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The Hidden Healthcare Heroes: A Lab Techs Journey Through the Pandemic

The Hidden Healthcare Heroes: A Lab Techs Journey Through the Pandemic

Like many 2020 graduates, I was forced out of school and thrown into a mid-pandemic job search which, for a time, yielded nothing but rejection as most companies were reeling from the early days of lockdown.

Eventually, The Cleveland Clinic asked me to join their Covid team at their main campus’ laboratory. I felt lucky to get the position without having any lab tech accreditations. The benefits were second-to-none, the pay was great, and it just made sense at the time. The Clinic is a prestigious institution, their lab was first-rate, and I would be joining the fight against Covid.

Unprecedented Circumstances 

The circumstances were unprecedented for the Clinic as well. The Clinic had always staffed the Molecular Microbiology team with certified professionals. Still, the demand for testing during the pandemic was so high that the Clinic had to staff two additional shifts to accommodate round-the-clock Covid testing and hired uncertified technicians to fill the positions. 

As a result, 12 other fresh graduates and I were onboarded quickly and thrown right into the midnight shift. In the beginning, I was so happy to be helping and working during the pandemic. I felt proud to be on the front lines, honing my skills and discovering what it was like to work under intense pressure. My work was good even when the work was hard. There was no room for error and no time to waste. 

At the Clinic, we used state-of-the-art equipment and rarely felt the shortages we were hearing other colleagues complain about at the two other hospital systems in the county. However, once the learning curve shifted and the pressure intensified in late 2020, the happiness I felt about coming in every day began to fade.

Although the Clinic had stockpiles of reagents and personal protective equipment (PPE), our most powerful analyzer only had enough supplies to run a few hundred Covid tests per shift. The rest were extracted and resulted by hand. Although the STAT samples were run in a different department, the routine, employee, and pre-op samples were sent to us, corresponding to almost 2000 samples per shift. 

Though the best in the business, the machines we worked on were never meant to be run at this intensity and would frequently break down during the second shift. Those of us on the third shift were then left to deal with these problems despite our lack of technical training. Even worse, there were no supervisors on staff to help us problem-solve or troubleshoot, which only added to the pressure. 

The demand for Covid testing was so great that we were stuck running the same tests every day, with no room to train on other platforms and no opportunity to learn something new to keep us interested in our careers. The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error.

After a year and at least 50,000 Covid tests later, I decided to move to the smaller county hospital to get off the graveyard shift and begin working on more than just Covid testing. No sooner had I started my training, I was forced back into Molecular Microbiology to handle the Omicron variant surge. 

This time, the hospital environment was completely different. Suddenly, a team of two to three people had to manage over 700 samples, including STATs, without the money, instrumentation, and supplies we had at the Clinic. The hospital asked us to put in as many overtime hours as we could manage, and from December to February, I worked at least 60 hours per week. 

There would be some days when I would get deep blisters on my hands from opening up sample tubes for 12 hours straight, and there would be days when we would have to skip lunch because there were too many ICU samples. Vacation days or brief time off to see my family was simply out of the question. 

After only six months at the hospital, I burnt out. Although I had been earning a lot of overtime pay, I decided it wasn’t worth it. I became another frontline worker who dropped out of the industry after only a few years. 

Unfortunately, it wasn’t just me who felt overwhelmed. Around the time I resigned, the Clinic began to hemorrhage techs, who left for better opportunities at different hospitals or in different fields. Of my original 15-or-so-member team two years ago, only four remain in the same department, and only about half remain in the clinical lab field at all.

Raising Awareness About Role of Labs Techs During the Pandemic 

The American Society of Clinical Pathology – the largest association for laboratory professionals – has stressed  the importance of promoting MLS/MLT programs to produce certified, well-trained lab professionals, to fill major staffing shortages. However, filling the positions is only one piece of the puzzle. 

In my experience, we techs were left unsupported and unmentored throughout the pandemic. No one cared if we were learning or growing in our job, and there was little encouragement for us to enter training or residency programs. We were just expendable foot soldiers: this is not a policy that leads to long-term job retention.

I am not writing this simply to bemoan my plight. It takes a particularly strong person to stay in a job like this, and I turned out not to be that kind of person. 

You need to be a warrior with the physical and mental toughness of a soldier or superhero. I don’t regret the experience because I now understand how difficult this industry is for unseen workers. The nursing profession has been hit extremely hard, and I saw that firsthand. 

The effort from the lab techs needs to be acknowledged as well. We, too, are a female-dominated profession facing the same problems of burnout and understaffing. We also feel like expendable resources on the healthcare team, even though patient care couldn’t happen without us. 

Like nurses, techs are a well-educated, intelligent group of people who must work with care and focus, yet no one recognizes how hard they work, and no one praises them. Not to mention that within the healthcare industry, the profession lacks prestige, even though 70% of medical decisions are based on laboratory test results.

Late last year, during the worst of the Omicron variant surge, the only people I could commiserate with were the nurses who thanked us for running their pediatric ICU tests first. They understood what we meant when we said we were drowning and stopped calling the lab to pester us for results because they knew that the positivity rate in Cuyahoga county was the third highest in the country and that the entire system was overwhelmed. 

Unfortunately, when things died down, that kindness seemed to fade.

Lab techs still need your recognition and respect. In addition, hospitals need to address the issues of staffing and career development, or we will be woefully unprepared for the next pandemic.

India is Still Reeling After Brutal June/July Surge

India is Still Reeling After Brutal June/July Surge

What explains India’s rapid spike, then sharp decline in cases?

India emerged in June and July of 2021 from a particularly savage second wave of COVID-19, with total confirmed cases at about 32 million and more than 400,000 deaths . But this could be a dramatic under-counting. Alternative estimates have put excess deaths in the range of 3.4 million to 4.9 million.

This wave was driven by multiple coronavirus variants, including alpha, which was first detected in the U.K., and delta, first identified in India and now the main source of infections in many countries. Because the emerging threat was not recognized early enough, health care services were overwhelmed starting in early April, with the lack of reliable oxygen supply becoming a major problem.

Originally published in The Conversation Both the alpha and delta variants are highly contagious, with delta being nearly twice as transmissible as the original strain of SARS-CoV-2. The rapid rise in cases in India is attributed to the high viral load – the amount of virus infecting a person – of delta, which is about 1,000 times higher than other strains. This resulted in widespread infections among household members with rates as as high as 80% to 100%.

The decline of cases in India has been surprisingly rapid given that there were daily new cases in the range of 400,000 in the first week of May and the test positivity rate in some districts was as high as 20%. Similar sharp declines were observed more recently in the U.K., Netherlands and Israel – perhaps a result of a combination of high vaccination rates and high infection levels. Daily cases in India are now between 30,000 and 40,000 per day.

What’s the progress with vaccination in India?

With the vaccination campaign substantially picking up in India, about 15% of adults have now received both doses of the vaccine and nearly 40% a single dose. A record 8.8 million doses were administered on Aug. 17, 2021 in a bid to achieve the 250 million target for August, although some projections consider it likely will be missed.

Supply situations continue to be challenging. Production of the Covaxin vaccine, developed by Indian company Bharat Biotech, did not accelerate as envisaged, at least in part due to quality issues of some batches. Negotiations with Moderna haven’t worked out and Johnson & Johnson received emergency authorization for use in August. Production of the Russia-developed Sputnik V by an Indian partner has been delayed and manufacturing is expected to be on track only by September. Covishield from AstraZeneca continues to be the workhorse, accounting for 87.5% of the vaccines administered to date.

An estimated 9 million doses will need to be administered daily through the next five months to meet the target of vaccinating all adults by Dec. 31, 2021. For comparison, average daily vaccinations in the U.S. at its peak in April was 3.5 million per day. An added challenge for the Indian campaign will be the vaccination of children. Vaccination of an estimated 400 million in the 2-18 years age group is likely to begin in March 2022though emergency authorization is expected to begin this month.

How many of India’s 1.3 billion people have been infected?

In the aftermath of the second wave from roughly April to June, the Indian Council of Medical Research conducted the fourth round of a national sero-survey in June and July 2021 to test for antibodies in blood samples from residents across 70 districts of 21 states. The overall sero-prevalence was 67.6%, a huge increase from 24.1% recorded in the third round from December, 2020 to January, 2021. The presence of antibodies indicates that a person has either been exposed to the coronavirus or has been vaccinated.

Sero-positivity among children was 57.2% in those aged 6-9 years and 61.6% among those who are 10-17 years old. Experts believe that there is not much scientific evidence that children would be disproportionately vulnerable in a third wave. The government, however, anticipates the possibility of intermittent surges in the number of cases and prepared operational guidelines for children and adolescents in preparation for a third wave. Seroprevalence among those above 45 years was 77.6% and 66.7% among younger adults, indicating the effect of vaccination as well as infections.

The coronavirus had spread through the entire country; seroprevalence among the rural population (66.5%) was only slightly lower than in urban counterparts. A wide range of interstate differences have emerged, from a low of 44.4% in Kerala to 79% in Madhya Pradesh.

The extent of undercount – the difference between estimated cases (based on seroprevalence) and actual cases detected by RT-PCR and rapid antigen tests – is particularly worrying. Nationally, the system missed 33 cases for every one detected.

What are the prospects for the weeks and months ahead?

With about 40,000 cases and 400 deaths each day as of mid August, a new uptick is likely in the cards. The Indian states experiencing most of these new cases are those with relatively lower sero-prevalence, ranging between 50% and 70%. The 400 million sero-negative pool – that is people who have not been infected or had the vaccine – continues to be a large vulnerable group.

Forecasting by modelers indicates a third wave beginning in August and peaking at 100,000 to 150,000 infections a day by October. An alternative projection expects the peak in cases going until November. States currently reporting higher daily cases are also testing at two-three times the national average. The case fatality rate in these states is also lower than the national average and health service capacities are not yet stretched. For its part, the federal government announced the second phase of its emergency response policy with targets that go until March 2022.

Has the economy opened back up?

COVID-19 vaccination in India has been marked by both inequity and hesitancy; negotiating both will be crucial in the weeks ahead.

The range of vulnerabilities have included rural and remote locations and a lack of access to the internet; a gender divide has emerged too with more men being vaccinated than women. As vaccination progresses with underlying inequities, the phenomenon of “patchwork vaccination” emerges – pockets that are highly vaccinated and adjacent to places or communities with low coverage. The communities with low coverage are vulnerable to hyperlocal outbreaks.

Most economic activities have resumed, and the education and entertainment sectors are opening up too. A joint statement on June 6, 2021, issued by the public health associations in India urged that district-level sero-surveys be undertaken by the state or federal health services to enable a more granular understanding of the epidemiologic context to enable planning. While this was accepted in principle, such systematic surveys have yet to be rolled out.

The World Health Organization advises that public health and social measures in the context of COVID-19 be guided by local transmission dynamics. Planning at the district level in India shall be crucial in the journey ahead.
The Conversation

COVID Behind Bars: Correctional Officers are Driving up Infection Rates

COVID Behind Bars: Correctional Officers are Driving up Infection Rates

Prisons and jails have hosted some of the largest COVID-19 outbreaks in the U.S. , with some facilities approaching 4,000 cases. In the U.S., which has some of the highest COVID-19 infection rates in the world, 9 in 100 people have had the virus; in U.S. prisons, the rate is 34 out of 100.

I study public health issues around prisons. My colleagues and I set out to understand why COVID-19 infection rates were so high among incarcerated individuals. 

Using data from the Federal Bureau of Prisons, we discovered the infection rate among correctional officers drove the infection rate among incarcerated individuals. We also found a three-way relationship between the infection rate of officers, incarcerated individuals and the communities around prisons.

No stranger to outbreaks

Prisons, jails and other correctional facilities routinely deal with infectious diseases. Hepatitis B and C as well as tuberculosis are all incredibly common in prison populations.

Because of that, prisons have established policies and procedures for handling infectious diseases. Many of those policies are the same as those for preventing the spread of COVID-19 – such as medical isolation of individuals with active infections, increased cleaning and surveillance of the disease. 

Public health experts have encouraged prisons to think about the role of correctional officers in infection spread for years and more recently have warned that correctional officers are a weak link for COVID-19 infections in prisons.

Even though prisons have policies for disease control, many of which include guidelines for correctional officers, prisons are at a disadvantage in stopping the spread of COVID-19. Current prison conditions – including poor ventilationovercrowdingand a lack of space for social distancing and isolation – make respiratory diseases like COVID-19 very difficult to control. 

For instance, before the start of the pandemic, the Federal Bureau of Prisons, along with nine state prison systems, has been operating at over 100% capacity. During the pandemic, even with massive early release and home confinement programs, many states remain at 100% prisoner capacity – or more

Additionally, U.S. prisons have been facing chronic staffing shortages. In the federal system, the issue is so severe that staff not trained as prison guards – including nurses – are being reassigned to guard the prison population. Short staffing makes the daily business of running a prison difficult during the best of times, not to mention during a pandemic. 

As early as March 2020, many prisons attempted to mitigate these conditions by granting early release and home confinement. Some also blocked all visitors and outside contractors. While helpful in some cases, ultimately these actions did little to stop outbreaks. 

Responding to COVID-19

Initially, public health organizations such as the Centers for Disease Control and Prevention went back and forth on the need for masks. Then mask mandates became a partisan issue. By midsummer 2020, 30 states mandated masking for correctional officers, prisoners or both. The Bureau of Prisons adopted a masking policy in late August, requiring correctional officers to mask when social distancing was not possible.

As the second and third waves of COVID-19 swept through the nation and the federal prison system, the mask mandate made only a small dent in slowing the uptick of infections among prisoners. 

Additionally, vaccine adoption rates among correctional officersand incarcerated people are low, weakening this line of defense. Across all states, incarcerated people have not been prioritized for the vaccine. Even when the vaccines are available, many incarcerated people are skeptical about receiving them due to mistrust of prison officials. 

Two-way vectors

We found the relationship between COVID-19 infections among correctional staff and incarcerated individuals is also shaped by the incidence of COVID-19 in the community surrounding the prison. Because correctional officers move between the prison and the community at the beginning and end of each shift, they can carry COVID-19 between these two spaces. 

Even when correctional officers test negative for COVID-19, they can still drive COVID-19 rates both inside and outside the prison via asymptomatic or pre-symptomatic spread. Our data showsthat when COVID-19 rates in the outside community get worse, so too do rates among the incarcerated population.

Prison policies aimed at stopping the spread of COVID-19 should be designed with an eye toward controlling the disease in the prison population, among correctional officers and in the community around the prison. 

For example, prison systems should be just as concerned with vaccination rates in the communities around prisons as they are with vaccination rates among correctional officers. Both rates will have an impact on the spread of COVID-19 within a prison.

 

Health Crisis in PR? Nurse of the Week Abigail Matos-Pagán Will Be There – She Even Makes House Calls

Health Crisis in PR? Nurse of the Week Abigail Matos-Pagán Will Be There – She Even Makes House Calls

Nurse of the Week Abigail Matos-Pagán, DNP entered a bright-blue house in Mayagüez, Puerto Rico earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother’s small room. Matos-Pagán had come to provide a Covid-19 vaccine for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed.

Wildelma Gastón asked for her rosary to be placed on her chest and motioned to her “good arm,” where Matos-Pagán injected a first dose of the Moderna vaccine. The Gastón household, made up of five family members, breathed a collective sigh of relief. Though the vaccine had been available for months, Wildelma had been unable to reach a vaccination site. According to the Centers for Disease Control and Prevention’s COVID Data Tracker, Puerto Rico’s vaccination rate in March was one of the lowest among U.S. states and territories despite receiving more than 1.3 million vaccine doses. The rollout highlighted disparities in access to medical services, and the challenges of tracking and reaching remote citizens, such as Wildelma.

With each trip to school or work, family members worried about bringing the virus into their home and the threat to Wildelma’s life. Matos-Pagán also vaccinated two of Beatriz’s children, who are students at the University of Puerto Rico-Mayaqüez, during her visit.

“We have been waiting a long time for this moment,” Beatriz Gastón said as she hugged Matos-Pagán goodbye, expressing gratitude for the home visit. To her, the vaccine is more than protection from the coronavirus — it clears the way for the family to be together with her mother.

To Matos-Pagán, it is her latest calling. The nurse practitioner, who has guided relief efforts after hurricanes and earthquakes in Puerto Rico and elsewhere, has made it her mission in the U.S. territory to vaccinate as many people as possible against covid. Some residents of Mayagüez, a city on the western shore of the main island, candidly call her “The Vaccination Queen” and show up at her home asking for help in getting a shot.

According to The New York Times’ case tracker, as of Friday, Puerto Rico has had more than 182,000 covid cases and at least 2,594 deaths. About 57% of the population is fully vaccinated, but many of the unvaccinated are hard to reach because they live in remote mountainous communities or have chronic illnesses that leave them homebound. Matos-Pagán has vaccinated around 1,800 people in Puerto Rico so far, including 1,000 who have chronic illnesses or are bedridden.

In the pandemic’s early days, Carmen Blas’ health declined, and she began using a wheelchair. Blas, 78, was confined to her home, on the third story of an apartment building, which kept her safe from contracting covid, but later she couldn’t find transportation to a vaccination site. In June, her two children, Lisette and Raymond, visited from Wisconsin to help and immediately called the public health officials to get Blas inoculated.

“I usually come back every year and this was the longest I’ve ever been away. It was especially hard as my mother’s health worsened, and I worried I might never see her again,” said Raymond, who planned to extend his visit for as long as he was needed.

Matos-Pagán came to Blas’ home in Aguadilla, Puerto Rico, to give her the vaccine. The family cheered the moment the vaccination was over.

“It’s been really special to have intimate moments in someone’s home during vaccinations. You can tell how much it means to their entire family,” Matos-Pagán said afterward.

Mobilizing during a crisis is nothing new for Matos-Pagán. In the aftermath of Hurricane Maria, which cut off water and electricity to the entire island and claimed more than 3,000 lives, Matos-Pagán conducted initial community assessments in Puerto Rico’s remotest and hardest-hit cities. Flooding and debris made many roads inaccessible, blocking these communities from basic needs such as food, water, prescription medications and transportation. Then, after a series of earthquakes in 2020 rocked the island, leaving even more people without housing or in substandard structures, Matos-Pagán organized local nurse practitioners to provide community health care. They supplied at-risk populations with their medicines when pharmacies closed, and teams set up mobile medical tents near overcrowded hospitals.

“I’m hyper and busy in my daily life, but when there is a crisis, I am calm and still. Grounded. I feel like I’m where I belong,” she said.

Matos-Pagán was born in New York City. She became interested in medicine after watching nurses support her mother, who died of complications from an aneurysm when Matos-Pagán was 9. Her mother’s death taught her “nothing was permanent,” she said, which has inspired her to act when disaster strikes and support people through personal tragedy and loss.

Logo of CONCID, founded by Matos-Pagan in 2003
Logo of CONCID, founded by Matos-Pagan in 2003

Matos-Pagán returned to Puerto Rico to study nursing and later earned a master’s degree and a doctorate at the University of Puerto Rico-Mayagüez. Through her work, she holds various titles: first commander of the Puerto Rican Disaster Response Team, and director and founder of the Coalition of Nurses for Communities in Disaster.

Her experiences managing medical professionals and resources during hurricanes have taken her to locations across the U.S. Atlantic coast and the Caribbean. During the covid pandemic, she was recruited to assist in triage leadership for an ICU floor short on resources in El Paso, Texas, and a hard-hit senior living facility in Maryland.

“Not everyone is built for this. It’s really sad, depressing work,” Matos-Pagán said. “But even when there are mass casualties, you can still save lives and get people’s basic needs met. I’ve seen communities come together in the most incredible ways. It’s a challenge, but that’s what keeps me going.”

And, even as she is rapidly trying to get more covid shots into the arms of Puerto Ricans, Matos-Pagán is preparing for the next crisis. Hurricane season officially began in June, and she will be on disaster-ready duty until the end of November.

ISI Healthcare Worker Study: Covid Antibodies Continue to Protect 1 Year After Infection

ISI Healthcare Worker Study: Covid Antibodies Continue to Protect 1 Year After Infection

Despite a large heterogeneity in Spike-specific antibody levels, most individuals remain seropositve for at least one year after infection

One year after infection by SARS-CoV-2, most people maintain anti-Spike antibodies regardless of the severity of their symptoms, according to a study with healthcare workers  co-led by the Barcelona Institute for Global Health(ISGlobal), the Catalan Health Institute(ICS) and the Jordi Gol Institute (IDIAP JG), with the collaboration of the Daniel Bravo Andreu Private Foundation. The results suggest that vaccine-generated immunity will also be long-lasting. 

One of the key questions to better predict the pandemic’s evolution is the duration of natural immunity. A growing number of studies suggest that most people generate a humoral (antibody) and cellular (T cells) response that is maintained during several months, maybe years.

During the first wave of the pandemic, the team at ICS/IDIAP JG in collaboration with Carlota Dobaño’s team at ISGlobal started a follow-up study of a cohort of healthcare workers with COVID-19 – a total of 173 people working in healthcare centers of central Catalonia. Most infections were mild to moderate, although some cases required hospitalization. The research team took regular blood samples from September 2020 onwards to measure the level and type of SARS-CoV-2-specific antibodies in these patients. This work was possible thanks to the support of the Daniel Bravo Foundation, which equipped ISGlobal with the latest technology and necessary resources to perform the study and rapidly reach conclusions during the subsequent waves.

“The results obtained until now lead us to believe that immunity to SARS-CoV-2 will last longer than we originally thought. Being a new virus, it is very important to understand how it behaves and affects different people”, says Anna Ruiz Comellas, researcher at the Catalan Institute of Health and co-author of the study.   

No significant decay in antibody levels was observed over the first five months, and at 9 months, 92.4% of peoples remained seropositive – 90% of them had IgG, 76% had IgA and 61% had IgM recognising the Spike protein or the receptor binding domain (RBD). The results were similar among healthcare workers who had not been vaccinated in April (95% had IgG, 83% IgA and 25% IgM).

“These data confirm that IgG have a longer duration, but IgM levels, which are supposed to last less, were unexpectedly quite sustained over time,” says Gemma Moncunill, ISGlobal researcher and senior co-author of the study, together with Ruíz-Comellas. Hospitalization, fever, and loss of smell and taste were associated with higher antibody levels at five or nine months.  

Four reinfections were observed among the participants. Two of them were symptomatic and occurred in seronegative individuals. Another asymptomatic reinfection occurred in a subject with very low antibody levels. These results indicate that anti-Spike antibodies protect against symptomatic infections. “They also indicate that people who have not been previously infected should be prioritised for vaccination, since those who have already been infected may be protected for at least one year,” says Anna Ramírez-Morros, first co-author of the study.

“Considering that antibody levels achieved upon vaccination are usually higher than those generated upon natural infection, our results suggest that vaccine-induced immunity will also be long-lasting,” concludes Carlota Dobaño.