Lab Matters Summer 2020 | Page 18

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