
To listen to the full interview with Pandori and more coverage of the outbreak, check out our latest podcast here.
Q: What does testing presumptively positive for coronavirus mean?
A: When the laboratories, other than the [Centers for Disease Control and Prevention] laboratory in Atlanta, generate a positive test result, we define it as a presumptive positive test result. It’s interesting because we can react to that from a medical public health perspective — it can be acted upon, but it doesn’t convert to a defined confirmed case until the CDC has received the positive specimen from us and has tested it themselves.
Q: How has the lab been handling the cases of confirmed coronavirus across the state?
A: This is the state lab for Nevada, and we handle specimens that originate anywhere in the state. There is a lab in Clark County that handles coronavirus testing specimens that originate in Clark County, but how it’s being handled here at the state of Nevada public health laboratory is that we perform the COVID-19 PCR [polymerase chain reaction] test.
We perform it for any clinician that has a patient who is symptomatic and then meets the criteria for testing. And right now, public health departments are helping clinicians decide whether a patient meets the criteria.
Initially, those criteria were rather narrow. A person had to have a certain link to another case or to travel to an affected area. But in recent days … the criteria expanded, so now a clinician might have a symptomatic individual and decide that they might want coronavirus testing, and that patient would not necessarily need to have an epidemiologic link to another case. It would just have to be ascertained that they don’t have something more common like what’s circulating right now, like flu or cold.
Q: Are you guys ramping up your efforts for coronavirus testing?
A: Yes, we are ramping up, to use the term you indicated. We started out back on Feb.11 with the ability to perform about 300 tests, and that was from a kit that was provided to us by the Centers for Disease Control, the CDC.
We’ve ramped up and … now have 1,800 reactions with which to test for coronavirus. So we’ve really considerably ramped up, but it’s not just chemicals and reagents, it’s also the training. We’ve gone from one person to now three people on our staff that can perform the test …
Nevada is a big state with rural areas, and we’re in the process now of establishing and refining our courier network capability so that we can get specimens from anywhere in the state to this lab for testing. So you have a network of drivers that are going to get contracts.
Because one of the things we’ve seen already in California — it’s not necessarily the most populated counties or areas that are going to see the initial cases.
Q: You said you have 1,800 tests. Is that how many people you can test?
A: We can do about 100 tests per day. The test takes between three and four hours for us to do. So we could do multiple runs in a day on multiple platforms, and we have the capacity to test… [depending] on whether we batch test or run people individually, but we can test approximately one thousand people.
Q: We have 1,800 reactions for a test kit — what does that mean? We’ve heard conflicting reports about the test kits, some saying they can be reused. Can they be reused, and how many do we have?
A: It gets to be a little down in the weeds here. So the test kits that were sent out by the CDC contained what we call 1,000 reactions.
What’s a reaction? Well, you could think of a reaction as a lab test, but when diagnostic laboratories perform this laboratory test, we don’t just run the specimen. We have to run what are called controls for every run. A control [is] essentially fake specimens that are positive and negative that determine whether or not the test is functioning properly. So that when we generate a result for a specimen, those controls, the positive controls have to be positive and the negative controls have to be negative so that we know the test functioned properly.
So that requires reactions as well. So if you think about it, if we were just to test one patient in one run, we would have a positive and negative control and a patient that would be three reactions.
So what you’re hearing about 500 tests or 300, people don’t really know what to say because in one run we can do up to about 21 or 22 patients and then two controls. But if we had one patient and two controls, you can see there’s an economy to the tests … We have enough reagents to test well over a thousand people here.
Q: What is the test using? A spit sample or something else?
A: A lot of people that I’ve communicated with that have questions about testing think of it as a blood test and why not? Because that’s a very common way to get a medical test, but in fact, this test doesn’t test your blood for coronavirus 2019.
What we’re testing are NP swabs, which are nasopharyngeal swabs that go into your nose and touch the back of your throat, and also throat swabs are OP swabs, as we may call them oropharyngeal swabs.
So the reason we’re testing those swabs is that’s where we find the virus when a person is ill, and in fact, transmission of the virus comes when those fluids are in the respiratory tract [and] are coming out through the nose or the mouth. And so you can imagine there’s virus in those droplets. And so we’re testing the swabs that touch those areas actually directly for the virus itself.
Q: So if someone in Elko gets sick, you can swab them there and then have a courier bring it to the university here in Reno to test?
A: When it hits the lab lobby here, it would get checked in, and I would say three to four hours later we would have a test result.
Q: When you take the sample, are you just putting it into certain chemicals that indicate whether there’s a virus or not?
A: The sample, which [is] the swab, if the swab touched a virus, let’s say in the back of the throat or in the nose, it goes into a tube that has some liquid in it. And so if there is virus on that swab it comes off the swab and into the liquid in what we call a collection kit.
So what we do is take that liquid that was touching the swab and then we ask [is] there virus in that liquid, and the way we do it is we look for the what’s called genome of the virus. So just like human beings or your cat or your dog or your pet lizard, there would be a genome of DNA, or RNA in this case, which is very similar to DNA. And we look for the RNA genome of this coronavirus.
Genomes are a great way to look for infectious agents because they’re very different and very specific to each organism.
Q: Do the test kits have an expiration date?
A: Right now it looks like there we have no expiration date, but that’s because we’re keeping these reagents at a temperature like minus 70 degrees Celsius, so they’re extremely stable at that temperature.
I think as the test matures, it’s currently offered under what’s called an emergency use authorization. So it’s been offered, even though we don’t have all the characteristics of the test worked out at the FDA.
So right now there’s certain aspects of the tests that we don’t fully understand, but based on very similar tests to this we know that they’re stable for a very long time at that temperature.
Q: Are you getting these tests from the CDC?
A: Yes, we got the test from the CDC. There’s now private organizations that work directly with the CDC to offer reagents, and we’ve actually initiated obtaining reagents from those sources as well, because we want to make sure that the state of Nevada does not run out of test kits. So we’re making every effort not to rely necessarily just on the CDC for that.
Q: Are you and the lab in Clark County the only labs with the testing kits?
A: In the state of Nevada as you and I are speaking to one another [March 5] the answer would be yes. I’m specific about that because this is a moving, evolving situation and the FDA is now saying that any lab can develop a test or run a certain lab tests.
So I think what we will see in the coming months is more labs in Nevada able to run the test, private labs and hospital labs, but for now it’s just public health laboratories here, the state public health lab on the school of medicine campus in Reno, and also the Southern district health lab that run it in Nevada.
Q: How does this compare to other outbreaks that we’ve seen like Swine flu or Ebola?
A: To answer it would A. force me to a speculate and B. use adjectives. I remember in 2009 when we had the swine flu, and I would say it mirrors that fairly closely in many respects. There was an origination in another country, and initially, we were seeing alarming death rates. It’s my memory that, that spread more quickly back in 2009 then this did. I mean… since November, we went from not having any cases to having over 90,000 cases today, but I think, if I remember correctly, that [in] 2009 [it] moved more quickly than that, but they share very similar dimensions otherwise.
So swine flu is actually a normal part of the influenza season now. So when we test for flu in public health labs, 2009 that strain from what we call now, the H1N1 pandemic strain. That’s very normal in the flu population, so to speak. So now people get it routinely and… the health community has ways of dealing with that.
What we’ve learned about that flu is it isn’t very different in almost any respect from any other of the H1N1 or H3 are [the] two strains that we’ve seen. It’s just a normal part of the, let’s call it flu flora, nowadays we just don’t talk about it anymore.
Q: Do you have anything else you want to tell me about coronavirus?
A: I just wanted to say that, that I appreciate being able to talk to you and to an organization like yourself about this… because what happens in public health is we’re trying to deal with this situation and one of the things that harms our ability to do that is misinformation. Because when people in the public have correct information, it makes dealing with this so much easier because ultimately we need the public’s agency in this in order to solve this.
And in that regard, it’s that this is spread very much like other respiratory viruses. So if you’re out there and you have symptoms, sneeze or cough into your elbow or cover your cough. It sounds hokey or like the same thing you’ve heard over and over again, but you’re the ones that have to play a role in stopping this. And if you’re sick, no matter what you have, just don’t go to work and don’t go out into public and try to ride the bus or anything like that. Just stay home and that, believe it or not, is the best thing that people can do to help. All of us can work together to get rid of this thing.