By Ninsiima Racheal
KAMPALA — It is no secret that COVID-19 has tremendously affected laboratory workers and scientists across Uganda.
For Kigozi Edgar, the Manager of the genomics and molecular biology laboratory at Makerere University’s College of Health Sciences, sleepless nights and over-the-top workload will forever remain etched in his mind. He and many other scientists at the testing center are continuously working hard to support effective and timely disease diagnosis, prevention, treatment and management of outbreaks.
Lately, laboratory work has been suddenly cast into the limelight because of coronavirus testing which is vital in determining whether one has SARS-CoV-2, the coronavirus that causes COVID-19 disease.
Although the laboratory’s working hours are ordinarily 8am-5pm, the molecular biology laboratory had to keep open for 24 hours in the first eight months after the outbreak of the pandemic in Uganda—which status has not even changed.
On average, three thousand samples from travelers, dignitaries, quarantined people and general public were handled daily and this necessitated laboratory staff members to work round-the-clock. The volumes were simply overwhelming.
“On a routine basis, staff were dropped home past midnight and in the wee hours of the morning but had to be back to the laboratory by 6am, irrespective of the time when they left. Many reported chronic burnout and fatigue; but one thing that kept us going was the mandated desire to save lives as professionals.” Kigozi recalls, also adding that this work went on throughout the weekend.
At one time, his phone rang of-the-hook as several people called-in to have them tested, and others inquiring about progress on both routine results and emergency samples. There was untold anxiety among the public and laboratory staff due to fear of the unknown as this was a novel disease.
Moreover, at the start of the pandemic, many of the laboratory staff were vulnerable to contracting the disease because of shortage of personal protective equipment (PPEs) such as gloves, facemasks, face shields and lab shoes.
However, with time, staff were provided with PPEs and COVID-19 testing supplies; Viral RNA extraction kits and PCR kits.
With an influx of testing samples for the laboratory, one time counting close to 6000 tests a day, extra personnel, including volunteers (professionals), came on board to help with the large mission that the pandemic presented them.
“Since the first case was reported in the country, the laboratory added about 70 personnel including data entrants/analysists, senior scientists, virologists and drivers to expand staffing levels” Kigozi said.
As testing ramps up, the laboratory scientists are now busier than ever, making sure patients receive accurate and timely results. When I visited the genomics and molecular biology laboratory on level three of the Pathology/Microbiology Building at Makerere University College of Health Sciences, I was accosted by different personnel, visibly engrossed in their work, ferrying samples from one end to another and others, meticulously processing samples with help of the state-of-the art technologies.
These workers wore the proper mandated personal protective equipment which consists of coveralls, coats and gloves in different sections of the laboratories.
The laboratory is demarcated into five major rooms—each with a different role and for purposes of preventing contamination. The first segment of the lab is designated to receive and sort various samples; the second for viral RNA extraction from the delivered samples; the third for Polymerase Chain Reaction (PCR) preparation; the fourth for running the PCR tests, and the data room.
Since the beginning of the pandemic, the molecular biology laboratory has conducted close to 300,000 tests. Today, it still performs up to 200 to 600 tests daily, and counting. The downside, however, is that focus on COVID 19 has reduced routine testing for other diseases such as Tuberculosis, HIV, STIs and Hepatitis B.
How COVID-19 testing is done
Without the valiant efforts of laboratory scientists, urgent testing doesn’t get done efficiently—but how exactly is this testing done?
Once a nasopharyngeal or oropharyngeal swab is taken off by a skilled health worker, the sample is sent to a laboratory for testing. This laboratory performs PCR testing, the commonest and most accurate form of testing applied for detection of SARS-CoV-2. Basically, PCR detects the virus’s genetic material- called Viral RNA – in the cells collected on the swab.
“When a laboratory technologist receives the sample, they perform Viral RNA extraction, which isolates genetic material from the biospecimen,” Kigozi explains.
After extraction, the Viral RNA is mixed with special reagents and then loaded to a Real time PCR machine. The machine converts the Viral RNA to DNA, a stable version of the genetic material of the virus and duplicates it into a million copies. The material is detectable when a person is infected. A typical high-throughput PCR machine tests about 96 samples per run and each run lasts about one and half hours.
So, what happens when the test results are finalized?
“The laboratory results are reviewed by the Quality Manager, Technical Supervisor, and a resident Virologist. If valid, the results are sent to the Laboratory Manager for approval before they are uploaded by the data team. This process typically takes an average of eight to 24 hours,” Kigozi says.
According to the World Health Organization, a positive result means you may have antibodies from an infection with the virus that causes COVID-19. On the other hand, a negative test result means you probably not have COVID-19 at the time you took the test. However, it is possible to be infected with SARS-CoV-2 but not have enough virus in your body to be detected by the test.
As a quality control measure, laboratory personnel at the genomics and molecular biology laboratory spend hours correlating and validating the tests to ensure that the equipment are performing these tests accurately. Additionally, the six-member data team at the laboratory swiftly designed a software local database dubbed, ‘MakCHS COVID-19 Testing Centre’ where only specimen and patients’ data is uploaded and hosted on the servers located at the Department of Immunology and Molecular Biology.
The software database, the first of its kind in the University, allows for quick data entry, but also comes with an added advantage of monitoring turn-around time.
“This database perfectly compliments Ministry of Health’s Results Dispatch System (RDS), given that once the results are added to the system, it is easier to transfer a full data set to the RDS. And this saves us a lot of time.” Kigozi explicates.