The Laboratory’s Role in COVID-19
The COVID-19 pandemic has thrown the world of laboratory medicine—which has always operated in the background—into the spotlight. The laboratory’s role in healthcare means laboratory professionals and pathologists are an integral piece of the pandemic puzzle. Pathologists and laboratory professionals develop, implement, and perform diagnostic tests. But what does this mean, exactly?
First, phlebotomists draw blood from patients and send it to the laboratory for testing. Important tests during the COVID-19 pandemic include liver enzymes, analytes that monitor kidney function, clotting assays, and blood cell counts.
After the blood is drawn, laboratory professionals, like those who specialize in hematology, analyze the blood. Sometimes this analysis is done manually (say, by looking at stained blood cells under a microscope), and sometimes they’re performed by large automated instruments.
Some tests, such the one for the virus that causes COVID-19, are performed using a swab of a patient’s nose or throat. Laboratory technologists perform these tests, too. It’s their job to make sure testing is performed in a timely manner, all systems are operating at peak function, and the results generated are accurate.
Pathologists play a large role in the everyday business of the laboratory, too. They oversee test validation—especially crucial when new tests, such as those for SARS-CoV-2, are created within the laboratory or by an accepted vendor. Pathologists also microscopically examine body tissues from COVID-19 patients in order to better understand the disease process and help guide treatment options for especially sick patients.
In addition, pathologists and pathologists assistants perform autopsies on patients who have passed away. Autopsies can be crucial in the beginning stages of an epidemic; they may play an integral role in discovering a new infective agent is causing disease in the population. Their expertise on how diseases affect the body will give researchers and clinicians important information on how to diagnose, treat, mitigate, and even cure an infectious disease.
TESTING
Let’s talk specifically about testing for COVID-19. There are two main types of testing: reverse transcription polymerase chain reaction (you may have seen this called RT-PCR) and serology testing.
RT-PCR
RT-PCR is a technique that makes millions of copies of a section of DNA or RNA specific to the virus being tested for. Once enough copies of this genetic material are made, they can be detected using sensitive analytical equipment. This is how laboratories are able to detect the presence of virus in the patient. When someone’s test for SARS-CoV-2 virus is positive, it means they’re currently infected with the virus and can potentially infect other people.
Serology Tests
Serology tests look for antibodies in the blood. When your body encounters a foreign invader—in this case, SARS-CoV-2—it mounts an immune response to try to kill or neutralize that invader. One part of this response are antibodies—proteins our cells generate that target a specific antigen. Serology tests generally can’t tell you if someone is currently infected, but it can tell you if someone has antibodies against a specific antigen—in this case the SARS-CoV-2 virus—which could indicate they’ve been exposed to or even sick with the virus.
Laboratory professionals and pathologists play a crucial role in making sure the right test is performed on the right patient at the right time. For COVID-19, this means they communicate with doctors and nurses to make sure RT-PCR testing is performed on patients who are suspected to currently have COVID-19 and serology testing is performed on patients that may have been infected with the virus in the past.
In addition, laboratory professionals and pathologists are integral to making sure tests accurately reflect what’s going on in the patient to ensure doctors can trust the results they generate. Laboratory tests must be:
- Accurate. This means the test result reflects what is actually going on in the patient.
- Precise. This means the same test performed on the same sample will generate the same result.
- Sensitive. This is a measure of how often a test is positive when the patient is actually positive for that condition. When a test is 99% sensitive, that means if 100 people with the virus are tested, 99 of them will test positive.
- Specific. This is a measure of how often a test is negative when the patient is actually negative for that condition. When a test is 99% specific, that means 99 people without the virus will test negative.
TREATMENT
In addition to diagnostic testing, laboratory professionals and pathologists contribute to patient treatment. This includes telling doctors which antibiotics will work for a patient’s bacterial infection, for example, or preparing units of blood for transfusions.
In cases of COVID-19, laboratories prepare and provide convalescent plasma. This is plasma taken from patients who have survived COVID-19 and so have antibodies in their blood. They donate their plasma so that it may be transfused into patients who currently have the illness. The antibodies in the donor plasma help patients fight off the infection. Blood bankers also prepare units of blood, plasma, and platelets as supportive therapy for COVID-19 patients.
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