Chasing the “New Normal”

Malcolm Bell, Co-Founder and CEO of Technopath Clinical Diagnostics, Fort Henry, Ireland

My primary work focus is on business development – managing the relationships with our customers and partners globally and developing the overall company strategy. I live in Ireland and I’ve gone from spending 50 percent of my time in the US to working entirely remotely – the new normal worldwide. I am pleasantly surprised by the unprecedented global experiment in working from home, given that I normally fly internationally almost every week.

One of the challenges of the current crisis is that many of our schedules are completely in disarray, especially with weekends blending into the working week. Work is becoming “unfiltered.” I receive text messages, emails, and unscheduled phone calls every day. The psychological benefit of looking forward to the weekend and having some restorative time with my family is, unfortunately, challenging when every day feels like the one before.

My company has been examining antibody responses to COVID-19. At this point, I would summarize the results into three buckets:

1. At the beginning of the pandemic, patients showed low levels of antibody production, which was worrying for both immunity and vaccine development.
2. We are now capturing data that shows very strong positive IgG results from totally asymptomatic donors through our testing with frontline responders in the US. Subsequently, we tested their partners and children over the age of 18. In all cases, partners and children were negative for antibodies. These results, albeit from a relatively small cohort, indicate that asymptomatic patients may not be infectious.
3. Determining seroconversion can be important for understanding the immune response and infection rates. Our findings indicate that seroconversion and antibody production are delayed, but increase significantly over time. As we continue to collect data from repeat donors, results indicate that antibodies levels increase 200 to 300 percent between weeks six and eight post-infection, potentially resulting in a good level of immunity. How long that immunity is sustained will be better understood as we continue to sample these patients.

Unfortunately, nearly half of the U.S. states are currently reporting a spike in new coronavirus cases. For healthcare professionals, my advice is to continue focusing on people exhibiting COVID-19 symptoms (rather than asymptomatic patients). It’s about considering a person’s viral load, immune response, and overall health – and multiple studies now report that viral load is highest at the time of diagnosis. For the rest of us, it’s best to reduce exposure to any amount of virus, because the virus is transmitted efficiently from symptomatic person to person. For those who are unsure, antibody tests can establish whether you have been exposed to the virus.

Despite the terrible disruption around the world, people are creatures of habit, and how society will change in response to COVID-19 remains to be seen. Personally, having my elderly parents live with us for almost six weeks and interact with our kids has been great. I do think it’s important to establish some structure separating weekdays from weekends so that the pandemic doesn’t steal valuable family time. We all need to find ways of engaging in leisure to help reduce uncertainty – for me, it’s fishing!

Esther Youd, Consultant Histopathologist at Royal Glamorgan Hospital, Llantrisant, UK

As a histopathologist, my experience of the pandemic has been mixed. Pathologists who perform autopsies, like me, have had to adapt to new ways of working – in particular, reducing the risk of infection from routine autopsy work. My day involves wearing a full gown, apron, cut-proof gloves (and two pairs of latex gloves), a face visor, and an FFP3 mask. Although this takes time to put on and take off and can be uncomfortable and dehydrating, I’ve quickly adapted to this new norm.

Autopsies have been a fascinating area for learning about COVID-19. We’ve encountered people who have died suddenly in the community of unknown cause and were ultimately found to have COVID-19. In addition, I’m one of only a few pathologists in the UK performing autopsies on patients known to have died of COVID-19. Such consented autopsies are vital to researching how the virus affects people and learning how to manage living patients. Researchers’ demand for tissue samples from patients who have died of COVID-19 far outstrips the availability of such samples. It’s a pity that such autopsy studies were not a planned part of the UK’s response to the virus; we could have learned far more if autopsies had been performed in more patients.

Although the autopsy practice has been demanding, the surgical histopathology and cytology workload has dramatically decreased. Investigations and surgical treatments for non-COVID-19 diseases have been largely suspended, with only limited urgent or cancer surgeries performed. This has given many departments the opportunity to catch up on the reporting backlogs they face due to the country-wide shortage of histopathologists – 97 percent of departments lack sufficient consultants (1). But as more services are restored, histopathologists anticipate a significant rise in workload as delayed investigations and surgical treatments catch up. New technologies are vital to managing this coming onslaught in the face of continuing workforce shortages. But that alone is not enough. For the long term, training numbers need to increase to provide a future workforce.

Fortunately, we’ve developed new approaches to working. For example, I currently do microscopy reporting and administrative work from home, use video conferencing for meetings, and remotely conduct my work as Assistant Registrar at the Royal College of Pathologists (with a positive impact on the time, travel, and the environment). Digital pathology has helped facilitate training for our registrars now that close proximity at a microscope is no longer appropriate and online conferencing tools have been a great way to continue teaching.

One thing the pandemic has given us is the chance to reflect on the value of what we do – and some breathing space to think about how we can do it in the future.