Chief Laboratory Officer for the North Dakota Department of Health and graduate of UND’s Medical Laboratory Science program Christie Massen, Ph.D., M.S., MLS (ASCP), spoke with North Dakota Medicine in July 2020 about COVID-19 testing, false positives, true positives, and how her profession shines in trying times.
Thanks for your time, Christie. So—I suppose your life is all COVID all the time.
Yes, the past few months have been a whirlwind: discussing with others what test results mean and what lab tests are better, and what we should do in our lab for detection and monitoring for COVID in North Dakota. We also do some testing for people from South Dakota or Minnesota or Montana who have a need.
Does being the chief laboratory officer for the state mean you’re in the lab less these days?
I’m not really performing tests anymore, but I’m physically in the lab still. I oversee the daily operations and look to help improve the technology and bring on new instrumentation and make sure we stay up-to-date. With this SARS-CoV-2 [COVID-19] pandemic, we’re bringing on a lot of new instrumentation, diversifying platforms, and exploring the performance between the different tests, or looking at molecular or serology methods and helping our team know how to interpret test results. We used to do roughly 200 tests per day, culturing everything from tuberculosis and rabies to chlamydia, gonorrhea, and food-borne pathogens. Now, with COVID, we process up to 5,000 tests per day just for coronavirus. We’ve increased our capacity considerably. Pre-COVID, we had 19 of us, but now we have more than 130 employees!
On that note, I get the sense that the role lab science plays has been underappreciated throughout this pandemic, relative to other health providers. Can you describe for me what MLS has brought to the table in terms of containment over the past few months?
It’s incredibly important that people with our background are performing these tests. We’re trained to understand how the tests work. We’re highly trained to interpret them and make sure we deliver the most accurate results possible—to make sure we have quality control in place. It’s through this profession that you get the best results you can possibly get, reviewing validation studies and bringing on methods that work appropriately in our lab with our people. Having highly trained staff is, in my opinion, the number one effort in terms of putting out good results. It takes a lab scientist to know if what’s going on with instruments and results are correct. They know to ask if there are too many positives in a run [of tests], for example.
Do you feel that those making decisions higher up the chain are hearing you—are listening to what the lab scientists are telling them?
Yes. I believe people do trust what we’re saying, and they know we have the background and knowledge. That said, in a pandemic, there are a lot of opinions and voices saying a lot of things, which might not always be accurate. I would urge people to listen to what the laboratorians are saying because they have the best information about methods and the accuracy of these tests. There’s been a lot of chatter about false positives and negatives, often by people who don’t have the background to know what that really means. Every test has a sensitivity and specificity, and will inevitably have false positive or negatives. But we work really hard to reduce the chances that this happens. I’d urge people not to be afraid to ask laboratories about the reliability of their tests. There are different methods out there being used that are less reliable, which a laboratorian can help you understand. A rapid test may have a higher risk of false negatives or positives, compared to these higher-level assays used in larger labs.
Is there anything—one piece of information—you wish was better understood by the public or was getting more attention in the news?
I’m not sure if you saw the story where we had 80-some results that we changed to “inconclusive.” A lot of people were upset about that, and it was reported that we were sending out false positives. But that wasn’t the story. We don’t know that the results were false positives, but we do know that the tests weren’t conclusive, and that the lab found these problematic results and was able to address that up front. It was through our diligence that we were able to prevent what might have been potentially 80 false positives. So, the results that did go out were more accurate. I think that fact got missed by some people. There’s no way to detect an inherent false positive result within a test. But if the issue is an outside error—say a contamination of the tests, which is what we think happened— that’s something we can detect and fix.
So for you the story was actually a positive reflection on your profession’s work.
Yes. We could have sent out a bad result. Instead we have skilled and highly trained people looking at thousands of tests every day and can help ensure the most accurate results, which we did. That makes me proud to be a laboratorian. When we find those things, I’m proud because that’s when I know my people are doing their job, getting accurate results rather than just pushing out results to get them out.
Up until recently, we’ve had relatively low numbers in North Dakota. Thoughts on why? I know we have a rural population and we’re away from the early epicenters.
I think there are a lot of factors. Our geographical location played a role. It didn’t land here first. It could’ve, but since it hit the coasts first, we had more time to prepare as a population and as a lab. We had more time to bring on capacity and equipment for more testing to keep track of what was going on locally. That helped us detect those asymptomatic individuals who don’t know they’re sick. We were able to do community testing and were able to find more positive cases among asymptomatic individuals, and then do more contact tracing of those individuals to reduce spread earlier to flatten that curve better than some places. All of that has helped us have a less severe situation—so far. That time to prepare is huge. Some other cities didn’t have that time to prepare and bring in new equipment or staff—that was the game-changer for us.
Have you had a chance to visit the new UND MLS lab and classroom in Grand Forks?
I have not, unfortunately. But I’d reached out to [department Chair] Brooke Solberg, who is a friend of mine, in the first throes of COVID. I worked with her quite a bit when I was in Grand Forks. I needed some surge capacity. The lab here is doing so much testing and has so much equipment under one roof now that we had to determine what to do in an emergency—what if the lab floods?—and how we can further expand capacity and help reopen universities and so on. Since March we’ve been working with UND to set up a surge capacity lab to get a license for them, and equipment to possibly help us with COVID testing. And in the future, if we need it UND could help us with testing for hepatitis or chlamydia, gonorrhea, and so on. The added benefit for the university there is allowing students to use this molecular equipment before they even enter the workforce. We might even have the opportunity for them to do COVID testing before they enter the workforce. I’m excited about that partnership and hope to make a trip up to see the lab.
Interview conducted and edited by Brian James Schill