Behind the scenes, an award-winning lab helps Alaska track COVID

Presented by Alaska Native Tribal Health Consortium

For two years, since the start of the COVID-19 pandemic, there has been one unchanging, consistent message from public health officials: Testing is vital.

Before vaccines became available, testing was the single most powerful tool to help control the spread of the new virus, and access to tests has been a critical issue throughout the pandemic.

But that quick nasal swab is only the first step of the testing process. Behind the scenes, medical laboratories have spent the last two years inundated with samples, working harder than ever before to keep up with the demand for the results that determine whether a person is OK to travel, work or return to school.

At Alaska Native Medical Center, the in-house diagnostic laboratory has been running at full speed since early 2020, and not just to support the hospital’s own testing needs. In addition, ANMC’s lab has been handling tests for other healthcare facilities in Anchorage and around the state, helping earn them the highest healthcare honor in the state.

What put the Tribal hospital ahead of the game when it came to COVID-19 testing? Foresight -- and legwork.

“Chance favors the prepared mind,” said ANMC Laboratory Services Director Dr. James Tiesinga, quoting pioneering microbiologist Louis Pasteur. “We recognized early on the impact that this viral infection out of China was likely to have in Alaska, and specifically impacting Alaska Native people, and we took that and went to our Tribal leadership and alerted them to it. All of these things helped us to be one step ahead in this pandemic.”

Planning for a pandemic

Well before the COVID-19 virus began to surface, ANTHC’s board of directors included expanded molecular testing capabilities in its strategic plan for the 2020 fiscal year, well before the virus that causes COVID-19 began to surface. Negotiations to acquire rapid molecular tests were already underway when ANTHC’s laboratory directors began raising alarms about the new virus, which they anticipated would soon arrive in Alaska.

“We decided that we would both go to our leadership and tell them that this was something that we felt, as laboratory professionals, that we needed to start preparing for,” Tiesinga said.

Because of that early action, ANMC ultimately became one of the first facilities in the U.S. to acquire rapid testing equipment to detect the SARS-CoV-2 virus. On April 3, 2020, ANMC became the first hospital laboratory in the state to begin testing for COVID-19, and by the end of the month, the lab had three high-capacity analyzers and was running approximately 2,000 tests every day.

With its additional capacity and supplies, ANMC’s lab was in a position to share the wealth, and it did, offering COVID-19 testing services and collection materials to the other hospitals in Anchorage and private employers as well as clinics throughout the Tribal health system. That collaboration helped keep operating rooms open and protect workers on the job as COVID-19 continued to spread.

“It was only natural that we opened our doors to not only our Tribal partners across the state of Alaska, but to our local non-Tribal partners as well,” Tiesinga said. “We wanted to make our forethought not only to our benefit but to our community’s benefit overall.”

Investing in molecular technology

Since clinical lab tests are done out of sight and behind the scenes, many people don’t know exactly what the process looks like, according to ANMC Microbiology and Molecular Laboratory Manager Andrew Martinez.

“There’s nothing glamorous about being a pathologist or a laboratorian,” Tiesinga said. “Most people tend to overlook us here in our windowless facilities, often in the basement.”

When the lab tests for viruses like HIV, HPV and SARS-CoV-2, they work directly from the original sample using a specialized machine that digs down to the molecular level to detect the infection. Molecular tests take time -- and even with ANMC’s head start, the need for testing ballooned at a rate that made it tough to keep up.

In the very earliest days of COVID testing at ANMC, the lab still had only one instrument up and running, with a limited number of test cartridges.

“I think we got around 200 tests -- and we thought that was so many, and we were happy to have that,” Martinez said. “But we quickly realized that was going to last us about a week. Maybe.”

Even when multiple high-capacity machines began running full-time, it didn’t take long for the first wave of COVID-19 tests to overwhelm the lab’s capacity.

“This laboratory was like a war zone,” Tiesinga said. “We were receiving thousands of COVID samples every day from all over Alaska.”

As tests piled up, the lab hired more than a dozen new employees to help process, manage and track COVID-19 tests. Even then, it was clear ANMC needed more equipment.

“At that point, we probably had about 3,000 to 5,000 tests on our pending log, and we were able to run 500 a day,” Martinez said. “We realized that we were going to have to continue to expand our capability.”

More machines followed, and by 2021 the lab was running five high-throughput instruments in addition to machinery located throughout the hospital and other Tribal clinics.

In the thick of things

During those hectic first months, the chaotic mood in the lab was compounded by the unknown nature of what was then still widely referred to as “the novel coronavirus.”

“None of us was quite sure how infectious these samples were,” Tiesinga said. “There were times when I had people that were panicked, especially when these samples started coming in in large volume and we were having to stack them up in large biohazard bags on the floor. People were very concerned.”

Fear didn’t stop them from doing their jobs. Lab techs layered up in personal protective equipment, followed containment protocols to a T, and did their best to plow through the rapidly accumulating mountains of test samples.

“The vaccines didn’t roll out until almost a full year from the first cases of COVID in the United States,” Tiesinga said. “That is a full nine months into the pandemic before even the first vaccines were available to healthcare workers. That’s nine months of living in fear that you might become infected and die.”

Testing was the one clinical tool available to offer some reassurance to essential workers and patients during that time -- and the lab’s staff was serious about their role in providing that reassurance.

“That fear of not knowing how the virus was going to affect you, that was a real, palpable fear,” Tiesinga said. “That is what made the testing so important, not only from a public health surveillance perspective and being able to take prompt, timely interventions, but also giving people peace of mind: ‘No, I don’t have it.’”

Looking ahead

Since the start of the pandemic, the lab has processed more than 200,000 COVID-19 tests. Now that other hospitals have acquired high-capacity analyzers of their own, life at the lab has started to calm down somewhat. Lately, ANMC has been running about 500 tests a day -- a quarter of what it was doing in 2021.

“It feels like it’s been so long ago, but we’re still in it,” Martinez said. “This Omicron variant -- it felt like a step back for sure.”

As challenging as the past two years have been, he added, it has been exhilarating to be part of the historic rapid response and watch the speed at which researchers have worked to understand, treat and prevent COVID-19.

“Thinking about it from the scientist’s perspective, it’s definitely been a time of excitement and innovation,” he said.

Along with bringing PCR technology into the spotlight, the COVID-19 response has put hospitals like ANMC in a better position to respond to future public health needs, whatever they may be.

“It’s expanding the field of molecular testing,” Martinez said. “Just in our organization, we went from having two molecular platforms to having five -- so now we have the support to be able to do the testing that we need, and then also looking to the future. As a scientist and as a microbiology department, we’re looking to what’s coming next.”

In the Tribal health system, that means preparing for flu outbreaks, which disproportionately impact Alaska Native people. The lab is also procuring a sequencer to do variant typing in-house rather than relying on the overtaxed state epidemiology lab.

Although the lab staff has worked almost entirely behind the scenes, their contribution to Alaska’s health and safety hasn’t gone unnoticed. Last fall, the Alaska State Hospital and Nursing Home Association honored ANMC, ANTHC, Southcentral Foundation, and Tiesinga with its Beacon Award for “unwavering commitment to health equity” in recognition of the heroic efforts of the laboratory staff.

“I think that it’s been a challenging two years, and to have an organization recognize the work that we’re doing in the lab is definitely appreciated,” Martinez said. “Laboratorians, we don’t get very much recognition, but we’re not really the type of people that go out and seek that. We do it because we enjoy it and it’s just what we do.”

And they’re still doing it. While life is starting to return to something that feels more normal for many people, COVID-19 is still prevalent in Alaska communities -- and testing is still a critical tool in keeping it at bay.

“Healthcare was totally reliant on COVID testing for most of 2020, and even now into the present,” Tiesinga said. “Getting tested is the cornerstone of healthcare intervention for COVID-19.”

This story was sponsored by the Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with ANTHC. The ADN newsroom was not involved in its production.