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They come from all over the region: from smaller hospitals, from private medical centers, from nursing homes, but they always end in microbiology laboratory of the Cardarelli hospital in Campobasso. We talk about molecular buffers To date, the most reliable test to detect the presence of the SARS CoV-2 virus in our body.
For a few days the processed swabs, those giant cotton swabs stuck to the throat and nose before ending up in a clear test tube, are grown in number: from about 800 per day on average to over 1000 (with peaks even 1200).
How is this possible miracle invoked by patients, friends and family, we asked the doctor Massimiliano Scutellà, responsible for microbiology at the Tappino district hospital and regional contact person at the Higher Institute of Health for the diagnosis of Covid-19.
Scutellà, who works in the Cardarelli laboratories together with a group of biologists like him, is the man who, with his technical language well-informed person explain to Primonumero why making a buffer is “never a trivial operation.”
Doctor, meanwhile, tell us why you can process more tampons today than a few days ago. What happened?
“We have expanded the reporting capacity thanks to additional instruments that enter the process of processing the samples taken.”
Let’s understand: Has Asrem bought new machinery?
“The molecular and microbiological diagnoses of the Cardarelli hospital were already possible thanks to the presence in the laboratory of highly sophisticated instrumentation.”
In Cardarelli – and here it is convenient to open a parenthesis – there is a very expensive and somewhat revolutionary machine in the medical sciences that performs the Pcr (Polymerase chain reaction or polymerase chain reaction, molecular biology technique that allows the multiplication, or amplification, of nucleic acid fragments whose initial and terminal nucleotide sequences are known). In a nutshell PCR studies bacteria and viruses and has many applications that are used not only to diagnose Covid 19. but also, for example, in cervical cancer screening programs. And it does many other things.
“But one thing – explains Scutellà – is to process a limited number of samples, another is to make diagnoses in a very high number of tampons as is happening today. This is why the supply has been doubled through the use of additional instrumentation which, I assure you, is not easy to find at this time: the demand for diagnostic and test equipment at national and international level is very high, it is a supply continuous. We have also set up a suitable laboratory that allows us to carry out more swabs and the computer systems have been improved to send data to the health management and the prevention department in real time to have an always updated situation and accelerate the communication process that in an early phase of the pandemic was slower ”.
An ad hoc lab, more machines and blazing-fast data. What else?
“Personal. Having a suitable team without professionalism would be useless: it is not about pressing a button, otherwise anyone could do it, Molecular tests have their own complexity because they consist of several phases: nucleic acid extraction, amplification, which in this case is the reverse transcription of the RNA virus, amplification, and reporting. Each of these steps requires continuous and constant monitoring by laboratory professionals where, I want to remind you, the ordinary activity also continues, that of understanding, which was done before Covid 19. That is why today there are those who carry out routine activity and who processes the tampons continue. Cardarelli hospital is the only regional center (with all specialties, the most important in Molise for simplicity, ed) and also has the task of conducting second and third level exams from radial hospitals (peripheral ones such as Termoli and Isernia) ”.
How many people work on Covid-19 diagnoses?
“Currently the nucleus is made up of 4 people (three biologists and a doctor) then we have two other technicians and a specialized biologist who collaborate with us.”
Well, well, there aren’t many of you …
“True. But also because those who do this type of work must be well united, it is not about alternating people, skills and qualities are needed because to the extent that automation can be pushed, human evaluation is always important. The work It is complex, we are in an advanced epidemic phase, we consider that at the same time patients with active infection are processed, those with previous infections that have never been diagnosed or with late infections that reach the report in the first instance. There is a lot of work behind to locate the infection Sars Cov-2 To be able to say ‘positive’ or ‘negative’ there is a real genetic and microbiological investigation “.
So doctor, explain it to us: what happens between the taking of the sample at the Cardarelli clinical engineering shelter and the opening of the medical record by the patient in which it is written positive or negative?
“For starters, there is an electronic procedure that tracks the tubes even before they enter the lab. There are many withdrawals, we cannot make a mistake in the labeling that is why a barcode is generated for each patient who will come that day to make the withdrawal. We do not identify people, the tubes are already traced, we only do a ‘check in’ before the tube enters the manufacturing process ”.
And for whom does the withdrawal do it elsewhere?
“The samples that arrive from the different collection centers are transported to the laboratory under suitable conditions and in turn are introduced into the processing circuit. This is why reporting times can vary (from 24 to 48 hours approximately) “.
And we come to the biological sample: once the cellular material is extracted from the nose and mouth, what happens?
“It happens that it ends up in a ‘centrifuge’ that after a vigorous ‘vortex’ allows the cells to be released and the buffer to be removed. After taking the sample, the nucleic acids are extracted and amplified. Then the operator comes into play who, after examining the different phases of a process already traced in electronic form and therefore free from any human error, enters into the merit of evaluating the positivity of the sample by analyzing what is called the amplification curve. “.
It really seems very complicated …
“And it is. For this reason, swabs, and with good reason, have not been carried out in a capillary way throughout the region. The transmission of specific data to the Ministry of Health and the ISS cannot be trivialized on the basis of tests carried out in such or which peripheral or private laboratory. The Cardarelli has an adequate structure which also means having a certified laboratory according to current regulations “.
But there are also private laboratories affiliated with Asrem that perform swabs for a fee (sample collection, no processing) or perform faster tests such as antigenic and serological.
“As for the public hospitals in Termoli, Agnone, Isernia and also Campobasso, they have been equipped with rapid tests (serological and antigenic) that give the result in a short time. A necessary measure in cases where a patient exhibits obvious symptoms or when they must immediately enter the hospital for hospitalization, urgent intervention or any medical procedure that cannot be postponed. Antigenic swabs, along with those from antibody research, raise the bar for Covid 19 diagnosis in the region, which is excellent. “
Let’s summarize: there are two objective limits to the diagnostic capacity expressed by the Campobasso laboratory: the first refers to the machines that process a certain number of samples at the same time (about 90) and the one that multiplied by the number of hours in which they are in operation bring the invoice. a thousand results per day according to the Asrem bulletin. The other reason concerns the staff: the test is automated but not automatic and requires human intervention.. Not just any man, but a specialized biologist capable of intervening in the very complicated phases of virus isolation.
In short, tampons are easy to tell, but putting them on the mat is not at all obvious.
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