ENVIRONMENTAL HEALTH
During a Pandemic, All Hands On Deck
By Nicholas Ancona, MPH, specialist, Opioids Biosurveillance; Jennifer Liebreich, MPH, manager, Environmental Health and Sarah Wright, MS, manager,
Environmental Laboratories
COVID-19 has changed how
environmental health laboratories
work across the US, but the need for
testing and surveillance hasn’t gone
away. As of the writing of this article,
multiple states have furloughed
laboratory scientists due to COVID-19
budget implications. Such reductions in
environmental health staff will continue
to affect the work environment.
Biomonitoring
Environmental health laboratories that
test people for chemical exposures
have been challenged with not only
reduced staff due to reassignment,
but implementing safety and physical
distancing measures as well. The major
impacts are that implementation of
critical public health projects have been
postponed and analytical testing has
been delayed.
Biomonitoring California was forced to
curtail its statewide survey this spring,
reducing the number of participants
enlisted in 2020 from 350 to 90. Specimen
collection and testing for statewide
surveillance will be interrupted for at least
one year. New Hampshire had planned
to launch a lead biomonitoring study,
but specimen collection partners in the
hospitals are too busy with COVID-19
to manage specimen collection for the
project at this time. The NH program
also suspects that potential participants
may be uncomfortable with traveling to
hospitals for specimen collection, so this
study has been temporarily postponed.
The versatility and testing capacity of
chemists in biomonitoring and Laboratory
Response Network for Chemical Threats
(LRN-C) laboratories has been an asset
during the pandemic because they were
able to shift to supporting the pandemic
response. For example, staff were able
to pivot from toxicology to supporting
roles in molecular diagnostics and
specimen processing.
Opioids Biosurveillance
As hospitals prioritize COVID-19 response
work, emergency departments have
decreased or stopped submission of
clinical specimens from opioid overdose
patients to public health laboratories for
biosurveillance. In some jurisdictions,
opioids biosurveillance program activities
have been suspended indefinitely. In
others, chemists are being cross-trained
to assist with COVID-19 testing, pulling
them away from critical fentanyl analog
analysis testing. These reductions in
opioids biosurveillance may slow down
or temporarily stop access to timely
information on the specific types
of opioids from which patients are
overdosing. It can also limit the ability
to piece together potential community
overdose clusters, which is information
that epidemiologists and public safety
officials use to help inform action. At a
time when fatal and nonfatal overdose
incidence is steadily increasing, concerns
of social isolation, economic downturns
and disruptions to established illicit drug
trades are shared across the nation’s
public health community. Recent data
from the Overdose Data Mapping
Application Program (ODMap) show that
overdose incidence rose 18% in March
2020, 29% in April 2020 and 42% in May
2020 when compared to March, April and
May 2019.
Cannabis
Under state stay-at-home orders,
cannabis testing programs have remained
open and are considered essential testing
services; some with reduced staff or
with staff working from home. Cannabis
testing laboratories vary widely and may
include pesticide laboratories in state
agriculture departments, public health
laboratories and stand-alone programs.
At the national and international level,
development of certified reference
materials, to ensure cannabis is pesticidefree
for example, has been delayed
by COVID-19 response efforts. Some
states have been delayed in licensing
private cannabis testing laboratories. In
other states, cannabis ballot measures
will be impacted by COVID-19 in
states where votes are delayed.
16 LAB MATTERS Summer 2020
PublicHealthLabs
@APHL APHL.org