Days before the Cayman Islands entered its 12-week lockdown, those at the Health Services Authority were told they would need to conduct Polymerase Chain Reaction (PCR) tests to identify the coronavirus genetic material in infected people. The difficulty was that the laboratory was in no position to conduct hundreds, let alone tens of thousands, of tests in such a short space of time.
Just a few months later, the lab’s seven-person team has carried out nearly 20,000 tests, which is equivalent to 10 years’ worth of processed tests under the lab’s normal schedule.
“Normally, even if it is a simple test, it’s a week to two weeks of constant laboratory work, followed by another four weeks of data analysis,” said Angela Tanzillo-Swarts, a forensic technical DNA specialist, who serves as a manager at the HSA lab.
Tanzillo-Swarts said each year the lab turns out results for about 2,000 tests, the bulk of which are DNA tests for paternity cases and for criminal trials before Cayman’s courts. However, in light of the national emergency at hand, the lab had to rethink its operations.
This is where Cayman’s winning streak begun.
PCR testing was introduced to Cayman in 2007. Since then, it had been used successfully to identify viral strains of diseases such as dengue, chikungunya, and Zika.
“To begin to run the PCR test for SARS COVID-2 [the coronavirus], the only thing that we were waiting on to get started on that was for the supplies that PAHO [Pan American Health Organization] was going to send us,” said Tanzillo-Swarts.
The testing supplies arrived on a Thursday, and the lab was expected to begin processing results on Monday. However, before any swabs could be processed, the lab had to then find a way around its next obstacle – a lack of trained people capable of completing specific tasks at each step of the procedure. That’s where the second victory came.
Fresh from university and still trying to find full-time employment, Julian Jervis was interning at the hospital’s pharmacy. He was one of the first pieces of the puzzle to fall into place.
“I was given the role as a forensic assistant; however, the forensic department wasn’t open yet,” said Jervis. “We were at the peak of COVID, lockdown was about to take place… so they brought me in and took me into the pathology lab.”
Jervis’ role was to secure and process hundreds of test samples that were generated each day. He then turned them over to Jonathan Smellie, a young doctor in training who had hoped to be practicing medicine in the hospital’s emergency room.
“I got a phone call from Ms. Angela, and she was picking up on the fact that I did PCR during my undergraduate and masters experience,” said Smellie, who had applied to be a doctor in March. “My interviewers were telling me they wanted me to go into the lab to work and, at the time, I wasn’t sure why.”
Smellie would go on to singlehandedly extract more than 14,000 samples, which were prepared for testing. He said, for him, the tests were not just DNA samples in a tube.
“Coming from wanting to be a doctor, every sample I’m processing is a person, not just some random test,” he said. “Every person you process could be the next positive person that you are able to isolate and prevent from spreading [the virus] to other persons in the community.”
For Smellie and other lab assistants, the workdays were long, and the thought of taking a break felt nothing short of a guilty pleasure.
“Everybody else around me that I knew was locked down, hard curfew, and they were all very concerned about the situation,” said Smellie. “So it had a meaningful impact, what I was doing, so I almost had a feeling of guilt. Because if I’m not working, or Ms. Angela or Christian, then samples aren’t getting processed. That’s what kind of drove the whole process.”
Even with two young capable Caymanians like Jervis and Smellie, the HSA’s lab still needed another trained person who was familiar with a high-demand DNA output facility. That’s where Christian Taylor, who previously worked at a large laboratory in Canada, came in.
“Coming from a lab that employs 300 people, and is about as big as a modern football stadium, this lab at the HSA is doing the same work as that lab,” said Taylor, who has processed more than 16,400 tests. “This much smaller lab was able to get the same output without sacrificing quality.”
The HSA lab team uses a multi-verification process from the collection of the samples to the final result analysis.
“Every step of the chain follows dedicated procedures and protocols, and everyone is dedicated to following those procedures,” said Taylor. “The average Caymanian can be very confident that their government and the HSA laboratory is doing great work.”
The lab’s victories in helping to secure testing equipment and competent personnel has resulted in Cayman having one of the highest testing per-capita rates in the world.
Tanzillo-Swarts said, although her team has been able to achieve impressive results in such a short period of time, there is much more work to be done.
“We still need people to come forward and get the testing done,” she said. “One of the reasons why other countries have recognised that they had a second wave, is because they never stopped testing.”
Along with the PCR tests, the HSA lab also offers antibody tests.