IMPACT of SARS-CoV-2 INFECTION on laboratory workflow: Experience of INT-IRCCS "fondazione g. Pascale" in NAPLES

ABSTRACT

Focusing attention on cancer patients' frailty, Cancer Institute-IRCCS "Fondazione Pascale" in Naples has planned a tightened program of health surveillance for patients (PTs) and healthcare providers (HPs), in order to early detect and promptly quarantine subjects with SARSCoV-2 infection. This program requires a multidisciplinary asset, within which Laboratory plays a crucial role. In our experience, the attention has focused on application of biosafety conditions, as stated by World Health Organization's guidance. A validated internal protocol was derived from it. Laboratory diagnostic workflow provided 3 steps: 1) rapid immunochromatographic assays (ICAs) to detect SARS-CoV-2 IgM and IgG from plasma samples of PTs and HPs;2) automated qualitative electrochemiluminescence immunoassays (ECLIAs) to detect SARS-CoV-2 antibodies from serum samples of HPs;3) Real-time PCR detection of SARS-CoV-2 RNA from nasopharyngeal swabs (NS) of PTs and HPs. Health surveillance program planned an initial evaluation of PTs and HPs with rapid ICAs (automated tests being not available yet) and a further screening with molecular tests on NS sent to external COVID-19 reference Laboratories. Subsequently, our Laboratory was included in CORONET network, allowing us to perform molecular tests for SARSCoV-2. At the same time, availability of automated ECLIAs allowed us to screen HPs periodically, continuing to perform ICAs to all PTs afferent to hospital triage. At the beginning of the surveillance, rapid ICAs allowed to screen 1920 PTs (89 of which resulted positive, 4.63%) and 1050 HPs (48 positive, 4.57%). Subsequently, HPs' screening with ECLIAs revealed 25 positive subjects out of 1018 tested (2.46%). Early detection and quarantine of positive cases allowed to find very low percentages of positive SARS-CoV-2 subjects to molecular tests from NS 1 positive out 2215 NS from HPs (0.05%) and 1 positive out of 742 NS from PTs (0.13%). All Laboratory staff efforts have been directed to guarantee an adequate turnaround time. The element "time" has been crucial to subject promptly to quarantine personnel identified as positive and to isolate patients affected, thus allowing health surveillance program to ensure an adequate protection for cancer patients afferent to our Institute.