CLIFTON, N.J. -- On a laboratory table that normally sits empty, hundreds of feces samples are arranged in stacks six vials high.
They've traveled by ground and plane, across seven different eastern U.S. states, for one purpose: to be tested for parasites, including cyclospora. And they're coming faster than scientists here can test them.
So much for summer Fridays at Quest Diagnostics.
Quest typically performs between 30 and 40 cyclospora tests a day across its 10 labs equipped to do them. Now they're processing more than 1,500. Scientists and technicians are working overtime to manage the brown onslaught.
Yes, it smells. No, it doesn't gross them out.
"You get used to it," says Anna Genis, a medical laboratory technician. "It becomes part of your job." She works mostly under a hood, which vents the chemical and fecal fumes.
Many lab professionals say feces aren't actually the worst thing they handle. That's sputum, the mucus found deep in the airways.
Before the cyclosporiasis outbreak, Genis also handled blood and urine samples for malaria or tick identification. But these days, it's all feces, all the time.
In the microbiology lab, she prepares the stacks of samples piling up in the queue for examination. On July 30, samples near the front are marked 7/22 -- over a week old. Lady Gaga's "Bad Romance" is blasting in the background.
"Just to keep the sanity," she says.
Genis arrived at the lab at 5:30 a.m. and isn't likely to leave before 6 p.m. The parasitology bench -- focused on infections caused by parasites -- has transitioned to a full-capacity, seven-day-a-week operation. On Sundays, when there would normally be just one technician, there are now three or four.
The outbreak, which is believed to have sickened more than 18,000 people and been linked to the deaths of two, continues to spread. And staff know their work might be what stands between a patient getting the right treatment or not.
"I know behind this, one person is sick and is waiting for the results," says Sandra Molano, a Quest medical laboratory scientist.
It's also how public-health authorities detect the spread of the outbreak. Labs report test results to state and local authorities, who pass on data to the Centers for Disease Control and Prevention, allowing investigators to identify cyclosporiasis hotspots.
The painstaking nature of this type of cyclospora test, compounded by the overwhelming volume of samples, underscores why the outbreak has been so hard to get a handle on.
Each sample must be handled one at a time. A portion of the raw stool is transferred into a centrifuge, where it's spun to concentrate the parasites and make them easier for scientists to spot under a microscope. Technicians then carefully pour off the excess liquid top layer and place a drop of the concentrated sediment onto a glass slide before smearing it evenly.
In the sample before Molano, there's only one egg-like cyclospora "oocyst" on the slide, making the microscopic translucent parasite even harder to spot. It can take 10 to 15 minutes of scanning per slide, she says, to avoid giving a patient a false negative.
"It's like a needle in a haystack," says Rodney Rohde, a clinical microbiologist and professor at Texas State University. "You're going to get eye strain."
Some lab workers, in fact, have been experiencing physical ailments.
Miranda Keith, a supervisor in Quest's microbiology laboratory in Lenexa, Kansas, took a break from her supervisory duties last week to work 10-hour shifts examining stool samples at the company's St. Louis lab.
"The first or second day, my friend and I kind of were like, 'There's kind of a different stink,'" she recalls.
By the second day, her neck was aching and she was taking migraine medication to ward off headaches caused by intense microscope light.
"I was just trying to get through a tray at a time," she says, "but there were layers of smears that had come in overnight."
Orders for tests that look for other gastrointestinal pathogens have increased alongside cyclospora. Some labs are asking clinicians to limit unnecessary tests. But ordering all tests at once can spare patients from having to submit another stool sample.
"It's difficult to poop in a cup," says Seema Malhotra, who manages the Quest microbiology lab in Clifton. "What if it's not cyclo? Then what?"
Lab professionals may soon have a reprieve from the stacks of fecal samples. Early testing signals suggest the outbreak may be turning a corner. During the week of July 12-18, the test positivity rate for cyclospora peaked at 14.2% and dropped to roughly 10% the last week of July, according to data from test company bioMérieux, which makes a different type of test for cyclospora.
In areas experiencing severe outbreaks, such as parts of Michigan, shortages of certain testing supplies have created supply-chain strains. Many state public-health labs, funded through government budgets and grants, lack the resources to perform genetic sequencing on cyclospora to trace and compare outbreak strains. This all in turn muddies the water for getting accurate state and federal case counts.
Public-health experts say workforce reductions at federal agencies, including in outbreak surveillance and laboratory operations, have also contributed to testing and tracking delays.
Still, Dave Anderson, Quest's vice president of lab operations in the East region, is relieved to see hopeful signs. He wants laboratory staff to get their weekends back.
He's also ready for a change of topic. "People have been asking me a lot about their stool samples."
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