By Chris Bowling
This week will play a critical role in experts’ ability to test for Covid-19 as stockpiles and supply chains of necessary testing materials strain under massive demand.
Dr. Peter Iwen, director of the Nebraska Public Health Laboratory, a partnership between the University of Nebraska Medicine, Nebraska Medicine and the Nebraska Department of Health and Human Services, is one of two labs testing samples from across the state for this strain of coronavirus, Covid-19. Due to dwindling supplies his staff could run out of reagents—materials used for the test’s chemical analyses—by early next week.
“We are to the point that we can not get all the components that we need to run the test,” he said.
These materials range from kits used to extract samples to enzymes used to multiply cells and increase labs’ ability to detect Covid-19, and there have been shortages of them across the nation.
They are used at the state lab to test up to 100 samples a day. However, Iwen said his lab has only processed at most 60 on their busiest day. The University of Nebraska Medical Center, the state’s other Covid-19 testing facility, also has the capacity to test 100 samples a day.
This comes at a time when officials across the country promise increased testing. Before March 1, Iwen’s lab was one of four, including the Centers for Disease Control and Prevention, that could test samples for Covid-19. Since then, the number of cases has escalated along with promises to test more.
Across the country, private and public hospitals, as well as drive-thru options have started offering tests. Now these producers are under pressure to produce as much as possible to meet a dramatic and immediate spike in demand.
“I don’t see them wrapping up very fast,” he said. “Unless they’re building new factories, and they’re not.”
To Iwen this week will be a make or break moment in a pandemic marked by such instances. In addition to working with the CDC and material providers, Iwen said he might have some “scoops” to fast-track materials to his lab and keep testing on track.
The timing is essential, he said, because right now requests to re-up their supply are backordered up to three weeks.
“I think this next week is going to be very telling to see where this all is going,” he said.
This moment comes as Iwen said his four-person staff nears four weeks of seven-day weeks and 12-hour days.
With worries of what a sudden spike in cases could do to a health industry—where some projections put the peak number of sick people in need of hospitalization exceeding hospital bed capacities—Iwen said his staff is feeling the effects already.
“We just can’t do it,” he said of the non-stop work schedule. “So I have to think about, ‘What are we going to do next month? Or next week for that matter.’”
Those days consist of testing up to 30 samples at a time in a process that takes between four to five hours.
That process starts with the lab receiving sample collections from around the state. Often those have been screened and cleared by an epidemiologist to make sure the individual meets the standard for Covid-19 testing. Lately, however, the lab has received many unscreened samples which requires additional work to make sure the samples meet the right criteria, Iwen said.
Then, in a high containment facility, they extract the RNA and multiply it to detectable levels.
As summer approaches, Iwen, like others, hopes Covid-19 cases will recede, pointing to lower cases in the southern hemisphere. By next fall, it will most likely resurface, but Iwen hopes we will have built immunity to the virus by then. However, he acknowledges there’s no guarantees as this virus is moving quickly and we are in unknown territory.
“This is outside the box,” he said. “I don’t think there’s a model that’s going to predict what’s going on.”
That became apparent early on when Nebraska Public Health Laboratory was one of a few labs in the United States able to test for Covid-19. At the time Iwen’s team got consistent results from the CDC test kit when several labs could not.
Iwen’s team reached out to the CDC and soon found themselves on a call with high-ranking members of the government organization. Those officials with the highest authority on infectious diseases in the country wanted Iwen and his small team’s help figuring out what went wrong and how to fix it.
“The CDC is reeling quite frankly, and they want help,” he said. “That’s when it became a reality to me.”
It—this virus and the scrambled response to it—has already amounted to a true inflection point in medicine and society. Not much is known about what happens next: how long the pandemic will last and what its ramifications will be. Individually, people are distancing themselves from each other, quarantined in their homes or greeting each other with elbow bumps instead of handshakes. Meanwhile President Donald Trump’s administration recommends people avoid gatherings of more than 10 people and the stock market continues to tank.
For his sake, Iwen recommends his kids and relatives to think logically, avoid people who are coughing and wash your hands. But above all, people still need to live their lives. Staying inside your room or loading up on toilet paper and face masks is understandable but not totally necessary, he said.
Still, there’s no downplaying this is a moment in history. For Iwen, who’s in his 60’s, he can remember where he was when John F. Kennedy was shot or the Space Shuttle Challenger exploded. Covid-19 and the pandemic of early 2020 will be one of those moments too, he said.
“This will be similar to what we talk about to our grandkids,” he said. “That we actually lived through something like this.