Setting up a new laboratory, calibrating highly sensitive machines capable of detecting microscopic pathogens and training staff to carefully prepare samples can take a month or longer under normal circumstances.
As the state embarked on an effort to quickly expand its ability to test and track individuals who have contracted the coronavirus last month, CHI Health St. Elizabeth got a new lab running in under a week.
The expedited process came as Test Nebraska, a $27 million initiative launched by Gov. Pete Ricketts in coordination with a trio of Utah companies in late April, seeks to perform 3,000 coronavirus tests per day across the state.
With polymer chain reaction, or PCR, machines and test kits manufactured by Co-Diagnostics in hand — test materials provided by Nomi Health, one of the Utah companies the state contracted with — St. Elizabeth was able to meet a tight deadline, President Derek Vance said.
People are also reading…
And in the following three weeks, the Test Nebraska lab has built up its capacity to do an average of 1,500 tests per day. On Wednesday, the day for which the most current data is available, the St. Elizabeth lab reported results for 1,700 tests.
Speaking at his afternoon news conference Thursday, Ricketts said the program hadn't met the target he set more than a month ago but said the work done so far matters.
"We're continuing to push the team to get there," Ricketts said. "But it's 1,700 tests we wouldn't have otherwise."
Outside the main entrance at St. Elizabeth earlier Thursday during a news conference to discuss the Test Nebraska lab, its performance and the validation process, Vance announced the hospital lab will "be at the capacity of 3,000 tests per day" beginning Friday.
"The capability and capacity of the lab to get those tests through and through timely is critical," he said. "As of tomorrow, we will be at that 3,000 capacity here at the laboratory, which we are very excited about."
Collection still lagging
While the lab said it will have the capacity to analyze up to 3,000 tests per day — adding to the results from the state's public health lab, other testing done by hospitals like CHI Health and Bryan Health, and corporate laboratories outside the state — Test Nebraska has fallen short of collecting that many swabs to date.
Three testing sites have been operating in Nebraska's largest cities — Omaha, Lincoln and Grand Island — as well as in locations experiencing local outbreaks of COVID-19 such as Lexington, Schuyler and Crete, which have all seen surges in case numbers in recent weeks.
Each site has the ability to perform 500 nasalpharyngeal swabs manufactured by ATL Technology each day, long swabs that enter through the nose and touch the back of the throat, taken by either CHI Health staff or members of the Nebraska National Guard.
Those samples are boxed and sealed in a cooler, then transported by the Nebraska State Patrol directly to the lab at St. Elizabeth in Lincoln. Multiple batches of tests may be dropped off in a single day, depending on the test location.
But not every mobile site set up through Test Nebraska is performing the 500 tests per day. On Wednesday, a Test Nebraska location in Clay Center, population 724, collected 68 swabs through the initiative, for example.
Other test locations outside Omaha and Lincoln may only collect a few hundred swabs, falling far short of the 500 available.
Plus, Vance said, only three mobile testing sites have been operating at a time. The state is likely to double that number in the coming weeks now that the lab has more capacity to process tests.
After some early glitches with Qualtrics, the system that receives test results and reports them to the state public health department, reporting to individuals and local health departments, has improved and waiting times have reduced.
Ricketts said Thursday the average turnaround time for Test Nebraska was 2.2 days.
"Most of the time, it's faster than that, but that is what we hold as our expectation," Vance said.
Validation engenders confidence
As of Thursday, 18,412 test results through Test Nebraska have been reported, with 596 of those results being positive for COVID-19, or about a 3.2% positive rate, according to Dr. Gary Anthone, the state's chief medical director.
The rate of positives is far below the roughly 13.9% reported for all coronavirus tests done in Nebraska since the coronavirus arrived in March.
Infectious disease specialists in Utah raised concerns last month over the accuracy of the test kits provided by Nomi Health to Test Utah, a precursor to the Test Nebraska program. Roughly 2% of the tests done through Test Utah were positive compared to 5% for the rest of the state's tests.
Vance said Thursday the relatively low positive rate for tests done through Test Nebraska should not be cause for alarm.
Early testing in Nebraska was only given to health care workers, first responders and those deemed high-risk or who were showing symptoms and had a doctor's order, which accounted for nearly 1 in 5 tests to come back positive.
Test Nebraska doesn't require approval from a doctor or those tested to be showing symptoms.
Individuals can sign up for the program online — more than 153,000 Nebraskans have done so — and complete a questionnaire about potential exposure or any symptoms they are experiencing before scheduling a test in their area.
The two different testing pools produce two different outcomes, Vance said. One group was from a pool more likely to have the virus, while the other is expanded to the general public.
Becky Croner, the lab director at CHI Health St. Elizabeth who is overseeing the Test Nebraska lab, said Thursday she is confident the tests performed through the initiative are accurate.
Samples run on the PCR machines purchased from Nomi Health by the state have shown them to accurately report positives and negatives about 95% of the time, Croner said, which is below the 99% rate for both reported by Co-Diagnostics to secure approval from the Food and Drug Administration but above lab standards.
The lab at CHI Health St. Elizabeth processed specimens already tested by CHI Health's core lab in Omaha and the Nebraska Public Health Lab at the University of Nebraska Medical Center to compare how closely its results matched.
Of the 20 samples provided by CHI Health's core lab, one reported a false positive, according to a report provided to the Journal Star, which Croner attributed to a likely error preparing the specimen to be run.
In 38 comparisons provided by the state's public health lab, there were five reported discrepancies, according to a report. Those results weren't necessarily wrong, Croner said, but were rather the result of a more sensitive test run by the state's public health lab in line with Centers for Disease Control and Prevention guidelines.
"I wouldn't be running this test in this laboratory if I didn't believe in it," Croner said. "I believe the results are correct. If there is any reason I don't believe the results are correct, we pull it and run it again."
The validation process was also a time for the CHI Health St. Elizabeth lab to improve its process to ensure a high confidence in the test results its reporting, she added, while adhering to the instructions provided by Co-Diagnostics.
While there have been reported problems with Test Utah and Test Iowa, and while PCR testing "in general is tricky," Croner said the Test Nebraska lab hasn't had the same problems as its counterparts.
"Every lab is independent and does things differently," Croner said. "You have to be very careful and very diligent, and I think our lab is doing a really, really good job with it.
"Everyone is learning more, and that's just how it goes," she added.
Photos: COVID-19 Test Nebraska lab at CHI Health St. Elizabeth
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Test Nebraska
Reach the writer at 402-473-7120 or cdunker@journalstar.com.
On Twitter @ChrisDunkerLJS
In this Series
Milestones in Nebraska's coronavirus fight
-
Updated
Governor to require hospitals to keep beds open for COVID patients, further restricts large gatherings
-
Updated
COVID-19 death count climbs in Lancaster County following surge in recent cases
-
Updated
Positive cases in LPS schools pass 200 — including 10 in one elementary — but officials say no school spread
- 123 updates