New Lab Matters: Biosurveillance and the opioid epidemic

Lab Matters Spring 2020, Issue 2

The opioid crisis remains a public health emergency in the United States, with more than 67,000 drug overdose deaths in 2018. Forensic and crime laboratories provide data on fatal opioid overdoses, but a sole focus on fatalities omits valuable data that could be used to protect communities. In this issue’s feature article, we discuss how public health laboratories can play a vital role in battling this crisis by contributing their analytical capabilities and knowledge of public health surveillance systems.

Here are a few of this issue’s highlights:

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New Lab Matters now available: Unsustainable

According to data published by the advocacy group Trust for America’s Health, there is a $4.5 billion gap between current funding levels and what is needed to achieve “an adequate level of public health protection” nationwide. Even though budget news for FY2020 is better than it has been, it continues a worrying, long-term trend of public health underfunding and public health laboratories being forced to draw on short-term crisis funding to maintain day-to-day activities. In this issue’s feature article, we examine the challenges that public health laboratories face, especially during the COVID-19 response.

Here are a few of this issue’s highlights:

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COVID-19 Testing Needs to Be Limited to Priority Groups Until Sufficient Testing Supplies and Personal Protective Equipment is Available Nationwide

Prioritize testing for COVID-19 image

The Association of State and Territorial Health Officials (ASTHO), Association of Public Health Laboratories (APHL) and Council of State and Territorial Epidemiologists (CSTE) issued the following policy recommendations regarding testing for the novel coronavirus (COVID-19).

Due to the widescale shortages of laboratory supplies and reagents, we strongly urge public health and healthcare professionals to prioritize COVID-19 testing among three specific groups:

  1. Healthcare workers and first responders with COVID-19 symptoms.
  2. Older Americans who have symptoms of COVID-19, especially those living in congregate settings.
  3. Individudals who may have other illnesses that would be treated differently if they were infected with COVID-19 and therefore physician judgement is especially important for this population.

Testing for individuals outside these three groups is not recommended until sufficient testing supplies and capacity become more widely available.

Community-based COVID-19 testing (drive-through, walk-up, etc.) should be focused on making tests available to the three priority groups above. The goal of providing these community-based testing sites is to limit potential introduction of COVID-19 in healthcare and congregate settings.

While some communities may have sufficient testing supplies and/or personal protective equipment (PPE) to expand COVID-19 testing to other groups, mass testing of any American for COVID-19 at this time will quickly deplete the existing supply of testing reagents, laboratory supplies, and PPE needed to manage patients in clinical, in-patient and other residential settings.

Healthy individuals who are not able to get tested should practice social-distancing and follow the recommendations of their local and state public health authorities. Individuals with mild illness should stay at home, practice self isolation, monitor their health and manage their symptoms using self-care, and contact their health care provider if their symptoms get worse.

For more information on COVID-19, including guidance and guidelines for healthcare and public health professionals, visit: www.cdc.gov/covid19

For more information on ASTHO, including resources for state and territorial health agencies, please contact preparedness@astho.org, or visit https://www.astho.org/COVID-19/.

For more information on APHL, please contact info@aphl.org or visit www.aphl.org/COVID-19.

For more information on CSTE, visit www.cste.org or call 770-458-3811.

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New Lab Matters: Making data fly

Cover of Fall 2019 issue of Lab Matters magazine illustrating high volume of data

In today’s technology-connected world, information moves quickly. But in the world of public health, pathogens often travel faster than the data needed to diagnose, treat and prevent illness. Reporting delays and incomplete or incompatible data delay insights into pressing public health problems. The solution? Investing in public health infrastructure and resources to rapidly deliver data to public health and clinical decision makers.

Here are a few of this issue’s highlights:

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Supporting rapid exchange of public health data is urgent, crucial and laden with challenges

By Jody DeVoll, advisor, communications, APHL 

In an era when digital communications move at blazing speeds, public health laboratories still have to resort to fax, email or phone to exchange data with some partners. Yet, this is only one of the obstacles to rapid exchange of critical public health laboratory data needed for public health surveillance, emergency response and patient care.

The volume of public health laboratory data presents an obstacle in and of itself. Infectious diseases, environmental toxins, foodborne illnesses, radiological exposure, hazardous chemicals, high consequence pathogens, antibiotic resistance: public health laboratories test them all. Add to this exponential increases in volume from the expansion of advanced molecular technologies like next-generation and whole genome sequencing, and the result is terabytes of data that public health laboratories must manage, interpret, store and share.

In addition, dozens of different, stand-alone systems make programming and maintenance of laboratory reporting systems labor-intensive and costly. For example, the US Centers for Disease Control and Prevention (CDC) maintains over 100 surveillance programs, each with its own reporting system. Dari Shirazi, APHL’s health information technology manager, explains how these many systems affect public health laboratory operations: “It’s as though you have a houseful of furniture to arrange in dozens and dozens of different houses and, periodically, you receive shipments of additional furniture that also has to be arranged.”

Of course, CDC is not public health laboratories’ only data exchange partner. Other federal partners, state and local health agencies, hospitals and others also require laboratory data, and they too want it parsed and transmitted through their proprietary systems.

With all these demands, data scientists at public health laboratories face a mountain of work, yet their numbers are few. The number of graduates in public health informatics has not kept pace with demands for workers from public and private sector institutions. As a result, graduates can choose from an array of positions, and they often choose private sector jobs which tend to be higher paying and longer-term than lower-salaried, time-limited positions at a public health laboratory.

Huge data volumes, a multitude of reporting systems and a shortage of public health data scientists make data exchange a laborious, costly and frustrating enterprise for public health laboratories. However, the implications extend beyond laboratories to the populations the data is intended to protect, in other words, us. According to Peter Kyriacopoulos, APHL’s senior policy director, “We are fast approaching the confluence of events on the management of public health data that threatens the very relevance of governmental public health. The volume of data generated by new laboratory technologies adds to the burden of over 100 inefficient data reporting systems that each have been designed to move specific information to a point at CDC, which constrains the utility of that information.

Fortunately, there are signs of change. Four national health organizations — APHL, the Healthcare Information and Management Systems Society (HIMSS), the Council of State and Territorial Epidemiologists (CSTE) and the National Association for Public Health Statistics and Information Systems (NAPHSIS)  – launched the Data: Elemental to Health campaign calling for a $1 billion investment in congressional funding over the next decade to modernize public health data/IT systems and develop a skilled workforce of data/IT specialists. Under the plan, state, local, tribal and territorial health departments would receive direct funding for these purposes through the CDC.

Over the last six months, the campaign has convened stakeholders, made the case for improved data systems to congressional and administration staff, appeared before the House Appropriations Subcommittee, hosted Hill briefings and organized a Day of Digital Action. Already there are results:

  • The House appropriations bill includes $100 million in fiscal 2020 for public health data systems and workforce modernization
  • The House LIFT America Act authorizes $100 million per year for five years to develop public health data systems and train staff
  • The Senate Saving Lives Through Better Data Act authorizes $100 million per year for five years for systems and people
  • The Senate Lower Health Care Costs Act authorizes “such sums as may be necessary” over five years to modernize data systems.

How would legislation initiated through the campaign support public health laboratories? First and foremost, it would help them to strengthen their LIMS. Shirazi explains, “A LIMS is a living, breathing thing that has to grow with lab needs. These needs change every year as the lab takes on new and novel types of testing.” Building LIMS capacity would enable laboratories to expand capability for data capacity, exchange and analytics; eliminate manual entry of test results; and provide secure, instantaneous communication of results to health partners. In addition, legislation initiated through the campaign would underwrite laboratory systems for exchange of electronic health records, National Notifiable Disease Surveillance System data, vital health records (e.g., notices of births and deaths) and other public health surveillance data.

Looking forward, the US would do well to complement the advances initiated under the Data: Elemental to Health campaign with a data transfer solution that consolidates all public health data systems into one. Kyriacopoulos notes that: “the creation of a single reporting site, that multiple data providers and users can report to and receive information from, would be a significant improvement that would allow for the efficient and comprehensive use of this data throughout the federal/state/local public health system.”

 

Photo credit: James Marvin Phelps

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New Lab Matters: A game-changer in the fight against antibiotic resistance

New Lab Matters (cover): A game-changer in the fight against antibiotic resistance

Given the global rise of drug-resistant pathogens over the past few decades, some physicians and scientists warn of a possible antibiotic apocalypse—a scary, post-antibiotic era. But a $160 million CDC effort now aims to keep antibiotic resistance rare. And as our feature article shows, the “game-changing” keystone of this effort is the Antibiotic Resistance Laboratory Network.

Here are just a few of this issue’s highlights:

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New Lab Matters: The promise and challenge of newborn screening in 2019

New Lab Matters cover depicts a newborn baby

Newborn screening is a public health success story, ongoing for 56 years. On the one hand, new treatment and laboratory testing options open up the possibility of expanded screening panels. On the other hand, testing laboratories and follow-up providers are generally under-resourced and straining to keep pace with growing workloads. But as our feature article shows, scientists are working diligently to improve the accuracy and precision of existing tests and to bring on new disorders, even as they continue the high-stakes work of screening tens of thousands of infants a year.

Here are just a few of this issue’s highlights:

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New Lab Matters: The ABCs of PFAS

New Lab Matters: The ABCs of PFAS | www.APHLblog.org

First discovered in the 1930s, per- and polyfluoroalkyl substances (PFAS) now pervade almost every aspect of modern life. In fact, PFAS compounds are found in everything from dental floss to cookware. But human exposure to PFAS comes at a cost, and as old compounds are removed from production, new compounds take their place. So how does a public health laboratory handle this challenge with limited resources? As our feature article shows, by establishing new public-private partnerships.

Here are just a few of this issue’s highlights:

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New Lab Matters: Time to welcome the next generation of public health laboratory scientists

New Lab Matters: Time to welcome the next generation of public health laboratory scientists | www.APHLblog.org

The Bureau of Labor Statistics estimates that 12,000 new laboratory professionals are needed each year to meet consumer demand. At the same time, while automation has eliminated some less-skilled laboratory jobs, the growing sophistication of public health laboratory analyses has generated demand for scientists with highly specialized training. As our feature article shows, laboratories are recruiting new talent for the “hidden profession” by taking a hard look into what they really want, and how they want to work.

Here are just a few of this issue’s highlights:

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New Lab Matters: When the water comes, be prepared

New Lab Matters: When the water comes, be prepared | www.APHLblog.org

According to a study by the National Center for Atmospheric Research, the volume of rainfall from storms will rise by as much as 80% in North America by the end of the century. Not only do storms and floods threaten public health laboratory facilities, but receding floodwaters pose serious public health risks. As our feature article shows, the best weapon in a public health laboratory’s arsenal is preparation for inundation…from any source.

Here are just a few of this issue’s highlights:

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