From comprehensive disease surveillance to better hiring and retention practices, planning ahead with a clear set of pandemic prevention and preparedness strategies will be critical for clinical laboratories to meet the challenges of the next major viral outbreak.
By Arvind Kothandaraman, MBS
During a pandemic, every second matters—especially in laboratories. Today, well past the two-year milestone since COVID-19 was declared a worldwide pandemic, we’re learning more about how governments, non-profits, and other public and private entities are working together to formulate strategies that will enable fast action to manage future outbreaks and prevent pandemics.
COVID-19 may be one of the greatest global health crises of our lifetime. The unique challenges faced by clinical laboratories throughout the course of this pandemic can be avoided if future prevention and preparedness efforts incorporate five vital strategies.
1. Global Surveillance
The World Health Organization (WHO) reports1 that confirmed (as of this writing) COVID-19 cases are declining globally, however, it is clear that clinical labs cannot and should not completely cease COVID-19 testing. Testing programs can be classified into one of three categories: diagnostics, screening, or surveillance. While diagnostic surveillance and screening facilitates identification of active infections in symptomatic and asymptomatic individuals, surveillance examines outbreaks at a population level. Viral surveillance plays an important role in elucidating the larger context of an outbreak. In some applications, surveillance monitors environmental factors such as SARS-CoV-2 levels in wastewater. Surveillance is also practiced in the analysis of the genetic variants of a virus to understand its origins and evolution. Tracking zoonotic disease spillover is of particular importance as research shows most human infectious diseases2 (60-75%) are derived from pathogens originally circulated in non-human animal species.
A multi-layered, multiomics approach to surveillance—one that leverages technologies like next generation sequencing, real-time polymerase chain reaction (RT-PCR), mass spectrometry and infrared spectroscopy platforms—should be foundational for future pandemic prevention and preparedness programs.
2. Improvements in Assays and Testing Modalities
As SARS-CoV-2 has demonstrated very clearly, viruses can and will mutate rapidly. Some mutations are insignificant, while others can result in a greater rate of transmissibility or more severe disease. What we experienced with the SARS-CoV-2 variant Omicron (B.1.1.529)3 illustrates the value of resilient viral surveillance and continued importance of tests that identify the mutated version of the virus.
Prioritizing continual improvements in test sensitivity, specificity, and accessibility will be imperative in pandemic prevention. Gold-standard RT-PCR tests have demonstrated near 100% analytical sensitivity4 in SARS-CoV-2 detection. The FDA recently granted Emergency Use Authorization to a diagnostic test that detects chemical compounds in breath samples5 associated with a SARS-CoV-2 infection. In a study of 2,409 individuals, this test was shown to have 91.2% sensitivity and 99.3% specificity.
3. Thoughtful Talent Management and Recruitment Initiatives
While all industries and employees were forced to adapt to new ways of working during the COVID-19 pandemic, healthcare workers were certainly one of the most impacted. Laboratory technicians logged back-to-back overtime shifts to deliver much needed test results that helped identify infections, spur decision-making, and, ultimately, limit the spread of COVID-19. High rate of burnout has emerged as a common theme among laboratories globally.
Cross-training laboratory personnel is one pandemic prevention strategy that could help avoid this challenge in the future. Ensuring that people can work across multiple areas of the lab ensures operations can continue to run smoothly when an unforeseen absence or sick leave arises. Beyond that, gaining new skills and disciplines is advantageous for employees who will feel fulfilled through this process. Another option is the creation of job and internship experiences for students at colleges and universities. With a limited pipeline of graduates6 in these fields, creating and cultivating pathways for more of these individuals to gain relevant training and experience will be beneficial.
4. Automate Where it Makes Sense
In tandem with improved recruitment and retention initiatives, automation offers tremendous benefits in future pandemic prevention and preparedness efforts by helping optimize and improve lab operations.
Throughout the course of the COVID-19 pandemic, testing demand has ebbed and flowed, presenting challenges in resource allocation and scheduling among other issues. For those that have not already done so, adopting fully automated, end-to-end workflows could preempt these challenges. Today, workstations can be designed specifically to meet a given lab’s requirements and brought to fruition in the form of compact, modular instruments. These next-generation lab workstations offer high-throughput, standardization, and the flexibility that labs need to adapt to changing demand. Many also offer an added benefit of connectivity to software options that further optimize a lab’s operations. For example, remote lab monitoring solutions allow lab managers to view and record lab processes from a mobile device or desktop, either on-site and out of the lab, or from the comfort of their homes. They can also notify users if there has been an interruption in certain processes when an error has occurred or if there is a need for human intervention. Automation comes in the form of hardware or software allowing lab leaders to further support their staff by relieving them of monotonous work and reallocating that time to other activities with greater value-add.
5. Pandemic Prevention Requires Continued Public-Private Collaboration
If there are any silver linings to be found with this pandemic, one would be the increased level of collaboration across industries and geographies to combat COVID-19. Governments, corporations, research institutions, and other vested parties worked at rapid speed to establish the capabilities and infrastructure needed to respond. In fact, public-private partnerships have fueled the aforementioned strategies for pandemic prevention and preparedness—from the viral surveillance enabled by collaborators of the WHO’s Global Influenza Surveillance and Response System7 (GISRS), to automation initiatives informed by technical experts in the private sector, completed for and on behalf of public health labs.
Clinical laboratories play an important role in each of these strategies for pandemic prevention and preparedness, and society will benefit from their continued involvement.
About the Author
Arvind Kothandaraman, MBS, is managing director, specialty diagnostics for PerkinElmer, Inc. His primary interest is in equipping clinical laboratories with the tools needed to meet their technical and operational goals. Prior to PerkinElmer, Kothandaraman held positions at Thermo Fisher Scientific, BioReference Laboratories, and Advanced Analytical Technologies.
1. “Weekly epidemiological update on COVID-19 – 27 April 2022.” World Health Organization. April 27, 2022. www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—27-april-2022.
2. Ellwanger, J. H., & Chies, J. (2021). Zoonotic spillover: Understanding basic aspects for better prevention. Genetics and molecular biology, 44(1 Suppl 1), e20200355. https://doi.org/10.1590/1678-4685-GMB-2020-0355
3. “Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern.” World Health Organization. November 26, 2021. www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern
4. “How Good Are COVID-19 (SARS-CoV-2) Diagnostic PCR Tests?” Yohe, Sophia, MD, FCAP. College of American Pathologists. Undated. www.cap.org/member-resources/articles/how-good-are-covid-19-sars-cov-2-diagnostic-pcr-tests
5. “Coronavirus (COVID-19) Update: FDA Authorizes First COVID-19 Diagnostic Test Using Breath Samples.” U.S. Food and Drug Administration press release. April 14, 2022. www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-covid-19-diagnostic-test-using-breath-samples
6. “Addressing the Clinical Laboratory Workforce Shortage.” The American Society for Clinical Laboratory Science (ASCLS). July 2, 2020. ascls.org/addressing-the-clinical-laboratory-workforce-shortage/
7. Global Influenza Surveillance and Response System (GISRS). World Health Organization. Undated. www.who.int/initiatives/global-influenza-surveillance-and-response-system