FEATURE
Coordinating and planning — that ’ s the bottom line . You have an action plan . And then the next day , something changes , and you have to make adjustments ”
Vanda Makris
Microbiologists Laura Tsaknaridis and Vanda Makris are ready to get to work . Photo : Oregon PHL
Communities have continued to grapple with recurring outbreaks , such as sexually transmitted infections and gastrointestinal pathogens , and are now in the midst of an active influenza season . Some places have seen growing emergence of antibiotic-resistant Candida auris and other organisms . As the pandemic enters its third year , public health laboratories are drawing on a variety of strategies to keep up with a full gamut of pathogens amid ongoing COVID-19 testing needs .
Clear Focus
When there is always too much work to do , setting clear priorities is essential — which often means getting external guidance on what not to do , said Megan Crumpler , PhD , HCLD , director of the
Orange County Public Health Laboratory in California . Their administration helped them prioritize specific public health groups rather than tasking their laboratory with mass community COVID-19 testing .
“ Now we ’ re down to about 900 to 1,000 samples a week , so it ’ s become manageable ,” she said .
It also means knowing what ’ s most critical .
“ Some things we can put off — maybe syphilis for a day or so — and we wouldn ’ t impact our turnaround time ,” said Shane Sevey , virology and immunology manager of the
Oregon State Public Health Laboratory . “ You start with the most important results that need to get out that day , and then you kind of work backward .”
National and regional reference laboratories , for example , have to maintain those testing responsibilities regardless of a pandemic .
“ We can ’ t say , ‘ well , there ’ s COVID , we can ’ t do [ National Influenza Reference Center ] testing ;’ or ‘ sorry , there ’ s COVID , we can ’ t do [ Antibiotic Resistance Laboratory Network ] work .’ That ’ s just not an option ,” said Allen Bateman , PhD , MPH , D ( ABMM ), director of the communicable disease division of the
Wisconsin State Laboratory of Hygiene . “ We ’ re the only lab in the state that can do rabies testing and the level of tuberculosis testing that we do . That ’ s what we should be and need to be focusing on .” The state health department has been a key partner in setting and holding those priorities . “ There has never been higher testing capacity , ever , for any other test than [ there is now ] for COVID-19 ,” Bateman added . “ Massive COVID testing is not our role anymore .”
In South Dakota , Southern and his staff work closely with the Office of the State Epidemiologist and the Office of Disease Prevention Services to set testing priorities .
“ The communication between those three principal teams — epidemiology , laboratory and disease prevention — is absolutely critical to determine what tests we need to escalate in importance , and what we can deescalate or send to someone else ,” he said . That helped them manage immediate needs and stay focused on surveillance , outbreak detection and facilitating investigation .
Through creative use of some federal funding , the South Dakota team is reinforcing laboratory infrastructure to help absorb some of the additional testing and surge attributed to both COVID-19 and non-SARS-CoV-2 pathogens . Part of that process has also involved helping other clinical laboratory partners develop programs and infrastructure that can support public health needs , such as supporting matrix-assisted laser desorption / ionization ( MALDI ) mass spectrometry for tuberculosis testing
6 LAB MATTERS Spring 2022