Dartmouth-Hitchcock can now do COVID testing in Lebanon, but shortages limit the number

  • Rachel Barney, genomic technologist at DHMC’s laboratory for Clinical Genomics and Advanced Technology, preparing patient samples for SarS-CoV-2 testing. Rick Adams—Dartmouth-Hitchcock Health

Monitor staff
Published: 3/23/2020 7:42:21 AM

Dartmouth-Hitchcock Medical Center has established its own test for COVID-19, greatly expanding the state’s ability to identify who has the disease, but supplies of many materials are so limited that it will be used only within specific health-care settings and not in the population as a whole.

“We’re not testing sub-clinical (cases), we don’t have the capabilities, the protective equipment. … We’re not South Korea,” said Dr. Edward Merrens, chief clinical officer for Dartmouth-Hitchcock Health, in a conference call Monday. “In a perfect world, anyone with a cold symptom you would sample but we don’t have that ability.”

He said the facility began work on creating a testing system on March 2 and had it confirmed by March 17. The center will soon be running “several hundred” tests a day, producing a result within 6 to 12 hours. It has 2,000 test kits in stock and access to 3,000 more. 

The only other place in the state that can confirm the presence of the new coronavirus is the state’s Public Health Laboratory in Concord.

Merrens said Dartmouth-Hitchcock had already done “several hundred” tests, largely to supplement Concord. “Like a lot of state labs it is overwhelmed with testing,” Merrens added. Tests sent to out-of-state labs can take 4 or 5 days for results to come back.

Dartmouth-Hitchcock is the first lab other than a state laboratory in northern New England to do COVID-19 tests.

The expansion of testing ability does not mean that tests can be run on any sick person who wants it or any person who has been potentially exposed to COVID-19. Such widespread testing to pinpoint the spread of the disease has been key in some countries which have kept COVID-19 in check, such as South Korea.

The problem with widespread testing is a shortage of equipment from start to finish, Merrens said. 

These shortages range from not having enough of the specialized swabs “like long, flexible Q-tips” that grab cells from inside the patients’ nose, to getting material known as “transport medium” that holds the cells as they are taken to the lab, to obtaining supplies of chemical reagents and primers for finding the genetic material and seeing if it corresponds to the new coronavirus.

As an example of the struggles, Merrens said when the center ran short of transport medium the Centers for Disease Control allowed them to use normal saline, which required extensive re-validation of the tests to make sure the results were still accurate. And now saline is in short supply, as well.

Worst of all are the widespread shortages of gowns, masks and gloves needed to protect medical staff when they take the initial samples from patients. 

“We can’t compromise on the protective equipment. That is (why) we limit the testing ability to the areas where we have the most impact,” said Merrens.

That mostly means testing will be done on health-care workers, who are at extreme risk because of their job, and on select patients in hospitals or places of extreme concern such as nursing homes.

Developing the test protocol and equipment was difficult, he said: “Some people were logging hundreds of hours a week to get this going.”

In the conference, Merrens noted that without widespread testing, the much-reported number of confirmed cases in the state is not an accurate reflection of what is happening.

“We have to realize in the U.S. the number of positives is a fraction of the true positives that are out there. They do not reflect the actual prevalence of disease in the population,” he said.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)



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