It was the first Monday morning of March when residents of tiny Hanover, New Hampshire, learned that an employee at nearby Dartmouth-Hitchcock Medical Center had become the state’s first confirmed case of COVID-19, the respiratory illness caused by the novel coronavirus. After recently returning from a trip to Italy, the man had been tested February 28 and told to stay home pending results.
But he hadn’t, and by Wednesday, his secret was out: He’d left his home the same day he was tested to attend an evening social event, where he infected another male medical center employee. In a town of 11,000, gossip travels fast—by late afternoon Main Street chatter centered on patient zero’s identity and what was going on at Hitchcock, as it’s known among locals.
Just a few miles out of town, Dartmouth-Hitchcock was already conducting drive-up COVID-19 testing at its sprawling, tree-lined campus. Patients could drive up to the emergency room entrance, pull into a private area and roll down their windows for a quick swab by teams in full protective gear.
“Drive-up testing isn’t like driving up to McDonald’s,” says Dr. Edward J. Merrens, Dartmouth-Hitchcock Health’s chief clinical officer. “This was arranged with the state and our team provided it. The patients were coordinated; we knew they were coming and we provided that kind of testing in a way that was good for the patients.” With an eye on managing resources, Merrens supported the development of a new test that could be processed quickly, allowing the hospital “to better use the rooms and the staff and support services that we have for patients who might have this disease.”
On the other side of campus, Greg Tsongalis and his team were putting in marathon days in the state-of-the-art Laboratory for Clinical Genomics and Advanced Technologies as they raced to develop the medical center’s own test for COVID-19. Tsongalis, the lab’s director, first began tracking developments of COVID-19 in China in mid-January and discussed testing options with his team soon after.
While it’s not unusual for Dartmouth-Hitchcock to develop diagnostic tests, the one for COVID-19 was different. “This is a national health crisis beyond anything I have ever experienced,” Tsongalis says. “There is always a sense of urgency in these situations, but we continue with our operational plan, scale up when needed, and be sure our staff are all OK.”
Beginning in mid-February, his team arrived at the lab at their usual 6:30 a.m. start time, but found themselves staying 14 or 15 hours each day, well beyond their typical 10-hour schedule. The days stretched into weeks. Nevertheless, the mood remained “very positive and upbeat,” Tsongalis says.
Unlike the old method of growing cultures, which could take days to weeks and required a living sample, the test Tsongalis wanted to develop would yield results in about four hours. It would be for use within the Dartmouth-Hitchcock system, and to augment the state’s testing abilities, which Merrens describes as “robust.” And it had to meet newly established protocols from the Food and Drug Administration and the Centers for Disease Control and Prevention.
On March 18, just as New Hampshire recorded 13 new cases of COVID-19, bringing the state’s total to 39, Tsongalis and his team made their test available to hospitalized patients and health care workers, including first responders who had direct contact with patients. On March 23, they publicly announced their successful test launch. By then, more than 100 people in New Hampshire and over 10,000 people across the United States had tested positive for the virus. More test kits were urgently needed.
“It’s critical to managing who has the virus and even more importantly, who’s negative for the test so they can get back to their daily routine,” Tsongalis says in a video released along with a statement from Dartmouth-Hitchcock. The lab is currently able to process about 100 tests per day, but Tsongalis says that by next week that number will be up to 1,000, with results available to patients within 24 hours.
By the time the video news release was made, Tsongalis was looking hopeful but tired. To develop the test as quickly as possible, he and his team gave up family time they’ll never get back. Tsongalis still makes a point of eating dinner at home, he says, “but it just gets to be a bit later each night.”
Jaimie Seaton is a freelance writer based in New Hampshire. Send comments to firstname.lastname@example.org.