How COVID-19 has Reshaped Pathology
Sep 04, 2020 Cedars-Sinai Staff
COVID-19 has changed the way the world operates. With millions of people infected around the globe and a rising national death toll, the respiratory illness is having a dramatic impact on healthcare delivery, particularly in the realm of pathology and laboratory medicine.
Pathologists are not only charged with identifying the most efficient ways to detect COVID-19, they must also conduct standard pathology practices safely and effectively.
"Having an in-person presence is hard to replace. But with the pandemic, we're learning about which tasks we actually do as well—or better—remotely."
"During the first week of March, before the coronavirus really hit California, we were already transforming unused lab space into a biosafety lab focused exclusively on COVID-19 testing," says Dr. David Frishberg, chair of Pathology & Laboratory Medicine at Cedars-Sinai. "By March 21, we were turning around COVID-19 tests within eight to 14 hours."
Converting unused space into high-tech labs is an enormous undertaking, but the pandemic has produced a few silver linings. The adaptations doctors have made in response to the public health crisis may have a place within pathology for decades to come.
Pathology under the microscope
Pathology labs, which handle human biological samples, must establish safeguards to protect laboratory physicians and staff from contracting COVID-19 while continuing to offer comprehensive pathology services to all patients. Here are just a few ways Cedars-Sinai physicians are achieving that goal:
- Reducing on-site personnel: In March, shortly after doctors detected the first cases in the U.S., Cedars-Sinai adopted strict policies to limit the number of people on-site. "One of the first adaptations we made was to get people out of harm's way," Dr. Frishberg says. "During the early days of the pandemic, we sent many of our workforce home and rotated them every week or two." The only exception: staff who worked in the laboratories testing for COVID-19.
- Focused physical distancing: The novel coronavirus spreads through the small droplets our bodies generate when we cough and sneeze. That's why maintaining a physical distance of 6 feet or more from other people helps protect against transmission. The virus can also remain infectious on surfaces for extended periods. To reduce the risk of transmission in pathology labs, plastic shields are being installed to sit atop microscopes, and faculty and residents discuss cases while masked—when it's not possible to sit at least 6 feet apart.
- Increased screening: By July, standard surgical volumes were back up, in part because Cedars-Sinai's rapid COVID-19 testing allowed operating rooms to efficiently plan appropriate personal protective equipment for procedures. Cedars-Sinai continues to take precautionary measures to ensure safety of its staff and patients, including:
- Performing temperature checks for anyone entering Cedars-Sinai facilities, including staff and employees before the start of their shifts
- Requiring masks and minimizing the number of staff to ensure physical distancing
- Increasing disinfection protocols in all laboratories
- Greater use of technology: In the pre-pandemic model, pathologists sat side by side and reviewed slides through a dual microscope. Now, they stream video from microscopes, discussing slides remotely and hold tumor board meetings virtually. "New technology even allows us to scan slides digitally and share the detailed images," Dr. Frishberg says. "The quality of those images is far superior to a standard microphotograph."
The wave of the future
The COVID-19 pandemic is underscoring the need for remote access for pathologists and biological risk-management. Some of the clinical adaptations pathologists have implemented during the pandemic may not be temporary.
Take remote slide-reading, for example. "The pathology community has been interested in advancing remote slide-reading for more than a decade," Dr. Frishberg says. "In radiology, doctors collect X-ray information digitally and it goes into the computer.
"In pathology, we still have to examine the tissue, process the samples, which can take six to 12 hours, produce the slide and scan the slide. It's cumbersome, expensive and it slows things down."
While this process is still challenging, the demand for remote review created by COVID-19 has stimulated scaling up and developing protocols for specimens that can be digitalized more efficiently.
For example, doctors can scan small diagnostic biopsies on a single slide in less than five minutes and review it remotely. The Food and Drug Administration has given pathologists the go-ahead to use this process, called whole slide imaging, in response to the COVID-19 pandemic.
"We're conducting validation studies comparing the diagnoses pathologists arrive at with traditional glass slide protocols to those derived using these advanced imaging technologies," Dr. Frishberg says. "The results so far are very promising."
Tumor board meetings and other case conferences, too, may be best conducted in a virtual format, even after the pandemic ends. Instead of spending huge chunks of time navigating traffic and parking, doctors can meet remotely and share images through screen-sharing technology.
"Having an in-person presence is hard to replace," Dr. Frishberg says. "But with the pandemic, we're learning about which tasks we actually do as well—or better—remotely."