Pathology Versus Pandemics

Sir Jonathan Van-Tam
Pro Vice-Chancellor of Faculty of Medicine and Health Sciences, University of Nottingham and former Deputy Chief Medical Officer of the Department of Health and Social Care, UK.

Professor Mike Osborn
President of the Royal College of Pathologists and Consultant Histopathologist for North West London Pathology at Imperial College Healthcare NHS Trust, London, UK.

Tell us about the very early days of the pandemic…
 

Jonathan Van-Tam: In the very early days, we were looking at China and thinking, “We haven’t got much information here. Is this real? What does it represent? Does it or does it not feel like the start of another pandemic?” The point at which I knew it definitely was and that it was coming our way was January 16, 2020. My next realization was that we had a clearly severe disease heading toward us at 100 miles per hour and we were going to take a big hit, but we still had to get other politicians to realize it was real and not just a scaremongering story.

What were your initial priorities when you realized the extent of what was coming at you?
 

JVT: It was already too late to avoid the problem, so my initial priority was to get the National Health Service (NHS) as ready as we could; it already looked like bed availability in intensive care was going to be an issue. The other thing that immediately came to mind was that we need to get a vaccine – there is no time to delay.

Mike Osborn: At the Imperial College Healthcare NHS Trust, we were taking our lead from national healthcare professionals; of course, we are health professionals, but this was a pandemic accompanied by a nationwide response and therefore you have to listen and follow the advice of specialists in that area. I was talking several times a week with high-level people and royal medical colleges; we would discuss the situation and specialists would share how the colleges could work together. 

For the NHS and government organizations to best prepare and deliver the country’s COVID-19 response, individual groups were tasked with jobs that catered to their skill set. For example, my predecessor at the Royal College of Pathologists, Jo Martin, along with other members of the college, produced a national strategy for COVID-19 testing. She wasn’t in charge of the national policy, but we were able to provide data and guidance on how tests function, the various ways of using different tests, and what to look for in samples.

Other medical colleges and organizations provided guidance on infection control, how to diagnose and define the disease, and how to protect against it, while some colleges had input on how to carry on surgery during the pandemic, while protecting surgical patients. It was a mutual effort and there was a huge amount of collaboration that was critical to the success of the response.

When you were setting up your initial response, what role did you think pathologists and laboratory medicine professionals needed to play?
 

JVT: First of all, it was a new organism, so there were no readily available diagnostic assays – and those that were available were labor intensive, unsuitable for large-scale use, and required highly specialized staff. The need to upscale as much as possible was clear – and the laboratory medicine professionals at the heart of testing played an enormous role, swinging into action to significantly upscale diagnostic capacity across the world in record time.

Two and a half years on, our understanding of SARS-CoV-2 has changed a great deal – how have priorities shifted?
 

JVT: My main two priorities now are learning to live with COVID-19 in a way that wasn’t possible in early 2020 and recovering the health service and its staff. We also need to think of our next move with SARS-CoV-2 vaccines; our current vaccines are based on a form of the spike protein that is closely related to the wild-type variant, but we need to continue development to keep up with the virus’ evolution.

What lessons can we learn from COVID-19 for future pandemics?
 

JVT: We can’t predict the future, but, because of our increasingly close proximity to animals on an increasingly crowded planet, I have no doubt that there will be future zoonotic pandemics. Younger pathologists need to be careful not to dismiss COVID-19 as something that happened way back in 2020 and won’t happen again in their professional lifetime.

We have demonstrated the need for large-scale diagnostics in public health and infectious disease control, and we understand that we might need that kind of response again. I don’t think it’s possible to say the COVID-19 pandemic is over in the UK and that we won’t have problems with variants of concern in future, so we also have to be ready to upscale and reignite those widespread testing facilities we had during peak pandemic times.

Like many previous pandemics, we also learned that the way out of such crises is through vaccination and there is a clear need to develop more robust manufacturing infrastructure – not only in the UK but worldwide.

MO: These zoonotic events are inevitable, so you have to be prepared to deal with them; however, no two events are going to be alike. And that means you must learn broad lessons; for example, how to deliver messaging to politicians in a concise, defined, reliable way so they are best positioned to make public health decisions on a national level. They then need to make the public aware and keep them informed of what this means for them, their duties, and their responsibilities for maintaining their own health and the health of their families. Messaging needs to provide people with enough information to deal with the pandemic on a personal level, but needs to stop people from panicking and worrying. It helps to justify any dramatic policies, such as lockdowns, by giving intelligent – but simplified – information. Furthermore, relaying information around the importance of vaccination and how it is going to work has proved to be particularly useful.

During the pandemic, pathologists were involved in performing post-mortems on patients who had succumbed to COVID-19. And we have a post-mortem portal at the College that holds anonymous information on autopsies we have performed. Additionally, our members set up tissue banks around the world to store COVID-19-based tissue that, with consent, could be used for research or to develop vaccines or treatments. Importantly, these banks also hold post-mortem tissue – a valuable resource when dealing with a disease that can result in such varied outcomes, from mild illness to death. Certainly, it’s easy to acquire serum samples from less severe and recovering patients who are in hospital, but the tissue bank enabled researchers to explore very severe cases and compare and contrast both ends of the disease spectrum to gain a more complete picture of the disease. Going forward, we can use this same resource and apply it to future emerging threats.

How are pathologists helping advance COVID-19 knowledge?
 

MO: Pathologists and laboratory medicine professionals have played a huge role in learning about COVID-19, but let’s not forget that they play just as large a role in learning about diseases every day. We do this all the time and we will continue to develop our skills so that whenever the next threat arises, we’ll be ready for it. We have forged close collaborations with industry partners so that we can rapidly develop robust tests and roll them out on a national level. Many of these technologies were developed for COVID-19, but they are now being used for a range of diseases.

It’s important to realize that, although we live on this planet, we share it with millions of other species that have various bugs, diseases and bacteria – some of which can jump over to humans, like COVID-19. Veterinary pathologists investigating zoonotic diseases and transmission have always been vital, but this area is something that we now need to focus on even more.

Let’s talk about information and misinformation. What role should healthcare professionals play?
 

JVT: The UK’s response has always been to avoid engaging with misinformation because, when you respond to it, you amplify it and make it the center of attention. In my opinion, the best thing to do is to not engage with it directly; instead, release effective counter-messages that are clear, accurate, and speak in lay terms. Healthcare and research professionals tend to play to the professional language agenda and forget that complexity is not required when communicating with the public. Though it may appear demeaning to talk about science in ultra-simplistic terms, if you speak with the public enough, you come to understand that they’re looking for something they fully understand. As healthcare professionals, we forget that it isn’t just what we say, it’s how we say it – the whole communication package is important.

MO: Agreed. Messaging needs to be plain and simple, if you want it to strike home. Interestingly, that is also true when dealing with politicians; they need to understand what is going on and your points need to be backed up with proper data. When Chris Whitty and Patrick Vallance gave the daily COVID-19 briefings on national TV, they communicated their messages with charts and graphs. An image speaks 1,000 words in a way that everyone can understand.

The public eye is now cast more firmly on pathology and related disciplines – how do we keep it there?
 

JVT: The pandemic has drawn these professions into the public eye – and applications for these careers are rising. Now, we need to engage with the young people who are showing an interest and put together engagement activities to keep them interested. It’s not necessarily a once-in-a-lifetime opportunity, but we need to seize it now to draw in the next generation of budding scientists and laboratory medicine professionals.

MO: Realistically, the focus of the public eye moves all the time. During the COVID-19 pandemic, it was all over pathologists, laboratorians, doctors, and nurses; next week, it will be on the latest reality show or football scores. However, I think we’re in a good position to build on the level of understanding and appreciation to maintain a relationship with the media and discuss topics and issues that are pertinent to the population. Keeping our messaging relevant, simple, and interesting will keep people interested in our health communications. For example, monkeypox has kept lab medicine professionals in the public eye by making sure stories are sensibly covered with good messaging from people who can communicate well. When the gaze fully turns back to us, we’ll be in a position to build on it and not let it fade away.

What single key message would you like to send to the pathologists and laboratory medicine professionals – or the general public?
 

JVT: Pathologists and laboratory medicine professionals have put in a great shift during the pandemic. And, although it isn’t the most glamorous work, we really have needed and depended on you during these times. What I’d like the public to know is that some of the more silent professions in medicine have done an enormously fantastic job behind the scenes. We cannot thank them enough.

MO: You do a fantastic job; what you do underpins all healthcare. Pathologists conduct all blood, infection, and cancer testing (and more!) – even if you go to a primary care doctor, it’s still pathologists analyzing the tests and making a diagnosis. So you may not think you're interacting with patients and other healthcare professionals, but you are; you’re fundamental to everything. The public appreciates and understands this and you should be proud of and champion what you do because it’s fantastic. Healthcare would be on its knees without you.

For the public, I would say that we are here for you; you may not see us much in the background, but you wouldn’t have healthcare without us.

Watch Sir Jonathan Van-Tam deliver the Royal College of Pathologists Diamond Jubilee Foundation Lecture on lessons learned from the COVID-19 pandemic.