The past few months have been a whirlwind of news about, and activities in response to, the emergence and spread of the novel coronavirus, SARS-CoV-2. As this pandemic unfolds, laboratory personnel are key to the efforts to halt the virus’s spread and treat patients.
The consequences of the pandemic on laboratories are likely to go beyond those of more familiar emergencies, like floods or hurricanes. In addition to a possibly overwhelming surge in patients with COVID-19 illness, we might experience planned reductions in other patient populations, a changed patient mix to mostly or nearly all COVID-19 patients, supply shortages, and staff shortages as team members need to self-quarantine or stay home to care for family members.
A Good Start
CLSI 36-A:2014, Planning for Laboratory Operations During a Disaster, is an essential document for laboratory emergency preparedness planning during the COVID-19 pandemic. Chapter 10, which deals with planning for pandemic influenza, easily can be adapted to our current situation.
To help prepare for the pandemic, laboratory leaders at Mayo Clinic in Florida utilized this document to aid us in adjusting our hurricane crisis plan to the current situation. Our plan involves closing outpatient clinics, decreasing inpatient census, and providing only the essential testing our patients need.
To consider what testing might be most useful for COVID-19 patients we looked at the literature, recommendations from the Centers for Disease Control and Prevention, and practice guidelines or useful internet tools. Finally, we considered how our testing menu would change along with fluctuations in workforce availability, with staffing levels at 60%, 30%, and 15% of normal.
Our tiered plan involves shutting down one of our two labs—keeping open the one that already serves inpatient needs—and operating only our main chemistry analyzer and immunoanalyzer line. We also will shut or slow down testing on platforms where turnaround time can be delayed and will have the option of sending to a reference laboratory testing that we would normally perform in-house. In the current crisis, we will prioritize essential COVID-19 testing, along with testing we would perform during our hurricane response.
By focusing our test menu, we’re able to divert staff to our hospital laboratory, cover for absences, supplement our phlebotomy teams, and provide necessary rest to our staff.
To prepare for a limited menu offering, lab staff should be cross-trained between benches as much as possible. Analytes of specific or increased utility during our current crisis might be prioritized. In the extreme, lab staff might be asked to perform non-laboratory functions, or to supervise non-laboratory personnel assisting in the lab.
Attending to Staff
We also have to implement social distancing, maintaining 6 feet between individuals whenever possible, holding meetings via conference calls or in rooms large enough to accommodate all the attendees while keeping appropriate distance. Staff must remind one another, independent of hierarchical position, to maintain safe distancing. Reminders should be accepted with a spirit of gratitude that each team member is looking out for the entire team.
In addition, labs need to establish a clear line of authority beyond our usual supervisory structures. This way, if supervisors and leads are unable to work, we still will have a chain of authority for centralizing decision-making and prioritizing tasks. The entire lab staff needs to understand this structure going into the crisis.
In an ever-changing emergent situation with daily tasks and the workforce in flux, communicating effectively becomes more challenging. We need to speak precisely, avoiding the use of imprecise descriptors like he, she, there, and that to minimize confusion and inefficiency.
A good way to know if a message has been communicated effectively is to have the person receiving the information repeat it back, with the person giving the information asking questions about points that might be susceptible to misunderstanding. Taking the extra time to communicate effectively will pay off with the increased efficiency it affords in completing tasks.
An overlooked aspect of emergency planning—addressed in the CLSI document—is the emotional impact over time that working in an emergency has on employees. Initially, people come together as a team to tackle an overwhelming problem. But as time moves on and staff continue to work under stressful conditions, ignoring personal needs becomes unsustainable. To make it successfully through an extended high-stress situation rest has to be programmed into the plan, and we need to proactively identify all non-essential tasks and defer or cease them until the emergency ends.
We will remember the events of the next weeks and months for the rest of our lives. Clinical laboratory professionals are essential members of the medical community upon which our society depends. We will rise to the occasion and make ourselves and our country proud. Take care of yourselves and each other.
Jonathan Hoyne, PhD, DABCC, FAACC, is director of clinical chemistry at Mayo Clinic in Jacksonville, Florida. +Email: Hoyne.Jonathan@mayo.edu