Feb 25, 2021

Interviewer: The challenge to provide expanded asymptomatic COVID-19 testing for 62,000 Utah university students, faculty, and staff. The solution is a story about innovation and collaboration, and a group known mainly just to researchers called HSC Cores. Dr. Michael Good, CEO of University of Utah Health, the dean of the University of Utah School of Medicine, and the Senior Vice President of Health Sciences, visited HSC Cores to learn how they made it happen.

Dr. Good, what was the main challenge when it came to making asymptomatic testing more widely available, and how did HSC Cores help solve that problem?

Dr. Good: We started that program last year, with those that lived in our dorm residence but were having trouble getting the capability, enough tests at an affordable cost and was really pleased when, through Dr. Andy Weyrich, our vice president for research, Dr. John Phillips, and other members of our research community pointed out that we do PCR testing in our Core laboratories, that we could probably scale this up. But, also, you know, this innovation starts with this capability in our lab, but it is surrounded by our clinical operations team, who set up a methodology that specimens could be obtained in a very efficient manner. And then our IT teams had to come together, the notifications are automated, people get an email notice back with results typically in somewhere between 4 to 10 hours, almost always same day. And there's a . . . so there's a really neat, and I think, uniquely Utah story there, with related to IT, with related to clinical operations, with related to Core Lab PCR capabilities, are all coming together to offer this great service to our team members throughout the university.

Interviewer: Just a great example of cross-campus collaboration to make more testing happen. But there is also some innovation going on, I understand, at HSC Cores in order to do the number of tests that were needed. Tell me a little bit about that. You saw what this system looks like, and I guess it was pretty incredible.

Dr. Good: First of all, kind of at the heart of this, if you will, is a very clever, it's about a oh, an inch tall, and maybe 3/8 of an inch wide, a very small collection tube that has a orange cap on it. In the little bag with the collection tube is a funnel and a toothpick. When you first see that, you say, "Well, what's that for?" and then later on you say, "That is so amazing."

So, first of all, you take the cap off of the . . . the orange cap of off the collection device, you drop the funnel in, and as the team will tell you, they'd actually like you to drool, rather than spit. We do know that saliva carries the coronavirus. Work by our faculty showed that actually saliva is a reliable source for doing these tests.

So anyway, put the funnel into the little collection tube, and then drool until the one inch or so tube is filled up. Now, this is where the toothpick comes in handy because on occasion you'll get an airlock. Your drool, your saliva will be in the funnel, but it won't make in its way down into the collection device. So you take the toothpick and just kind of help break that airlock and get the saliva into the tube. And that is, kind of, if you will, the clinical operations piece of this on the front. You know, the risk of the shoutout is I'm going to miss a whole bunch of people. But this is Dr. Richard Orlandi and Cameron Wright, a key member of his team, Michael Bronson, Nikki Gilmore. We've got a group of about 8 or 10 people that work on the frontend of this, if you will, the collection.

Interviewer: So then you got to see what happens after you drool in the tube and how it gets processed on the backend. Tell me about that.

Dr. Good: And that's where the Core Lab team really comes to work. Again, a lot of innovation has gone into this. So I believe the number's 96 tubes are loaded into a cartridge, into a rack. Now, they're going to add the reagents that are necessary for the test. But think about it, you got 96, 1-inch tubes, sitting in this rack. So the team went to work, and to help with throughput, actually acquired a decapper, D-E-C-A-P-P-E-R, decapper. So the cartridge goes into the decapping machine where a whole bunch of mechanical hands come down, if you will, and literally unscrew the caps off of these 96 specimens, and then from there, the decapped specimens go in, under a hood, and that's where our Core Lab team goes to work.

Derek was on point, running the bench the day I was there, as he explained about . . . I think they mixed it 10 times, if you will. A micropipetter first put in the reagent and then pulled it in and out of the micropipette 10 times to make sure it was mixed. Back in the decapper, now the recapper, R-E-C-A-P-P-E-R, those caps come back down on the cartridge, the cartridge goes into a heat deactivator, the heat both deactivates, if you will, the virulent properties of the coronavirus. It also deactivates enzymes in our saliva. If we don't deactivate those enzymes, they could potentially degrade the coronavirus that they're trying to detect.

From there, that cartridge with the reagents for the PCR reaction go into the analyzer, and then the machine goes to look for the specific genes that have been identified as being most reliable to detect the coronavirus. If one of those tubes start to show a positive reaction, if they start to detect coronavirus, the instrument knows which sample, and which individual that ties back to. And the tray I was watching be analyzed, I think three or four specimens were starting to show coronavirus as the machine cycled, and they kind of floated up to the top, if you will, so that the team there could take a look. And they get a really nice visual display that they can look at the pattern coming off the machine and visually confirm that, "Yeah, that looks like . . . that is the pattern we see when coronavirus is in the specimen."

Interviewer: Just amazing. Amazing innovation. The toothpick thing, I can wrap my head around all the stuff you explained, I don't even know how people come up with that. Just an amazing group at Cores, to be able to not only do that type of testing, but then when called up to scale it up, it sounds like they just responded in such a great way.

Dr. Good: I am so impressed and I just want to reiterate how helpful this is to our campus. I've received numerous thank you's and compliments from all across the campus. Any member of the University of Utah team, with or without symptoms, can now get a test. And, you know, the piece of this, has been taking the Core Laboratory capability, particularly the PCR capability, and then the team that just really came together. I mentioned Dr. Weyrich and Dr. Phillips. Derek Warner was the one mixing the reagents under the hood. Really a shoutout for Derek, I think he's put a lot of the pieces of this puzzle together. James Cox, another member of the Core Lab team who helped my tour, who led me around, introduced me to members of the team. Michael Powers, Brenda Smith, Elliot Francis. This isn't just one or two people coming together. This is three separate teams, the Core Labs, the clinical ops team, and the IT team. Within each of those teams, there's probably six or eight people that played a leading role in making all this happen. So this is uniquely Utah, and it's so important and such an important service, now available here on campus.

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