In a special session titled “COVID-19: Past, Present, and Future,” Admiral Brett Giroir, MD, provided a sobering reminder of the current state of the pandemic in the U.S., highlighted the integral role of clinical laboratories in managing the crisis, and described new initiatives to ensure the country is prepared to withstand the next novel pathogen.

”While we still have a lot of work to do, the end of the pandemic is in sight,” he said. Giroir is the Assistant Secretary for Health at the U.S. Department of Health and Human Services and has led the administration’s efforts to help states scale and coordinate testing supplies during the pandemic.

In his introductory remarks, Giroir described the increasing numbers of COVID-19 cases throughout the country and added that, in contrast to earlier stages of the pandemic, it’s impossible “to surge resources into one city or community because the whole U.S. is affected. While we’re seeing that mitigation is working in the central part of the country, both coasts are still exploding.”

Until vaccines become widely available, Giroir reiterated the importance of basic safety measures and noted that “we have no magic bullets. Wearing a mask is still critically important, as well as washing hands.” He also strongly recommended avoiding large social gatherings and “mixing in bubbles that you don’t normally mix in.”

While noting that there are challenging days ahead, Giroir reminded attendees that many lessons have been learned since the beginning of the pandemic which have guided the development of public health strategies to prevent further spread of the virus. First, he noted that “with SARS-CoV-2, the highest viral load actually precedes symptoms. We could never have imagined this in March or April.”

Further complicating efforts to contain the virus through contact tracing and quarantine of exposed individuals, he noted that at least 50% of the general public and up to 90% of young, healthy individuals with detectable SARS-CoV-2 RNA do not experience symptoms. As asymptomatic carriers increase the risk of community transmission, Giroir highlighted the importance of laboratory testing. “Diagnostics are a core part of our strategy. We need to be better prepared in the next decade than we were in this decade.”

To achieve this vision, Giroir identified several logistical challenges that will need to be overcome. He pointed out that traditional clinical laboratory tests “have been developed so that they cannot be copied, which makes them difficult to scale.” He also described our dependence on international supply chains for essential supplies and reagents as a key area for improvement. Lastly, he pointed out that our SARS-CoV-2 testing network consists of a diverse mixture of commercial reference labs, hospital labs, and public health labs which often have competing interests.

To deal with these limitations, Giroir stressed the need to improve our capacity to rapidly expand selected technologies, build a domestic manufacturing pipeline for essential supplies and reagents, and implement a “formal mechanism for collaboration, communication and planning across a very diverse system.”

When asked to identify the single greatest challenge encountered during the pandemic response, Giroir indicated that “getting information to the American people is the most critical and challenging item.” He noted that competing media narratives made it difficult to provide clear messaging and effectively communicate risk adjustments and other nuanced concepts to the general public. Through it all, Giroir maintained his sense of humor, advising “if you’re going to have a pandemic, try not to have it in an election year.”

Attendees at this session left with a clear sense of where we are now, where we’re going, and how laboratorians can contribute to the ongoing pandemic response. As an indication of his appreciation for the laboratory community, Giroir closed by saying “I really, sincerely thank you for all that you’re doing. I wish I could present you all with a medal but for now it’ll have to be my sincerest thanks.”