With the deployment of Point of Care Machines and an expansion of recent efforts to manufacture collection kits to use in testing for COVID-19, The Nevada Independent once again talked with the director of the Nevada State Public Health Lab, Dr. Mark Pandori, to learn where the state is with its various testing efforts.

Pandori covered the lab’s preparedness and safety, the arrival of new rapid testing machines, the continued efforts to manufacture collection kits and serology testing in the state.

Lab preparedness and safety

The Nevada State Public Health Lab has consistently been receiving and processing more than 150 specimens a day and is seeing some days with 300 or more.

In order to improve safety and prevent repetitive motion injuries, the lab is looking to automate some of the processing of specimens with robotic devices. Robots also would reduce the amount of time that lab workers have to handle specimens.

The staff is trained to deal with samples up to biosafety level three (BSL-3). COVID-19 is classified as a biosafety level two (BSL-2) disease. Other specimens that are BSL-2 include influenza, measles and bordetella pertussis. BSL-3 includes diseases such as tuberculosis. There are many differences between BSL-2 and 3, including severity, ability to spread in a population and whether the microbes are indigenous or exotic. There are four biosafety levels with BSL-1 posing the lowest risk of infection and BSL-4 posing the highest risk.

Pandori said the lab environment itself has been evaluated for the presence of the virus.

“We've also done environmental testing in our own lab, and we're not finding that this stuff's getting splashed all over the place,” he said. “We're finding really, really encouraging data that we can't find traces of the virus anywhere where that work is done.”

ID Now machines

The state has received 15 testing units called ID Now machines that can produce results in about 15 minutes because they use technology that is more sensitive — and under new FDA guidelines, a doctor’s order is not needed in order to get one.

“These ID Now machines are interesting because under the Emergency Use Authorization, they are waived. So what that means is that you don't need a doctor or a clinician around to order that test,” said Pandori. “You know, there are state laws that vary from state to state, but overall, the idea here is since it's waived, you don't need a licensed individual to order or run the test.”

“Like the tests that we run in the lab that detect the virus, it does the same thing, but at the point of care, and it does it in 10 or 15 minutes,” said Pandori. “Those are going to be distributed around the state according to how the Department of Health and Human services and the governor's office [decide to] make that consideration.”

The machines can perform only a limited number of tests, though, because they use new cartridges for every test — and each machine comes with just 8-10 cartridges. The lab expects to get more cartridges as manufacturing ramps up.

Collection kits

The Carson City Library, the School of Medicine at UNR and the Innevation Center in Reno are all helping 3D print some of the materials for the collection kits that the public health lab is assembling and sending out across the state.

Vincent Lombardi is heading up an effort at the UNR School of Medicine to help get surgical grade resin for 3D printing of parts of the collection kits. Pandori said the medical school has secured enough raw materials to 3D print about 60,000 swabs for the collection kits.

“I don't expect this rapid testing thing to help out a whole lot, given the shortage of cartridges right now,” Pandori said. “I mean, if they can get us the cartridges quickly, it will certainly help. And I know that the private labs are still ramping up their testing — and with automation, we should be able to ramp up ours. So I have a lot of confidence that whatever's coming our way we're gonna meet head on.”

Serology

Right now there is no plan to introduce serology testing, a blood test that detects antibodies and that can determine whether a subject had and recovered from COVID-19.

“There's a lot of interest in serology right now and the reason for that is because we want to know two things. One is who has been exposed? Because if you've been exposed to this virus, you would make antibodies,” said Pandori. “Number two, some people are suggesting that we can use that information to say to people that if you've had the infection and you have antibodies that you could report back to work and you know, maybe you're immune to the virus. I'm only saying that I think right now we don't know for sure 100 percent that people that are positive on a serology test can't get COVID-19 again.”

The lab remains mainly focused on testing symptomatic people and people who have been in contact with confirmed cases, he said.