ILOVENEWS

The BC Centre for Disease Control Public Health Laboratory’s
Response to COVID-19

Muhammad Morshed, MSc, PhD, SCCM, Clinical Professor, UBC
Michael Donoghue, Senior Project Manager UBC CDC
The BC Centre for Disease Control Public Health Laboratory (BCCDC PHL) serves many important functions as British Columbia’s Provincial Reference Laboratory, including receiving ~5,000 samples a day which translates into carrying out ~12,000 tests daily. Many of these tests are for rare or complex pathogens including those of public health importance. However, its pandemic response mandate is one of the most vital to get right. For COVID-19, the BCCDC PHL hit the mark.

Within ten days of China releasing the SARS-CoV-2 genome, the BCCDC PHL created a nucleic acid test and began to offer testing. It then shared the test protocols, reagents, and provided guidance to other front-line laboratories in BC and Canada.

Since January, B.C. laboratories have conducted more than 506,000 tests.

Two days after Dr. Bonnie Henry, the Provincial Health Officer for British Columbia, arrived at the BCCDC to inform the media of the province’s first confirmed case, Genome BC provided research funding to start sequencing SARS-CoV-2 from patient samples. This allowed us to determine if new cases were part of a known outbreak or the strain was derived from a newly imported case. It also helped monitor COVID-19 cases connected to a Vancouver dental conference and highlighted the potential impact of mass gatherings in spreading the virus.

To date, members of the Department of Pathology and UBC who work at the BCCDC have been successful in leading numerous research projects such as creating step-by-step self-collection kits for remote tree planters, evaluating COVID-19 serology, working on integrating provincial test result data in real-time–an unparalleled amount of work.

These successes have come from decades of experience and teamwork dealing with numerous novel pathogens and previous epidemics, including: SARS, MERS, West Nile virus, Ebola, H1N1, Hepatitis C, HIV, Syphilis, Zika, as well as seasonal influenza, food, and waterborne outbreaks. For example, the foundational work for integrating the provincial COVID-19 negative and positive test results in real time came from repurposing our PLOVER database which had been developed to integrate data on carbapenemase producing organisms (CPOs) and enteric pathogens. Solid science is always built on the shoulders of others and a solid pandemic response depends on teamwork across medical, clinical, scientific, and operational domains.

The combined efforts of BCCDC have built a publicly accessible “COVID-19 Dashboard” that tracks key metrics for the people and health professionals of British Columbia

Diseases do not respect jurisdictional boundaries and COVID-19’s rapid worldwide spread is a reminder of that. Yet British Columbia and much of Canada have mounted a robust COVID-19 response. This has only been possible through stakeholders working together to support each other and share expertise. The BCCDC Public Health Laboratory has strived to be a model of collaborative working in its response to this pathogen of public health importance. Testing for COVID-19 is a prime example of that. Rather than trying to centralize testing at one site after developing the SARS-CoV-2 real-time PCR assay, the BCCDC PHL rolled out the protocol to other hospital testing sites throughout the province and beyond, as well as sharing it with the private sector, to maximise capacity.

After that, we worked with our St Paul’s and Children and Women Hospital laboratory colleagues to evaluate all the SARS CoV-2 chemiluminescence antibody testing products. Colleagues from both Surrey Memorial Hospital and Vancouver General Hospital offered samples. This rapid collaboration placed BC in the national lead, but we then shared these results with our national partners. Recently, the Federal Immunity Task Force published a SARS CoV-2 national serology guidance document with participants from the Canadian Public Health Laboratory Network, Canadian Association of Microbiology and Infectious Diseases, Association of Medical Microbiology and Immunology; Canadian Association of Clinical Chemists (https://www.cmaj.ca/content/cmaj/192/34/E973.full.pdf).

In addition, the BCCDC PHL has played a key role in policy development. This includes several BC policy documents such as serology guidance documents, FAQ, SARS-CoV-2 testing, collaborating with PICNet on protocols and documents, as well as leading development of COVID-19 associated IPAC guidelines and policies.

Beyond traditional service, the BCCDC PHL is also evaluating more innovative approaches for COVID-19 serology testing, such as the use of Dried Blood Spots to test for SARS Cov-2 serology in hard to reach and incarcerated population, with provincial and national partners. In collaboration with Dr. David Goldfarb at BC Children’s and Women’s hospital, Dr. Hoang has validated and is currently implementing saline gargle in BC as a swab-independent collection method for COVID-19. This not only holds the promise of making COVID-19 sampling much easier for the patient (compared to a nasopharyngeal swab) but mitigates the challenge of global supply of nasopharyngeal swabs for testing.

While COVID-19 affects us all, it has also brought the medical and scientific community closer together in British Columbia. COVID-19 is a shared threat that unites our efforts to protect our community. For it is only by working together will we be able to tackle COVID-19 and pandemics to come.

Acknowledgements: . We would like to thank all our colleagues for providing their contributions. Photo credit: Michael Donoghue


Pathology Faculty at BCCDC in Action!

Dr. Krajden

Mel Krajden BSc, MD (McG.), FRCPC

Dr. Krajden is a UBC Professor in Pathology and the Medical Director, Public Health Laboratory, Provincial Health Services Laboratories.
Highlights of Dr. Krajden’s COVID-19 achievements:
  • Led the BCCDC PHL’s efforts to go from having no test for a new pathogen, to carrying out thousands a day in a matter of weeks.
  • Championed the need for the sequencing of SARS-CoV-2 patient samples, securing early research funding from Genome BC, and provided an environment for sequencing efforts to thrive at BCCDC PHL.
  • Due to his expertise, Dr. Krajden is on the leadership group of the Federal COVID-19 Immunity Task Force and the lead for the Federal COVID-19 Testing Working Group.
  • Created the extensive Hepatitis Testers Cohort which pivoted into the BC COVID-19 patient cohort to unlock epidemiological and host-pathogen relationships.
  • Recently awarded the Order of BC to acknowledge his leadership of BCCDC’s Public Health Laboratory.
Dr. Hoang

Linda Hoang MSc, MD, DTM&H, FRCPC

Linda Hoang is a Medical Microbiologist and the Associate Director at the BCCDC PHL but also the Program Head of the Bacteriology & Mycology Lab within the PHL. She is currently a Clinical Associate Professor in the Department of Pathology & Laboratory Medicine at UBC. Dr. Hoang is also the Medical Co-Chair for the Provincial Infection Control Network (PICNet), that leads in Infection Prevention and Control responses and guidance for COVID-19 in BC.
Highlights of Dr. Hoang’s COVID-19 achievements:
  • Dr. Hoang has been providing strategic leadership on how whole genome sequencing (WGS) efforts on COVID-19 can be integrated into regular routine service for the BCCDC PHL to create an organizational-wide genomics transformation. This is part of her larger vision of implementing and operationalization of WGS for public health and infection and prevention in acute care settings in BC.
  • She also has led the program to create COVID-19 self-collection kits using swabs and a saline gargle for remote tree planters.
  • Dr. Hoang leads the coordination of validation and procurement of COVID-19 collection devices (e.g nasopharyngeal swabs) to ensure sufficient supplies for BC and works closely with PHSA Supply Chain and laboratories across BC.
  • She leads in the standardization of reporting of COVID-19 results across all laboratories in BC.
  • Dr. Hoang has fostered Chris Fjell’s work in the development, implementation, and maintenance of PLOVER, a key database for public health to access COVID test results.
  • Dr. Hoang is a key leader in the UBCCDC Research Resumption Committee, ensuring that non-COVID-19 researchers can still safely carry out their work of public health importance at the UBC lab space in the BCCDC.
    • Dr. Hoang showing an assembled box for remote tree planters with all the supplies needed for a self-collection of a suspect COVID-19 sample
Dr. Sekirov

Inna Sekirov MD, PhD, FRCPC, (D)ABMM

Dr. Sekirov is a Clinical Assistant Professor, in the Department of Pathology & Laboratory Medicine at UBC, a Medical Microbiologist at the BC Centre for Disease Control and the Head of TB and Mycobacteriology Laboratory, BCCDC PHL.
Highlights of Dr. Sekirov’s COVID-19 achievements:
  • Dr. Sekirov is the principal investigator for the Prognostication of the Genome BC supported ACE2 Receptor project, examining the potential of using ACE2 as a biomarker of COVID-19 severity. She has shown a link between ACE2 expression and viral load, providing valuable insights into the COVID-19 disease. She is pursing further work to investigate correlations with COVID-19 patient outcomes and transmission potential, with hope that these findings can be translated into clinical applications for patient triage and follow up.
  • Dr. Sekirov also co-leads the implementation of SARS-CoV-2 serological testing at BCCDC and is an active member of the Canadian Public Health Laboratories Network COVID-19 Serology working group, as well as a Co-PI or co-applicant on a number of SARS-CoV-2 serology research studies seeking to investigate the dynamics and longevity of immune response to COVID-19 and make testing more available to vulnerable populations.
    • Dr. Sekirov holding the COVID-19 serology control samples to test for antibodies.
Dr. Morshed

Muhammad Morshed MSc, PhD, SCCM

Dr. Muhammad G Morshed is a Clinical Microbiologist and Program Head of Zoonotic Diseases and Emerging Pathogens as well as Parasitology at the BCCDC PHL. He is also a Clinical Professor in the Department of Pathology and Laboratory Medicine, Faculty of Medicine, UBC.
Highlights of Dr. Morshed’s COVID-19 achievements:
  • Dr. Morshed has led the BCCDC PHL investigation and evaluation of serology testing.
  • He’s the PI of both CARE (GBC) and ASSESS-DBS (MSFHR) to evaluate the sensitivity, specificity, and practicality of using point-of-care, EIA, dried blood spot, and other serological approaches to detect and quantify COVID-19 antibodies.
  • CARE (GBC) is also quantifying the immune kinetics of antibody response to evaluate the likelihood of re-infection.
  • He also part of the Canadian Public Health Laboratories Network COVID-19 Serology working group.
  • In addition, Dr. Morshed co-leads the implementation of the SARS-CoV-2 serological testing at BCCDC PHL. At present, he is also evaluating SARS CoV-2 pseudo-neutralization test.
  • He is a Co-investigator on Dr. Danuta Skowronski’s COVID-19 Immunological investigation: Quality, Quantity, and Kinetics of Antibody and Cell-mediated responses (MSFHR).
    • Dr. Morshed has played an important role not only in the scientific response to COVID-19 but also in knowledge translation such as this national CTV interview.
Dr.Jassem

Agatha Jassem, PhD, (D)ABMM, FCCM

Dr. Jassem, an Accredited Clinical Virologist, is the Head of Virology Laboratory at BCCDC PHL. During this year while the BCCDC has been responding to COVID-19 Dr. Jassem has been on maternity leave. However, anyone who knows Dr. Jassem will not be surprised that this has not stopped her from playing multiple key roles.
Highlights of Dr. Jassem’s COVID-19 achievements:
  • Dr. Jassem is leading a project aimed at understanding the interactions between coronavirus antibodies to inform sero-prevalence surveys, severity profiles, and vaccine strategies (funded by MSFHR). Population-based studies will involve the use of a comprehensive peptide array including all coronavirus epitopes and a pan-coronavirus multiplex immunoassay. The peptide technology will also be used to support the study of antibody responses in two CIHR-funded household transmission studies.
  • She is also a co-investigator for BCCDC PHL projects designed to develop high-throughput PCR strategies for SARS-CoV-2 detection, characterize SARS-CoV-2 antibody responses, and validate dried blood spots for SARS-CoV2 antibody detection
  • As a BC Lab Lead for the Canadian Sentinel Practitioner Surveillance Network, she also supports monitoring of SARS-CoV-2 prevalence and respiratory virus vaccine effectiveness.
Dr.Jassem

Natalie Prystajecky, PhD, SCCM

Dr. Natalie Prystajecky is the Program Head, Molecular and Microbial Genomics Lab and the Environmental Microbiology Lab, BCCDC PHL
Highlights of Dr. Prystajecky’s COVID-19 achievements:
  • It was Dr. Prystajecky and her team who developed BC’s COVID-19 test in just ten days once the genome was released by creating a SARS-CoV-2 real-time PCR assay that is now used throughout the province.
  • Co-leads an effort with the Genomic Science Centre to develop “homebrew” supply chain independent reagents needed for testing called EXPands (GBC).
  • She has been instrumental in BCCDC’s sequencing efforts collaborating with the BCCDC embedded Dr. Harrigan Lab and provided both content expertise and leadership to the efforts and is Co-PI on RESPOND (GBC), R2ESPOND (CIHR), and CanCOGen (Genome Canada). Dr. Prystajecky is the co-chair of the CanCOGen CPHLN committee.
  • Dr. Prystajecky has started a successful research program to detect SARS-CoV-2 in wastewater which is useful for surveillance purposes.
    • Dr. Prystajecky holds wastewater samples that her team is testing for SARS-CoV-2.
Dr.Levett

Paul Levett PhD, DSc, (D)ABMM, FCCM, FAAM

Clinical Assistant Professor, UBC, Clinical Virologist, BCCDC PHL
Highlights of Dr. Levett’s COVID-19 achievements:
  • Evaluation of a rapid antigen detection tests which can substitute for a PCR test for SARS-CoV-2 detection.
  • Member of clinical team in virology and high-volume serology.
  • He is part of the CARE (GBC) and ASSESS-DBS (MSFHR) research team due to his expertise in virology and high volume platforms.
  • Dr. Levett is also part of the Canadian Public Health Laboratories Network COVID-19 Serology and the Respiratory Virus Infections (ReVI) Working Group working groups.
  • He also plays an important role supervising the day-to-day operation of PCR testing for SARS-CoV-2 and is coordinating molecular testing of clinical samples for COVID-19 testing.
Dr.Hsiao

William Hsiao, PhD

Dr. Hsiao is BCCDC PHL Senior Scientist (Genomics & Bioinformatics) and is a Clinical Associate Professor, Pathology & Laboratory Medicine, UBC and Adjunct Professor, SFU.
Highlights of Dr. Hsiao’s COVID-19 achievements:
  • Dr. Hsiao is a PI on the CanCOGeN VirusSeq project, a national project to apply genomic sequencing to track the virus to respond to the outbreak responses. Together with HostSeq Project, the CanCOGeN Initiative received (via Genome Canada) $40 million dollars from the Ministry of Innovation, Science and Economic Development
  • He leads the COVID-19 contextual data harmonization effort in Canada and his team has developed bioinformatics tools for COVID-19 data collection, harmonization, and management.
Dr.Petric

Dr. Martin Petric, PhD, FCCM (Ret)

Dr. Petric, Professor Emeritus since 2011, had worked at the BCCDC PHL as a Clinical Virologist where he focussed on research mainly with the SARS-CoV-1 and Pandemic influenza viruses. He has returned from retirement to join the BCCDC PHL team and works on the implementation of neutralization tests involving live SARs-CoV-2.
Highlights of Dr. Petric’s COVID-19 achievements:
  • Growth of SARS-CoV-2 virus in the BSL-3 laboratory
  • Implementation of the neutralizing antibody tests for SARs-CoV-2
  • Production of control SARS-CoV RNA for nucleic acid tests and inactivated SARS-CoV for antigen assays
  • Growth of SARS-CoV-2 from patient specimens.
    • Dr. Petric carrying out tissue culture work for his SARS-CoV-2 live virus neutralizing antibody assay