Impact of COVID-19 on laboratory medicine in Italy: national analysis of the EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) questionnaire

AUTORI

ABSTRACT

Dear Editor,

according to the World Health Organization (WHO), the European thus continent, including Italy, is experiencing a “polycrisis” and “permacrisis” that goes far beyond infectious disease epidemics, armed conflict, and climate change (1). The ongoing coronavirus disease 2019 (COVID-19) pandemic, which has hundreds of millions of confirmed cases and over 3 million recorded deaths in Europe (2), is another issue that has elevated public health to the top of the scientific agenda. Additional harmful situations include airline mishaps, terrorism and bioterrorism, civil unrest, earthquakes and tsunamis, fires, chemical, biological and radioactive emergencies, tornadoes, thunderstorms, and hail. Not to mention the harm caused by the ongoing Ukrainian war, which is worsened by horrific attacks on healthcare facilities and workers (3).
Laboratory medicine has mostly been unprepared for the majority of these natural, environmental and even human challenges (4,5). The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has hence made the decision to form a Task Force called “Preparation of Labs for Emergencies” (TF-PLE), which will work to enhance readiness and implement suitable laboratory diagnostic solutions in areas affected by various anthropogenic and non-anthropogenic emergencies. The terms of reference specifically call for taking steps to:
– survey the state-of-the-art in EFLM countries to comprehend the level of laboratory preparedness for emergencies and possibly establish (or identify) a benchmark;
– identify priority areas (i.e. types of emergencies) to become specific targets for laboratory medicine in emergencies;
– provide guidance on appropriate strategies to prepare laboratory medicine facilities to face these challenges.
The Task Force initially designed a special survey to gather comprehensive data about the emergency readiness of European laboratories, the results of which are presented and debated here.
A number of inquiries about the degree of interruption encountered by European and non-European laboratories during the first three years of the COVID-19 pandemic are included in the EFLM TF-PLE questionnaire (Figure 1). The layout was created with Google Forms and then made available to the roughly 12 000 prospective contacts of the EFLM via an official newsletter. Between May 8 and June 14 2023, responses were gathered. They were then entered into an excel spreadsheet and graphically plotted.
A total number of 235 responses, including 41 from Italy (20.5%), were received throughout the questionnaire’s online availability. The majority of Italian respondents (29/41; 70.7%) worked in public laboratories, with 34/41 (82.9%) of them employed in facilities that also provided urgent or stat tests. In terms of yearly testing volume, the percentages of laboratories performing fewer than one million tests, one to four million tests, five to eight million tests, and more than eight million tests were, respectively, 41.5%, 24.4%, 14.6%, and 19.5%.
Figure 1 summarizes the responses to the single questions. Essentially, “shortage of some non-COVID reagents and/or supplies” and “shortage of COVID reagents and/or supplies” were claimed by 65.8% and 80.6% of responders, respectively, in both cases for short periods of time. As it concerns the “impossibility to run all lab tests requested” and the “impossibility to run all COVID tests requested”, the positive replies were 51.4% and 62.1%, respectively, in both cases for short periods of time. Finally, during the past three years of the pandemic, up to 67.7% of respondents claimed to have occasionally experienced burnout, and 55.9% additionally reported an increase in patient animosity.
Taken together, the findings from the first EFLM TF-PLE questionnaire reveal that the ongoing COVID-19 epidemic has severely disrupted the integrity of laboratory diagnostics in Italy. A temporary scarcity of COVID and non-COVID reagents was reported by more than 60% of Italian respondents, and a slowdown in diagnostic activities was observed by more than 50% of Italian respondents. The American Association for Clinical Chemistry (AACC) reported similar numbers in its global questionnaire, which was set to expire in January 2021. In the American survey, nearly 80% of all respondent laboratories reported difficulty in carrying out routine testing or increasing testing capacity, while up to 60% of all respondents reported difficulty in obtaining all materials necessary to run all routine laboratory (COVID and non-COVID) tests. Approximately 70% of all respondents felt burnout during the final period of survey availability. Such a large influence on laboratory workout is not surprising, given that the volume of both COVID and non-COVID laboratory tests has been reported to have increased dramatically the pressure on clinical laboratories during the pandemic (7).
In conclusion, the information obtained from the initial EFLM TF-PLE questionnaire demonstrates that the COVID-19 pandemic has significantly impacted laboratory medicine in Italy, both in terms of availability of resources and well-being of the profession. Thus, in some areas of the laboratory arena, cultural change, proactive planning, and even reengineering may be necessary to be better prepared for the many predictable challenges of the future.

BIBLIOGRAFIA

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