Since the early 1980s, UBC’s CMPT program, led by medical microbiologist Michael Noble, MD, has provided external quality assessment (EQA) for clinical microbiology and water testing laboratories. This includes providing biological samples related to:
“Typical of every jurisdiction in North America and probably around the world, BCCDC got swamped beyond swamped,” said Noble, the Clinical Microbiology Proficiency Testing (CMPT) program’s first and current Chair, in an exclusive interview with Dark Daily. “The increase was 10-fold, and they were unable to provide all the services they wanted to do. And since I was already running a proficiency testing program across the province, they asked if I would provide that service for COVID-19 for laboratories that were doing the testing.”
Michael Noble, MD (above), is Professor Emeritus (active) in UBC’s Department of Pathology and Laboratory Medicine and Chair of the Program Office for Laboratory Quality Management (POLQM). He began his career as a medical microbiologist but soon focused on laboratory quality management. Within the Department of Pathology and Laboratory Medicine, Noble co-developed the Clinical Microbiology Proficiency Testing (CMPT) program in 1983, a program he still chairs but will soon pass on to a new leader. (Photo copyright: University of British Columbia.)
CMPT’s Proficiency Testing Serves Labs Worldwide
UBC’s CMPT external quality assessment (EQA) program serves all medical laboratories in British Columbia, as well as other labs in Canada, Europe, South America, and the Caribbean. Just over 200 laboratories currently participate in the program. More labs participated in past years, before lab consolidation affected CMPT and other programs as well, Noble said.
CMPT’s proficiency testing ensures that participant laboratories that have been provided with simulated samples can perform tests at the “level of quality and competence required,” notes UBC’s CMPT website.
“Samples are complex, highly realistic, and clinically relevant. CMPT samples contain host elements as well as targeted pathogens,” Noble explained on his blog, “Making Medical Laboratory Quality Relevant.”
COVID-19 Brings Non-Traditional ‘Laboratories’ to CMPT’s Proficiency Testing Program
UBC’s proficiency testing for SARS-CoV-2, the coronavirus that causes the COVID-19 infection, differs from other CMPT programs. That’s due to new participants that entered the laboratory testing program during the COVID-19 pandemic that are performing COVID-19 testing in non-traditional locations, Noble stated.
“In our proficiency programs, we had mainly been dealing with traditional clinical laboratories,” Noble explained. “But now, we find people doing COVID-19 testing—even though defined as medical laboratories—who are working in airports, or in tourism, or the movie industry, or forestry. They may never have worked in an actual clinical laboratory. So, it’s a very different style of proficiency testing. There has been a lot of handholding, teleconferences, discussions, and one-on-ones with that group,” Noble said.
Participant laboratories receive viral material that “simulates typical samples.” They need to demonstrate proficiency by performing the test and reporting it as positive, negative, or inconclusive.
“Our product is derived from a pure culture of a single strain of SARS-CoV-2, and it appears to be effective for all targets,” Noble stated.
Detecting COVID-19 by Gargling and Rinsing
UBC’s program typically offers simulated sampling for detection of SARS-CoV-2 in nasopharyngeal swabs. However, the BC Center for Disease Control’s (BCCDC) mouth rinse and gargle sample collection for diagnosis of COVID-19 also is available and widely used in Canada, Noble said.
In his career, Noble transitioned from medical microbiology to qualitology, which he describes as “the study of quality in the medical laboratory.”
In stressing the importance of laboratory quality testing, Noble describes the possibility of laboratory testing going awry and leading to a microbiological public health emergency.
“What happens if there’s a stool sample, and someone misses the presence of Campylobacteriosis in the stool? What happens if that’s part of a foodborne disease and there’s an outbreak in the city and samples are being missed? How many people will be impacted as a result of that error?” he asked.
University of British Columbia Endows a Chair for Laboratory Quality Management
Noble says UBC’s Program Office for Laboratory Quality Management (POLQM) has involved organizations worldwide and certified more than 500 people.
“The impact they have over their laboratories has been huge. Maybe that would have happened without us. But we were a part of that. And our impact is not one laboratory or one city or one province but widespread, and that’s a real and enriching experience to have,” he said.
But now it is time for him to move on. Noble secured (through UBC), a benefactor to establish the endowed Chair for Laboratory Quality Management. The family of the late Donald B. Rix, MD, a Canadian pathologist and philanthropist, gave $1.5 million (matched by the university) to create the Associate Professor (Grant Tenure) Donald B. Rix Professorship in Laboratory Quality at UBC, Department of Pathology and Laboratory Medicine.
Long-serving pathologists and medical laboratory professionals may remember that Rix was the founder and chair of MDS Metro Laboratory Services (now known as LifeLabs Medical Laboratory Services). It grew into the largest private medical laboratory in Western Canada.
Referring to this endowed new Chair for Laboratory Quality Management, Noble said, “I think this is the first named position of laboratory quality in North America.” UBC has commenced reviewing applications for the position, which is expected to be effective in January 2022. Pathologists and clinical laboratory scientists with appropriate qualifications and interest in this position should contact Dr. Noble’s office at the University of British Columbia Faculty of Medicine.
Medical technologists and clinical laboratory professionals are the unsung heroes of the COVID-19 pandemic and the public is beginning to notice
Medical technologists (MTs) and clinical laboratory scientists (CLSs) are the foundation of every successful clinical laboratory. But they seldom make the news. Therefore, it is worth noting, during this COVID-19 pandemic, when clinical laboratory professionals receive public recognition for the important role they play in fighting the disease.
A news story published by the Canadian Broadcasting Corporation (CBC), titled, “Lab Tech Who Found B.C.’s 1st Case of COVID-19 Recalls ‘Sheer Terror’ of Discovery,” describes a laboratory technologist’s experience in British Columbia when she discovered the Canadian province’s first positive case of COVID-19 in January of 2020.
Finding COVID-19 for the First Time
On January 27, 2020, Rebecca Hickman, Public Health Laboratory Technologist, Molecular Biology and Genomics at BC Centre for Disease Control (BCCDC) was carefully monitoring samples for COVID-19 and fearing a positive result for the SARS-CoV-2 coronavirus when her worst fear appeared before her eyes.
“I actually started to see it get positive within a few seconds,” Hickman recalled. “My first feeling was sheer terror, from a personal point of view.”
When Hickman realized a sample was going to test positive, she called Tracy Lee, Technical Coordinator at BC Centre for Disease Control and co-designer of the BCCDC’s COVID-19 test. Hickman had to interrupt Lee in a meeting, who then hurried to the lab to watch the test complete. It was a definite positive, the first confirmed case in British Columbia.
“To design, validate, and implement a molecular laboratory test usually takes months if not years, and so to do that in the span of days is a huge achievement,” Hickman told the CBC.
The following day, it was announced to the residents of BC that the COVID-19 coronavirus was in their province and that they needed to start taking necessary precautions. “This is the first time in my life I’ve ever found things out before I read it in the news,” Hickman said.
Supply Shortages Challenge British Columbia Clinical Laboratories
Hickman noted there have been several challenges in dealing with COVID-19 over the past year. “The instability and craziness of it all has been the hardest part,” she said. Last spring, the BC lab, like most labs, had to deal with a shortage of supplies and personal protective equipment.
According to BC Centre for Disease Control (BCCDC) data, as of March 2, 2021, there have been 81,367 confirmed cases of COVID-19 in the province of British Columbia. A total of 75,255 of those individuals have recovered from the coronavirus, more than 300 patients remain hospitalized, and 1,365 British Columbians have perished due to COVID-19. The population of the western Canadian province is approximately 5.1 million.
Today, Hickman, spends a majority of her time in the laboratory doing whole genome sequencing of confirmed COVID-19 cases. The data she collects is used for outbreak response and for tracking new variants of the SARS-CoV-2 coronavirus that are appearing in different parts of the world. “It has been easily the most difficult year of my life, but also the most fulfilling,” she told the CBC. “What we have achieved here over the last year is huge.”
In their laboratory at the B.C. Centre for Disease Control in British Columbia, Canada, researchers Tracy Lee (above left) and Rebecca Hickman (above right) “are designing new tests to quickly identify variants of the COVID-19 virus,” North Shore News (NSN) reported. Now, wrote NSN, “the pair are working on a new type of ‘rapid test’ that will be able to detect ‘variants of concern’—particularly the U.K., South African, and Brazilian variants—at the same time as determining if a test is positive for COVID-19. When it’s finalized, that test is expected to dramatically speed up the process of hunting the variants.” (Photo copyright: North Shore News.)
Clinical Laboratories on the Front Lines
Last year, the American Society for Clinical Pathology (ASCP) produced a docuseries titled, “Laboratories on the Front Lines: Battling COVID-19” which highlighted the critical work clinical laboratories are doing to care for patients during the SARS-CoV-2 pandemic. The five-part series interviewed medical laboratory professionals across the US about their experiences during the pandemic.
In one episode, Stephanie Horiuchi, Clinical Microbiology Specialist at UCLA Health Systems, discussed how challenging and rewarding it has been working on the pandemic.
“Very long days. I’m not going to lie. Very, very long days, but it’s rewarding. I know the importance of what I am doing, and I know the importance of what needs to be done,” she said. “So, the time that I am here, it does go by very fast. You look up at the clock and you’re like oh, its 9pm. And then when I go home, it’s just eat and go to sleep and then rinse and repeat.
“I feel that this is a really important area of work that we all do as microbiologists,” Horiuchi continued. “And to just serve patients every day and to know that I am helping someone, it really warms my soul.”
In another episode of the docuseries, Professor of Pathology and Laboratory Medicine Alyssa Ziman, MD, Division Chief, Clinical Laboratory Medicine at UCLA Health, was interviewed regarding how they are coping with the increased demand for medical laboratory services.
“It’s been a really difficult and challenging time for our health system, for our laboratories, for our staff that are working through to provide the best possible patient care,” she said. Ziman is also Medical Director, Transfusion Medicine, at UCLA Health and Medical Director, Clinical Laboratories, at Ronald Reagan UCLA Medical Center. “Every day is a new challenge and a new way to adapt to changing rules from the CDC and from the LA County Public Health Department and to really evolve, so that we can continue to provide the testing that we have and continue to support our staff and our patients.”
Unsung Heroes of COVID-19
The COVID-19 pandemic has placed a strain on medical resources throughout the world. Clinical laboratory professionals are emerging as the unsung heroes of the crisis and the entire medical laboratory profession is receiving much deserved positive recognition for the crucial role laboratories are playing in fighting the pandemic.
