Written evidence submitted by The Royal College of Pathologists (CLL0063)

The College has already submitted its COVID-19 Testing: a national strategy and other briefings, and Professor Jo Martin gave evidence on test, trace and isolate on 10 November. The responses below have been collated by the Chairs of the indicated Specialty Advisory Committees (SAC) to seek to give as wide a response as possible from the College and its members.

Dr Lance Sandle BSc MBChB CSci FRCPath FFCI

Registrar

Cellular Pathology:

From a cellular pathology point of view, what about ‘the effect of the pandemic on non-COVID patient pathways’?

I am thinking of patients with serious non-COVID conditions, like cancer and suspected cancer, etc.

Medical Microbiology & Medical Virology:

The one thing which appears to be missing from the list of suitable topics is antibody detection, how to do it and what it means, and also how you might apply this and if so what are the rules of engagement.

Toxicology:

From a toxicology perspective there is nothing direct but the following comments are made  

The first few are not directly related to toxicology

• the deployment of non-pharmaceutical interventions like lockdown and social distancing rules to manage the pandemic;  
• the impact on the social care sector;   
• the impact on BAME communities
• testing and contact tracing;   
• modelling and the use of statistics;   
• Government communications and public health messaging;   

The latter 2 have some indirect input with regard to preparedness to other national/ city wide disasters such as nerve agent attacks

• the UK’s prior preparedness for a pandemic- As a humble NHS clinical/forensic toxicologist I was never able to get the information about how our local areas would deal with a nerve agent attack
• the development of treatments and vaccines- again indirect, but I have never been able to get a collated response as to testing and treating if we do have another large nerve agent attack  

Immunology:

From the Immunology SAC, the main thing to add would be about serology/antibody testing for SARS-CoV-2.

Antibody testing was rolled out at reasonable speed by the government although we still do not have a clear strategy or plan on what we are meant to be using those tests for, beyond public health surveillance. In addition, evaluation of the various antibody assays appears to have been done in a relatively un-coordinated fashion with no clear direction from the government as to who was leading on this or how it should be carried out (or at least that is how it felt like).

Multiple individual labs were carrying out separate evaluations using different sera sets, and one wonders whether a more streamlined approach could have resulted in better use of resources. In addition, antibody testing can be done in all pathology networks now, but there is still a lack of any guidance on how they could be used to help with clinical management.

Given the resource that was spent setting up the antibody tests, it would perhaps be worthwhile thinking about how we could better use them?

Clinical Biochemistry

Specifically on the bullet points:

• the deployment of non-pharmaceutical interventions like lockdown and social distancing rules to manage the pandemic;   

       Clinical Biochemistry staff have been affected by social distancing in the laboratory, where keeping a safe distance is difficult due to the tasks and handover required, also preventative measures such as Perspex are impractical in the laboratory environment.

• the impact on the social care sector;

       A  more general point is the local PHE preference to use NHS labs (pillar 1) in preference to pillar 2 laboratories to support care homes. This is due to the interoperability and availability of clinical advice.

• testing and contact tracing; 

       Testing is a considerable drain on workforce resource, with flow of financial support not timely. Why NHS infrastructure was not used for all testing (identification, swabbing, transport, testing, resulting and advice) is not clear. What is clear that a pillar 1/pillar 2 model has led to increased risk and bureaucracy.

• modelling and the use of statistics;   

       The use of statistics has not been used effectively to devise strategy, but has been used to reinforce operational control. Modelling for, example on pooling, came out in April, however was adopted too late to ensure its affective use.

• Government communications and public health messaging; 

       Relatively clear to public. Not clear to NHS staff re infection control and planning for delivery of testing services. The Pathology community have been ineffective in articulating the complexity of Clinical laboratory work and COVID tests in particular.

• the UK’s prior preparedness for a pandemic;

       Lack of use of NHS infrastructure in planning. We did not need pillar 2, we did need the capacity, which should have been invested in those laboratories that showed competence.

More specifically Clinical Biochemistry has been involved in:

• Long COVID assessment and treatment
• Treatment and management of COVID. Algorithm development, POCT, novel biomarkers
• Flexible working. Many Clinical Biochemistry and Molecular trained staff have been involved in supporting the COVID laboratories, carrying  validation and verification
• Many of Technology validation centres have been led by Clinical Biochemists, as the technology is protein or antigen based
• Publications and Education. Clinical Biochemistry (medical or Scientific) have published an educated fellow laboratory staff, clinical staff and the general public.
• Restoration. The Clinical biochemistry departments have restored routine services, despite supporting the testing service
• Many of the Pathology Incident Directors are Clinical Biochemistry leaders.

Nov 2020