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In the final days of 2019, a new virus that was initially referred to as “Wuhan Pneumonia” was infecting its first hosts in the capital of central China’s Hubei province. About two months later, it had infected some 85,000 people and taken almost 3,000 lives.
Scientists identified this new kind of pneumonia as a coronavirus—the name of a large family of viruses found in both animals and humans, ranging from the common cold to more severe diseases like Severe Acute Respiratory Syndrome (SARS). This particular new virus is known as SARS-CoV-2 (COVIN-19) and the disease states are known as COVID-19.
As one would expect, as new cases of the infected around the world began to rise from the double digits into the triple and quadruple, social media channels from Twitter to TikTok turned into a free-for-all of fear, finger-pointing and conjecture. All the while, political and health leaders continued to tout different perspectives, adding to the confusion. Depending on which source is narrating, the problem can seem alarmingly serious or mildly disconcerting.
Meanwhile, cities in the U.S. Japan, South Korea, Italy, and Iran (among other countries) have given the situation public emergency status—some of them closing schools, transportation lines and quarantining areas as precautionary measures.
With such a mixed reaction from public health officials and political leaders, the media has turned to past events to make comparisons.
A History of Recent Viral Epidemics
The years 2003 and 2012 had their own mysterious boogeyman coronaviruses, SARS followed by MERS, in which victims died in about 10 percent and 35 percent of cases, respectively. By comparison, the new coronavirus has a much lower estimated mortality rate, ranging from 1 to 4 percent, with higher mortality at the epicenter in China.
But in early February, the number of deaths from the new coronavirus had surpassed the combined number of casualties caused by its previously named predecessors—just over 1,000—and almost tripled to 3,000 deaths by the end of the same month.
It begs the question: if the mortality rate is so much lower, why are there so many more deaths? Studies show that COVID-19 is more contagious than SARS or MERS. For every person diagnosed,, the COVID-19 is likely to be passed to three to four others, which is an exponential rate of increase. This is similar to the rate in which seasonal influenza spreads (based on current projections.)
Because of this, and the fact that the virus hasn’t been contained as successfully as one would hope, it has affected a much larger pool of people than SARS and MERS together. Now, experts are saying that if the outbreak were to go uncontrolled, it could affect two-thirds of the world population. Of course, this is a worst case scenario; the true outcome is yet to be seen.
Before we can understand the true severity of the virus, “There are questions we need answers to,” stated Tedros Adhanom Ghebreyesus, the director-general of WHO. This includes the specific source of the virus, the proportion of people that will ultimately become infected, and the timeline of the development of a vaccine. “Harnessing the power of science is critical for bringing this outbreak under control.”
To cut through the confusion of this ongoing health crisis, we turned to a scientist.
Meet the Expert: Dr. Rodney Rohde, Professor and Chair of the Clinical Laboratory Science Program at Texas State University
Dr. Rodney Rohde is a specialist of virology, microbiology, and molecular biology. He serves as the associate dean for research, department chair, and professor in the Clinical Laboratory Science Program within the College of Health Professions at Texas State University.
Dr. Rohde has experienced the fields of medical laboratory science and epidemiology firsthand. He spent the first decade of his life in a public health laboratory and zoonosis control division where he performed both laboratory testing and acted as a molecular epidemiologist for zoonotic agents, such as rabies, hantavirus, SARS, and the flu.
“There is a lot of power from the media and public perspective,” he said. “In addition to the good, solid, cautionary journalism that details and discusses the ongoing threats and new and scary outbreaks, we need to improve the dissemination of information.”
As a leader in clinical microbiology and medical laboratory education, Dr. Rohde wants to address the real issues when it comes to public health threats rather than playing into fear mongering, starting from the source of information on diseases—the labs themselves.
Who Are the People Involved in Managing Epidemics?
The first people that we think of that are involved in managing viral outbreaks are doctors and nurses, who are dealing with the patients on the frontlines. But the professionals behind the scenes are also instrumental in understanding and managing outbreaks like the coronavirus. They are the medical laboratory personnel team: the clinical microbiologists and generalist medical laboratory professionals.
“These laboratorians are strictly educated and clinically trained in the specific testing of hematology, immunohematology, clinical microbiology, and clinical chemistry so that they can perform medical laboratory testing,” Dr. Rohde said. Their tasks include sample taking, preparing and conducting chemical and biological analyses, and diagnosing patients.
Epidemiologists are also key players: “They devote more time to understanding prevalence, incidence [of diseases], and utilize techniques in statistical modeling and ‘in-the-trenches’ investigations to understand disease transmission,” Rohde said. They usually work at universities, public health institutions, government organizations or laboratories.
Trouble With Identifying the Virus
At the root of the problem for laboratorians is the challenge to quickly identify the virus in patients. It is not as simple as drawing blood and getting a positive or negative result.
China’s National Health Commission said officials in Hubei province were originally counting cases based on doctors’ analyses and lung imaging rather than relying on laboratory test results. As a result of changing the protocol, in mid-February, more than 13,000 new infections were reported within a 24-hour period, skewing the data to make it seem like the disease was spreading faster than it was.
So, keeping an accurate tally of the number of people infected, which is essential for planning and delegation purposes, is a problem in itself.
“The primary challenge with any laboratory test is to create a test that has high specificity and high sensitivity so that one will have little to no false positives or false negatives,” Dr. Rohde said.
As of early March, less than ten U.S. state health departments (as well as the CDC’s lab) have the ability to test for the virus. Suspicious cases far from these stations must be sent via express mail to be tested.
Other commercial tests are being developed, which will enable more health institutions to identify the virus, but so far, expanded screening for the coronavirus hasn’t been as fast as the public—or the government—would like.
Challenges for Laboratories and Hospitals
Another major concern is the ability to deal with a large influx of patients (sometimes referred to as a “surge”), should the disease become widespread, which is a real possibility.
“As we project outward with the potential for this to be a much longer situation, one of the things that we’re actively working on is projecting the long-term needs for our health care system,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases said in February.
Dr. Rohde agrees: “The primary challenge in any and all U.S. hospital medical laboratories and public health laboratories—if the new coronavirus becomes widespread—is the issue of both human resources and product resources.”
Hospitals need beds, protective gear for staff, as well as more expensive equipment like ventilators and ECMO machines, which are used to provide respiratory support for patients with lung complications, STAT reported. Most hospitals only have a handful or fewer of these machines onsite.
And within the labs themselves, test kits and other necessary products like reagents (i.e., a substance used in a chemical reaction to detect, measure, or make other substances) could run short if laboratories don’t have sufficient inventory.
“There is a concern about the number of testing kits available to confirm this virus, not only right now, but in the pipeline,” Dr. Rohde said in a podcast with Outbreak News Today. “Will those kits, which have been approved now by the CDC for the U.S. be pushed out to areas that don’t have the infrastructure, the laboratory infrastructure, or the testing personnel in a rapid or quick way?”
The Role of Medical Laboratory Professionals in Outbreaks
But perhaps the most valuable resource? The medical personnel themselves. “Many people do not realize that medical laboratory professionals have as bad or worse personnel shortages as other healthcare professionals,” Dr. Rohde said.
He is speaking of the ongoing shortage of medical laboratory scientists (MLS) and medical laboratory technicians (MLT) being felt in hospitals and laboratories across the U.S. The is a 7 percent average vacancy rate among medical lab positions, according to a recent survey. This deficiency has been going on since the 1990s, but over time, the problem has only gotten worse.
“It is ridiculous how we expect our public health agencies, healthcare, and medical laboratories to handle large-scale outbreaks, much less the daily workload, on a shoestring budget and a skeleton crew,” Dr. Rohde said.
“First, we as a nation and world must begin to understand the critical and necessary support for public health,” Dr. Rohde advised. Demand for medical laboratory technologists and technicians is forecasted to spike by 11 percent between 2018 and 2028—more than double the average increase in demand among all occupations, according to the U.S. Bureau of Labor Statistics.
Dr. Rohde says that science-oriented students are often steered towards medical school or nursing, or they are told to major in biology, chemistry or STEM, but are not always advised about the profession of medical or clinical laboratory science.
Labs and hospitals affected by the shortage overcompensate by piling more duties on current employees, which generally results in less efficient operations and longer wait times for patients. In normal circumstances, this is manageable, but in emergency situations—like with the new coronavirus—this poses more of a problem than simply longer wait times for patients.
“I know we will continue to see deadly new pathogens from the microbial realm (chikungunya, zika, Ebola, etc.), as well as ongoing visits from old foes (like influenza, tuberculosis, measles, healthcare associated infections such as MRSA), regardless of any actions we undertake,” Dr. Rohde wrote prophetically in November 2019.
As far as vaccine developments go, scientists have already created a few promising vaccine candidates. If these vaccines prove effective, they could be ready for larger-scale trials by June.
There are still plenty of questions about the coronavirus that remain unanswered for the time being, but if there’s one thing that we can learn from the coronavirus outbreak, it’s that we should expect anything. As Dr. Rohde said, “This is about as close to certainty as death and taxes… Microbes do not read the books or follow the rules. We must always be prepared.”
Nina Chamlou is an avid writer and multimedia content creator from Portland, OR. She writes about aviation, travel, business, technology, healthcare, and education. You can find her floating around the Pacific Northwest in diners and coffee shops, studying the locale from behind her MacBook.