Implementation of a COVID-19 Screening Testing Program in a Rural, Tribal Nation: Experience of the San Carlos Apache Tribe, January–February 2021

The COVID-19 pandemic has disproportionately affected tribal populations, including the San Carlos Apache Tribe. Universal screening testing in a community using rapid antigen tests could allow for near–real-time identification of COVID-19 cases and result in reduced SARS-CoV-2 transmission. Published experiences of such testing strategies in tribal communities are lacking. Accordingly, tribal partners, with support from the Centers for Disease Control and Prevention, implemented a serial testing program using the Abbott BinaxNOW rapid antigen test in 2 tribal casinos and 1 detention center on the San Carlos Apache Indian Reservation for a 4-week pilot period from January to February 2021. Staff members at each setting, and incarcerated adults at the detention center, were tested every 3 or 4 days with BinaxNOW. During the 4-week period, 3834 tests were performed among 716 participants at the sites. Lessons learned from implementing this program included demonstrating (1) the plausibility of screening testing programs in casino and prison settings, (2) the utility of training non–laboratory personnel in rapid testing protocols that allow task shifting and reduce the workload on public health employees and laboratory staff, (3) the importance of building and strengthening partnerships with representatives from the community and public and private sectors, and (4) the need to implement systems that ensure confidentiality of test results and promote compliance among participants. Our experience and the lessons learned demonstrate that a serial rapid antigen testing strategy may be useful in work settings during the COVID-19 pandemic as schools and businesses are open for service.

COVID-19 Information Sharing with Blockchain

COVID-19 is a disease caused by a novel coronavirus originated in Wuhan, China. The virus rapidly spread over more than 200 countries around the world and caused deaths of more than 690.000 of people. To prevent rapid spreading of this disease, the information sharing related to the findings about the COVID-19 disease must be fast and secure between countries. Since the COVID-19 related health data such as the symptoms and private patient records are confidential, such information requires privacy protection. The blockchain and smart contracts are well-suited solutions for speed, privacy, and security needs of dissemination the COVID-19 related information. Blockchain based e-health solutions have been discussed for years. However, a pandemic is more important than the regular health problems. Thus, this study proposes how critical pandemic related information should be shared between the participating countries and can be accessed by health data actors such as researchers, doctors, laboratory staff, authorized institutions of different countries as well as the World Health Organization.

Experiences of Healthcare Workers of Hospitalised Individuals with covid-19 in Kano, Nigeria: A Qualitative Study

Background: Management of patients with covid-19 needing hospitalisation is challenging worldwide. However, little or no information has been gathered regarding the experiences of healthcare workers (hcw s) involved in the care of patients with covid-19 in poorly resourced settings. This study explored the experiences of hcw s managing hospitalised patients with covid-19 in a treatment centre in Kano, Nigeria. Methods: hcw s directly or indirectly involved in managing patients with covid-19 in one of the two treatment centres in Kano, Nigeria, were sampled based on being information-rich cases. The study participants were interviewed individually via telephone using a semi-structured interview guide. Data collection was stopped when content saturation was attained. Data was analysed using thematic synthesis. Results: Eleven hcw s, comprising two medical doctors, five nurses, a laboratory staff member, a community health extension worker, an environmental health officer and a cleaner, participated in this study. Four major themes were generated: (i) the profile and readiness of hcw s prior to being engaged to work in a covid-19 treatment centre, (ii) the experience of hcw s while working in the covid-19 treatment wards, (iii) challenges with working in covid-19 treatment wards, and (iv) post-treatment support for covid-19 patients. The participants had variable prior experience in managing patients with infectious diseases. Interventions offered were mainly antiviral therapy, nursing care, counselling, nutritional interventions and toilet hygiene. Challenges encountered included insufficient cooperation from patients, poor personnel welfare, lack of human resources/equipment and issues interfering with wellbeing (stigma). Conclusion: The studied population exhibited professional competence and success in managing hospitalised patients with covid-19 during hospitalisation, despite existing challenges.

Prevalence of SARS-CoV-2 infection among COVID-19 RT-PCR laboratory workers in Bangladesh

BackgroundHealth care workers (HCWs) at the frontline are confronting a substantial risk of infection during the coronavirus disease 2019 (COVID-19) pandemic. This emerging virus created specific hazards to researchers and laboratory staff in a clinical setting, underlined by rapid and extensive worldwide transmission. This study aimed to investigate the prevalence of SARS-CoV-2 infection among COVID-19 RT-PCR laboratory health workers in Bangladesh.Materials & MethodsThis retrospective study was conducted between October 2 to December 2, 2020. A total of 508 participants, including doctors, scientific officers, medical technologists, and cleaners working in several COVID-19 RT-PCR laboratories, were included in this study. Data were collected from each participant using a semi-structured questionnaire prepared in the format of an anonymous Google form. All participants provided informed consent. The Ethical clearance was obtained from the Institutional Ethics Review Committee of Shaheed Suhrawardy Medical College, Dhaka, Bangladesh. All statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) version 25.0 software (SPSS, Inc).ResultsOut of the 508 participants, 295 tested positive for SARS CoV-2 RT-PCR. Among the positive cases, 202 were men, 93 were women, with the median age of 30 years. The most positive cases were medical technologists (53.22%) followed by doctors (28.8%). Out of the 271 symptomatic positive cases, the most typical symptoms were fever (78.5%), fatigue (70%), loss of smell and taste (65%), cough (64%), and others. Hypertension, obesity, and diabetes were found in 8.8%, 8.8%, and 7.1% positive cases. A + blood group was present in 37% of the positive cases, followed by the B+ blood group (27%) and O+ blood group (25%). Inadequate supply of personal protection equipment (PPE), absence of negative pressure ventilation, laboratory contamination, and no training on molecular test methods were found in 13.8%, 67.8%, 44.7%, and 40.6% of positive cases, respectively.ConclusionEvaluating the infection status of laboratory health workers is crucial for drawing attention from the public, providing practical suggestions for government agencies, and increasing protective measures for laboratory health workers.

COVID-19 related challenges faced by Medical Laboratory Staff: A Review of Literature

Laboratory testing on the confirmation of COVID-19 results is an essential component and without the expertise of trained laboratory technicians this is not possible. The aim of this study was to review the impacts of COVID-19 on medical laboratory staff. The literature search was done using Medline, Embase, Scopus, and Proquest databases, and relevant keywords were applied to find studies which have been conducted in the field of Medical Laboratory Science specifically looking at the impacts on staff caused by the Covid-19 pandemic. All the studies pertaining to the topic published in 2020 and 2021 in English language were reviewed and the main themes were identified. The results showed that impacts of COVID-19 were felt by the staff, as they were pushed to their limits causing stress and burnout. Apart from this laboratory staff were faced with issues such as; shortage in terms of human resources, consumables, testing kits and reagents. This was an added factor to delays in testing and disruption to the testing Turnaround time (TATs) and also contributed to the stress and burnout of staff. Laboratory professionals and other health care staffs were pushed to the limits to ensure patient care was not affected and each patient was attended too without delay. Laboratory personnel’s were pushed to their limits to ensure that test results were given on time.

Use of The WISN Method to Assess the Health Workforce Requirements for the High-volume Clinical Biochemical Laboratories

Background: The clinical laboratory services, as an essential part of health care, require appropriate staff capacity to assure satisfaction and improve outcomes for both patients and clinical staff. This study aimed to apply the Workload Indicators of Staffing Need (WISN) method for estimating required laboratory staff requirements for the high-volume clinical biochemical laboratories. Methods: In 2019, we applied the WISN method in all 13 laboratories within the Center for Medical Biochemistry of the University Clinical Centre of Serbia (CMB UCCS). A review of annual routinely collected statistics, laboratory processes observations, and structured interviews with lab staff helped identify their health service and additional activities and duration of these activities. The study outcomes were WISN based staff requirements, WISN ratio and difference, and a recommendation on the new staffing standards for two priority laboratory workers (medical biochemists and medical laboratory technicians).Results: Medical biochemists' and laboratory technicians' annual available working time in 2019 was 1508 and 1347 working hours, respectively, for the workload of 1,848,889 samples. In general, the staff has four health service, eight support, and 15 additional individual activities. Health service activities per sample can take from 1.2 to 12.6 min. Medical biochemists and medical laboratory technicians spend almost 70% and more than 80% of their available working time, undertaking health service activities. The WISN method revealed laboratory workforce shortages in the CMB (i.e., current 40 medical biochemists and 180 medical laboratory technicians as opposed to required 48 medical biochemists and 206 medical laboratory technicians). Workforce maldistribution regarding the laboratory workload contributes to a moderate-high workload pressure of medical biochemists in five and medical laboratory technicians in nine organizational units.Conclusions: The WISN method showed mainly a laboratory workforce shortages and workload pressure in the CMB UCCS. WISN is a simple, easy-to-use method that can help decision-makers and policymakers prioritize the recruitment and equitable allocation of laboratory workers, optimize their utilization, and develop normative guidelines in the field of clinical laboratory diagnostics. WISN estimates require periodic reviews.

Educational cost-effective intervention to reduce pathologist’s peripheral blood smears reviews with non-contributory findings: an academic institution experience

Peripheral blood smear (PBS) review by a pathologist is a necessary and invaluable diagnostic tool. However, innovative highly sophisticated haematology analysers that flag peripheral blood abnormalities have decreased the need for a PBS review. Ordering practices including PBS reviews lumped as part of an ‘order set’ or with complete blood count (CBC) constituted most PBS requests at our institution. A retrospective review of all PBS review orders from 1 April 2016 to 31 January 2017 was performed to investigate the ordering practices at our institution. A total of 2864 PBS were ordered during the above study period. In many cases, the PBS report did not add any significant clinical information beyond that acquired by the CBC and differential count. These findings inspired policy changes within our institution for pathologist PBS reviews. Within the electronic order system, all PBS orders for inpatients were linked to a pop-up window with criteria for peripheral smear review and instructions on the approval policy. Outpatient orders required clinicians to request pathology approval. This implementation reduced total number of PBS orders by 42.5% with no adverse effect on patient management. Empowering pathologists and clinicians with guidelines on PBS review orders is a beneficial educational exercise of resource utilisation. Discussion with physicians regarding clinical indications reduces non-contributory PBS reviews, provides guidance to appropriate testing, and aptly allocates pathologist and laboratory staff time and resources.

Ten Years of Universal Testing: How the Rapid Diagnostic Test Became a Game Changer for Malaria Case Management and Improved Disease Reporting

In 2010, the World Health Organization changed its guidance on malaria case management, recommending parasitological confirmation of all suspected cases before treatment with an antimalarial. This recommendation was in large part as a result of the availability of quality assured malaria rapid diagnostic tests (RDTs) that made it possible for malaria diagnosis to be performed by laboratory staff in all health facilities irrespective of the facility’s place in the tiered health system. Community health workers and other non-laboratory health workers who traditionally did not perform malaria testing due to the technical and logistic demands of smear microscopy were now able to test for malaria. The use of RDTs has led to substantial increases in testing rates, improved quality of case management, as well as more accurate reporting of malaria cases. Although current RDTs have limitations, they remain one of the most important tools in contemporary malaria control. Further improvements to existing products, such as increased sensitivity for non-falciparum tests, diversification of Plasmodium falciparum antigen targets, along with strengthened health system support for current RDTs will further enhance their utility in malaria control and prevention.

Decision support or autonomous artificial intelligence? The case of wrong blood in tube errors

Objectives Artificial intelligence (AI) models are increasingly being developed for clinical chemistry applications, however, it is not understood whether human interaction with the models, which may occur once they are implemented, improves or worsens their performance. This study examined the effect of human supervision on an artificial neural network trained to identify wrong blood in tube (WBIT) errors. Methods De-identified patient data for current and previous (within seven days) electrolytes, urea and creatinine (EUC) results were used in the computer simulation of WBIT errors at a rate of 50%. Laboratory staff volunteers reviewed the AI model’s predictions, and the EUC results on which they were based, before making a final decision regarding the presence or absence of a WBIT error. The performance of this approach was compared to the performance of the AI model operating without human supervision. Results Laboratory staff supervised the classification of 510 sets of EUC results. This workflow identified WBIT errors with an accuracy of 81.2%, sensitivity of 73.7% and specificity of 88.6%. However, the AI model classifying these samples autonomously was superior on all metrics (p-values<0.05), including accuracy (92.5%), sensitivity (90.6%) and specificity (94.5%). Conclusions Human interaction with AI models can significantly alter their performance. For computationally complex tasks such as WBIT error identification, best performance may be achieved by autonomously functioning AI models.