FEATURE
With an impending fiscal cliff coming for public health laboratories , we have found that it was important to think about how capacity built during COVID-19 could be repurposed for other pressing needs within our state and any future testing needs .”
Emily Travanty , PhD
“ With an impending fiscal cliff coming for public health laboratories , we have found that it was important to think about how capacity built during COVID-19 could be repurposed for other pressing needs within our state and any future testing needs ,” said Emily Travanty , PhD , laboratory director at the Colorado Department of Public Health and Environment .
State , local and territorial public health laboratories receive most of their funding from the federal government , primarily through the US Centers for Disease Control and Prevention ( CDC ). From fiscal year ( FY ) 2014 to 2023 , CDC ’ s budget increased by just six percent after adjusting for inflation , according to Trust for America ’ s Health .
There won ’ t be much growth in the coming year either . In 2023 , Congress passed the debt ceiling agreement , or the Fiscal Responsibility Act of 2023 , which rescinds COVID-19 relief funding and sets spending caps for two years . Under these limitations , President Biden ’ s fiscal year 2025 budget request includes mostly flat or tiny increases . For CDC , Biden requested $ 9.68 billion , a $ 499.2 million increase , according to the National Association of County and City Health Officials . However , there was no request for a funding increase for Public Health Emergency Preparedness ( PHEP ) cooperative agreements , which is where public health laboratories get most of their preparedness funding . There was also no request for increased public health infrastructure and capacity money .
Modern Equipment
Two primary areas public health laboratories invested in during the pandemic ’ s early days were equipment and personnel . Surge funding allowed laboratories to buy a lot of new equipment . This was necessary not only to respond to the need for COVID-19 testing and surveillance , but it often benefited multiple laboratory programs and initiatives . And for some laboratories , it was a long time coming , after years of working with older , slower and lessefficient machines .
Now , laboratories have faster , more efficient and modern machines , including next next-generation sequencing equipment and high-throughput molecular testing platforms . They have been able to pivot from COVID-19 testing to an expansion of their previous work , such as adding more sexually transmitted infections to their testing list .
In Colorado , the focus from the beginning was diversification to allow for sustainability . Colorado was the first state to open a drive-through COVID-19 testing site . Initially , the laboratory could test about 160 samples a day . After new equipment arrived , laboratory staff rapidly scaled up to 20,000 samples in one day , Travanty said .
“ We had to add additional equipment in order to meet that demand , and we focused on open platforms . And that was the key to sustainability of our funding ,” Travanty said . “ We put our funding into separate instrumentation for extraction and amplification , so that it could , in the future , be applied to extraction and amplification to detect other pathogens .”
The Colorado State Public Health Laboratory also replaced its refrigerators , freezers and biosafety cabinets . The diversity of equipment helped mitigate supply chain issues and later allowed the staff to pivot to non-COVID-19 samples . “ Those pieces of equipment have also been able to be used for things like the Mpox response , some Neisseria meningitidis testing , West Nile virus surveillance , and , of course , flu ,” Travanty said . “ We have been talking recently about ‘ Are we prepared to surge if we are needed to for any future respiratory and flu-type outbreaks ?’”
Wastewater Surveillance
New equipment has also allowed laboratories to expand their wastewater surveillance programs . In September 2020 , CDC launched the National Wastewater Surveillance System to detect SARS-CoV-2 in wastewater across the country and track COVID-19 prevalence . This was the first time wastewater surveillance was used as a federally supported and centralized public health tool .
Public health laboratories embraced wastewater surveillance as an early warning sign for potential outbreaks . Like many states , Delaware used COVID-19 funding to implement a wastewater surveillance program , initially to detect SARS-CoV-2 , then other pathogens .
“ We have expanded wastewater testing for not only COVID-19 but multiple respiratory viruses , as well as any emerging threats , such as fungal diseases like Candida auris , or vector-borne diseases like West Nile virus , and even food-borne diseases such as hepatitis ,” said Gregory Hovan , MBA , director of the Delaware Public Health Laboratory .
Colorado already had a strong sequencing program focused on foodborne illness when COVID-19 hit four years ago . The laboratory was able to quickly pivot expertise in genomic surveillance to add wastewater testing , beginning first by looking for evidence of SARS-CoV-2 and then adding other respiratory viruses , like flu and respiratory syncytial virus ( RSV ).
Now , Travanty said , laboratory personnel are looking to “ right-size the testing so that we get representative samples across the state and can maximize the amount
16 LAB MATTERS Summer 2024
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