What has been the general experience of clinical laboratories supporting the COVID-19 response?

A: SARS-CoV-2 has overwhelmed the public health system globally, challenged scientific knowledge, and upended our daily lives. This pandemic has been like no other public health emergency in modern memory, requiring the effort and coordination of multiple government agencies, the medical and healthcare communities, and cross-functional scientific disciplines to develop testing platforms to better assist public health and clinical laboratories.

Furthermore, this pandemic has presented several challenges specific to public health and clinical laboratories, including sustained high demands for specimen collection, testing, and rapid diagnostic turnaround times; shortages in testing reagents, personal protective equipment, and other resources; and extended work shifts. To make matters worse, some clinical laboratories have also seen a decline in their normal testing activity and have had to contend with lost revenue and financial challenges as well.

What is one of the biggest safety gaps that laboratories need to tackle?

It is often challenging to determine the appropriate safety measures to implement in a laboratory when working with a new infectious agent such as SARS-CoV-2. As a result, although SARS-CoV-2 is a novel virus, most of the Centers for Disease Control and Prevention’s (CDC) guidance on how to handle it safely is based on previous experience with similar coronaviruses.

In particular, because every laboratory’s circumstances are slightly different, CDC recommends that each laboratory perform site- and activity-specific risk assessments to develop appropriate safety measures tailored to that laboratory’s unique situation. This includes determining the number of people that a laboratory can safely accommodate while maintaining social distancing, assessing cleaning procedures, and reviewing emergency operational plans, especially those focused on how to protect staff at higher risk for severe illness from COVID-19.

We at CDC believe that, unfortunately, many laboratories are failing to perform these assessments, making this the biggest gap with regard to safety in clinical laboratories today. Training on how to conduct a risk assessment is often not provided to clinical laboratory professionals or included in many laboratory training programs. Because of this, laboratories tend to rely on generic hazard assessments instead of site- and activity-specific risk assessments. The clinical laboratory community, including those of us at CDC, are working to address this gap by implementing a consistent approach for training on risk assessments and appropriately managing risks to keep laboratories and their staff safe.

What additional actions can laboratory professionals take to ensure workplace safety?

In addition to conducting better and more frequent risk assessments, laboratory professionals must understand their specific roles and responsibilities, receive adequate training, and revise procedures accordingly before and during an emergency response. Responding to the challenges of the COVID-19 pandemic should reinforce the importance of good laboratory practices, particularly those related to laboratory quality, safety, and accreditation.

Furthermore, a systems improvement process should be implemented to ensure that the laboratory is prepared to respond not only to the current COVID-19 pandemic, but also to future public health emergencies. Although the laboratory response to COVID-19 has been challenging, it has demonstrated the important role that clinical laboratory medicine plays in both patient care and public health. The critical work of clinical laboratory professionals has never been so well-recognized, and thus it is more important than ever for clinical laboratories to continue focusing on operating with integrity and excellence.  

Reynolds M. Salerno, PhD, is the director of the division of laboratory systems at CDC in Atlanta.+Email: yyw2@cdc.gov

The author thanks his CDC colleagues Aufra Araujo, PhD, Bill Arndt, PhD, Alicia Branch, PhD, Jasmine Chaitram, MT(ASCP), MPH, Bin Chen, PhD, Kristi Singletary Meadows, Meredith Reagan, and Senia Wilkins, MPH, for their support with developing responses to these questions.