Mislabeled Sample at UCSD Medical Center Leads to Release of Coronavirus-Positive Patient into the Public

One of the leading medical schools in the nation accidentally released a patient who tested positive for the cornovirus.

The incident happened at University Of California San Diego, and was the result of a miscommunication with officials at the Atlanta based Centers For Disease Control.

San Diego’s ABC 10 reports:

An evacuee who tested positive for the coronavirus in San Diego was mistakenly released back into quarantine because their test sample was mislabeled.

Four evacuees were brought from MCAS Miramar to UC San Diego Medical Center and provided samples for testing within the last week. Three of those four samples were not labeled in compliance with the same regulations between UC San Diego Health and the CDC, according to a Centers for Disease Control and Prevention spokesperson.

Because of this, when the samples were brought to the CDC in Atlanta, three of them were not immediately processed.

The CDC says the team in Atlanta then reported that the samples tested negative, when three of those samples had not actually been tested.

As those three patients were heading back to the base to finish out their 14-day quarantine orders, the mistake was discovered. Officials asked the three patients to self-isolate in their rooms while they tested their samples.

CDC officials said two samples came back negative and one was positive.

The CDC says the team in Atlanta then reported that the samples tested negative, when three of those samples had not actually been tested.

As those three patients were heading back to the base to finish out their 14-day quarantine orders, the mistake was discovered. Officials asked the three patients to self-isolate in their rooms while they tested their samples.

CDC officials said two samples came back negative and one was positive.

The patient, a female, spent the night in her room on the base, before being returned to the hospital for isolation.

UCSD Medical Center says she is in good condition and has minimal symptoms.

CDC officials are now investigating whether the woman may have come into contact with anyone after they were released for a short time. But based on what they’ve learned so far, they say it appears unlikely anyone else is at risk.

The San Diego Tribune adds:

After trading written statements in the morning, CDC officials appeared alongside UC San Diego and county public health officials in a joint news conference Tuesday evening, providing a deeper set of details, including a notice that a young girl sent to Rady Children’s Hospital Wednesday and released Friday has been readmitted. Though she tested negative last week, new symptoms, officials said, warrant a fresh test.

Officials, including Dr. Christopher Braden, the CDC’s point person on the ground in San Diego, stressed repeatedly that no member of the public was ever exposed to novel coronavirus , even though clerical confusion led to a female patient being removed from an isolation room at a UC San Diego Health hospital Sunday and then returned Monday due to a positive coronavirus test that was at first thought to be negative.

There was a mismatch, he said, between a sample-labeling process that the university used and one that the CDC uses to track the multitude of specimens that flood into its Atlanta headquarters from all over the globe.

Though the proper forms and information had been filled out in San Diego, Braden said, key “two factor” information designed to make sure that each patient’s identity is confirmed, was not present in a format that could be brought into the CDC’s automated tracking system once samples from three of the four adult university patients were sent to Atlanta.

But CDC personnel in San Diego weren’t aware of this problem when they called in to get the results for three patients whose samples, they believed, were being processed as part of a much larger group from across the nation. When word came down that all cases in that batch had come back negative, Braden said, that was solid enough confirmation that the patients could be removed from the hospital and returned to quarantine.

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