FEATURE
Residents wait in line at a DC Health location administering the mpox vaccine in Washington , DC . The US government declared the mpox outbreak a public health emergency in order to bring awareness and resources to combat the spreading of the virus . Photo : Alex Wong / Getty Images
Mangal says it ’ s difficult to tease out why CDC never activated the LRN during COVID-19 , but she points to the bioterrorism aspect of LRN ’ s conception .
“ One of the things that we have to keep in mind is with mpox CDC had tests for a broad range of viruses to quickly rule out smallpox viruses so the network was prepared to respond . There are other instances where the LRN has been utilized to respond to emerging infectious diseases that don ’ t fit the profile for biological warfare . We ’ d like to say that the LRN is utilized for emerging infectious diseases outside of the bioterrorism space , but in reality , it hasn ’ t fully caught up to that expectation .”
Taylor adds , “ The question becomes , ‘ What is the LRN ’ s mission ?’ The LRN was not used during the COVID-19 pandemic in any way . At the individual public health laboratories , LRN staff were used to add surge capability , but they didn ’ t use an LRN test . It wasn ’ t done in LRN laboratories , as such .
“ SARS-CoV-2 as a new emerging pathogen was certainly not on the list of tests to develop ,” Taylor continues , “ but given the capability of the LRN laboratory at CDC to develop tests , one would have thought that they would do it .”
The LRN tests also need to be updated , experts agree . Tests need to be automated and available for a variety of highthroughput machines , not from only one or two vendors . Tests should also be multi-targeted . Taylor points out how helpful it would have been to have had one test last fall that could differentiate between SARS-CoV-2 , influenza and respiratory syncytial virus .
“ But ultimately , we need to be pathogen agnostic , meaning that we have to have a test that will detect an unknown ,” Taylor says . “ And the way to do that at the moment is metagenomic sequencing . Metagenomic sequencing is beyond a research test , but you need quite a bit of capability and informatics capability in laboratories to be able to do it . That needs to become a gold standard test rather than something that ’ s done in a very high capability laboratory .”
Last year , as the mpox cases and number of samples increased , CDC brought in commercial laboratories , which had BSL-2 capability . “ The mpox outbreak that we just had spread incredibly quickly . The first identification was in Massachusetts , and then all of a sudden it was all over the country , and so high-throughput was needed ,” Taylor says .
“ If public health laboratories had had a test that did have more high-throughput capability , then the public health laboratory could have controlled the level of testing required ,” Taylor continues . “ So the LRN system worked , but it didn ’ t work as effectively as it ought to in this day and age .”
One challenge with using the commercial laboratories rather than improving capacity in the public health laboratories was that once the commercial laboratories took on much of the testing , it was difficult to collect public health information .
“ There needs to be clarity on how the data coming out of the commercial laboratory is shared back to the public
16 LAB MATTERS Spring 2023