The 2011 movie Contagion is often lauded for its medical and epidemiological accuracy. While there are several points of similarity between the fictional disease depicted in the movie and COVID-19 (such as the spillover event, rapid worldwide spread, and empty streets as governments enforce city-wide quarantines), the role medical laboratory professionals play during an outbreak isn’t shown onscreen. Obviously, that’s not an accurate depiction of the role the laboratory plays in everyday healthcare, let alone what pathology and laboratory professionals do during a crisis situation.
In reality, the laboratory plays a critical role in the course of a pandemic, from beginning to end. While people socially distance themselves, laboratories are humming with activity, as medical and public health laboratory professionals are hard at work 24 hours a day, seven days a week.
The chain of pathology and pandemics, in real life
Pathologists who perform autopsies can be the first ones to raise an alarm that a novel disease has made an appearance. According to Constantine Kanakis, MD, MSc, MLS(ASCP)CM, forensic pathologists and medical examiners are critically important in public health detection and sounding early alarms. “That’s one reason it’s so important to acknowledge we’re experiencing a shortage of forensic professionals,” Dr. Kanakis says. “Fewer pathologists performing fewer autopsies means a novel pathogen could go undetected in the early stages of an epidemic.”
In the movie Contagion, for example, a pathologist performs an autopsy and immediately notes an issue. With one call he alerts the world, but in reality, it’s simply not that easy. So what does this mean, exactly, for the public at large?
According to Rodney E. Rohde, PhD, MS, SM(ASCP)CMSVCMMBCM, FACSc, Chair and Professor of Clinical Laboratory Science, there’s a standard “chain of command” that pathologists and other laboratory professionals would follow in these type of instances. “The first call would be to the primary hospital and local infection control and prevention team. Then, the state public health laboratory, which in turn notifies the CDC,” he says. In addition, there would be a chain of contact for all health professionals that may have come in contact with or have been exposed to the novel agent during the care of patients, such as phlebotomists and bench technologists as well as possible isolation of the patient from other patients. Dr. Rhode adds, “We must always remember it’s critical to protect our first line responders so we don’t lose highly qualified personnel that would be difficult or even impossible to replace.”
Critical next steps
Once it’s clear that something out of the ordinary is going on, laboratories have protocols in place for the next steps, such as identifying the virus, figuring out its mode of attack, and determining its effects on the body. In the movies, this happens in a matter of minutes. In actuality, those events could take days to weeks, and laboratory professionals are there at every step of the process.
According to Krista Urchenko, MPH, BSc, MLT, a medical laboratory technologist in Ottawa, Ontario, Canada, who has experience working in outbreak situations, laboratory professionals are absolutely vital in the response to outbreaks. She says the viral sequencing scene depicted in Contagion is surprisingly close to how it actually works in the real world. “They show structuring of the virus, its receptors, where it can bind and how the proteins would fold in 3-D modeling.”
While our current methods of detecting and identifying novel pathogens are more advanced than they were even a decade ago, laboratory scientists are crucial when developing diagnostic tests for novel viruses. According to Kathryn Golab, MLS(ASCP)CM, level 2 medical laboratory scientist and a student in the Doctor of Clinical Laboratory Science program at the Rutgers University School of Health Professions, “Most laboratory developed tests are variations on testing available elsewhere. Thanks to the availability of PCR testing, we traditionally don’t need to worry about culturing viruses in the laboratory anymore. We take the specimen and prepare it for PCR analysis.”
So how does this relate to the situation that is unfolding now, as healthcare professionals work to contain and combat the novel coronavirus? “In the case of SARS-CoV-2,” Ms. Urchenko says, “Chinese laboratories were first to sequence the genome of the virus and provide that data globally in order to help other labs develop their own diagnostic test quickly. Some laboratories in places like the U.S. and Canada were ready to respond without delay.”
In a pandemic, a big part of the laboratory’s role is behind-the-scenes. But there is a critical role for them onsite as well.
“It’s an interesting question,” says David Peaper, MD, PhD, Assistant Professor of Laboratory Medicine at the Yale School of Medicine and Director of the Virology Laboratory at VACT. “Most of the testing required to identify infected patients early in an outbreak is specialized and can only be performed in state labs or the CDC. It’s important to differentiate between testing performed to identify an infection and otherwise routine testing, such as complete blood counts and chemistry panels.” For example, he adds, “during the Ebola outbreak in 2014, some institutions set up special labs next door to intensive care units with dedicated testing equipment and staff.”
According to Ms. Urchenko, laboratory professionals and pathologists working at ground zero of a pandemic should expect to have a lot of contact with other healthcare professionals. “The lab’s main role is to be available to doctors, nurses, and other healthcare professionals to explain testing and the laboratory’s capabilities in terms of volume of testing.” This information keeps the diagnostic and clinical wheels running smoothly and helps eliminate mistakes that can make the outbreak worse, such as mislabeled specimens.
Overall, while movies such as Contagion can depict the epidemiology and sociological sides of an epidemic, they don’t highlight the important role laboratory professionals and pathologists play during a crisis situation. Pathology and laboratory medicine is important in the grand scheme of healthcare; an outbreak such as SARS-CoV-2 highlights just how important the laboratory professional's role is for public health.