Our Laboratories Transformed: Reaching One Million COVID-19 Tests at Montefiore Einstein

At the end of January 2023, with little pomp or fanfare, Montefiore Einstein laboratories processed their millionth molecular test for COVID-19. That’s about one result every 80 seconds since the start of the pandemic.

“This is a remarkable achievement and is really a testament to our laboratories’ coming together with a commitment to the health and well-being of the entire Montefiore Einstein community,” said D. Yitzchak Goldstein, MD, FASCP, Co-Director of Molecular Infectious Diseases Testing and Director of the Molecular Genetics Laboratory, Montefiore Einstein, and Assistant Professor, Pathology, Albert Einstein College of Medicine. “Without an ‘all-hands’ sense of responsibility, we could never have achieved this milestone.”

While the virology lab may have developed Montefiore Einstein’s first available COVID-19 testing, several laboratories throughout the network had to work together to ensure capacity and timely results for all patients.

“Often, when we have some novel emerging infections, the local health departments can cover some of the initial testing burden, but in 2020 we quickly realized this was going to be a lot bigger than anybody expected,” said Wendy A. Szymczak, PhD, Director, Clinical Microbiology Laboratory, Montefiore Einstein, and Associate Professor, Pathology, Albert Einstein College of Medicine. “As testing needs rose, we updated our equipment to accommodate greater capacity and oversaw the distribution of testing to other hospital sites as well.”

Montefiore Einstein’s laboratories were at the forefront of the pandemic response, running their first PCR test on March 9, 2020, the same day as some of the largest, most well-resourced, national reference laboratories in the United States. Montefiore Einstein’s teams of dedicated laboratory directors, technologists and support staff worked tirelessly to ensure that the hospital network and testing capacity remained in line with organizational needs. This distributed approach to testing, and the triage of samples based on patient needs, was one of many comprehensive workflows that the Department of Pathology developed to help achieve this one-million-sample milestone.

“It is truly remarkable what our labs have been able to accomplish,” said Amy S. Fox, MD, MS, Executive Vice Chair, Pathology, Montefiore Einstein, and Professor, Pathology and Pediatrics, Albert Einstein College of Medicine. Dr. Fox was the Director of the Virology Laboratory at the start of the pandemic. “Being able to foster and strengthen the services that our interconnected laboratories provide reinforces the supreme value our department adds to patient care.”

The notable successes did not come easily, and the lab teams experienced challenges just as novel and numerous as the virus they were helping to fight. Global supply shortages meant that every lab had to validate test performance on several different swab types. Reagent shortages meant a diverse array of testing instrumentation had to be adopted.

“When a COVID swab is sent to our laboratories now, it can be processed on any one of eight different types of instruments, each diligently validated and each with advantages and disadvantages utilized, depending on patient need,” Dr. Fox said.

Momka Narlieva, Manager, Virology Laboratory, Pathology, Montefiore Einstein, said her staff faced numerous challenges.

“When my team realized the impact of the testing burden, they voluntarily adjusted the hours and days of operation of the lab, not only to keep up with demand, but also to ensure there was no impact to any of the other patient work we perform,” she said. “Montefiore Einstein laboratories’ technical staff members are truly some of the unsung heroes of the pandemic.”

One initial challenge may have been the most important of all: getting patient results to the chart.

“Without our truly extraordinary partners in IT, not a single result would have been verified,” said Dr. Goldstein. “We kept them very busy with our ever-changing needs, but they performed exceptionally despite their limited resources.”

Drs. Szymczak and Goldstein also helped guide and design the IT reporting with redundancies, so that tests could be performed and verified on all Montefiore Einstein campuses. Results from all instruments could appear similarly to the clinician with little knowledge of the complex array of shuttling and shifting due to challenges behind the scenes. This planned redundancy also ensured there were fail-safes in place and backup testing plans, which could be immediately implemented in case of an unexpected challenge waiting around the corner.

“We learned a lot about the necessity of having to act quickly and pivot when needed,” said Dr. Goldstein. “We didn’t have time to complain about what was going wrong; we needed to deal with it.”

Dr. Szymczak added, “It really gave us the courage to move forward together and the trust in each other to understand we would be able to do it again if and when the need arises.”

“As we approach the three-year anniversary of the COVID-19 pandemic in our hospital, it’s essential that we reflect and learn,” Dr. Fox said.

The laboratory’s milestone is a reminder of the critical role that laboratories play in the pandemic response. Laboratory testing is an essential tool for the patient-facing clinicians and certainly in identifying and containing emerging infections. Montefiore Einstein laboratories’ one millionth PCR test is a testament to their commitment to the health and well-being of the community, and we are grateful for their hard work and dedication.