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Department of Pathology develops strategy to support GuideSafe™ Entry Testing, process more than 200,000 samples

Nearly a quarter-million college students across the state of Alabama can be tested for COVID-19 with a free, rapid, non-invasive nasal swab-based procedure, to ensure a negative test — or quarantining in the case of a positive result — before returning to campus.

This opportunity was made possible by the implementation of GuideSafe™ Entry Testing, a large-scale testing strategy implemented throughout the state to ensure a safe return to campus for more than 200,000 college students for the upcoming fall semester. GuideSafe™ Entry Testing is part of GuideSafe™, a multi-tool platform formally announced Aug. 3, that also includes GuideSafe™ HealthCheck, GuideSafe™ Exposure Notification Application and GuideSafe™ Event Passport.

The University of Alabama at Birmingham’s Department of Pathology, led by George Netto, M.D., the Robert and Ruth Anderson Endowed Chair, adapted its clinically offered lab-developed testing capabilities to a pooling test approach. This strategy will allow for ramping up testing capacity tenfold for the next 20-plus days leading up to the start of school.

“We opted for a simpler way of collecting specimens, by allowing students to do a nasal swab themselves, that makes it faster and easier than the nasopharyngeal swab, which requires a health care professional to administer,” Netto said. “The utilization of nasal swabs coupled with our in-house-developed pooling strategy will enable us to significantly ramp up capacity while maintaining full testing accuracy.”

Development of the testing strategy was led by the director the Microbiology Section, Division of Laboratory Medicine, Sixto Leal, Jr., M.D., Ph.D., an assistant professor of pathology.

“The pooled testing approach allows for labs to do preliminary screening from several student samples at once,” Leal said. “Knowing that only a minority of those tests will be positive allows us to then focus on those few positive test results and pursue secondary confirmatory testing.”

This approach greatly increases test capacity to accommodate the more than 200,000 college students statewide looking to return to campus this month.

All student testing is part of GuideSafe™ Entry Testing and will be conducted in partnership with UAB, announced by Gov. Kay Ivey at the end of June. It will be complemented by the GuideSafe™ tracking software to promote safe reentry and ongoing COVID-19 monitoring. The app includes GuideSafe™ HealthCheck, which allows individuals to assess their health and symptoms, as well as GuideSafe™ Exposure Notification Application, which is backed by Google and Apple technology. That feature can anonymously alert someone if they are at risk from being in proximity to someone who has tested positive for COVID-19.

A Three-Pronged Approach

Tackling the challenge of testing so many individuals in such a short time frame could only be achieved by a comprehensive three-pronged plan: Develop a logistics grid of specimen collection; information technology infrastructure to track specimens and reporting results while maintaining HIPAA privacy standards; and a high-capacity test at low cost, given that tests are offered free to students.

UAB Pathology faculty and staff partnered with UAB Hospital Labs staff, led by Sherry Polhill, associate vice president of Hospital Labs, to develop and assemble the test kits, which will be used at 13 collection spots throughout the state. This allows for students to visit a testing site within a 30- to 60-minute drive from each campus.

“We developed the ability to multiply test processing volumes, testing 5,000 to 10,000 specimens a day at the UAB Department of Pathology, without infringing in any way upon the high volume of critical routine testing we are currently offering to our patients, our affiliate institutions, health care workers and our community,” Netto said.

UAB also partnered with Everlywell to mail test kits to out-of-state students and those who are slated to return to campus early. Out-of-state students can self-administer their tests and send in for analysis.

In a span of four weeks, the majority of these tests will be processed at UAB, each with a 24-48-hour turnaround time. Pulling off this collaborative effort in a very short time frame required identifying lab space on UAB’s campus and adding up to 20 laboratory technicians to increase specimen processing capacity.

“Stepping up to this crisis has many additional benefits for future work with our partners,” Netto said.

He outlined new relationships forged with private-sector companies to develop the IT infrastructure and utilize a mail-in testing approach to those patients outside Jefferson County seeking health care at UAB. Netto credits the state for its crucial support.

“The state of Alabama was very generous in its support,” he said. “The return on investment of time and energy to get this up and running is an investment in our COVID-19 testing capacity at UAB for months and years to come, to deploy in our ongoing fight against COVID.”

UAB Pathology is also working with pathology departments and hospital labs at other statewide institutions, including the University of South Alabama in Mobile, to increase their testing capacity using a model similar to UAB’s.

(Courtesy of UAB)

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