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Q&A: Administrator of Hawaii’s labs confronts the coronavirus challenge

                                Edward Desmond, administrator of the Hawaii Laboratories Division, finds himself in the middle of a public debate over coronavirus testing. Who should get tested? Who should conduct the tests? Why can’t everyone get tested?
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Edward Desmond, administrator of the Hawaii Laboratories Division, finds himself in the middle of a public debate over coronavirus testing. Who should get tested? Who should conduct the tests? Why can’t everyone get tested?

Last spring, Edward Desmond was appointed administrator of the Hawaii State Laboratories Division, an unobtrusive agency in Pearl City that conducts testing in support of the state’s environmental and public health programs.

Seven months later, in Wuhan, China, COVID-19 made its first appearance.

Now, with the respiratory illness spreading unchecked — Hawaii topped 100 confirmed cases this week — Desmond finds himself in the middle of a public debate over coronavirus testing. Who should get tested? Who should conduct the tests? Why can’t everyone get tested?

The state Department of Health also came under fire when a misreading of test results led to the erroneous announcement that Hawaii had its first coronavirus-related death.

“It was a clerical error” that wasn’t caught when the results were reviewed, Desmond said. “We’re going to change our protocols so that now we have a second review.”

Desmond isn’t sanguine about the current pandemic, or the challenges ahead. But as a 40-year veteran of managing public health and hospital laboratories, he sounds unfazed.

“I will tell you, this is not my first rodeo,” he said. “And we’ve got a great staff here, and so we are prepared to keep our morale up and do this through the long haul.”

While the division of about 100 people hasn’t expanded, some have been reassigned to COVID-19 work, Desmond said. In addition, he expects to make one or two emergency hires, but it’s not a simple process.

“For us to train somebody to do this sophisticated and somewhat hazardous work, it’s a matter of weeks or months to get people up and going,” he said.

Desmond, who holds a Ph.D. in microbiology from Texas Tech University, came to Hawaii from the California Department of Public Health, where he supervised the tuberculosis and mycology section for more than 25 years. The National Tuberculosis Controllers Association even has an award named after him: the Ed Desmond TB Laboratorian Award.

Desmond was born in Buffalo, N.Y., and grew up in California. He is married with three adult children, and lives in Mililani Mauka.

Question: What have we learned from other pandemics that can be applied to our COVID-19 mitigation efforts?

Answer: The influenza pandemic of 1918-1919 illustrated that community measures slow the spread of a respiratory virus. The community measures that proved to be effective — that same ones we have been promoting as safeguards against COVID-19 — include handwashing, social distancing such as avoiding large gatherings or staying at home if you are sick, among others.

Q: How many tests can you conduct?

A: The State Laboratories Division currently has the capacity to conduct about 525 tests per week, or an average of 75 each day. These tests are for those who are considered to be “persons under investigation” (PUI) because they have flu-like symptoms and have visited a location that had a COVID-19 outbreak or have been in contact with someone who has symptoms of infection from the virus. In addition, our target is to conduct 250 COVID-19 tests each week as part of our recently implemented community surveillance program. This program tests random samples collected from patients at doctor’s offices and outpatient clinics as a way to proactively track the extent of COVID-19 in communities across our state.

We’ve tested something like 300 specimens from people who live in Hawaii who have not traveled, and so far none of them have been positive. We expect that to change because we know the virus is here.

Q: Can you handle the workload?

A: We have been able to manage the incoming requests by working around the clock. The Department of Health’s Disease Outbreak Control Division has well-informed criteria for determining which patients are at risk of the disease, so the number of PUI samples remains within our capacity for testing now. The numbers of community surveillance samples are adjusted to increase the testing volume up to our capacity limit.

Q: What about private labs?

A: The division also is approving private-sector laboratories to conduct COVID-19 tests in Hawaii. This will significantly expand overall testing capacity. There are several private-sector labs that test large volumes of samples and have automated instrumentation for the purpose. At the state laboratory, we will continue to focus on testing that guides control measures, with less emphasis on guiding the diagnosis of individual patients. Because the private sector has taken up mass testing, I don’t see us changing our mission.

Q: What are some problems with widespread testing?

A: We run into capacity issues. All of the specimens for coronavirus testing had to be collected by a health care professional who would take a nasal pharyngeal swab and have to put on a gown and a mask and gloves — personal protective equipment (PPE) — when taking the specimen. And there’s a real shortage of those. We have a serious concern the medical community might not have enough. If we were to expand laboratory testing … we would be in competition with those who arguable need (the PPE) more.

Q: What steps has the Food and Drug Administration (FDA) taken to ease restrictions on testing?

A: The FDA has cleared testing by highly automated testing instruments that are able to test large numbers of samples. Some private-sector laboratories (including those in Hawaii) have these high-volume instruments and should be able to greatly increase the volume of testing, provided that the manufacturers can keep up with providing the consumable supplies required for these instruments.

The FDA said that self-collected specimens seem to give satisfactory results. Patients might be able to collect their own specimens. They would have to have a specialized type of swab, because a cotton-tipped swab is not going to do it. And then they have to have a viable transport medium. We have to assess what this means for us. If we are not in competition with health care providers for the PPE, then maybe broader testing is something that we could support. If the patients are collecting the swabs themselves, nobody has to use PPE for collecting the specimens.

Q: Explain in layman’s terms the testing process.

A: A doctor takes a swab from the back of the nose or throat . The medium used to transport the virus to the laboratory is then treated to release the genetic material of the virus. This process inactivates the virus so that it is no longer infectious. Using sophisticated instruments, the lab is able to amplify the virus. If it is present, we are able to detect it with fluorescent probes.

Q: How quickly can you get results?

A: Within 24 to 48 hours.

Q: Are you concerned about possible mutations of the coronavirus?

A: Mutations are likely to occur, but so far there is no indication that mutations are changing the course of this outbreak. The structure of the genetic material of the coronavirus is different from the influenza (flu) virus. The flu virus keeps evolving, and at this time, there is no evidence to suggest that the coronavirus can do this. The mutation of the flu virus makes it difficult for us to be immune to the new strains. The new strain of the virus comes back seasonally and this is why it’s important to get a flu shot every year.

Q: How else is COVID-19 different from the flu?

A: There are important differences between COVID-19 and the flu. There is no vaccine to prevent COVID-19 infection and no treatment for COVID-19. For influenza A, there is a medication called ostelamivir or Tamiflu that can help with treating severe cases. At this time, we don’t have a drug to effectively treat COVID-19.

Getting a flu shot is one of the best things you can do for yourself and for others, especially seniors who are the most vulnerable because they generally have weakened immune function and underlying health conditions such as diabetes. Since the symptoms are similar to the coronavirus, a flu shot can help to minimize confusion and rule out the flu when there is possible COVID-19 infection.

Q: What else should we know about the lab’s work?

A: The staff of the state public health laboratory possesses solid expertise and I’m confident in our capability to respond and help protect the communities of Hawaii. They’ve been rising to this occasion by working around the clock and are committed to ensuring our island community’s safety.

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