Lab Matters Winter 2020 - Page 4

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