Beyond the laboratory: how COVID-19 reshaped specimen collection, testing workflows, and diagnostic algorithms

Area of Science:

• Public Health Laboratory Science
• Infectious Disease Diagnostics
• Epidemiological Surveillance

Background:

• The SARS-CoV-2 pandemic necessitated a significant scale-up of public health laboratory functions.
• Key shifts included decentralization, self-sampling, less invasive specimens, point-of-care testing, and new surveillance methods.

Purpose of the Study:

• To highlight critical changes in public health laboratory operations driven by the pandemic.
• To discuss challenges and future directions for respiratory virus testing and surveillance.

Main Methods:

• Perspective piece analyzing shifts in laboratory services during the pandemic.
• Review of decentralized testing, self-sampling, and point-of-care device implementation.
• Examination of diagnostic accuracy challenges with alternative specimens and rapid tests.

Main Results:

• Decentralized testing and rapid lateral flow tests increased due to demand, offering speed and affordability.
• Variable diagnostic accuracy of self-tests and alternative specimens (e.g., saliva) compared to molecular assays.
• Increased testing for respiratory pathogens post-pandemic, potentially due to immunity debt and multiplex panels.

Conclusions:

• Over-the-counter self-tests are now prevalent, but require enhanced regulatory oversight and data connectivity.
• Decision-makers must balance testing access with clinical performance for acute respiratory infections.
• Implementation of robust diagnostic stewardship programs is crucial for effective management.