A mid-marathon rumination on the successes and failures of laboratory testing in the pandemic.
Sten Westgard, MS
A month ago, around the 4th of July, the US had reached almost the goal of 70% adult vaccination, and celebrated the national holiday with something closer to normality. A chance to gather again, to hug friends and family, to celebrate. It also seemed like the moment to commemorate our victory over the COVID19 virus.
Given the state of the pandemic outside the US, and the voraciousness of the Delta variant, it was premature to declare victory at all, we are not finished yet, we may not even be through the first quarter of this deadly game. But for the US, the summer was supposed to be end zone.
In the past 18 months, there has been ample dissection of what went wrong in the US pandemic response, from initial CDC testing method failures to the vacuum of political leadership. At the same time, there’s been a similar media narrative praising all the hard-won accomplishments, the heroic achievements, the sacrifices of our healthcare heroes.
If this is a victory for laboratory testing, it is a strange victory. It’s not the win we were hoping for, nor is it the win we needed.
There is a famous book, called Strange Defeat,, written in 1940 by the French historian Marc Bloch. In it he tried to unearth the great failures that led to France’s catastrophic and astonishingly rapid defeat at the hands of the Germans, indicting great institutional and leadership failures. As historians contemplate the disastrous first year of the pandemic response, the same theme has renewed currency, invoked by Andrew Bacevich in After the Apocalypse and George Packer in Last Best Hope.
(Yes, I know with those two books, my political stripes are showing. The links provide benefit to the Connecticut Food Bank)
I’d like to take up this thread but pull it in the opposite direction, focusing not on defeat, but on what we suppose is a victory.
Exhausted, not exhilarated, certainly not invigorated.
When the crisis hit, laboratories started from zero. There were no tests. And yet labs and the diagnostic industry responded with a speed never before witnessed. New methods sprinted to market. The laboratory workforce reconfigured itself to validate, verify and run these new test methods almost overnight. It is an achievement that cannot be overpraised.
But from the public perspective in the US, the early weeks and months were a desert of no testing, and even when the tests came into existence, there were no tests available, the spread of the virus having outpaced the supply of testing.
From PCR to antibody to antigen, the testing methods available are now ample to the need. But testing lagged so far behind, it was the vaccinations that truly saved the patients, not the laboratories. In the public mind, the laboratory was not where the war was won.
In the thick of this crisis, laboratory professionals worked punishing hours, 6-7 days a week, grappling with constant supply shortages, allocations, and a rollercoaster of regulatory recommendations.
As vaccinations have risen, some testing volumes have diminished, but for many hospital labs, there is now a new normal – COVID19 testing on everyone, on top of the typical routine testing workload. So the post-pandemic workload is greater than the pre-pandemic, which was already crushing.
As the news from medical technology programs comes in, I have not heard of larger incoming classes, expanded programs, or new programs being established. It’s as if the pandemic has made no impact at all on the number of people entering the profession.
If, after all this, we can’t attract enough new talent to the laboratory, does this mean we’ll never get enough people for the workforce?
The Silence of the Labs
Another element I find concerning: despite the oceans of print spent on the pandemic, very little has come directly from labs and lab professionals. Even when the media trained its spotlight on COVID19 testing, labs tended to shy away from the limelight.
I think partly this is driven by a reticence endemic to the laboratory: a reluctance to say something that wasn’t perfectly correct, and an impulse to wait until the things we spoke about were 100% confirmed and bulletproof, meant we absented ourselves from much of the pandemic conversation. And when others were saying things that were probably wrong, we also were a bit too quiet.
Other forces kept labs silent – the legal departments of healthcare institutions tend to think only in terms of risk aversion – so they didn’t want staff to talk about their challenges, or share their problems, for fear of exposing themselves and their labs to liability.
What disappointed me more was the media’s continued shunning of laboratory professionals. The face of our profession was supplanted by general clinicians, pathologists, and the usual suspects of media MDs. I know that many laboratory directors and association officers did their best to represent and promote the profession, but that was too often overwhelmed by the noise of the willingly misinformed and the proudly ignorant.
A Triumph, or the Last Full Measurement?
My father used to joke, with just a note of seriousness, that the general public would only truly understand the value of laboratory testing if labs were to go on strike. A day without testing would shock the patients, the clinicians, and the healthcare executives who too frequently ignore/neglect/abuse the laboratory. Suddenly, everyone would realize the true importance of testing.
Well, that shock happened, different than anyone expected, and the aftershocks keep coming.
I have heard from a colleague who have said this was going to be their “last pandemic.” That is, they made it through the toughest times of 2020 and 2021, but that’s all they can do. They gave their last full measurement. Retirement, for some of the greatest generation of laboratory professionals, is now at hand. It’s fitting that they go out on a win – it’s traditional that generals retire after winning a war – but it’s also true that the new laboratory professionals coming in, when there are replacements, do not have the same training and strengths of the previous one.
So, instead of a triumph, we have the same crisis that we were facing before: too much work, not enough staff, not enough respect or resources given to us.
There are plenty of cheer-leading articles out there, from prominent leaders in the laboratory world. It’s part of their job to provide us that sunny vision of a shining lab on a hill, to promise that the path ahead of us is always going to improve. I wish I could agree with them. But I don’t believe this pandemic guaranteed that the laboratory has a brighter future ahead.