Twitter Chat Wrap-Up: Ramping Up Your Lab’s COVID-19 Testing Capabilities – Best Practices & Lessons Learned

Greeting from Wash, DC. As CLIA Lab Dir at GW Med Center, but not a molecular pathologist, I’m going to represent the general lab director’s (and CAP Governor) perspective on gearing up for #Covid19 testing. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

And I am a clinical microbiologist at the Mayo Clinic, who serves as the Chair of the CAP Microbiology Committee. I will do my best to share my own experiences and what I know from our committee's work. #capchat

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Kamran Mirza #hemepath at @loyolapathology joining from Chicagoland- no COI #capchat https://t.co/5AGmFT8iD8

— Kamran Mirza MD PhD (@KMirza) April 1, 2020

Nicole Riddle, Tampa, FL. Been testing in-house for several weeks. #capchat

— Nicole D. Riddle, MD (@NRiddleMD) April 1, 2020

Hi everyone, Samreen Fathima, PGY-1 AP/CP at Baylor University Medical Center, Dallas. Here to learn more about the topic. No COI #capchat #pathologists

— Samreen Fathima (@DrSamreenfatima) April 1, 2020

Shu Garcia here, MS2 and a Medical Laboratory Scientist in the Philippines 🇵🇭🇵🇭! So excited for this #capchat and acquire knowledge from the frontliners in #pathology!

— Shu, RMT (@anueru432) April 1, 2020

Following #capchat for yet another an important discussion among Lab Medicine physicians in US, on the evolving landscape of diagnostic testing for COVID-19 in US hospital systems. Should be of interest to not only physicians and staff but also biotech, VC, and healthcare media

— Simon Boyi Chen (@simonbchen) April 1, 2020

@AadilAhmedMD Hemepath fellow @Yale_LabMed no COI #capchat

— Aadil Ahmed (@AadilAhmedMD) April 1, 2020

Nadia Naumova, Charleston WV, testing in house for almost two weeks now. Almost catching up. #capchat

— Nadia Naumova, MD (@NadiaNnaumova) April 1, 2020

Steve Gauerke in San Diego. It’s difficult to assess different platforms/tests based on their cost, TAT, sensitivity (use as a screen or confirmation), and throughput volume. We should have Biofire about to come on line, are looking at Panther, and also Abbott. #CAPchat

— Gershwin (@Gershwi21663230) April 1, 2020

Following #CAPchat and #Pathchat now for insights on COVID-19 testing! Very relevant to what my own country (the Philippines) is struggling with now.

— celestrinmd (@celestrinmd) April 1, 2020

Nguyen PediPath Montreal Qc Canada. No Coi #capchat here to learn

— Van-Hung Nguyen, MD (@vhnguyenmd) April 1, 2020

Q1: #CAPchat I'm sure a lot has been going on in everyone's labs. What challenges in #Covid19 testing has your lab overcome, and what challenges remain? @ParasiteGal @DonKarcherMD

— CAPathologists (@Pathologists) April 1, 2020

A1: #capchat Boy, where to start? We have been seeing shortages across the spectrum of testing, from swabs, transport media, extraction reagents and testing kits. We have largely overcome this by 1. making our own transport media (saline) and 2. using more than 1 COVID-19 RT-PCR

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A1: We didn’t have platform for CDC assay in our clin lab. We pulled in equipment and reagents from our research labs to set up LDT while waiting for Cepheid and other commercial assays. We’re now running the first 2; still waiting for another commercial test. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

Started with LDT, then bought other equipment to do more LDT instead of fighting for Cepheid et al. Local hospital excited to have Roche, but then couldn't get kits 😕 #CAPchat https://t.co/HwuR3XkeGC

— Nicole D. Riddle, MD (@NRiddleMD) April 1, 2020

#capchat what have others been doing to overcome challenges?

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A1 –@UWVirology lab has ramped up to ~3k tests per day, 12h TAT from inlab. Requires 24/7 staff. All divisions have trnasferred multiple MLS and CLT to perform and accession #SARSCOV2 #COVID19 samples. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

We got a lot of collection kits out of the state stalk pile. It is so weird to be quickly validating or accepting collection devices that we always told providers not to use.

— Cynthia Flynn (@CynthiaFlynn15) April 1, 2020

A1: We’ve heard about the transport media shortage. Clever to validate saline! We’re so far okay with transport media. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

Some of the faster tests that are FDA approved are only available in some areas is challenging. #capchat Q1 https://t.co/fxid8wKa02

— Dr. Bui Pathologist (@DrBuiPathology) April 1, 2020

A1: I’ve heard of many labs quickly validating PBS and 0.9% NS. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

We've in house testing (RT-PCR) for over two weeks now with ~4000 tests performed. Adding rapid testing to about 400 per day with 6 hour turn-around time. #capchat

— Aadil Ahmed (@AadilAhmedMD) April 1, 2020

A1 – Don't forget the critical role of #LDT #COVID19 #SARSCOV2 testing – many commercial tests not available until recently. #CAPCHAT #PATHCHAT https://t.co/HA9S0IpNTK

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

Yes, we have several LDTs, bringing up more 👍 #CAPchat #COVID19 https://t.co/LpZBkXrnMs

— Nicole D. Riddle, MD (@NRiddleMD) April 1, 2020

A1: Great strategy! We’re using Cepheid for rapid (1-hour) TAT, LDT for same day TAT. We’re gearing up both for growing volume. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

A1 – Do you have multiple #LDT for #SARSCOV2 #COVID19 to accommodate supply chain limitations? #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1. Yes, we created our own LDT. Then shortly afterward, we added testing on the Roche 6800 and Abbott m2000 platforms – now at 7000 tests/day capacity! But Mayo Clinic Labs serves all of the U.S., so we need as much capacity as possible to help out others.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

#capchat Serological testing: Is there value in offering an EARLY (IgM/A) test for CoV-2 or is IgG sufficient alone?

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

#capchat It would be best to have both IgM and IgG, but kits are in short supply. Also, keep in mind that some kits (IgM and IgA particularly) have shown a lot of cross-reactivity with normal circulating coronaviruses (i.e. cause of the common cold). Verification is essential.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Some of the Elisa assays are including IGA for early infection. Which is interesting given the route of infection .

— Cynthia Flynn (@CynthiaFlynn15) April 1, 2020

I guess that a better option is antigenic test, since the idea is identify who have the virus present and do not depend of the immunological state or response of each patient. In that way we can take decisions quickly for the patient and their own environment surround it.

— NIRSEN (@NirsenGarcia) April 1, 2020

Heard that it comes positive 7 days after onset of symptoms. Then it will only be good for asymptomatic carriers. By the time it is positive most people will be non-infective?

— Abhirup Sarkar (@AbhirupMD) April 1, 2020

How reliable the IgM IgG serology testing kits. #CAPchat

— tejas patel (@tejaspatel_dr) April 1, 2020

A1. #capchat Some are quite good; others not so much. In-house verification with real patient studies are key if possible.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A2. We are waiting for the large vendors to offer this testing. https://t.co/S56z6QI34l… #capchat

— Deepak Mohan, M.D. (@dmohanmd) April 1, 2020

I do think this could be great to document recovery if the HCW force is continually stretched.

— Dustin Shackleton (@ShackletonMD) April 1, 2020

This question I would also like to ask, as the difficulty in our country is that we don't have a lot of molecular labs yet in place, so the process is taking longer than we want it to. https://t.co/1snFkWNmTG

— celestrinmd (@celestrinmd) April 1, 2020

Read the guidance! pic.twitter.com/yWlcnxWTOF

— Sara (@sesiegler) April 1, 2020

A1. There is a lot of interest in using serologic testing to look for evidence of immunity: possibly to screen people to go back to work, and maybe to identify IgG donors. #capchat #pathologists #COVID19

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A1. To add, has there been enough evidence of recovered patients' donated plasma for treatment, to start considering bloodbank guidelines for IgG donors? #pathchat #capchat

— Shu, RMT (@anueru432) April 1, 2020

Getting requests for convalescence plasma but I’m not aware of available quantitative Ig tests as Ltd data/recommendations are for “high timer” donors

— Mark Pool, M.D. (@dailysignout) April 1, 2020

#CAPchat Which vendors are developing and/or currently offering high-throughput, automated tests for CoV-2 serology? I've asked DiaSorin and Bio-Rad but no real progress. Need options.

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

I believe Euroimmun is.

— Eric T Weimer, PhD (@ericweimer) April 1, 2020

They have ELISA. I’d be surprised if they are making reagent for automated platforms.

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

If the serologic #SARSCOV2 #COVID19 assays are accurate, it will help us determine the true incedence of infection. Right now we only know a limited amout of infection rate in community. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

This is important—serologic testing isn’t what we are using for diagnosis. #COVID19 #capchat https://t.co/fKZT2wZwBB

— mkintx (@mkintx1) April 1, 2020

Serology is the new #coronavirus testing hot topic.#capchat https://t.co/q9mkZ4Wgrx

— Timothy Craig Allen (@TimAllenMDJD) April 1, 2020

A1: Our ID folks not interested in serologic tests now. Maybe later for population tracking, definitely for immunity testing during next phase of pandemic. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

The most sufficient, diagnostic and reliable testing for #COVID19 is the demonstration of Viral RNA by RT-PCR procedure. IgM and IgG serology resting kits are not to be relied upon. #CAPchat @YmlsfNigeria @AMLSNNational @AMLSNLagos

— Peter Obami, MS, BMLS (@PeterObami) April 1, 2020

A1. #capchat. To overcome the challenge of short of swabs, USF using 3D printing instead, pretty cool, right? @USFResearch #covid19. https://t.co/iHyyvAjWoR

— Dr. Bui Pathologist (@DrBuiPathology) April 1, 2020

A1. #capchat Wow, very cool! I see how you can make the plastic shaft, but how do you make the flocked or wrapped swab itself?

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A1 – are you using media for transport? #SARSCOV2 #COVID19 #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1. #capchat We prefer viral transport media, but performed in-house validation of 0.9% NS and PBS; both show excellent 7-day viral RNA stability.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Any feedback from #FDA about that type of in-house made collection device? #CAPCHAT #SARSCOV2 #COVID19

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

And where are they using the swabs? In clinic? I hadn't heard about this. Where are they testing them? Is that validated? That's really cool.

— Nicole D. Riddle, MD (@NRiddleMD) April 1, 2020

Ok that is amazingly innovative. Swabs are a major issue in our area. Did your institution already own a 3D printer? 🙏 thx

— Dustin Shackleton (@ShackletonMD) April 1, 2020

We’re evaluating the Abbott POC test. Negative result in 13 minutes hope to better triage negative patients to allow routine “elective” surgery-like oncology surgeries #CAPchat

— Mark Pool, M.D. (@dailysignout) April 1, 2020

A1. #capchat That's great Dr. Pool. Most labs in the country are not able to get reagents, even if they already have the instruments in-house. Abbott is prioritizing kit delivery to areas of the U.S. that are hardest hit to date.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Yes. I’ve understand they can push the devices out but are parsing the reagents out to selected sites.

— Mark Pool, M.D. (@dailysignout) April 1, 2020

Is that symptomatic patients or all patients?

— Gershwin (@Gershwi21663230) April 1, 2020

“All” patients in both in and outpatient settings. We’re only getting a limited number of tests to start with but will be used primarily to sort sick patients and confirm negative for potential surgical patients.

— Mark Pool, M.D. (@dailysignout) April 1, 2020

That would be great, really need to get care to our head and neck/airway patients

— Inna Husain (@Drinnahusain) April 1, 2020

Will we be able to trust a negative on these rushed to market EUA tests?Taking pts off precautions/home isolation when there is limited data on sensitivity?#CAPChat

— Frank Ingram, MD (@Chucktowndoc) April 1, 2020

A1. Good question Dr. Ingram – we don't really know yet, given that there are no published data (or even package insert data) for the EUA tests. Clinical sensitivity is the biggest question. Analytical sensitivity seems quite good – IF the virus is present in the sample.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Most #SARSCOV2 #COVID19 #LDT with published analytical sensitivity have limit of detection orders of magnitude below viral load of acute symptomatic infection. Pre analytical variables may lead to false negative results. Sample collection adequacy most important. #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1. #capchat Agree Dr. Konnick. Some reports out of China indicate that clinical sensitivity is 60->90%, but the lower sensitivities are mostly due to poor specimen collection.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Patients repetitively tested on same high sensitivity platform vary markedly over time including negative, so it is not just an analytic issue.

— Robert Homer (@rjhomer57) April 1, 2020

Please address the advantage of the Abbott test. I thought it is practical to have this quick and easy to use test especially for screening of large number of people, right? #capchat #covid19 https://t.co/mOFQnreiiZ

— Dr. Bui Pathologist (@DrBuiPathology) April 1, 2020

A1. #capchat Abbott has 2 tests – a high volume test on their m2000 platform, and a ~15 min POC test. The latter has VERY limited availability, unfortunately. Most in the U.S. will not be able to get test kits.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

And 1-sample per time point. Good for priority samples but not for large scale testing. This is lost on gov't leaders.

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

ID Now simply can't screen large numbers of people. Best to use for priority patients that need rapid TAT. It won't be okay for large-scale testing.

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

It seems fast but each instrument can only do ~4 tests per hour and requires a dedicated tech. A tech may be able to run 2 instruments. The Rush idea of screening preop patients is interesting.

— Gershwin (@Gershwi21663230) April 1, 2020

#capchat the abbot test; 60% sensitivity #flipAcoin what is its specificity???

— David N. Alter MD DABCC🧬 (@ClinChemMD) April 1, 2020

Preanalytical variables still predominate in my opinion. Multiple samples would be a solution, but cannot be supported yet due to supply issues. Maybe best practices for next spring? #CAPCHAT #PATHCHAT #SARSCOV2 #COVID19

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1. Good evening Dr. Karcher and Dr. Pritt. What are your thoughts in the proper manner of specimen collection? Just saw from NEJM that swabbing the floor of the NP is more effective. #capchat https://t.co/jL5xHqOZI0

— Shu, RMT (@anueru432) April 1, 2020

A1. #capchat Limited PPE is definitively a problem. NP swabs potentially generate aeorsols. However, nasal swabs, oropharyngeal swabs, and saliva are viable (but slightly less sensitive) alternatives, and can be more easily collected – even by patients! This is FDA-allowed.

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A1. #SARSCOV2 #COVID19 self-collected samples are very important to decrease exposure to providers. What are data on accuracy vs provider collected? #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

I have a very hard time imagining a patient doing an NP self-swab well. #capchat

— mkintx (@mkintx1) April 1, 2020

A1. #capchat The FDA has a limited amount of data and are now saying that self-collected swabs are OK. I'm sure we will see more data soon!

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Especially at urgent cares where they're already short of staff, I personally know one where patients are asked to self-swab #capchat

— Aadil Ahmed (@AadilAhmedMD) April 1, 2020

United put out a press release claiming self collection had 90% sensitivity compared to standard testing. This is what FDA relied on. I suspect they have the data. I guess we are expected to practice medicine by press release in these unprecedented times. https://t.co/4RhWLxTMTE

— Benjamin Mazer (@BenMazer) April 1, 2020

waiting for #SARSCOV2 #COVID19 self collect data to be published. Note that this is self collect under observation, not self collect at home. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1: We’re not looking at self-collection yet, but may be important to protect care team members. Must be properly validated first! #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

#capchat here in india our testing rate is around 5/10,00,000 and that’s why our positive rate is also very low. Will it advisable to test all quarantine people, at present most of them are not tested

— tejas patel (@tejaspatel_dr) April 1, 2020

We have heard reports of providers being vomited on by children while a NP specimen for #SARSCOV2 #COVID19 testing is being obtained. Not worth the exposure risk to providers. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

This is as concrete a challenge as it is! Though most COVID19 patients are adults, there is also a subtle rise on pediatric age group. Given the recommendation of the swab being inside for 15 seconds, I imagine an OP swab, saliva spx would be easier #capchat #pathchat

— Shu, RMT (@anueru432) April 1, 2020

Kids love sticking things in their noses (ask a #pediatrician). I suspect kiddo mid-turbinate self collect for #SARSCOV2 #COVID19 sample would be much better than provider collected…. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A1: Yes! We’re shooting to have at least 3 platforms running to protect against kit and/or reagent shortages for any of our platforms. Insurance that we stay in business! #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

I’m the lab medical director for a community hospital in Northern CA and testing access has been very limited. We’ve been trying to get test kits for Cepheid and BD Max, but no luck. TAT from public health and comm labs now 3 days; was 5-10 days last week. What else can we do?

— Rebecca Johnson (@rjohnsonMN) April 1, 2020

A1. That's too bad Dr. Johnson. Test shortages are one of the biggest challenges facing our clinical labs in the U.S. #capchat #pathologists #COVID19

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

I’m the lab medical director for a community hospital in Northern CA and testing access has been very limited. We’ve been trying to get test kits for Cepheid and BD Max, but no luck. TAT from public health and comm labs now 3 days; was 5-10 days last week. What else can we do?

— Rebecca Johnson (@rjohnsonMN) April 1, 2020

This is unfortunately a common story 😔 #CAPchat #COVID19 https://t.co/DcCy1qGShY

— Nicole D. Riddle, MD (@NRiddleMD) April 1, 2020

Unfortunate that companies producing #SARSCOV2 #COVID19 assays cannot supply reagents quickly enough. #Patholgoists need to be able to develop #LDT under #CLIA to care for #patients. #CAPCHAT #PATHCHAT https://t.co/H1VPS1tsa9

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A4: we have Luminex assay and just got validated for Cepheid. The challenge is TATs from community hospital going to the bigger hospital; also reports of false negatives and positives causing confusion amongst clinicians

— VAISHALI PANSARE (@VaishaliPansare) April 1, 2020

We have Cepheid, but no kits until May at the earliest was the last we heard. No Luminex platform. We have a BioFire, but need to wait until mid April before finding out whether we will get any kits. #capchat

— Rebecca Johnson (@rjohnsonMN) April 1, 2020

A1: Cepheid is very limited in ability to deliver. They’re prioritizing now; hopefully more available soon! #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

We currently have Cepheid/Biofire/Qiagen platforms but no word on if/when we’ll ever get test kits. When administrators and clinicians ask, “Why can’t we just buy a PCR machine?” one remembers the limited understanding of what we do among those outside the lab. #CAPChat

— Frank Ingram, MD (@Chucktowndoc) April 1, 2020

Great opportunity to educate our colleagues! #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

We have had grad students come to us asking to help perform #SARSCOV2 #COVID19 tests, but they don't meet credentialing criteria! So we have had them help with accessioning cases! #AllHandsOnDeck #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

Do the pathologist have the opportunity to sign out #covid19 reports remotely? Are the positive results considered critical value? #capchat https://t.co/6JLlzQY3OT

— Dr. Bui Pathologist (@DrBuiPathology) April 1, 2020

#Pathologists do review borderline #SARSCOV2 #COVID19 cases and problematic samples – having medical and scientific expertise is the key to providing accurate and timely results. #Pathology and Laboratory medicine are the practice of medicine! #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

Great point Dr. Konnick. It is also important to have the pathologist on the institutional response team to provide guidance regarding testing and how the lab can meet patient needs. #capchat #pathologists #COVID19 @andytof

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Most of these assays do not require direct #pathologists signout, but under enforcement discresion by #CMS, this is currently allowed, correct? #SARSCOV2 #COVID19 #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

It’s still under the hospital CLIA numbers and the medical directors name will go on the report. Eventually, we have to pass CAP or JHCO inspection.

— Cynthia Flynn (@CynthiaFlynn15) April 1, 2020

A2: We diverted techs and space to #Covid19 test development. At our current #Covid19 volume, still no impact on usual lab workflow, but we’re bracing for possible workflow disruption with major increase in #Covid19 demand. #capchat #Covid19

— Donald Karcher, MD, FCAP (@DonKarcherMD) April 1, 2020

A2 – Huge drop-off in AP and molecular oncology testing as ORs closed to anticipate #SARSCOV2 #COVID19 patient wave. We have transferred staff, faculty, residents, and fellows to SARS testing. #CAPCHAT #PATHCHAT

— Eric Konnick, MD (@Molecular_MD) April 1, 2020

A2. To answer succinctly: completely! We now have 3 shifts (used to just be 2) and we have divided our techs into 2 groups that don't have contact with one another (back-up in case someone gets sick). So far we have been able to maintain other testing. #capchat #pathologists

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

A2: Surgery schedule reduced and thus blood bank and AP staff with decreased workload…retasked to help with accessioning/send out/resulting of #COVID19 tests #CAPchat

— Frank Ingram, MD (@Chucktowndoc) April 1, 2020

#capchat We are all doing are best. Stay strong. "Do not go gently into that good night."

— David Grenache, PhD (@ClinChemDoc) April 1, 2020

A2. We've also seen a drop-off in non-COVID testing. We are still in the early days of this pandemic in the U.S. Many changes still yet to come. Stay strong! #capchat #pathologists #COVID19

— Bobbi Pritt, MD (@ParasiteGal) April 1, 2020

Thank you, Drs.!! We value your expertise and perspective. Good luck, everyone! Goodnight! #CAPchat

— Frank Ingram, MD (@Chucktowndoc) April 1, 2020

Our deepest thanks Doctors! @ParasiteGal @DonKarcherMD @Molecular_MD !! Time is so short to address everything 😉 This has been a much informative and helpful #pathchat! #capchat

— Shu, RMT (@anueru432) April 1, 2020