An Overview of the Outbreak

We asked pathologists and laboratory medicine professionals to tell us how their professional and personal lives have changed during the COVID-19 pandemic.

Jeffrey Myers, A. James French Professor of Diagnostic Pathology and Vice Chair for Clinical Affairs and Quality, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA

COVID-19 has changed everything. Just one day before hosting an off-campus strategic planning event for our laboratories on Thursday, March 12, our university president announced the cancellation of all classes – to resume on Monday, March 16, using alternative formats for remote participation until the end of the semester (April 21). He also announced a halt to all international travel and any university activities that would convene more than 100 people, and strongly discouraged domestic travel. Now that April 21 has come and gone, none of these things have changed – except that we now avoid convening more than five people.

Over the last five weeks, we have seen COVID-19 cases in our state jump from two to 30,791; of those, 870 are in the county in which we work. We immediately created and operated a Regional Infectious Containment Unit and, over a period of just four weeks, converted much of our hospital to COVID-19 care. We’ve all learned about social distancing practices and the importance of respiratory etiquette and frequent hand hygiene. We’ve adjusted to reduced workloads in many, but not all, areas by dividing ourselves in half and working every other week to comply with an executive order to “stay home and stay safe.” We’ve grown familiar with places we might never have heard of otherwise: Wuhan, the Lombardy region, and others. Collectively, we’ve monitored not just each other’s health, but also that of Tom Hanks, Boris Johnson, and many others whose names have drifted across our newsfeeds and newspapers. Our vocabularies have expanded to include a bewildering array of terms and acronyms – RICU, PUI, CoV2, PPE, PAPRs, PPP, and more. We’ve asked for pathologist volunteers to set up a field hospital that has not yet, and may never, come to pass, learning along the way that many were willing to do whatever it took to help on the frontlines of this devastating pandemic.

We have been reminded daily of the laboratory’s importance in caring for the sick and safeguarding public health. Laboratory professionals unable to do their work from home instead chose temporary residence in hotels to be closer to their 12-hour shifts. Their work included developing – in record time – a test that went live with a daily capacity of 60 and quickly grew to 1,100. Since then, our capacity to test has been limited not by our ability to do the work, but by the availability of the supplies required to collect specimens. Of the 1,500 members of our workforce tested to date, 290 were positive for SARS-CoV-2.

We began today with the lowest number of COVID-19 patients since April 2. We peaked on Wednesday, April 8,followed by a plateau and now likely a decline. As of this morning, nearly 60 of our patients have died and passed through our morgue. Nearly a dozen of them underwent autopsy examination, sharing what remained of their worldly selves so that others might learn more about a novel virus to which none of us was immune and for which specific and effective treatments remain largely theoretical.

There is much work to do on our way back to whatever the “new normal” may be, recognizing that the risk of COVID-19 remains ever-present and a threat to our community, our university, and our health care providers. But whatever else I may remember about the COVID-19 pandemic, I will remember the remarkable work done by staff, trainees, and faculty in just five weeks.

George Netto, Robert and Ruth Anderson Endowed Chair, UAB Department of Pathology, University of Alabama at Birmingham, Alabama, USA

Our department faculty and staff have been  proactive and nimble in our response to COVID-19. Pathologists and laboratory medicine professionals, both here at UAB and nationally, have been at the forefront of fighting this pandemic. We are used to working behind the scenes – but now, our colleagues have stepped up to tackle COVID-19.

For example, thanks to the efforts of Sixto Leal, Assistant Professor of Laboratory Medicine, and our talented molecular pathology faculty, UAB was among the first academic medical centers in the country to offer in-house testing by launching a laboratory-developed COVID-19 RNA test over a month ago. We are currently testing 300–500 patients and healthcare workers daily, with a turnaround time of less than 24 hours. This includes all inpatient admissions, all patients undergoing surgical procedures at UAB Hospital, and labor and delivery patients. A second COVID-19 RNA testing platform with less than two hours’ turnaround time is now operational. Our ability to scale up to high-throughput testing has allowed us to support rural and affiliate hospitals throughout the state; we have faculty working full-time in more than half a dozen smaller hospitals, meeting a crucial need. Testing materials are becoming increasingly scarce, but our faculty are partnering with the UAB Department of Biomedical Engineering, other departments across campus, and national academic centers to create innovative solutions for shortages of nasal swabs and other testing materials.

Serological testing, believed to be the next phase in tackling this pandemic, launches in our department in the Immunology Lab led by José Lima this week to help assess patients, employees, students, and healthcare workers for COVID-19 exposure. This will be critical to reopening clinical, research, and educational services at UAB. 

Our administrative teams work tirelessly behind the scenes to adapt to remote work, from enabling educational opportunities for trainees to ordering food for clinical staff to facilitating online meetings. The laboratory medicine team helped organize and promote blood drives at the outset of this pandemic so that our blood supply levels – which were critically low – have leveled off.

We can talk about our frustration with the lack of federal response or planning to keep our healthcare workers safe – but today, we focus on forging ahead and making a difference toward reopening our country. We hope to learn some hard lessons from this experience that will improve our healthcare system in the immediate future.