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Dutch Patient with Longest COVID-19 Case of 612 Days Had More than 50 SARS-CoV-2 Mutations Before He Died

Study of the 50 Omicron variants could lead to new approaches to clinical laboratory testing and medical treatments for long COVID

Patients infected with SARS-CoV-2 can usually expect the COVID-19 illness to subside within a couple of weeks. However, one Dutch patient remained infected with the coronavirus for 612 days and fought more than 50 mutations (aka, variants) before dying late last year of complications due to pre-existing conditions. This extreme case has given doctors, virologists, microbiologists, and clinical laboratories new insights into how the SARS-CoV-2 virus mutates and may lead to new treatments for long COVID.

According to Scientific American, when the 72-year-old male patient was admitted to the Amsterdam University Medical Center (Amsterdam UMC) in 2022 with the Omicron variant of SARS-CoV-2, he was also found to have myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN) overlap syndromes. Thus, the patient was determined to be immunocompromised.

“This was complicated by the development of a post-transplant lymphoma for which he received rituximab [a monoclonal antibody medication used to treat certain autoimmune diseases and cancers] that depletes all available B-cells, including those that normally produce the SARS-CoV-2 directed antibodies,” according to a press release.

The medication the patient was taking for his pre-existing conditions may have contributed to his body being unable to produce antibodies in response to three shots of the Moderna mRNA COVID vaccine he received.

Magda Vergouwe, MD, PhD candidate at the Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, who lead a study into the patient, theorized that some of the medications the patient was on for his pre-existing conditions could have destroyed healthy cells alongside the abnormal cancer-causing B cells the drugs were meant to target.

“This case underscores the risk of persistent SARS-CoV-2 infections in immunocompromised individuals,” the researchers said prior to presenting their report about the case at a meeting of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in Barcelona, Spain, Time reported. “We emphasize the importance of continuing genomic surveillance of SARS-CoV-2 evolution in immunocompromised individuals with persistent infections.”

“Chronic infections and viral evolution [are] commonly described in [the] literature, and there are other cases of immunocompromised patients who have had [COVID] infections for hundreds of days,” Magda Vergouwe, MD, PhD candidate (above), Center for Experimental and Molecular Medicine at Amsterdam UMC, told Scientific American. “But this is unique due to the extreme length of the infection … and with the virus staying in his body for so long, it was possible for mutations to just develop and develop and develop.” Microbiologists, virologists, and clinical laboratories involved in testing patients with long COVID may want to follow this story. (Photo copyright: LinkedIn.)

Risks to Immunocompromised Patients

Pre-existing conditions increase the risk factor for COVID-19 infections. A 2021 study published in the Journal of the American Board of Family Medicine (JABFM) titled, “Prevalence of Pre-existing Conditions among Community Health Center Patients with COVID-19,” found that about 61% of that study’s test group had a pre-existing condition prior to the outbreak of the COVID-19 pandemic.

When the Dutch man was admitted to Amsterdam UMC with common and serious COVID-19 symptoms, such as shortness of breath, a cough, and low blood oxygen levels, he was prescribed sotrovimab (a monoclonal antibody) along with other COVID treatments.

About a month after being admitted his COVID-19 symptoms decreased, so he was first discharged to a rehab facility and then finally to his home. However, he continued to test positive for the coronavirus and developed other infections that may have been complicated by the persistent case of COVID-19.

The Amsterdam UMC doctors emphasized that the man ultimately succumbed to his pre-existing conditions and not necessarily COVID-19.

“It’s important to note that in the end he did not die from his COVID-19,” Vergouwe told Scientific American. “But he did keep it with him for a very long period of time until then, and this is why we made sure to sample [the virus in his body] as much as we could.”

One in Five Adults Develop Long COVID

Long COVID does not necessarily indicate an active infection. However, in as many as one in five US adults COVID symptoms persist after the acute phase of the infection is over, according to a study published recently in JAMA Network Open titled, “Epidemiologic Features of Recovery from SARS-CoV-2 Infection.”

“In this cohort study, more than one in five adults did not recover within three months of SARS-CoV-2 infection. Recovery within three months was less likely in women and those with pre-existing cardiovascular disease and more likely in those with COVID-19 vaccination or infection during the Omicron variant wave,” the JAMA authors wrote.

The origins of long COVID are not entirely clear, but according to the National Institutes of Health (NIH) it can develop when a patient is unable to sufficiently rest while battling off the initial virus. According to Vergouwe, the SARS-CoV-2 genome will always grow quicker when found in a patient with a compromised immune system.

Unique COVID-19 Mutations

More than 50 new mutations of the original Omicron variant were identified in the Dutch patient. According to Vergouwe, “while that number can sound shocking, mutations to the SARS-CoV-2 genome are expected to evolve more quickly in those who are immunocompromised (the average mutation rate of the virus is estimated to be two mutations per person per month),” Scientific American reported. “What does make these mutations unusual, she noted, is how their features differed vastly from mutations observed in other people with COVID. [Vergouwe] hypothesizes that the exceptional length of the individual’s infection, and his pre-existing conditions, allowed the virus to evolve extensively and uniquely.”

COVID-19 appears to be here to stay, and most clinical laboratory managers and pathologists understand why. As physicians continue to learn about the SARS-CoV-2 coronavirus, this is another example of how the knowledge about SARS-CoV-2 is growing as different individuals are infected with different variants of the virus.

—Ashley Croce

Related Information:

Longest-Ever COVID Infection Lasted More than 600 Days

COVID Patient’s Infection Lasts Record 613 Days—and Accumulated Over 50 Mutations

72-Year-Old Patient Had COVID for Record 613 Days, Accumulated over 50 Mutations from Virus Before It Killed Him

Prevalence of Preexisting Conditions among Community Health Center Patients with COVID-19: Implications for the Patient Protection and Affordable Care Act

The Risk Factors for Long COVID Have Finally Been Revealed

Prevalence of Pre-existing Conditions among Community Health Center Patients with COVID-19

Epidemiologic Features of Recovery from SARS-CoV-2 Infection

Genetic Testing of Wastewater Now Common in Detecting New Strains of COVID-19 and Other Infectious Diseases

Clinical Laboratory Technician Shares Personal Journey and Experience with Burnout During the COVID-19 Pandemic

It’s not only medical laboratory technicians, healthcare workers across the board continue to deal with extreme pressures that preceded the pandemic

Burnout in healthcare is a constant problem, especially in overstressed clinical laboratories and anatomic pathology groups. To raise awareness about the plight of medical laboratory technicians (MLTs) and other frontline workers in the healthcare industry, a former lab tech recounted her experience during the COVID-19 pandemic that led to burnout and her departure from the lab profession during 2020-2021.

Suzanna Bator was formerly a laboratory technician with the Cleveland Clinic and with MetroHealth System in Cleveland, Ohio. Her essay in Daily Nurse, titled, “The Hidden Healthcare Heroes: A Lab Techs Journey Through the Pandemic,” is a personalized, human look at the strain clinical laboratory technicians were put under during the pandemic. Her story presents the quandary of how to keep these critical frontline healthcare workers from experiencing burnout and leaving the field.

“We techs were left unsupported and unmentored throughout the pandemic. No one cared if we were learning or growing in our job, and there was little encouragement for us to enter training or residency programs. We were just expendable foot soldiers: this is not a policy that leads to long-term job retention,” she wrote.

Clinical laboratory leaders and pathology group managers may find valuable insights in Bator’s essay that they can use when developing worker support programs for their own clinical laboratories and practices.

Suzanna Bator

“The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error,” Suzanna Bator wrote in Daily Nurse. Burnout in clinical laboratories is an ongoing problem that increased during the COVID-19 pandemic. (Photo copyright: Daily Nurse.)

Hopeful Beginnings and Eager to Help

During the early days of the COVID-19 pandemic, folks in every industry stepped up. Fashion designers tasked their haute couture seamstresses with making personal protective equipment (PPE), neighbors brought food and supplies to their immunosuppressed or elderly neighbors, and healthcare workers took on enormous workloads outside of their own departments and traditional responsibilities, The New York Times reported.

When Bator joined the Cleveland Clinic’s COVID-19 team she had no clinical lab tech accreditations. Nevertheless, she and 12 other non-accredited hires were quickly put onto the second and third shifts to keep up with SARS-CoV-2 test demands.

“In the beginning, I was so happy to be helping and working during the pandemic. I felt proud to be on the front lines, honing my skills and discovering what it was like to work under intense pressure. My work was good even when the work was hard. There was no room for error and no time to waste.”

At the Cleveland Clinic, Bator and her colleagues did not experience the equipment and supply shortages other clinics faced, at least not in the beginning of the pandemic. That began to change in late 2020.

Unrelenting Pace and Supply Shortages as Pandemic Grew

Despite their state-of-the-art equipment at the Cleveland Clinic, problems began to arise as the pandemic wore on.

“The machines we worked on were never meant to be run at this intensity and would frequently break down during the second shift. Those of us on the third shift were then left to deal with these problems despite our lack of technical training. Even worse, there were no supervisors on staff to help us problem-solve or troubleshoot, which only added to the pressure,” Bator noted.

And the high demand for testing left little room for new lab techs to hone any other skills.

“The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error,” she added.

Eventually, Bator left the Cleveland Clinic for a county hospital to “get off the graveyard shift and begin working on more than just COVID testing,” she wrote. However, soon after her move the Omicron variant hit, and she was once again running COVID tests.

Six months later she had had enough. She burned out and “dropped out of the industry after only a few years,” she wrote. And she was not the only one.

“The [Cleveland] Clinic began to hemorrhage techs who left for better opportunities at different hospitals or in different fields. Of my original 15-or-so-member team two years ago, only four remain in the same department, and only about half remain in the clinical lab field at all,” Bator wrote.

Burnout in Clinical Laboratories

Worker burnout is a state of mental and/or physical exhaustion caused by a heavy workload. Those experiencing burnout may feel emotionally overwhelmed, anxious, and depressed. Burnout can manifest in physical, mental, and emotional symptoms.

Burnout in the wake of the COVID-19 pandemic is an issue affecting all facets of healthcare. According to Forbes, a 2022 report by Elsevier Health found that 47% of US healthcare workers plan to leave their current role in the next two to three years, in some measure due to the enormous pressures healthcare workers face.

And workers are not the only ones paying attention to burnout. On May 23, 2022, the United States Surgeon General, Vice Admiral Vivek Murthy, MD, issued a Surgeon General’s Advisory highlighting the need to address worker burnout.

“COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point,” Murthy noted. “Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”  

Healthcare workers were facing high levels of burnout before 2020, the COVID-19 pandemic only made the issue worse. The National Academies of Medicine (NAM) reported in 2019 that worker burnout had reached a “crisis level,” and that during the pandemic, half of all healthcare workers reported symptoms of at least one mental health condition.

Training Programs Needed to Offset Worker Shortages and Retain Staff

As Bator reported in Daily Nurse, “The American Society of Clinical Pathology (ASCP)—the largest association for [medical] laboratory professionals—has stressed the importance of promoting MLS/MLT programs to produce certified, well-trained lab professionals, to fill major staffing shortages. However, filling the positions is only one piece of the puzzle.”

Bator points out that there wasn’t space nor time for guidance or advancement with the sheer volume of SARS-CoV-2 testing they had to complete.

“Late last year, during the worst of the Omicron variant surge, the only people I could commiserate with were the nurses who thanked us for running their pediatric ICU tests first,” she said. “They understood what we meant when we said we were drowning and stopped calling the lab to pester us for results because they knew that the positivity rate in Cuyahoga County was the third highest in the country and that the entire system was overwhelmed.”

Suzanna Bator is just one early-career worker among many healthcare professionals who have experienced this type of burnout due to the COVID-19 pandemic. As made evident by her piece, the pathology and clinical laboratory professions are losing workers who otherwise might have entered training programs to further their careers in those fields.

The issue of worker burnout is not just a temporary stressor on the clinical laboratory industry. Both worker burnout and staffing shortages in labs preceded the pandemic and will have continuing long-term effects unless steps are taken to reverse it.   

Ashley Croce

Related Information:

The Hidden Healthcare Heroes: A Lab Techs Journey Through the Pandemic

Burnout: Symptoms and Signs

Christian Siriano and Dov Charney Are Making Masks and Medical Supplies Now

Clinician of the Future Report 2022

New Survey Shows That Up to 47% of US Healthcare Workers Plan to Leave Their Positions by 2025

Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being

New Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation

Researchers Use Genetic Sequencing and Wastewater Analysis to Detect SARS-CoV-2 Variants and Monkeypox within Communities

Researchers surprised that process designed to detect SARS-CoV-2 also identifies monkeypox in wastewater

Early information about an outbreak in a geographical region can inform local clinical laboratories as to which infectious agents and variants they are likely to see when testing patients who have symptoms. To that end, wastewater testing has become a rich source of early clues as to where COVID-19 outbreaks are spreading and how new variants of the coronavirus are emerging.

Now, scientists in San Diego County are adding monkeypox to its wastewater surveillance, according to an August University of California San Diego (UCSD) Health press release. The team at UCSD uses the same process for detecting SARS-CoV-2.

Ongoing advances in genetic sequencing and digital technologies are making it feasible to test wastewater for infectious agents in ways that were once too time-consuming, too expensive, or simply impossible.

Rob Knight, PhD

“Before wastewater sequencing, the only way to do this was through clinical testing, which is not feasible at large scale, especially in areas with limited resources, public participation, or the capacity to do sufficient testing and sequencing,” said Knight in a UCSD press release. “We’ve shown that wastewater sequencing can successfully track regional infection dynamics with fewer limitations and biases than clinical testing to the benefit of almost any community.” (Photo copyright: UC San Diego News.)

Same Process, Different Virus

Following August’s declaration of a state of emergency by California, San Diego County, and the federal government, UCSD researchers added monkeypox surveillance to UCSD’s existing wastewater surveillance program.

“It’s the same process as SARS-CoV-2 qPCR monitoring, except that we have been testing for a different virus. Monkeypox is a DNA virus, so it is a bit of a surprise that our process optimized for SARS-CoV-2, which is an RNA virus, works so well,” said Rob Knight, PhD, Professor of Pediatrics and Computer Science and Engineering at UCSD and one of the lead authors of the study in the press release.

Knight is also the founding director of the Center for Microbiome Innovation at UCSD.

According to the press release, RNA sequencing from wastewater has two specific benefits:

  • It avoids the potential of clinical testing biases, and
  • It can track changes in the prevalence of SARS-CoV-2 variants over time.

In 2020, at the height of the COVID-19 pandemic, scientists from the University of California San Diego and Scripps Research looked into genetic sequencing of wastewater. They wanted to see if it would provide insights into levels and variants of the SARS-CoV-2 within a specific community.

Individuals who have COVID-19 shed the virus in their stool.

The UCSD/Scripps researchers deployed commercial auto-sampling robots to collect wastewater samples at the main UCSD campus. They analyzed the samples for levels of SARS-CoV-2 RNA at the Expedited COVID-19 Identification Environment (EXCITE) lab at UCSD. After the success of the program on the campus, they extended their research to include other facilities and communities in the San Diego area.

“The coronavirus will continue to spread and evolve, which makes it imperative for public health that we detect new variants early enough to mitigate consequences,” said Knight in a July press release announcing the publication of their study in the journal Nature, titled, “Wastewater Sequencing Reveals Early Cryptic SARS-CoV-2 Variant Transmission.”

Detecting Pathogens Weeks Earlier than Traditional Clinical Laboratory Testing

In July, the scientists successfully determined the genetic mixture of SARS-CoV-2 variants present in wastewater samples by examining just two teaspoons of raw sewage. They found they could accurately identify new variants 14 days before traditional clinical laboratory testing. They detected the presence of the Omicron variant 11 days before it was first reported clinically in the community.

During the study, the team collected and analyzed 21,383 sewage samples, with most of those samples (19,944) being taken from the UCSD campus. They performed genomic sequencing on 600 of the samples and compared them to genomes obtained from clinical swabs. They also compared 31,149 genomes from clinical genomic surveillance to 837 wastewater samples taken from the community.

The scientists distinguished specific viral lineages present in the samples by sequencing the viruses’ complete set of genetic instructions. Mutational differences between the various SARS-CoV-2 variants can be minute and subtle, but also have notable biological deviations.

“Nothing like this had been done before. Sampling and detection efforts began modestly but grew steadily with increased research capacity and experience. Currently, we’re monitoring almost 350 buildings on campus,” said UCSD’s Chancellor Pradeep Khosla, PhD, in the July press release.

“The wastewater program was an essential element of UC San Diego Health’s response to the COVID pandemic,” said Robert Schooley, MD, Infectious Disease Specialist at UC San Diego Health, in the press release. Schooley is also a professor at UCSD School of Medicine, and one of the authors of the study.

“It provided us with real-time intelligence about locations on campus where virus activity was ongoing,” he added. “Wastewater sampling essentially allowed us to ‘swab the noses’ of every person upstream from the collector every day and to use that information to concentrate viral detection efforts at the individual level.”

Monkeypox Added to UCSD Wastewater Surveillance

In August, UCSD officially added the surveillance of the monkeypox virus to their ongoing wastewater surveillance program. A month earlier, the researchers had discerned 10,565.54 viral copies per liter of wastewater. They observed the levels fluctuating and increasing.

On August 2, the scientists detected 189,309.81 viral copies per liter of wastewater. However, it is not yet clear if the monitoring of monkeypox viral loads in wastewater will enable the researchers to accurately predict future infections or case rates.

“We don’t yet know if the data will anticipate case surges like with COVID,” Knight said in the August UCSD press release announcing the addition of monkeypox to the surveillance program. “It depends on when the virus is shed from the body relative to how bad the symptoms are that cause people to seek care. This is, in principle, different for each virus, although in practice wastewater seems to be predictive for multiple viruses.”

Utilization of genetic sequencing of wastewater sampling will continue to develop and improve. “It’s fairly easy to add new pathogens to the process,” said Smruthi Karthikeyan, PhD, an environmental engineer and postdoctoral researcher in Knight’s lab who has overseen wastewater monitoring at UC San Diego. “It’s doable on short notice. We can get more information in the same turnaround time.”

Thus, clinical laboratories engaged in testing programs for COVID-19 may soon see the addition of monkeypox to those processes.

-JP Schlingman

UC San Diego Researchers Add Monkeypox to Wastewater Surveillance

Wastewater Sequencing Reveals Early Cryptic SARS-CoV-2 Variant Transmission

Awash in Potential: Wastewater Provides Early Detection of SARS-CoV-2 Virus

National Wastewater Surveillance System (NWSS)

CDC National Wastewater Surveillance System Locates and Tracks SARS-CoV-2 Coronavirus in the Public’s Wastewater

CDC, HHS Create National Wastewater Surveillance System to Help Monitor and Track Spread of COVID-19

Four Thousand New Zealand Medical Laboratory Scientists and Technicians Threatened to Strike over Low Pay and Poor Working Conditions

Last-minute court injunction stopped a mass walkout, but allied health workers continue to push country’s District Health Boards for improvements

In New Zealand, the unprecedented surge in PCR COVID-19 testing due to the SARS-CoV-2 Omicron variant appears to have pushed the country’s 10,000 healthcare workers—including 4,000 medical laboratory scientists and technicians—to the breaking point.

On March 3, just 24 hours before the first of two walkouts was scheduled to begin, New Zealand’s Employment Court banned the strike that would have shut down medical laboratories in the country’s mixed public-private healthcare system. Medical laboratory workers make up 40% of the nation’s 10,000 healthcare workers who planned the nationwide strike to protest low pay and poor working conditions, according to 1News.

“COVID was the perfect storm for the profile of laboratories and how undervalued they have been for far too long,” said medical laboratory scientist Terry Taylor, president of the New Zealand Institute of Medical Laboratory Science (NZIMLS).

Judge Issues Injunction Restraining the Strike

New Zealand’s Public Service Association (PSA) is the country’s largest trade union representing more than 80,000 workers across government, state-owned enterprises, local councils, health boards, and community groups.

The PSA’s 10,000 health workers (which includes 4,000 medical laboratory workers) had planned to strike on March 4-5 and March 18-19, but, according to the New Zealand Herald the Employment Court stopped the walkouts due to the rise in COVID-19-related hospitalizations.

The Herald noted, however, that PSA union members in Auckland had already postponed their walkout after county District Health Boards (DHB) expressed concern over patient safety.

“Striking has always been our last resort, and our members in Auckland continue to demonstrate their commitment to providing quality healthcare to New Zealanders by working tomorrow,” PSA Organizer Will Matthews told the Herald.

He insisted, however, that DHBs need to respond to workers’ concerns. “The depth of feeling from our members, and the support for industrial action nationwide is unprecedented,” Matthews told 1News. “We are now in a position where strike action is our only remaining option to get the DHBs and the government to listen.”

Terry Taylor
In an interview with Stuff, medical laboratory scientist Terry Taylor (above), president of the New Zealand Institute of Medical Laboratory Science, acknowledged laboratory workers’ commitment to doing the work, but he is concerned about the next big testing surge. “Goodwill only goes a certain distance in the end when people are knackered and not getting what they need. At the moment, we have the capability to do 50,000 to 60,000 [tests] per day throughout the whole country, but we couldn’t run that for more than a week. We’d be dead, we’d be overrun,” he said. Clinical laboratory leaders in this country may want to make note of Taylor’s concerns, as laboratory conditions in this country become stressed as well. (Photo copyright: Newshub.)

Clinical Laboratory Workers Claim Low Wages, Poor Conditions, Irrelevant Testing

While no new strike dates have been set, Matthews said striking workers would include contact tracers and laboratory staff as well as nearly 70 other groups of healthcare workers, many of whom “don’t even earn a living wage.” According to Peoples Dispatch, allied health workers are working under the terms of a contract that expired in 2020.

The starting salary for a DHB medical laboratory scientist after completing a four-year degree is NZ$56,773 (US$39,519), while lab assistants and technicians start out at less than NZ$50,000 (US$34,804), Stuff reported.

In an interview with 1News, Taylor maintained that diagnostic labs in New Zealand have long been understaffed, undervalued, and their workers poorly treated. The COVID-19 pandemic, he says, has exacerbated an ongoing problem. Issues such as space constraints, for example, have become even more problematic.

“We’ve got extra machinery that’s come into the labs, we don’t get any more space, all these consumables sitting all over hallways and corridors, extra staff coming in to do the stuff,” Taylor told RNZ. “So, we’ve lost all our tearooms, we’ve lost all our office space, our conditions are markedly less than they should be.”

1News points out that the country’s medical laboratory scientists and technicians are processing more than 20,000 PCR COVID-19 tests per day in addition to running 120,000 other samples and 200,000 diagnostic tests. At the end of March 2020, the average number of COVID-19 tests processed per day was 1,777.

While New Zealand has preached to its citizens the need for widespread PCR testing, Taylor argued in February 2022 that the country must change its approach to offering PCR testing only to symptomatic individuals and close contacts.

“To run our diagnostic laboratories into the ground with endless irrelevant testing is a direct reflection of poor foresight, planning, and respect for the role of this critical health workforce,” Taylor told Newshub.

Necessity of Rewarding All Medical Laboratory Personnel

Medical laboratory scientist Bryan Raill is president of Apex, a specialist union of allied, scientific and technical employees. Raill told 1News the long-term solution is for the government to address pay equity, staffing levels, and worker wellbeing in the country’s historically undervalued medical laboratories.

“Medical laboratory scientists and technicians have to be fairly rewarded for the training, skill, and expertise they bring to the health system,” Raill said. “Medical laboratory scientists need a timely, fair, and equitable process to determine their worth.”

While the stresses on New Zealand medical laboratory workers are not identical, US clinical laboratory leaders will want to monitor the lengths to which New Zealand’s laboratory workers are willing to go to force improvements in their working conditions, staffing, and pay.

As the noted above, the government-funded health system is continually strapped for funds. Consequently, the health districts often defer capital investment in hospitals and medical laboratories. That is one reason why lab staff can find themselves working in space that is inadequate for the volume of specimens which need to be tested daily.

Andrea Downing Peck

Related Information:

Why the ‘Hidden Heroes’ of Our COVID-19 Response Are Striking

COVID-19 Omicron Outbreak: Health Strike Postponed after Employment Court Grants Injunction

New Zealand Employment Court Passes Injunction to Scuttle Health Workers’ Strike

10,000 Health Workers Strike as Omicron Wave Hits

After almost Six Million Tests, an Omicron Explosion Will Heap More Stress on Exhausted Laboratory Workers

Burnt Out Laboratory Staff Working in Poor Conditions, Institute Says

COVID-19: PCR Testing Reaches ‘Crisis’ Point, Public Health and Lab Staff Plea for Symptomatic Testing Only

Pathology Laboratory Consolidation May Leave New Zealand Holiday Destinations with Limited COVID-19 Testing Capacity as Omicron Variant Arrives

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