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ACB Expert briefing on the vital role of NHS laboratories in providing quality testing leading to the best possible patient care

30/04/2020 14:42:44

Testing for infection with COVID-19 novel virus Credit Lancashire Teaching Hospitals
Image credit: Lancashire Teaching Hospitals

As the NHS Pathology service in the UK hits the milestone of more than 500,000 diagnostic tests for COVID-19 the Association for Clinical Biochemistry & Laboratory Medicine (ACB) President, Professor Neil Anderson and Dr Rob Shorten Chair of the ACB Microbiology Professional Committee, explain the work of our members and what’s next in the battle against this disease. 

What have NHS laboratories achieved so far?

Since the start of the pandemic the focus of NHS laboratory staff has been to develop and implement rapid, accurate COVID-19 tests that make a real difference to patient care. Within a few weeks daily test capacity of tens of thousands has been established by a dedicated, expert professional workforce of Clinical and Biomedical Scientists and Medical Staff. This capacity has been achieved by NHS and Public Health Laboratories rapidly validating and rolling out testing for a novel pathogen against a backdrop of unprecedented global demand for reagents and consumables. COVID-19 results, as with all diagnostic tests, have been interpreted and acted upon by experts in their fields. In addition, our staff have introduced novel tests for the assessment and management of patients presenting at hospital with suspected COVID-19. ACB members strive to use better science to inform better testing and therefore provide better care.

Better science: How are NHS laboratories making sure tests are accurate?

All Pathology staff are collaborating and sharing cutting edge research from across the globe. We are signatories to the Wellcome Trust statement on sharing research in public health emergencies through our journal the Annals for Clinical Biochemistry, and have fast tracked and made open access all COVID-19 articles. Sharing the latest scientific evidence in this rapidly expanding field of research makes sure testing methods implemented in laboratories are as accurate and reliable as possible. This has allowed us to use the best evidence to control and influence the process from identification of individuals to be swabbed, through to how the results have been used clinically. Use of the evidence base ensures we can minimise the potential errors in this complex process.

What is the risk to laboratory staff carrying out tests for COVID-19?

We support our patient-facing colleagues who are rightly lauded for their professionalism and bravery. We must also acknowledge the critical contribution of our laboratory teams. Up and down the country Pathology staff are providing essential services such as taking blood from high risk patients, making samples safe, and performing vast numbers of tests on a dangerous novel pathogen, whilst maintaining a quality routine service to non-COVID-19 patients. Their dedication and skill warrants admiration.

Better testing: How have NHS laboratories responded to the increased demand for reliable COVID-19 testing?

Rapid upscaling of molecular diagnostics for a novel viral pathogen has never before been done on this scale in the UK. NHS laboratories reconfigured their workforces to establish COVID-19 testing labs to provide 24/7 services to patients within six weeks.  All this has been achieved alongside a continued commitment to routine patient services of the highest quality.

We have worked closely with our colleagues in industry. The production of swabs and testing reagents has been scaled up. These are vital to carrying out the most accurate testing methods for COVID-19 and new markers for patient management. Public health organisations, NHS, diagnostics industry and academia have worked together to coordinate the rapid response and staff from other pathology disciplines have been redeployed – all with one common goal – to beat the disease with the provision of consistent high-quality tests and the best possible patient care.

Better care: How are the results used?

The purpose of testing for COVID-19 infection is to understand how to best treat a patient and stop the transmission of disease. Test results lead to actions; public health interventions, infection prevention and control measures, and the individual clinical care of patients themselves. Laboratory diagnostics do not exist in isolation and a healthcare service cannot function without pathology.

Here are some examples of how this works in practice;

Preventing the spread of infections in hospitals

A patient presents to A&E with worsening shortness of breath after a week of having a cough and feeling tired. Swabs from his nose and throat were sent to the local accredited laboratory for COVID-19 testing. Patients entering the hospital are cared for in designated areas; ‘green’ (patients with no signs or symptoms of COVD-19), or ‘amber’ (patients with suspected COVD-19). This patient was cared for in an amber area. The registered Pathology staff in the laboratory detected the virus in these swabs and reported this positive COVID-19 result within 12 hours of admission. The patient was moved to a ‘red’ area where confirmed COVID-19 patients are cared for. This rapid result ensured that the patient received care directed to their diagnosis whilst limiting the chance of transmission of COVID-19 within the hospital.

Breaking chains of transmission through contact tracing, or ‘Test, Track & Trace’

Many have advocated this as a method to prevent new infections, in the next phase of the outbreak. This can be very effective and is used in other infectious diseases.

  1. Rapid testing: A patient is tested as positive for COVID-19 infection.
  2. Tracing contacts: Everyone who came into contact with this person are traced from the time the person was likely to have been infectious.
  3. Monitor contacts: are they unwell? If so, they too should be tested, and another round of contact tracing commences. Are they currently well? They should then be asked to self-isolate to prevent onward infections.

Rapid access to reliable results and swift contact tracing can break chains of transmission.

What’s next? Laboratory testing as a way out of lockdown

Enhanced laboratory testing has been advocated as a route out of lockdown. Regular testing of vast numbers of the population, combined with rigorous contact tracing could produce significant inroads in controlling the outbreak. ACB members will be at the forefront of providing increased testing, providing assurance around quality and result interpretation. The effective use of any diagnostic test comes from the action on receipt of the result, which lends weight to the view that testing large numbers of patients must not occur in isolation, and should be part of a clear national strategy.

Antibody tests that have been rapidly produced by industry colleagues are being evaluated to establish what role they can play in understanding the transmission of, and immunity to, the virus. More NHS laboratories are increasing their molecular testing capacity as supply chain bottlenecks dissipate. This means that the experts in laboratory diagnostics can do what they do best; provide rapid, accurate results that make a real difference to patient care.

 

About the Association for Clinical Biochemistry and Laboratory Medicine

The Association for Clinical Biochemistry and Laboratory Medicine (ACB) is dedicated to the practice and promotion of Clinical Laboratory Medicine. We promote better science, better testing and better care through our membership comprising of Clinical Scientists, Medical Practitioners, Clinical Academics, laboratory healthcare scientists and leading diagnostic companies.

For further information: communications@acb.org.uk

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