PRESIDENT’S MESSAGE
Being Ready for “The Next Big Thing”
According to the Centers for
Medicare and Medicaid Services, just
2.5% of all health spending in the
United States goes to public health.
Even though we work miracles with
tiny budgets, that’s not enough.”
Grace Kubin, PhD
As I write this in late January 2020, novel
coronavirus from China—technically
known as COVID-19—is spreading across
the world, putting public health once
again in the news and on the front lines. And we have to procure all the necessary
testing reagents and other supplies in
sufficient quantity to last throughout the
coronavirus outbreak, however long that
may be—your guess is as good as mine.
Here in the laboratory, we always try to
be ready for the “next big thing.” The
problem is, we never know what that
will be. And, in practice, every emergency
response tends to be unique. The 2009
H1N1 influenza pandemic hit Texas hard,
resulting in lots of testing for us. The
first person diagnosed with Ebola virus
in the United States walked into a Texas
hospital emergency department in 2014.
That public health scare generated less
testing, but a lot of consultation with
state epidemiologists and hospital and
emergency medical workers. At this point in the outbreak, I’m already
thinking about how COVID-19 will affect
the laboratory budget and hoping for
federal funding—coincidentally, the
topic of the feature story in this edition
of Lab Matters. CDC allotted us a small
pot of “contingency” funds through our
Epidemiology and Laboratory Capacity
(ELC) cooperative agreement. I’d like to tap
those. Of course, nothing is ever as easy as
one hopes; we’ll probably have to transfer
some of our internal funds to tide us over
until federal funding comes through.
So far, COVID-19 has prompted laboratory
outreach to clinicians seeing possible
coronavirus patients so we can provide
guidance on what we call “specimen
logistics”—what type of specimens
to collect, how to store them, how to
package and ship them safely to CDC for
testing, and how to fill out accompanying
specimen submission forms and ancillary
epidemiology forms. Because many of our
clinicians have never shipped specimens
directly to CDC, we’ve even had local
health department staff pick up the
specimens and bring them to us so we
can do the packaging and shipping on
their behalf. All of this takes up staff time,
which means other work gets backlogged.
At the same time, we’re anticipating the
release of the COVID-19 assay from CDC
so we can test specimens here in Texas
instead of sending them to Atlanta (which
overwhelms CDC and delays results
reporting). Once we receive the assay
for this brand new virus, several things
have to happen to assure compliance
with federal CLIA regulations for clinical
testing. We have to validate the assay
in our laboratory on our equipment to
make sure it performs as expected. We
have to provide proof of staff training and
competency conducting that specific test.
2
LAB MATTERS Winter 2020
If any Congressional staffers are reading
this column, IMHO, there are a couple
things Congress can do to beef up public
health preparedness and assure more
rapid, efficient outbreak response. First,
please don’t skimp on funding essential
public health services, like domestic and
global disease surveillance. According to
the Centers for Medicare and Medicaid
Services, just 2.5% of all health spending
in the United States goes to public health.
Even though we work miracles with tiny
budgets, that’s not enough.
Second, although we are grateful to
CDC for being forward-thinking about
“contingency” funding, the agency needs
some flexibility to allow us to use federal
dollars on what we need for the current
emergency, whether it’s COVID-19 or
something else. Right now, we have to
guess how much contingency funding
we might need in the next fiscal year for
equipment versus reagents versus surge
capacity staff support. Who knows what
we might be doing six months from now?
Public health threats are always evolving.
Threats like COVID-19 emphasize how
crucial public health is, even though we
don’t get top billing in the budget process.
Just remember, we can only help if we
have the resources to do our jobs. n
PublicHealthLabs
@APHL
APHL.org