Leadership: Pandemic Response – Public Health Laboratories Rise to the Challenges, with Kelly Wroblewski, Association of Public Health Laboratories
Posted: February 24, 2022
Author: Kelly Wroblewski
Public health laboratories are foundational to our nation’s public health infrastructure. While the COVID-19 pandemic response presented many significant challenges for public health laboratories, it has also provided opportunities to strengthen partnerships and implement new technologies that will enhance the ability to detect and respond to healthcare associated infections (HAIs) moving forward.
From the earliest days of the COVID-19 response, public health laboratories faced scarcity of laboratory reagents and supplies, staff shortages, inability to meet high testing demands, and outdated test ordering and reporting systems. Although several of those challenges remain, public health laboratories have adapted to the pandemic response by installing high throughput testing platforms, implementing electronic test order and result systems, enhancing their capability and capacity to perform genomic surveillance, and establishing training programs for point of care testing.
Public health laboratories’ genomic sequencing capacity is one of the most striking examples of technologic advancements made during the pandemic. While the recent COVID-19 Omicron variant wave exacerbated ongoing issues with testing, it also highlighted the significant developments made in genomic sequencing capacity and the ability of health departments to effectively utilize point of care tests performed in a wide variety of healthcare settings, both of which were not common practices early in the pandemic. Since March 2020, the number of public health laboratories that are performing genomic sequencing for SARS-CoV-2 to monitor the emergence and spread of variants and identify transmission networks has increased from five to 71.
Partnerships with HAI/AR programs, healthcare facilities and other entities have also been vital in preventing the spread of COVID-19 in healthcare settings. During the early stages of the pandemic, it quickly became apparent that residents of congregate settings would be at the highest risk of contracting COVID-19 and would be especially vulnerable to severe illness and death. Given this, public health laboratories worked with partners to rapidly develop interventions to respond to these populations’ unique needs.
Some of the most significant partnerships between public health laboratories and HAI/AR programs during the pandemic occurred through interventions aimed at limiting transmission and preventing outbreaks in long-term care facilities (LTCFs). To support implementation of a CMS testing directive encouraging serial screening of residents and health care personnel (HCP) to facilitate rapid case identification, public health laboratories worked with HAI/AR programs and LTCFs to develop testing training programs, extend CLIA licenses, support acquisition of CLIA certificates of waiver, and establish mechanisms for reporting. Notably, a collaboration between Minnesota’s HAI/AR program and public health laboratories demonstrated the importance of serial screening in LTCFs to limit the spread of COVID-19, and the utility of genomic sequencing to determine the source of transmission. In addition, the Michigan Department of Health developed a COVID-19 webpage specific to LTCFs with training materials and videos that public health laboratories helped develop to ensure that testing is conducted properly.
Gains made during the COVID-19 pandemic response can be leveraged to improve detection, reporting, response, and investigation of future HAI/AR outbreaks. For example, public health laboratories’ advancements in performing genomic sequencing are already being applied to support SARS-CoV-2 testing, as well as other HAIs and AR pathogens including carbapenem-resistant Enterobacterales and Candida auris. HAI/AR programs and public health laboratories partnerships that were strengthened during the pandemic will continue to be valuable for sustainable and innovative approaches to prevent and control HAI/AR outbreaks. Similarly, public health laboratories’ experiences are helping inform development of resources such as CORHA’s product offerings and will continue to equip health departments and healthcare facilities with the tools to improve HAI/AR outbreak responses.