When COVID-19 was beginning to sweep through New York City in late March and early April, the Mayo Clinic laboratories were already receiving about 5,000 to 6,000 samples for COVID-19 testing per day.

At the time, the lab was able to process 2,600 samples per day.

Dr. Joseph Yao, infectious disease specialist at Mayo Clinic, was coordinating efforts to build testing capacity at the lab.

Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

It was then Yao realized his task would be bigger than he initially thought.

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“I said we had better be prepared for the worst,” Yao said.

Currently, the lab on Superior Drive is able to process 20,000 samples in a single day.

However, the lab has also received up to 50,000 samples to test for COVID-19 in a single day.

“We’re still 15, 20 thousand behind,” Yao said. “We’re always behind by about 24 hours.”

A team of technicians verify COVID-19 samples before passing it on for testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
A team of technicians verify COVID-19 samples before passing it on for testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

Building capacity to process and determine results on about 20,000 COVID tests per day required a massive undertaking of planning, hiring, construction, acquisition of equipment and a lot of imagination and adaptation.

Along the way, the lab has experienced shortages of essential materials such as dry ice.

The company that manufactures the machines for one of the three fully automated systems used to test the samples cut their supply of testing kits to the lab by nearly 50 percent due a shortage of those kits amid worldwide demand.

Walls in the facility have been cleared to make room for more staff and room to receive and process test samples.

Anyone who worked in the lab a year ago would hardly recognize it now, said operations manager Angela Reese-Davis. And the progress continues. During a tour Tuesday, she pointed at a wall jutting into the floor space that’s wrapped in plastic. It's slated to be removed.

“We’re getting really scrunched in here for space,” she said.

Limited supplies

Mayo was in a good position to take up the task of processing the tests. The lab had two automated systems built by Roche that the FDA specifically authorized in March for emergency use to test for the virus. By June, Mayo had enough machines to process about 8,000 tests per day on the Roche automated machines alone.

However, demand for the kits needed to process the tests rose around the world. Roche, in order to meet demand, cut the Mayo lab supply to about 4,500 kits per day, effectively cutting their use of the system in half, Yao said.

David Meyer with global logistics transfers a new shipment of samples onto a conveyer belt to begin their processing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester.  (Ken Klotzbach / kklotzbach@postbulletin.com)
David Meyer with global logistics transfers a new shipment of samples onto a conveyer belt to begin their processing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

“They just cannot make enough of them, and the manufacturers were caught off guard,” Yao said. “The whole supply chain is under siege.”

Yao added it takes about a year to establish factories to build the kits and make reagents — chemicals and materials that trigger the reactions needed to perform the test.

A logistical puzzle

That bottleneck was just one of the puzzles Mike Baisch had to deal with. Baisch, as system engineer of the project, continues to put together a puzzle that has moving pieces and solve problems that have variables that change daily.

One solution was to add systems that are less automated to the lab’s testing arsenal. Those systems take longer to process tests and require people to physically move samples and material. It sounds inefficient, but it has helped the lab continue to increase testing volume despite the shortage of test kits.

Mayo lab assistant Haley Pike distributes COVID-19 samples for testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Mayo lab assistant Haley Pike distributes COVID-19 samples for testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

Manufacturers of those systems were approaching Yao with the selling point they weren’t experiencing shortages of kits and reagents.

“There’s a good reason why,” he said.

Adding those systems made the already difficult task of building staff even more difficult.

Ramping up staff

Over the entire year last year, hiring personnel brought in about 45 new employees to the lab, said Sarah Mason, head of the lab’s training program.

In a two-week span earlier this month, 180 new staff members and contract workers were brought onboard. Mason has streamlined the process to get a new hire onto the lab floor faster, turning a two-week orientation course into a one-day session, she said.

Mayo Clinic employees from other departments have also stepped up to work in the lab — some putting in 20 or more hours per week in addition to their other job duties, Reese-Davis said.

Staff start their day with a morning briefing in an area dubbed “COVID Creek” where samples are assessed and verified before testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Staff start their day with a morning briefing in an area dubbed “COVID Creek” where samples are assessed and verified before testing November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

“Staff have done an amazing job adapting,” she said. “Some people are experimenting with tasks they’ve never done before.”

Offering minor rewards such as cookies helps too, she added.

Navigating the 'creek'

The shift leaders meet every day to review the day’s challenges and review the numbers of expected specimens coming in that day. Their huddle space is unofficially dubbed "Covid Creek."

“We have the numbers before the samples arrive, and we can anticipate the flow,” said Todd Walker, lab supervisor.

Bands of colored duct tape on their lab coat sleeves distinguish them in a sea of lab coats. The tape color indicates the wearer’s role or department. The policy was a suggestion from new hires who couldn’t tell whom to go to when they had questions about the job.

The leaders and lab assistants also work to plan for challenges and come up with ideas to meet them.

A recent problem was a shortage of dry ice. Dry ice is used to keep the samples frozen until they’re ready to be tested. If allowed to thaw and sit too long before being processed, the material in the sample will break down and make testing the sample for virus useless.

Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)

To keep COVID-19 and all other test samples frozen, the lab uses up to 15,000 pounds of dry ice per week.

As planning for distributing vaccinations begins, the demand for dry ice to store and transport that will put a further strain on supplies. The lab needed a long-term solution.

Leaders brought in 53-foot, refrigerated trucks to park at the lab. New doors on the building were required to make the solution viable.

“The management team has taught us to think on our feet,” said Jane Masching, who has worked at the lab for about four years.

The adaptations and changes can be dizzying, she said, but one goal has kept her and her colleagues oriented through them.

“We know, at the end of the day, there’s a patient behind that sample,” Masching said.

Hiba Abu Madi, a clinical lab technologist within Mayo Clinic’s Department of Laboratory Medicine and Pathology, enters information on a touchscreen preparing a robotic testing instrument to test COVID-19 samples November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Hiba Abu Madi, a clinical lab technologist within Mayo Clinic’s Department of Laboratory Medicine and Pathology, enters information on a touchscreen preparing a robotic testing instrument to test COVID-19 samples November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)
Tubes of COVID test samples are unpacked and carted to available testing stations at the Rochester lab November 17, 2020. Mayo Clinic staff and volunteers handle tens of thousands of COVID-19 test samples daily from around the country at the Mayo Clinic Laboratories in northwest Rochester. (Ken Klotzbach / kklotzbach@postbulletin.com)