How ARUP is helping Utah combat COVID-19

On the "U Rising" podcast, President Ruth V. Watkins engages in insightful conversations with students, staff, faculty, alumni and community stakeholders who are at the center of the state's flagship research university. President Watkins also connects with other leaders to give listeners a fresh take on top issues and innovations in higher education in Utah and across the country. You can subscribe to U Rising via iTunes, Spotify, Stitcher and other podcast streaming services.

Since March, ARUP and other commercial labs have conducted approximately 2 million tests for COVID-19. CEO Sherrie Perkins explains how the University of Utah-affiliated lab has stepped up, the challenges it has faced, what the work has meant for employees and its newly launched test to determine who has had the disease and who has not. Music by Taylor Hartley. Thanks to Brooke Adams and Dave White for technical assistance.

President Ruth Watkins: Welcome to the U Rising podcast, where you have the opportunity to meet people who are helping the U along its upward trajectory. Today we have a very special guest, Dr. Sherrie Perkins. Sherrie is the CEO of ARUP Laboratories. Talk about a busy and important person right now for the state of Utah and beyond. Sherrie, what a privilege to have you join us today. I'm so grateful to you for your time and your effort.

Dr. Sherrie Perkins: Thank you, Ruth, and it's really a pleasure to be able to talk to you and to talk a little bit about what we're doing at ARUP and the University of Utah about the COVID virus.

President Watkins: It's great, and maybe before we jump into COVID, you could give us a little bit of background about your history at the U and about ARUP.

Dr. Perkins: I came to the University of Utah in June of 1990. I can't believe it's been almost 30 years ago. I was hired by the Department of Pathology as a hematopathologist, which is a doctor that looks at and diagnoses diseases of the blood, bone marrow and lymph nodes. When I first came to the university, almost all my work was focused on clinical care of patients, particularly at the university hospital, teaching medical students and pathology residents and doing some basic research on the effects of aging in bone marrow that was supported by NIH grants.

At that time, NIH grants started getting a little bit tougher and so I went ahead and began to get more focused clinically, getting involved with a lot of clinical trials through the Children's Oncology Group with children that had either leukemia or lymphoma. Much of my academic work since that time has really been focused on identifying biomarkers for prognosis from patients in these large clinical trials run by the clinical oncology group.

As I went ahead and went further in my career, I became a little bit more involved in administration—something that happens to all of us as we go on in our careers. I was the acting chair of pathology for about six months while they were trying to get a new chair in. I was the head of the clinical pathology division, the head of the hematopathology section. I'm in a variety of other administrative roles. At this time, I was still doing a lot of clinical work for patients at the university hospital, but I also began to do more work for ARUP Laboratories.

ARUP Laboratories is a really interesting thing that has arisen out of partnership with the University of Utah. It's an amazing company that was formed by the academic group in the Department of Pathology at the university that supported doing complex or esoteric laboratory testing for a variety of different health systems and hospitals throughout the nation and really we actually serve patients in all 50 states in the United States.

ARUP has really grown to be, over the years, from just serving the Intermountain West to this very wide reach and it's become one of the largest reference laboratories in the United States. It's also really different because of its relationship with the University of Utah. It is a not-for-profit and it remains owned by the University of Utah, rather than being run by stockholders as many public companies are. Much of the profit that's derived from doing this testing for patients goes back to the University of Utah to support many different programs in research, in making sure that the programs at the university can be run and for scholarships. This is something that we as faculty members that run ARUP and those who work at ARUP are very proud of doing and see as one of our core missions.

President Watkins: ARUP is just a remarkable asset and stands out in so many ways. Certainly, it has benefited the University of Utah's research trajectory and also, frankly, all facets of the University of Utah. Thank you for your nearly 30-year history at ARUP. That's impressive. You've been an important part of that upward rise.

As we think about the last few months, ARUP has really been essential in expanding our capacity to test for COVID-19. I think you and I both believe that that's been important for maintaining public health in Utah. Tell us a little bit about what you've done in terms of testing thus far.

Dr. Perkins: Well, ARUP really saw the COVID virus as something that we thought was going to come to the United States really early. We saw a need for this diagnostic test and we started developing, in our own laboratory, some testing in the middle of February to be able to diagnose this virus when we heard about it coming out of China. This test was actually approved on March 10 by the FDA and we began offering it in a very limited fashion because it was very labor intense and you could only do about 500 tests a day. We then began to get involved with some commercial partners to try and find a way that we could do more of this diagnostic testing, which is molecularly-based, and to scale it up so that we could offer it to more people in Utah as well as people outside of Utah that are our clients.

So, by the time we got involved with these partners, we were able to scale up by more than fourfold and this was approved by the FDA on March 20. The problem that we had is that everybody—the COVID virus came so quickly—everybody was demanding testing and the need for and the demand for testing far outstripped our ability to do that. So, what happened was that because everyone was trying to be able to do the testing, there were a lot of problems with the supply chain, with the reagents that were needed and the machines to run the testing being diverted all over the place and you never knew from day-to-day how many tests you would be able to do. We began working with other partners and we continue to scale up so that now we can do about 6,000 of these diagnostic tests a day.

To date, if you look at ARUP in conjunction with all the other national reference labs, we've run over 2 million diagnostic tests since the beginning of March. However, every day we deal with these issues of testing supplies, shortfalls and deliveries and a very unstable supply chain making it very, very challenging.

The other thing that I think has really begun to come out, particularly in the last week, is the serologic test. This is not a test that diagnoses whether you have the disease but actually says that you have had it in the past. So, we don't use it to diagnose COVID, we just use it to say who has been ill, even if they were asymptomatic, or who has not been ill. This has been a very well-hyped, I would say, test because this has been touted as what is going to get America back to work. Unfortunately, there are a lot of things that we don't know about the testing.

We do know that we can identify antibodies in blood, and we can tell who has had the disease, but we don't know if that makes them immune. We don't know if they can get the disease again, so there's still a huge amount of work that needs to be done and ARUP is involved with a lot of different partners in academics as well as nationwide to try and identify what's going to be used.

We were able to validate a test last week and we actually have started offering it in Utah primarily to healthcare workers to find out who has been ill and who can probably return to work relatively safely. However, this test has not been approved by the FDA and there's a very limited supply chain again. We're beginning to work with another manufacturer that is going to allow us to really scale up and make this a much more automated test and appears to have a much more robust supply chain, but this is going to be a couple more weeks before we can get this up and running.

President Watkins: That just seems so both exciting and important. I wanted to ask in terms of the blood test or serologic test for immunity, typically with viruses, if you have had it, you do have immunity. How will we know that in this case and what will be required?

Dr. Perkins: Testing is being done looking at these antibody tests to see if they are identifying what are called neutralizing antibodies and neutralizing antibodies are antibodies that can bind and inactivate the virus. Being sure that we're identifying those particular antibodies is really important for saying that this may give you immunity. Unfortunately, although most viruses are ... you do have immunity from these types of blocking antibodies and there's very few cases where you do not have them and so we need to make sure that that's really the case with COVID virus.

Dr. Perkins: We have seen reports in the literature coming out of South Korea and out of some other places that people who have the disease and who had antibodies are actually coming down with a second round of the disease and that's all really concerning. The other thing is that not all antibody tests are the same. The COVID virus is actually a part of the coronaviruses, which are the same as your common cold, and so there may be some cross-reactivity, we may be identifying that I had a common cold about a year ago and it really is not the coronavirus or the COVID-19 that it's detecting. We have to be very careful in how we validate and use the information that's coming from these tests.

President Watkins: These are really great examples of why ARUP work matters so very much to public health. I think when I imagined the gradual coming back to work that I hope happens or getting on airplanes, one thing that strikes me that would be incredibly helpful is if there was some sort of very rapid screening ability that was somewhat less invasive maybe than the nasal swab approach. Do you anticipate any progress on getting a rapid screen or what that might take to develop?

Dr. Perkins: We're beginning to see these tests come onto the market and these are really called point-of-care tests. Unfortunately, I'm not sure that you're going to be able to get away from having a nasal swab injected into your nose and brushed around a little bit. That really is the best way to be able to find the virus. But we are finding that there are some tests that are coming out. Unfortunately, many of them are not quite as sensitive or specific as the tests that we are doing with PCR that take a little bit longer.

We do have a few instruments that are available through the Department of Health and at the hospital that can turn around tests in about 45 minutes to let you know if you're infected. That is really getting to the point of being able to find out in a much more rapid manner. Unfortunately, these machines only do a couple of tests at a time, so we're unable to open them to a tremendous number of people. They're going to have somewhat limited use in that respect.

President Watkins: Well, I think it's helpful to get your perspective on that and I'm glad ARUP is helping us all in this task. Sherrie, give us a sense of how many employees are at ARUP and the scope, the size of your effort.

Dr. Perkins: ARUP has about 4,300 employees. It's been very interesting during the COVID crisis because we've actually been able to have more than 900 working from home. Unfortunately, to do the laboratory testing you have to be on-site and so we do have about 2,500 employees that are coming in on various shifts to be able to go ahead and work with making sure that the testing is done both for COVID as well as all the other testing that we've received.

President Watkins: This must be an enormous burden on your team. Tell me about how this work has been impacting all of you at ARUP. I'm guessing some pretty long days.

Dr. Perkins: We have always been a 24/7 operation and we do testing seven days a week and we have shifts that run 24 hours a day. In that way, we were able to really adjust to these demands of testing. Typically, we did more than 50,000 tests a day. With the close down of much of healthcare, a lot of other testing hasn't been coming in. We’ve actually been able to redistribute some of our workforce and be able to use them to do COVID testing because the other types of testing have gone down because people are not going to the doctor, being seen for regular appointments or coming into the hospital.

We already were being very careful. In doing laboratory testing, you're dealing with blood and other body fluids, so we didn't really have to do a lot of new safety measures because we were already doing them. We did institute a lot of things like social distancing. We have been doing extensive and frequent cleanings, including doing these bombs that clean in crevices and things like that. We have increased use of masks and gloves, even when you're not in the laboratory and we've been doing very careful monitoring of our employees and our employees’ families for infection to make sure that we keep the workforce as healthy as possible.

President Watkins: It's a remarkable employee base and clearly the physical distancing part of that would be a little bit challenging, but we're glad you're implementing it. You are our heroes, just like our frontline medical care providers are. It's such critical work and I know it's promoting health and well-being in our state and in our nation. We all owe you a debt of gratitude, Sherrie, and I'm happy to be the one that gets to express that appreciation, but I know that there are many, many thousands of people behind me cheering you on every step of the way. Is there anything else you'd want the public to know about ARUP and/or about COVID-19?

Dr. Perkins: Well, I think that this is a very challenging time in both the state, the university and the nation's history. I do think we'll come out of it. It's going to change a lot of things and that's going to be, I think, very interesting as we look at working from home, different ways of doing things. But I'm really very optimistic and I'm looking forward to emerging on the other side of this crisis and getting back to normal.

President Watkins: I think we can all join you in that optimism because of the work that you do every day. Thank you so much. Dr. Sherrie Perkins, CEO of ARUP Labs.

Dr. Perkins: Thank you so much.

President Watkins: Thank you, listeners. I hope you'll tune in to the next U Rising podcast.