A Q&A with Dr. Susan Sanchez and Dr. Jesse Hostetter about COVID-19 surveillance testing

REPORTER – JOSIE PICKETT

Josie Pickett  

What is your normal position at UGA, your position in regards the COVID response, and how you are involved in combating COVID-19 on campus?

Susan Sanchez

I am a professor in the department of infectious diseases and section head of microbiology, molecular biology in the Veterinary Diagnostic laboratory, and then the technical director of our CLIA laboratory COVID-19 testing lab here at UGA at the College of Veterinary Medicine on the UGA campus, we have a different campus also. And it has another CLIA laboratory.

Jesse Hostetter  

I’m Jessie Hostetter. I’m a professor, and head of the department of pathology in the College of Veterinary Medicine. I’m also the executive director of the Athens and Tifton Veterinary diagnostic labs, and I am on the project team that put together the Legion Field testing and integrated that with the diagnostic lab.

JP 

As directors and lectures in the department of veterinary medicine, how did you come to be involved with UGA’s, COVID response?

JH  

I’ll start. So when the COVID pandemic started last spring, we were looking at ways that we could help UGA and help the community and this is both here and in Athens, as well as in Tifton. And we looked, you know, one of the things that we had the capacity and the expertise to do was to do testing for COVID. The testing process really isn’t significantly different from tests that we run here all the time, although they’re veterinary tests. Some of our sister institutions and other diagnostic labs, were also looking to start running Covid testing. And so, we felt that would be an avenue for us to take. And so that’s really how the whole process started with us pursuing testing. 

SS 

We have been able to run for many years now high complexity, molecular tests, which COVID-19 is one of those high complexity, molecular tests. And also we have the ability to do high throughput. In most human diagnostic laboratories, they have a lower throughput in hospitals, etc. So we can do hundreds of samples on a daily basis, because we’re working towards large animal data. 

JH  

I think what goes into that Susan, is also our laboratory information management system. So I think an important thing to realize is, you know, lots and lots of labs can do PCR testing. But I think, the reason that we could step forward is, one, we had the high throughput that Susan just mentioned, but also we had the ability to handle the data, so all of the patient information and results, and, you know, we have a system in place that can handle that. That’s a pretty large amount of information, and handling it securely.

JP  

From like a pathological/scientific perspective, why is surveillance testing such an important part of the response to COVID-19? And how does that relate to the proportion of people who stay asymptomatic with the virus?

JH  

Well, you know, the surveillance testing is part of a much bigger UGA effort. And so we’re, kind of one small part of this whole thing. You know, you have surveillance testing, you have testing at the health center, and DawgCheck are probably some of the bigger components, but also you have recommendations, masks, social distancing, those kinds of things all as part of the effort. The surveillance testing can give us an idea of what levels we’re dealing with, at least give us some ideas on a number of asymptomatic carriers. So you have to really have you have to handle that with care. We’re looking at a fairly, you know, small, unique population, there are some conclusions we can draw from [surveillance testing results,] and there are some limitations that we can draw from them. But it does help us to know, for instance, we monitor that every week, every day actually, and that’s a powerful indicator, because it’s possible that we might see an uptick in the in the amount of positive tests that are coming back on a given day. We can often see the opposite, we may see positive tests going down. And so I think it gives us sort of a  barometer, so to speak, you know, of what’s happening, at least to the population we’re testing.

JP  

Could you talk a little bit about what, what the process was for you of setting up the Legion field testing site? 

JH  

Well we worked with administration. You know, we started talking with administration back in the early summer, with their goals. And, you know, we started brainstorming ideas on how we would accomplish testing. And, you know, a number of ideas were looked at, and what kind of came out of the discussion was what we have at Legion field. We wanted an outdoor location that was easily accessible, and it was also protected from the weather. So quickly, legion came up to be a really nice spot. And that’s worked out really, really, really well for us. You know, the stage where the tests are taken, we can run up to four lanes, of people walking through there and getting a swab. And so it’s allowed us to move pretty quickly. This is in conjunction with the University Health Center. So the University Health Center played a big role in helping to get Legion field set up. So that’s an important piece of success there.

JP  

What knowledge, skills and experience, from your career up to this point, was most valuable for you in the process of doing COVID response?

SS 

I have done work in multiple laboratories in my lifetime. Some of them in the university, some of them private. I have started from scratch from just a new space and so I’ve had quite a bit of experience doing that, in this country, and others, so I have quite a bit of experience, being able to set up a laboratory and managing the right people. So when it comes to what skill sets do, you have to have, in addition to your degrees in microbiology, and PhD and master’s degree, etc, you also have to have a good skill set with people and knowing how to motivate them. I had to work with them to get the best workflow. And you know, not everybody is good with doing this strategic kind of organization and really having a vision of where things need to go. So having a team that works together is very critical.

JH  

My background is a little bit different than Dr. Sanchez’. I’m a pathologist, I’m not a microbiologist. And so, I came at this with a slightly different angle. I think my background, my PhD is in infectious disease. My training has been in infectious disease and Immunology and, you know, those core sciences were helpful at least for kind of understanding the disease itself at a level that helped me to understand the idea of testing and what we needed and the types of testing that we were proposing. I think for me, my role has really been to help with putting the teams together and getting the project up and running. And so, you know, I had the luxury of working with some really great people. I mean, Susan and her team, they’ve been doing this kind of work for, you know, this is what they do. This is what we do at the diagnostic lab. And we’re always prepared in the diagnostic lab, in case there’s an emergency outbreak of an animal disease. And so, you know, we had an emergency outbreak of disease, this time, it was a human disease, and we were able to step forward and help. Same at Legion, you know, I was able to work with with folks there and help coordinate some effort, again, help, I didn’t do it myself, I worked with a lot of people that were able to put together the testing and find out a workflow that worked very well and working with IT to get the information where it needed to be. So I think those were the things that were most important.

JP  

Could you talk a bit about one health and how it relates to COVID-19 in terms of the disease itself, and the response.

SS

So COVID-19 is a zoonotic disease which comes from animals. We’ve responded both to animal testing if we need to, and we do. And, as Dr. Hostetter mentioned earlier, we decided that we wanted to help the community and move from our traditional veterinary support to a human support. So that really is a one health perspective. We really are serving both humans and the animal community, we have the same test, the same techniques and we can help each other in times of need. We can break those silos [between health fields.] You know, just because one has a veterinary background that does not mean that we can’t do exactly the same test for humans. A human is not more than another animal, actually, so we’re pretty well suited to this type of work. There will be more transboundary diseases. There will be more spillovers, There will be more outbreaks in the future. So we really need to cooperate and work together within this interdisciplinary spirit that one health brings about.

JP  

What do you think UGA could be doing better as an institution in regards to COVID? Are there any precautions that like you suggested, or that like the greater scientific community suggested that either weren’t implemented for some reason? If you could get a message out to like UGA students with a guarantee that they would heed whatever advice you gave them, what would you say?

JH  

Well, I think for the most part I can’t really speak for UGA. I can speak for the labs and Legion field. And I think that the support we’ve had from UGA has been very, very strong. They’ve been behind us the whole way to get this set up and get it running and do what they can to get the testing accomplished. I think it’s a tall order. We didn’t have years to plan for this. In a perfect world, you take a long time to be able to put something together. And so I think that from that respect there’s been great support to Legion field and to our lab. For students, I think the important thing is what UGA has been telling us, and that is to follow the guidelines because we are learning more and more that they work and wearing your mask and standing away from other people seem to be at least in my feeling, two of the most critical things we can do to keep ourselves safe. I think getting tested is a good idea. If you’re testing, it helps you know what your status is, but it also helps the university because these as we talked about, these trends that we look at to get some idea or a glimpse of what is going on, is really helpful for us. So I think, you know, taking the five minutes that it takes and getting through and getting a test helps us and also helps you too.

SS  

Yeah, I think we could have done better with communication. I think our communication strategy [for reaching students] could have been better, and it still could improve and be more and more widespread, and potentially more using more of the tools that you guys use for your preferred modes of communication. Potentially, I think that that would have been very helpful. And I second everything Dr. Hostetter mentioned and, yeah, come and get tested, have your colleagues do the same. The more people they get tested, a better idea  of what’s going on we’ll have instead of having a very fragmentary view. Use DawgCheck and use all the tools that we and the University has provided to you to stay safe and keep yourself and your family safe. So, that would be my two cents.

Copy Editor: Halle Mastronardo

Photography Source: Hima Patel