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. 2022 Mar;102(3):115617.
doi: 10.1016/j.diagmicrobio.2021.115617. Epub 2021 Dec 11.

Implementation of large-scale laboratory-based detection of COVID-19 in the Veterans Health Administration, March 2020 - February 2021

Aditya Sharma  1 , Gina Oda  2 , Michael Icardi  3 , Larry Mole  4 , Mark Holodniy  5
Affiliations

Implementation of large-scale laboratory-based detection of COVID-19 in the Veterans Health Administration, March 2020 - February 2021

Aditya Sharma et al. Diagn Microbiol Infect Dis. 2022 Mar.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented numerous operational challenges to healthcare delivery networks responsible for implementing large scale detection of Coronavirus Disease 2019 (COVID-19), the infection caused by SARS-CoV-2. We describe testing performance, review data quality metrics, and summarize experiences during the scale up of laboratory-based detection of COVID-19 in the Veterans Health Administration, the largest healthcare system in the United States. During March 2020 to February 2021, we observed rapid increase in testing volume, decreases in test turnaround time, improvements in testing of hospitalized persons, changes in test positivity, and varying utilization of different tests. Though performance metrics improved over time, surges challenged testing capacity and data quality remained suboptimal. Future planning efforts should focus on fortifying supply chains for consumables and equipment repair, optimizing distribution of testing workload across laboratories, and improving informatics to accurately monitor operations and intent for testing during a public health emergency.

Keywords: COVID-19; Laboratory performance; Surveillance.

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Figures

Fig 1
Fig. 1
Metrics of SARS-CoV-2 tests performed in Veterans Health Administration, March 2020 to February 2021. (A) Total monthly tests performed. (B) Monthly tests performed by location of performing laboratory. “Outside VISN” and “within VISN” describe whether the test performed in a VHA laboratory locate in a different or the same VISN as that in which the specimen was collected. (C) Monthly tests performed by type of patient. (D) Monthly tests performed by setting where specimen was collected. VISN = Veterans Integrated Health System. VHA = Veterans Health Administration.
Fig 2
Fig. 2
Selected metrics of SARS-CoV-2 testing in Veterans Health Administration, March 2020 to February 2021. (A) Percentage of overall tests that were performed at the Public Health Reference Laboratory (PHRL). (B) Percentage of hospitalized persons tested for SARS-Cov-2 by PCR or antigen tests.
Fig 3
Fig. 3
Longitudinal characteristics of SARS-CoV-2 tests performed in Veterans Health Administration, March 2020 to February 2021. (A) Test positivity among unique persons tested by month. (B) Monthly median turnaround time.
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