Michael Perry, DrPH, MEd, director of the biodefense laboratory at the New York State Department of Health Wadsworth Center, remembers the February 2020 day when he encountered the state’s first SARS-CoV-2 specimen.
The virology laboratory asked Perry’s team to look at a concerning specimen that came in. “By the next week, our whole group was pulled in to help with increased specimen numbers,” he said.
Perry’s mind ran through a catalog of questions—do we have an assay to detect this? What safety precautions and procedures will we need? How will we assess risk? What is the right level of information to provide for something we know so little about?
COVID-19 caught the world off guard—including many public health laboratories. Aging laboratory infrastructure, along with a lack of high-containment laboratory capacity to keep pace with the surge, impacted testing and response nationwide. Supply chain issues and rigid contracts meant some public health laboratories didn’t have timely access to needed equipment. Shortages of staff properly trained for surge response led to laboratory team burnout.
How can public health laboratories ensure their infrastructure is ready for the next emergency? Lessons learned from the COVID-19 pandemic—and strategic use of pandemic-era funding and flexibility—are helping today’s public health laboratories prepare for tomorrow’s challenges.
Adjust Where Possible
Managing emerging needs during a pandemic surge can create challenges for public health laboratories. One such example is the need to train new staff members quickly.
Perry said it’s impossible to train team members brought in during a surge in every task. A strategy that worked well for him was training for specific, limited roles—like accessioning, extractions or reviewing results—to keep work moving.
During COVID-19, her team set aside time to batch prep work for extractions that required premixing certain chemicals. “Instead of doing it in real time, we’d prepare what we needed for certain measurements so we could grab and go as we were putting runs together,” she said.
Invest in Future Readiness
Many public health laboratories have used COVID-era funding to make changes that support readiness and response. Christina Egan, chief of the Biodefense and Mycology Laboratories and deputy director of the Division of Infectious Diseases at New York’s Wadsworth Center, said her division used COVID funding from the
US Centers for Disease Control and Prevention (CDC) and Prevention Epidemiology and Laboratory Capacity Program to address equipment needs identified during COVID.
“We acquired many computers,” she said. “We brought in all these people during COVID, but they needed computers. We also acquired tablets, which offered flexibility for tasks such as inventory, laboratory surveys and inspections.”
Management software was another critical investment, according to Egan. “These tools help track projects, inventory and personnel,” she said. “There’s so much that goes into running the laboratory outside of testing. We tried to be thoughtful in how we used these funds, anticipating our future needs.”
Cirrincione, who recently moved into a newly built facility, said she kept future readiness and response in mind when designing her space. “Our new laboratory has multiple autoclaves, so we’re not dependent on just one,” she said. “We also have flexible use spaces and training areas that we can turn into functioning laboratories if needed. We also have some shell space that we can turn into whatever we need. It gives us a lot more flexibility to respond.”
Flexibility and Redundancy
The COVID-19 pandemic demonstrated the importance of flexibility and redundancy in public health laboratories during emergencies. Procuring critical reagents, equipment and biosafety materials was often problematic. Planned redundancy can help ensure future readiness.
Cirrincione is using different equipment options to better manage supply chain issues that could affect laboratory operations. “Now, if one pipette tip is on backorder, we can switch to another,” she said. “I also now fit, train and test my people with two different types of respirators. We use N95s, but we also use powered air purifying respirators. We have both options because we ran out of N95s during COVID and now we can switch back and forth.”
Flexibility in contracts has also proved critical to managing both supply chain issues and needed personnel. In California, laboratorians who test specimens are required to have a state public health microbiologist license that requires a six-month training course and board exam—a requirement that severely limited capacity, said Jeremy Corrigan, DrPH, MS, director of agency operations and laboratory director at the
San Diego County Public Health Laboratory. “During the federal public health emergency, some personnel requirements were waived,” he said. “That opened doors for me to bring in bachelor-level scientists to support the surge.”
A key responsibility of Corrigan’s role is overseeing contracts and agreements. “Flexible language in contracts—such as the broader term ‘pathogen of concern’— and in data use and material transfer agreements is important,” he said.
Corrigan knows a thing or two about flexibility. Four weeks after moving to San Diego in 2022, his public health laboratory building was closed for structural deficiencies amid the COVID response. He stood up a temporary laboratory and recently opened a new, fully modernized laboratory building.
“This space is designed to be flexible, and to support new instruments,” he said. “We know the instruments we use today are not the instruments we’ll use tomorrow.”
Redundancy is also part of the readiness puzzle. Tactics like standing orders help ensure supplies are in place and eliminate administrative burdens. Multiple testing platforms also help keep work moving during a surge.
“We’re looking at having multiple instruments that can be used and validated as part of these assays,” Perry said. “The pandemic reaffirmed that supply chain resilience and data connectivity are vital to laboratory capabilities. Without access to reagents or the ability to share results in real time, even the best science stalls.”
Corrigan noted that while redundancy is important, it can add cost and complexity. “Looking back, the only way I was able to survive was to have different platforms because I did run out of reagents,” he said. “But with redundancy, you must validate each test and train your staff on them. So, redundancy is good and it’s bad.”
A Nimble Workforce
Perry said an agile, cross-trained staff is critical. “The pandemic required everyone from senior scientists to new hires to pivot quickly to unfamiliar workflows,” he said. “We realized how important it is to maintain a baseline of readiness across our entire workforce, not just among the specific response team.”
Cirrincione said Dallas County often sees unusual pathogens. “We’re used to one-offs, but COVID was a different ball game,” she said. “It was a lot of samples, and it was sustained. We can plan for all the scenarios, but it’s rarely going to hit the way you planned. If we’re not adaptable, we’re more likely to crack under the pressure.”
Repetitiveness and burnout affected her four-person team, which ran all the COVID samples, she said. “We would run 300 samples a day during COVID,” she said. “We’d start first thing in the morning and fax out paper test results by 6 p.m. I still have dreams about filling out those little bubbles indicating positive or negative and making sure they were correct. It was just constant going.”
Many laboratory teams took on new tasks that required new processes. “This was the first and only time in my 20-year public health career that we were asked to report results directly to patients,” Corrigan said. “Creating an electronic non-manual portal process to report results was critical to our success.”
Preventing team burnout during the next pandemic is something Perry thinks about a lot. “I’m not so worried about the next pathogen,” he said. “I worry about my group and the burden a surge has on them, especially the longevity of it. They’re the heart and soul of the testing and the work.”
To help prevent burnout, Wadsworth offers training to help enhance and enrich the scientific lives of team members, focusing on career development, mentoring and leadership pathways. “We want to give people a sense of progression and purpose beyond the bench,” Perry said. “We want to strengthen a creative and supportive culture that values work-life balance, celebrates achievements and recognizes the essential roles laboratorians play in protecting health.”
Corrigan said it’s important to monitor team morale, efficiency and burnout. It’s also important to consider different approaches to short-term and long-term surges. Asking team members to cover extra hours may work temporarily, but it’s not sustainable for a long-term surge. “In those instances, we need to bring in additional staff or rely on external partners such as commercial laboratories,” he said.
Nurture Strong Partnerships
Building relationships with community partners helps support readiness and response. Strong relationships require visibility, which builds trust and enables mutual aid, said Corrigan. “We have to share the great things we’re doing to keep the public safe on a day-to-day basis,” he said.
Corrigan said that through a state partnership with PerkinElmer, Inc., the county received high-throughput testing equipment. “I didn’t have space in my laboratory for these big instruments, but they did at UIHS,” he said. “I helped their laboratory manager get set up and trained so they could handle high-throughput testing. There was no cavalry coming to northern California—it was on us to handle. It was a great partnership between the county and the tribal nations.”
In San Diego, a laboratory testing task force met regularly during the pandemic to share resources and discuss challenges. Participants found the group so valuable that it has kept going. “It keeps us connected,” Corrigan said. “Knowing who to call in a surge—before you need help—is really critical.”
Perry said strong communication channels with epidemiologists, clinical laboratories, emergency management teams and first responders allow his team to move faster and more effectively. “The trust and shared experience that grows from training, exercising and communicating regularly makes real-world response faster, smoother and safer,” he said.
Cirrincione said she plans to use her new training space to strengthen partnerships with sentinel and hospital laboratories. “I have an open-door policy on biosafety,” she said. “My goal is to aid these laboratories in risk assessments and teach them what to look for when it comes to highly infectious disease—what’s a red flag, what they can send to us and how we can help them. We’re working to strengthen all our relationships moving forward.”
Innovation Supports Readiness
Boosting surge capacity in future emergencies requires embracing high-throughput instrumentation and robotics, according to Corrigan. “There just really isn’t any other solution,” he said. “Human power is not enough to keep up with the volume we see in a pandemic.”
Corrigan said he is now adapting all laboratory assays to be performed on high-throughput instrumentation. “I want them validated and ready to go,” he said. “We’ll pivot back to our lower-throughput efficient platforms, but now, I’m ready to turn on my high-throughput instrumentation when I need it. Liquid handlers and continuous loading platforms enable higher volumes. I’m boosting all my automation right now to make sure we’re ready for anything that comes.”
Other technologies beneficial to readiness and response include whole genome sequencing and wastewater surveillance. “I think of these capabilities as arrows in my quiver to look for pathogens of concern,” Corrigan said.
Yet ensuring public health laboratories are ready to respond also means not forgetting the lessons of the past.
“You can’t flip a switch on readiness. It has to be nurtured,” Perry said. “For me, that means building flexibility in staff and budgets, cross-training staff and maintaining supplier relationships long after a crisis ends. Sometimes, as we get separated from one incident to the next, it’s easy to think, ‘Do we really need to do that?’” But when something happens, you’re going to wish you maintained those capabilities for readiness.”