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The usual response I receive when I divulge my chosen career path is ‘who cares that much about viruses?’ accompanied by a titter and a roll of eyes. But over the last six months I have been more likely to hear ‘you must have been waiting your whole life for this!’
I’m not sure any virologist is enjoying the moment now it has come, but we are equally unsurprised that a virus is at the centre of a global pandemic. With it have come many opportunities for trainees to become actively involved in novel clinical or service provisions.
In this blog, I’ll relate my experience of helping to set up a healthcare worker SARS-CoV-2 testing programme. I hope that it inspires other trainees to get involved with similar projects and encourages you to see your value within them.
Why was the programme set up and how did I get involved?
Addenbrooke’s Hospital sits on a large biomedical campus with the Cambridge PHE laboratory, university research facilities and an active occupational health department working collaboratively within. We set out to test all hospital staff and their household contacts showing even the mildest of symptoms for COVID-19, and to provide a rolling surveillance programme to all staff without compromising patient testing.
We hoped that it would provide not only reassurance to healthcare workers (HCWs) but also prevent onward transmission to other HCWs, family contacts and, importantly, patients. We also hoped it would get staff back to work quicker at a time when demand for a full and healthy working staff is high.
Some might say I was in the right place at the right time. I was providing what many of my peers were – hours of reviewing PCR curves and on hold to the busy local HPTs. I knew about the SARS-CoV-2 RNA assays being used, the clinical syndromes, the reporting process. And importantly, I was part of a network of other trainees in other counties who were also interested in HCW transmission and were ahead of us in testing their symptomatic staff. These relationships proved fundamental to give us the confidence that this programme could work.
What did I bring to the programme and what did I do?
Think about who and what you know – you may have a working relationship already with occupational health because of exposure to infection policies. Do you know the person behind the scenes designing the in-house assays? Who teaches the BMS and knows how LIMS systems work? Which infection control nurse is looking for a specialist interest?
As trainees, we often undervalue the skills we do have. We are the linchpins to service and often know how many departments work – particularly in the field of infection, where many cross the boundaries between understanding laboratory processes, clinical medicine, epidemiology, infection control, and preventative medicine.
Then it is down to being motivated. I had the opportunity to be involved from offset, from working through the practical processes (accept that isn’t all going to be glamorous – put up posters and check out changing facilities, it is fascinating to see the bowels of the hospital) to advising on getting a university laboratory set up with a clinical assay whilst creating protocols and reporting tools.
Has the programme been successful?
The programme started in the first week of April. We were very keen from the onset that alongside symptomatic testing, we would provide trust-wide screening of those that were at work and seemingly well. We knew that presymptomatic transmission had been important in the spread of COVID-19 infection and thus in the hospital environment the risk of nosocomial transmission and the consequences thereof are high.
Early analysis of just over 1000 staff members showed that 3% of those that were truly asymptomatic did not fit the PHE criteria or had clinically recovered, were nevertheless positive for SARS-CoV-2. Since then, policies have changed in our and many other hospitals – we wear appropriate PPE with all patient contacts, masks even in non-clinical areas and have a wider definition of the clinical picture of COVID-19.
Is it still relevant?
Yes! While numbers are low this is the time to ensure that we are doing all we can to get ready for any further waves which might happen as lockdown is relaxed. Our programme has evolved with the pandemic. For example, we have increased testing capacity to provide more frequent testing, there is now serological testing available, and we ensure HCWs are considered in cluster management.
Important learning points
This blog outlines just one example to illustrate that as trainees we can be a part of a larger picture in our trusts. I have learnt a huge amount from my involvement in this programme and am hugely grateful for the opportunity.
These are my top tips:
Read more about our project here: