Indian Journal of Pathology and Microbiology

EDITORIAL
Year
: 2021  |  Volume : 64  |  Issue : 1  |  Page : 1--2

COVID-19 and its impact on laboratory services


Ranjan Agrawal 
 MD; FIC Path; MIAC, DHA, Professor, Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Correspondence Address:
Ranjan Agrawal
MD; FIC Path; MIAC, DHA, Professor, Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh
India




How to cite this article:
Agrawal R. COVID-19 and its impact on laboratory services.Indian J Pathol Microbiol 2021;64:1-2


How to cite this URL:
Agrawal R. COVID-19 and its impact on laboratory services. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 May 18 ];64:1-2
Available from: https://www.ijpmonline.org/text.asp?2021/64/1/1/306548


Full Text



The current COVID-19 pandemic has necessitated significant changes in the way pathology laboratories operate. It has influenced the international economy with respect to sales, market share, growth, and revenue. There has been effect not only on the present market and but also on the future trend. It has left an impact on clinical chemistry, microbiology, histopathology, cytopathology, immunology, hematology, and genetic testing laboratories. These include the hospital-based, clinic-based, independent and reference laboratories as well as the standalone ones.

 Social Distancing



Compliance of social distancing has imposed limitations on staff members and workflow in all the laboratory sections. Everywhere the clinical and laboratory staffs have been separated and working from home has been encouraged. Staff members have to work in discrete teams without proper change over with long duty timings affecting the sleep pattern as well as the family time.[1] Laboratory workspaces were separated resulting in workers including medical personnel not having a chance to interact with people in other sections. These changes also required extra precautions such as repeated sanitization of hands and also the sitting space so as to accommodate limited number of staff in a single room at one particular time. Extra separate rooms for breaks and dedicated outdoor spaces became essential.

 Specimen Collection, Processing and Reporting



Some of the specimen collection centers were closed or shifted to other sites, resulting in discontinuation of services both for the staff members as well as the patients. Non-urgent sample testing was postponed. Screening clinics were established on war footing so as to meet the high demand for testing of the virus.

Large numbers of swabs for respiratory samples were received in the laboratories much more than their handling capacity further pressurizing the reagent and consumable supplies. Many a time extra staff was needed to be called in so as to assist with specimen registration, packing, and transportation. Rapid reporting of SARS-CoV-2 results required coordination between the scientists, information technologists, and pathologists not only for the working but also to ensure that the correct results were uploaded.

Major impact on laboratories following COVID-19 necessitated the rapid implementation of new test parameters, logistic difficulties, testing challenges, use of new safety precautions such as face masks, shields, and follow social distancing. Significant increase in the workload was observed in the emergency laboratory section and COVID-19 diagnosis and management-related testing. Otherwise, there was a significant fall in the overall demand in all the other sections. Viral transport media and citrated blue top containers demonstrated an increase in their utilization. In the clinical chemistry laboratory, there was an increase in ordering for the tests such as Procalcitonin and Lactate dehydrogenase, both of which predict prognosis in patients with COVID-19. The clinical virology section had an overall decrease in the testing volume. The workload in the hematology laboratory was minimized. Shifting to alternate tests such as peripheral blood smear examination and molecular tests over bone marrow examination was done so as to reduce the contact with patients.

Educational and training activities including conferences and seminars were cancelled, deferred, or shifted to the online or virtual mode. Medical students were prohibited from attending wards, clinics, and laboratories, with preference for online mode of teaching. Virtual teaching although was the demand of the time but somehow it cannot replace the real or microscopic teaching system. Microscope cameras and virtual images or sharing of screens were used for diagnosis and reporting. Digital pathology gained a higher mode.

 Operational Issues



Delivery of reagents and consumables was critical especially when all urgent tests were performed in-house. Starting of new ICU-like facilities in remote locations also required administrative support to ensure appropriate specimen transport and processing. Major changes in the working arrangements led to changes in the working of laboratory managers especially when, dealing with staff, ensuring changes in the working pattern, and organizing the duty rosters. These alterations affected the morale of the staff, following high anxiety levels and uncertainties especially the job insecurities. Management had already started adopting cost-saving practices during the pre-COVID-19 days following inflation, or economic crisis in different countries. Many of the employees feared impending job termination and losses.[2]

The outbreak embarked upon the already vulnerable laboratories with challenges related to availability of manpower, transportation, deficiency of personal protective equipment and gadgets, delay in procurement of essential items, declining financial turnover and apprehensions amongst the staff.[3] Some of the laboratory sections worked round the clock even during the imposed lock down providing diagnostic facilities to routine as well as COVID-19 cases. Unprecedented health actions for the public in general were introduced, including social distancing, travel restrictions, and imposition of quarantine. Globally, histopathology and cytology workload reduced substantially. The impact on cancer-related surgical procedures was however not much. There was a marked reduction in all the screening or functional pathology samples with almost all the specialties of medicine being affected.

High contagious surfaces including the benches, tabletops, toilets, and the entire premises were cleaned and wiped several times a day with disinfectants, further increasing the workload and economic burden. The imposed lock down led to closure of public transport utilized by majority of the staff for commuting to and fro from work. Pillion-riding on motorbikes was banned. The female staff, which does not self-drive, had to suffer as they were unable to share the ride.

In some laboratories stress management demonstrations or motivational lectures were conducted so as to boost the declining staff morale. Majority of other sections faced severe financial challenges during these tough times.

 Mental Health



The lockdown for a long duration imposed in various countries and nilsocial activities led to severe deterioration of mental health and increased stress levels among the staff.[4] The sanctions imposed by the organizations including a significant pay reduction, cancellation of all increments and incentives during the year further hiked their agonies. Motivation levels dropped down considering the safety issues and getting infected due to shortage of essential items and cost saving measures being adopted. The fear of carrying the virus home to their family members was much more and prevented them from concentrating during work.

Thus, the shifting demands on the clinical laboratories are likely to persist for the near future. It is still too early to predict when this pandemic would come to an end or the unforeseen consequences that might continue hence forth. I am sure that the New Year would bring in lots of new ventures, happiness, and prospects for all besides deleting all the difficulties that came in the way. I read somewhere—Let's welcome the New Year with the slogan “Twenty-Twenty Won”.

Happy reading to all!

Jai Hind.

References

1Ahmed S, Jafri L, Majid H, Khan AH, Ghani F, Siddiqui I. Challenges amid COVID-19 times – Review of the changing practices in a clinical chemistry laboratory from a developing country. Ann Med Surg 2020;55:300-4.
2Presti G. The dynamics of fear at the time of covid-19: A contextual behavioral science perspective. Clin. Neurops?ychiatr 2020;17:02.
3Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clin Chim Acta 2019;489:49-52.
4Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatr 2020;7:e15-6.