As the world was preparing to celebrate n December 31, 2019, China began reporting to the World Health Organization (WHO), a cluster of cases of pneumonia of unknown aetiology in Hubei Province. One month later on January 30, 2020, after further outbreaks in 18 other countries, the WHO announced that a novel coronavirus, SARS-CoV-2, was responsible for this public health emergency of international concern. It was declared a pandemic on March 11, 2020.
In the United States, efforts to diagnose and trace the disease were crippled due to chaos surrounding development and availability of testing kits. Although WHO had approved a test developed in Germany (with public access to the protocol) on January 17, 2020, the United States elected to pursue its own solution through the Centers for Disease Control (CDC). The roll out of this test was marked with significant problems with the assay resulting in deadly delays in tracking and containing the disease. This critical failure of our medical system highlights the indispensable role that diagnostics play in the delivery of quality healthcare.
The lack of early, frequent, reliable diagnostic testing for the virus has created a public health disaster. The United States has tested approximately 5.2 million people as of 4/25/2020. While this sounds like a lot of tests, and the number of tests/100,000 people is very high in the United States, the number of cases in the United States is also significantly higher than other countries. When considering the number of tests relative to the number of cases, other countries are in a stronger position. Therefore, in order to effectively combat this disease, significantly more investment in rapid and accurate diagnostic testing is an absolute imperative to control COVID-19.
In many respects, the current pandemic has been a great equalizer across nations. High Income Countries (HICs) are experiencing what is commonplace in Low-and Middle-Income Countries (LMICs), a perpetual lack of both human and physical resources. In LMICs, the baseline disparity is even greater in diagnostic services including pathology, radiology and laboratory medicine.
The ability to render a diagnosis is a cornerstone of disease prevention and treatment. Diagnostic testing, performed in a timely manner, plays a decisive role in disease management. Accurate diagnosis not only permits early institution of treatment and reduced hospital stay, but also limits other problems such as development of antibiotic resistant bacterial strains and other medical errors. Diagnostic weaknesses anywhere impact pandemic response everywhere. Each delayed diagnosis of COVID-19 poses an increased public health and public security risk for every person that infected individual has contact with during the incubation and asymptomatic period.
Thus, an urgent call to action for all stakeholders in healthcare should be set in motion immediately:
- We call on transparency in data regarding coverage of essential health services. In its 2030 agenda, the United Nations developed the Sustainable Development Goals (SDGs). SDG 3 is the goal targeting health and well-being for all. Universal Health Coverage was pioneered under the auspices of SDG target 3.8 with indicator 3.8.1 measuring coverage of essential health services. Data collection and tracking methods for this indicator are not made publicly available, in contrast to the other indicators. Diagnostic services are indeed essential and must be tracked.
- We call for increased governmental prioritization of diagnostics, namely pathology, radiology, and laboratory medicine. These services are still lacking, particularly in LMICs. Reasons include the high cost of equipment, the absence of a body of literature on diagnostics as it relates to LMICs, and the lack of diagnosticians and specialists.
- We call on health educators to employ curricula that emphasize total health system preparedness, including access and development of diagnostic services. This is paramount for any practitioner’s training, regardless of their future specialty.
While pandemics are as old as human existence, the COVID-19 crisis is a new challenge for the 21st century. We cannot see the enemy, but we can detect it. The role of diagnostics in combatting this virus and improving healthcare quality overall, has never been more apparent.
About the authors:
Hiba Ghandour, MD is a research associate in Harvard Medical School’s Program in Global Surgery and Social Change and a future cardiothoracic surgeon. Her research interests include access to affordable and quality cardiothoracic surgery in low income countries. She is also interested in surgical preparedness, surgical outcomes and national surgical policy design.Twitter: @hibazghandour
Sarwat Hussein MD, FACR, FRCR is a Professor of Radiology at the University of Massachusetts and is part of Consultant Radiologists at Richmond VA Medical Center. He is the previous Founding Chairman of Radiology in the Aga Khan University in Pakistan as well as the previous Chairman of Radiology in the King Faisal Specialists Hospital and Research Center in Saudi Arabia.
John Meara MD, DMD, MBA is the Kletjian Professor of Global Surgery, Director of the Program in Global Surgery and Social Change, and Professor of Surgery in the Department of Surgery at Harvard Medical School. Dr. Meara serves as the Plastic Surgeon-in-Chief of the Department of Plastic & Oral Surgery at Boston Children’s Hospital. He currently serves as a commissioner on the Lancet Commission on Diagnostics. . Twitter: @JohnMeara
Craig McClain, MD, MPH is a pediatric anesthesiologist and a Senior Associate in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children’s Hospital. He is faculty at the Program in Global Surgery and Social Change at HMS . He also serves as the Director of the Global Pediatric Anesthesiology fellowship in his department at BCH. He is Co-Director of the Pediatric Neuroanesthesia Service at BCH.Twitter: @McC_Craig
No competing interests to declare