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There Was Already a Molecular, Microbiology Lab Employee Shortage, Then SARS-CoV-2 Pandemic Hit

NEW YORK – On Quest Diagnostics' recent Q2 earnings call, company Chairman, President, and CEO Steve Rusckowski observed that since the SARS-CoV-2 pandemic arrived in the US this winter, microbiology has gone from something of a "backwater" within the laboratory "to front and center."

This has occasioned some growing pains, not least of all around staffing, Rusckowski said, noting that with regard to SARS-CoV-2 testing, the company has run into "capacity limits around the people and those that are trained adequately to deliver on this."

In fact, the COVID-19 crisis has ramped up demand in two of areas — microbiology and molecular testing — where trained personnel were already in short supply. Speaking in February shortly before the first wave of the pandemic hit the US, Austin Dickson, business development manager at Raleigh, North Carolina-based Lighthouse Lab Services, highlighted microbiology and molecular as among the hardest areas to staff.

The pandemic has only exacerbated that issue, Dickson said recently, as molecular assays have dominated SARS-CoV-2 testing thus far, and laboratories around the country have been rapidly ramping up their capabilities in this area.

"There was already a [staffing] shortage because molecular wasn't something that was prevalent in day-to-day lab testing, and [molecular testing] has increased, but the staff hasn't really caught up," he said. "Every lab is adding in PCR technology, so the demand is just at an all-time high, I would say."

Dickson said he was in some cases seeing lab techs trained in molecular make 10 percent or more over what they would have received pre-COVID-19.

"A $60,000 technologist is easily $65,000 or $70,000 at this point," he said, adding that relocation benefits are becoming more common, as well.

"You're going to have to compete [for trained personnel], but it is out there if your pay is very strong," he said.

Sonny Naqvi, CEO of St. Louis, Missouri-based AIM Laboratories, said that his firm has been running ads seeking techs with molecular experience for the last three to four months. When the pandemic started, AIM had the capacity to run about 100 to 200 molecular tests per day. It has since ramped that up to around 2,000, and it will be at around 4,000 to 5,000 in the next few weeks, Naqvi said.

"Finding the right people in the area of molecular science has been tough," he said. "We've hired about six or seven people for our molecular lab since this started back in February or March and we continue to look for two or three more. Experienced people are very, very difficult to find."

Patricia Tanabe, executive director of the American Society for Clinical Pathology board of certification, said that in the absence of enough experienced personnel, many labs have either redeployed people from other parts of the laboratory or used less experienced staff who still require some degree of training.

She noted that a colleague of hers has addressed her molecular staffing problem by using trainees with a science bachelor's degrees but without additional medical laboratory science education. These trainees can work for up to two years before they have to take the microbiology exam, following which they will receive a promotion to a tech position, Tanabe said.

Naqvi said his lab has taken a similar approach, bringing in a number of master's- and bachelor's-degreed personnel and training them.

Getting trainees without prior microbiology and molecular experience up to speed is "tough," though, Naqvi said, noting that the sample prep process was the most challenging part.

"Once you have prepped the sample it is easy, but the time it takes to prep the sample is very long, and the process is not only laborious, but you have to be very meticulous," he said. "One mistake can lead to you having to repeat the whole plate, which will cost a significant amount of money and create a significant amount of time delays."

Tanabe said that the large number of different instrument platforms currently being used for SARS-CoV-2 testing also presents a challenge, particularly for training employees without previous experience.

"It's not unheard of for a facility to have six different platforms, so not only do you have to train them, you have to train them to work on six different platforms," she said.

Dickson said he is also seeing many labs redeploy staff from other departments to microbiology and molecular testing. Typically, he said, it would take a few months for a tech trained in another area to become fully proficient in molecular, but, he noted, "it's trial by fire at this point, because they are really getting thrown in. When you have samples there, you have to process them."

Tanabe noted that even as labs struggled to fill molecular and microbiology positions, many have furloughed staff in other parts of the laboratory due to a decline in routine test volumes. In many cases, she said, these furloughed employees were at facilities that weren't doing SARS-CoV-2 testing and couldn't easily shift to ease the demand for molecular staff.

"There is this real diversity where there are large institutions that are just inundated with COVID testing and can't keep up, and then smaller places that aren't doing COVID testing and aren't doing anything else [due to the drop in routine testing]," she said. "So, they don't have the need within that facility."

Dickson noted that some labs were moving to more automated workflows to help manage the staffing crunch. In particular, the move from manual to automated RNA extraction can provide savings in terms of the personnel needed to run SARS-CoV-2 tests, he said.

Many laboratories are currently deciding whether adding staff or automated instrumentation will do more to help them build capacity, he said. "Which part of the funnel do we need to expand to increase throughput? A lot of times staff is the first thing they look to and then they realize that switching over to automated extraction will be able to increase throughput without hiring more techs."

This comes with challenges of its own, though, he noted. For instance, some extraction platforms might not have Emergency Use Authorization for use with the test kits and platforms a lab is running. There is also strong demand for the technicians and service engineers needed to set up and maintain some of these automated platforms.

"Within the past few weeks, I've had a few calls where people are asking about these liquid handling devices and whether there are service engineers or people who can set up the scripts and algorithms for how they are pipetting," Dickson said. "Demand is kind of outpacing what existed before in the industry. [Automation firms] have limited engineers that are out there."

He said that another area where he has seen an uptick in demand is for lab directors. This, Dickson said, has been driven by research labs with PCR expertise becoming CLIA facilities so they can perform SARS-CoV-2 testing.

In many cases, the heads of these labs don't have the certifications required to serve as director of a CLIA lab, he said. "They may have a PhD in molecular biology, but they might still not qualify based on the personnel requirements set by CLIA, so they need to find someone who has worked in the CLIA environment."