Hi everyone,

My name’s Gillian, I’m a girl guide leader based in Dublin. My current job is as a medical scientist in microbiology. There’s been huge change recently with the COVID-19 crisis going on and I’ve been asked to shed some light on what work life is like currently during the crisis.

Medical scientists are a hidden profession. When a sample is taken, it’s not just blindly put onto a machine and an interpretable result is available instantly. Medical science includes a wide range of specimen types, scientific techniques, interpretation and most of all people! There’s a huge team of scientists, lab aides, consultants, specialist registrars, administration staff, management, porters and more that work in laboratory medicine alone. All work to ensure specimens are tested correctly, results are interpreted correctly and results make it back to the physicians who requested the test. A huge focus is on quality and on maintaining our test turnaround times. As 80% of all patient diagnoses are based on laboratory testing, it a hugely important part of a hospital.

To be a medical scientist, you need to pay attention to detail, be meticulous and organised and of course be interested in biology. It’s one of few careers where the majority of workers are female. If anyone is interested in medical science as a career feel free to contact me.

My main specialty currently is medical microbiology. This mainly involves the investigation of infectious diseases; including the detection of viruses. The hospital I work in has one of the largest virology sections in Ireland outside of the national virus reference lab; this includes the serology lab and the molecular virology labs.  In our molecular lab, we test swabs for COVID-19 on our inpatients and staff. Testing was introduced incredibly quickly; scientists trained in molecular have to be very efficient as there’s very little room for error, one small mistake and a whole day’s work could be worth nothing and be completely uninterpretable. The testing for COVID-19 uses a scientific technique called realtime polymerase chain reaction (or rt-PCR). It can detect a very small amount of virus, this means that as each “run” has multiple samples, scientists must be incredibly careful to avoid cross contamination of one specimen to the next. For COVID-19, the test specimen of choice is swabs of the nose and throat. Like other respiratory viruses, higher concentrations of the virus are found is the nasopharygeal space, which is why nose and throat swabs are the easiest specimen to take.

 

What does “indeterminate” mean?

Some of you might be aware that approximately 100 patients were told they did not have the virus after their results were termed “indeterminate”. I have seen a lot of people upset by the fact that upon retesting, they were told they were weak positive instead. I don’t know personally why patients were told their result was negative, as that’s not what an indeterminate result means. In laboratory medicine, when a test result is reported as “indeterminate”, It means that the result is neither positive or negative. Based on that run, on that day, with that sample, we don’t know…yet! Especially in biology, sometimes we can’t solidly say a result is positive or negative. However, the important step is the next step, further investigation! We can retest the sample in duplicate or even triplicate, sometimes it can be down to the stage of infection and the consultant virologist might request repeat swabs or even a different more invasive specimen, such as a nasopharygeal aspirate, as this is a respiratory virus. The consultant is key here as they can talk to the clinical team and can see the whole picture of results on that patient. They can balance the risks and make appropriate decisions on the patient’s treatment.

Reporting results as indeterminate is the most correct thing to do. The error seems to be not the laboratories fault. It seems to have been a miscommunication somewhere along the line, after the result was released by the lab. What I’m trying to say here is, I hope people don’t see the “indeterminate” debacle and feel they can’t trust the system. This is a pandemic; it is an event never before seen in our lifetime. Over 12,500 people in Ireland have been confirmed as having COVID-19. That represents well over 12,500 tests, the only tests in the news are the positive cases, not the negative cases. That’s an incredible volume of testing in a very short timeframe!

Unfortunately, due to the lack of public exposure of medical scientists in these fields, as well as knowledge of what happens in a diagnostic laboratory, we are invisible! We may not be on the “front line” seeing patients, but we are busy testing lumbar punctures to see if a patient has meningitis, reporting possible blood stream infections, detecting HIV in a new patient, investigating a possible superbug outbreak in the hospital, handling all the specimens taken from COVID positive patients etc.

Since the outbreak, management separated the medical scientists, lab aides and admin staff into two teams that are never to see each other. This is a contingency plan as if one team goes down, the other team can take over. We are required to wear face masks in the lab. We have daily checks and we collectively are decontaminating every possible surface regularly. Our working day has been extended, we’ve staggered our breaks and are spread out at least 2m regardless. The work is manageable, due to the extended working day, but getting busier as intensive care is getting busier and some vital outpatient clinics are reopening. I think that when the storm finally hits, we are ready and will cope with demand on laboratory services. I’ve worked a fair amount of night shifts during the COVID-19 outbreak, at the beginning there were tons of phone calls from concerned members of staff asking for advice on sampling, materials etc but as information has been distributed it has calmed down. I’m proud of my colleagues and I’m happy that the lab has acted efficiently to cope with this pandemic and continues to do so. I’m keeping an optimistic outlook as while I don’t think life will go back to normal as quickly as the general perception promotes, I know that what we are doing is right.  For the sake of our loved ones, for the oldest in our communities, for the immunocompromised, if we can all keep our distance we can save lives.