Cooperation under pressure: Lessons from the COVID-19 swab crisis

Date:
August 18, 2021
Source:
American Society for Microbiology
Summary:
A major crisis that accompanied the rise of the pandemic was
lack of availability of the nasopharyngeal swab -- necessary
for testing for COVID-19, which in turn, was necessary to get a
grip on the pandemic. An account of how one group addressed that
crisis is published this week Journal of Clinical Microbiology,
a journal of the American Society for Microbiology.



FULL STORY ==========================================================================
A major crisis that accompanied the rise of the pandemic was lack of availability of the nasopharyngeal swab -- necessary for testing for
COVID-19, which in turn, was necessary to get a grip on the pandemic. An account of how one group addressed that crisis is published this week
Journal of Clinical Microbiology, a journal of the American Society
for Microbiology.


==========================================================================
"We met the challenge by creating all-new swabs, which were ready and clinically tested in just three weeks," said Ramy Arnaout, M.D., D.Phil., Associate Professor of Pathology, Beth Israel Deaconess Medical Center
and Harvard Medical School, and Associate Director of the Clinical
Microbiology Laboratories, Beth Israel Deaconess Medical Center (BIDMC).

"Handling crises successfully requires a different set of skills than the everyday," said Dr. Arnaout. "Competition and secrecy are out. Cooperation
and openness are in. Resolving the swab crisis was a case study in these
and other valuable lessons." As the first wave of COVID-19 broke out
across the United States, BIDMC, which had the largest in-house COVID-19 testing center in Boston, found themselves with only a week's supply of
swabs. "More manufacturing was the only lasting solution," Dr. Arnaout
said. He and his colleagues began reverse engineering swabs, to determine
if they could make them from scratch.

Swabs must be engineered to be neither too stiff, nor too flexible,
and must be individually packaged and sterile. BIDMC needed around ten
thousand a week; the country needed roughly ten million.

The first week, group members floated, shot down, resurrected, and
repurposed various ideas, said Dr. Arnaout. Ultimately, the team saw two options: to find a scalable means to assemble swabs, or else to "find
a way to make a stripped- down swab in a single go, without the need
for assembly." 3D printing had "advantages in speed of development and
in the variety of structures it can make." Dr. Arnaout had previously demonstrated that open and collaborative crowdsourcing is a viable route
to solving complex computational problems, specifically his work in computational immunology. He put this lesson to work in the COVID crisis.



==========================================================================
"We navigated our... networks, letting manufacturers know about the
swab crisis and what we needed from them to solve it," said Arnaout. "We
set up a free publicly viewable knowledge base online in the form of a
GitHub repository -- a type of website usually used by software engineers
to collaborate on coding projects -- to share everything we knew with
everyone who might want to know it. This was critical for lowering the activation energy for anyone who wanted to join the effort... By the end
of the first week, prototypes were rolling in." Over the course of the
second week, the team tested more than 150 prototypes.

"We were giving manufacturers feedback and suggestions one day and
receiving new prototypes the next," Dr. Arnaout said. "We put our
protocols and results online." The team spoke often with BIDMC's
Institutional Review Board, "whose help and quick feedback were
indispensable for cutting through red tape," Dr. Arnaout said. "We put our IRB-approved protocol online as well." BIDMC's technology ventures office assured the team that the evaluation and feedback they were providing to manufacturers would not constitute intellectual property, thereby avoiding
any haggling over ownership, which could have wasted precious time."
By the fourth week, the team had validated four prototypes for clinical
use. By summer's end, "millions of the swabs our coalition helped design,
vet, and mass-produce had been sold and used for COVID-19 testing"
across the United States and in Europe, Dr. Arnaout wrote.

That experience suggested five lessons:
1. Define the mission -- "a simple, clear, and concrete unifying
goal for
the entire team," said Dr. Arnaout.

2. Establish norms for behavior. At BIDMC, that took place "mostly via
conversations, repetition of the main message and personal example,"
said Dr. Arnaout. "Conversations often began or ended with an
explicit acknowledgment of the temptation to go it alone... and
a reminder that we were not going to give in to such temptation."
3. Leverage expertise. "At BIDMC, the clinical trials office handled
paperwork that the investigators would have handled themselves
under normal circumstances."
4. Practice open and clear communication, "by eliminating the
friction of
gatekeeping access to information," said Dr. Arnaout.

5. Stay positive.

"Perhaps we all can take the opportunity afforded by this
trying time to improve how we meet our everyday challenges," said
Dr. Arnaout. "By doing so, we might find ourselves further along, more
capable, and better prepared for when the next crisis inevitably hits." ========================================================================== Story Source: Materials provided by
American_Society_for_Microbiology. Note: Content may be edited for style
and length.


========================================================================== Journal Reference:
1. Ramy Arnaout. Cooperation Under Pressure: Lessons from the
COVID-19 Swab
Crisis. Journal of Clinical Microbiology, 2021; DOI:
10.1128/JCM.01239-21 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210818153745.htm

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