While other states have struggled to find sample collection kits used to test for COVID-19, as well as the laboratory capacity to process samples, Vermont created its own kits and expanded testing to the point the state is listed as fifth highest in tests per million people, according to Vox.

The Vox news website chart shows only New York, Lousiana, Rhode Island and Massachusetts ahead of Vermont as of Monday.

Dr. Debra Leonard, chairwoman of pathology and Laboratory Medicine for University of Vermont Medical Center, said the work toward bolstering Vermont’s COVID-19 response primarily was the result of collaborative efforts between the medical center and the UVM Larner College of Medicine.

“Back at the beginning of March, across the country and here, too, we did not have enough swabs and these specimen collection kits to be able to test everyone who was symptomatic. The head of the World Health Organization at one point back then was saying that the three most important things you could do for controlling COVID-19 are testing, testing and testing,” she said.

Leonard has been involved in Vermont’s efforts after Dr. Richard Page, the dean of UVM’s College of Medicine, Dr. Stephen Leffler, president and COO of the UVM Medical Center, and Dr. Mark Levine, commissioner of the Vermont Department of Health, asked Leonard to coordinate testing.

Helen Reid, health surveillance director and acting chief of the Vermont Department of Health Laboratory, said, early on, Vermont’s government and non-government staff worked together to develop a collaborative approach to overcome obstacles.

“Because we’re a smaller state, we rely on our relationships and our partnerships to solve problems and we’ve always done that. This is a really good example of that,” Reid said.

Reid agreed the work on sample kits and testing had been a factor in the promising work to slow the spread of the virus in Vermont.

Staff at UVM took an active approach to the lack of sample collection kits, which includes what looks like a cotton swab to take the sample, and a transport medium to preserve the sample until it can be tested.

Beth Kirkpatrick, chairwoman of the Department of Microbiology and Molecular Genetics and infectious disease physician at the medical center, said staff looked at everything they had at the medical school with the goal of leveraging whatever the medical center needed.

“The shortage that we were able to help with ... is the creation of the transport media. That’s sort of a salt solution with special ingredients in it that has to be made in volume. Each person who gets the swab has to have that swab go into about three CCs (cubic centimeters) of this special solution. We had to estimate how many of these we would need throughout the state of Vermont at the peak of the epidemic. Our best guess is we would need between 300 and 1,000 a day. We made the decision to make about 5,000 of these tubes a week, and that’s what we are still doing now,” she said.

Kirkpatrick thanked four laboratory technicians, Marya Carmolli, Cassandra Ventrone, Forida Nazib and Josephine Lenski, who have been helping to meet that need. All of the work was done by faculty and staff because students have been sent home.

Leonard said Linda Coulomb, who works in procurement for UVM, worked with Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, to find swabs early in the COVID-19 response. A source was identified and the two medical organizations got 100,000 swabs they split evenly.

Since then, other sources for the swabs were identified, Leonard added.

Phlebotomists at the medical center “stepped up,” according to Leonard. They had more time than usual because UVM, like other Vermont hospitals, has postponed all but the most necessary medical procedures, so the phlebotomists offered to assemble the sample collection kits. Typically, phlebotomists’ days are spent drawing blood from patients.

Now UVM has a little more than 12,000 sample collection kits that Leonard said they have been “distributing freely to wherever it’s needed, hospitals, physician office practices, medical locations around the state.”

Helen Reid, health surveillance director and acting chief of the Vermont Department of Health Laboratory in Colchester, said the state had been developing its own capabilities while working with collaborators like UVM to develop its own source of sample kits and testing sites.

“We’ve learned pretty quickly to pivot because we’ve had to. We’re never — at least in talking with people who’ve worked at this lab for 20, 30 years — we’ve never encountered these kinds of supply chain issues. We’re always prepared to test for outbreak situations but the continuous supply chain issues have been the biggest challenge … and threat to us, frankly,” she said.

Leonard said UVM officials had worked with several testing laboratories to find those with capacity and a reliable connection. For instance, early on sample collection kits were sent to the Mayo Clinical Laboratories in Rochester, Minnesota, but as airlines began to cancel flights, getting the samples to a laboratory about 1,275 miles away became an obstacle.

Another challenge was finding a laboratory that could connect directly with the electronic medical records of hospitals in Vermont so information about whether a patient was tested and the result of the test didn’t need to be added manually.

With multiple lab sources, Leonard said Vermont currently has capacity to get the results from a large number of sample collection kits.

The basic steps of testing for COVID-19 begin with collecting the specimen. The testers, when they get the kit, “sort of swish the swab around to release the virus if it’s there,” she added.

The genetic material, or RNA, is then extracted from the liquid.

Leonard said UVM approaches the validation in a slightly different way than the state laboratory to avoid competing for the same vendors.

Another test is expected to be ready to be implemented by UVM soon, Leonard said.

“We’re working in stages to be able to keep up with testing should we hit surge in Vermont like we’re seeing in some of the other states,” she said.



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