For an illness with no vaccine and limited treatment, testing and isolation are the best methods for stopping the spread. A UCLA Health doctor shared details about the testing protocol that his lab followed in its analysis of one possible COVID-19 case:
A fever somewhere above 101. Hypoxia, shortness of breath. And two critical check marks for risk: advanced age and a compromised immune system.
For Omai Garner, who directs clinical microbiology testing for UCLA Health, laboratories like his are central for ending this pandemic. Their protocol, initially developed in the 1980s, has been on the front line of viral diagnostic testing for almost two decades. “We need to do a lot more inquiry before we know how effective it will be,” he said, “because it is not based on the established standard for infectious disease diagnoses.”In a series of phone interviews last week, Garner shared details about the testing protocol that his laboratory followed in its analysis of one possible COVID-19 case.The mood that afternoon — just days after the city and county began shutting down nonessential activities — was calm yet wary.
Pain shot through the patient, trying to breathe through a gauze of congestion. Eyes welled with tears.The nurse extracted the swab — covered with a film of mucus, rich with the cells of the patient and a possible virus — and placed it into the accompanying test tube. “To a young African American teenager, the idea that Cuba Gooding Jr. was in this movie playing a hero in a suit, studying the Ebola and fighting it, well, I was hooked,” he said. “I wanted to be the one fighting the apocalypse.”
“If you look at the human genome, large segments of our DNA come from viruses,” Omai Garner said. “We are human because of our interactions with viruses.” Just three months ago, Garner first heard of a “mystery virus,” an “unknown infection,” spreading in China, but he didn’t give it a second thought. Viral outbreaks from unidentified pathogens happen all the time; a new one didn’t raise any immediate alarms.But a week later his phone rang. A lab colleague, Shangxin Yang, was concerned. He knew people near the city of Wuhan.Garner marked the date — Jan.
Garner was also concerned that the CDC criteria for screening were too narrow. “South Korea was having active cases,” he said, “but if someone traveled from South Korea and had the right symptoms, they didn’t get tested.”The clincher, though, was the test itself.Its flaw, he explained, was in requiring the presence of three viral genomic markers for a positive result. When health agencies around the country began running trials in late January, they found only two of the markers.
He placed No. 20SA-83 on a vortex spinner. The pinkish solution whirled and churned. He transferred it from the test tube into a small vial and lowered it into a Styrofoam rack. He soon had eight prepared specimens. After filling the eight compartments and closing their flaps, he removed the disc from the cabinet and inserted it into a thermocycler, a hooded gray machine just slightly larger than a pressure cooker.
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