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Do New Strains of SARS-CoV-2 Coronavirus and Inconsistent Distribution of COVID-19 Vaccines Threaten a Return to Normalcy in 2021? McKinsey Weighs In

The latest McKinsey report addresses when the COVID-19 pandemic is “most likely” to end and what needs to happen to get there

Clinical laboratory leaders, pathologists, and diagnostics professionals everywhere want to know when the SARS-CoV-2 coronavirus will burn itself out. When can we expect to return to normal? Since there is no such thing as a crystal ball, it might be helpful to review the latest report from international management consulting firm McKinsey and Company, titled, appropriately, “When Will the COVID-19 Pandemic End?

It’s a good question, and McKinsey is not certain of the answer. Barring other factors, McKinsey predicts “Transition toward normalcy in the United States remains most likely in the second quarter of 2021 and herd immunity in the third and fourth quarters, but the emergence of new strains and a slow start to vaccine rollout raise real risks to both timelines.” The report also states, “the emergence of more-infectious variants of SARS-CoV-2 increases the risk that this milestone will not be achieved until later.

“More-infectious viruses,” McKinsey continued, “require that a higher percentage of people be simultaneously immune to reach herd immunity. While a more infectious variant likely means more people are acquiring natural immunity through infection (despite ongoing efforts to minimize new cases), the net impact of more-infectious strains is likely to be that a higher portion of the population needs to be vaccinated, which may take more time.”

Challenges That May Slow Herd Immunity to COVID-19

“It is now harder to imagine the United States or United Kingdom transitioning to normalcy before second quarter 2021 or reaching herd immunity before third quarter 2021,” McKinsey added. “Herd immunity to a pathogen is achieved when a sufficient portion of a population is simultaneously immune to prevent sustained transmission.”

But problems in [COVID-19] vaccine distribution, supply shortages, and intermittent participation by the population could push the pandemic endpoint to 2022, cautioned McKinsey.

“We believe herd immunity in the United States is still most likely in third or fourth quarter 2021, but that the chance of delay until first quarter 2022 or beyond has increased,” the report states, “Even later herd immunity remains possible if other challenges arise, especially vaccine safety concerns or ambivalence to vaccination following a transition toward normalcy.”

Other factors that went into the firm’s “most likely” set of possible timelines include:

  • “Unexpected safety issues emerging with early vaccines,
  • “Significant manufacturing or supply-chain delays,
  • “Continued slow adoption,
  • “Further mutation [of the virus],
  • “A shorter-than-anticipated duration of vaccine-conferred immunity.”
Graph from McKinsey and Co. report about covid-19 herd immunity projections into year 2023
The graph above, taken from the McKinsey and Co. report, illustrates how “the probability of reaching COVID-19 herd immunity in the United States is highest in the third or fourth quarter, but could shift.” (Graphic copyright: McKinsey and Company.)

A ‘Transition Toward Normalcy’

In its report, McKinsey notes that “During this transition, controlling the spread of SARS-CoV-2 will still require public-health measures (such as continued COVID-19 testing and mask use in many settings), but mortality will fall significantly, allowing greater normalization of business and social activities.”

In apparent agreement, according to data from the COVID Tracking Project, as of Jan. 27, 2021, 107,444 people were hospitalized in the US with COVID-19, as compared to 130,000 hospital cases on Jan. 13, 2021. Numbers of new cases appear to be dropping, however, McKinsey predicts that “COVID-19 will not disappear during this transition but will become a more normal part of the baseline disease burden in society (like flu, for example), rather than a special threat requiring exceptional societal response.”

It may help that more people are taking one of the vaccines. A recent survey conducted by London-based research and analytics firm YouGov, found that people worldwide are becoming more willing to take the COVID-19 vaccine. For example, in the UK, 80% of those surveyed gave a thumbs-up to getting vaccinated, compared to 61% in November. In the US, however, still only about 45% said they will get the vaccine, up slightly from 42% who said so in July, YouGov reported.

However, McKinsey points out that “vaccine rollout has not yet proceeded far enough to protect much of the population.”

How Should Medical Laboratories and Other Healthcare Providers Proceed?

In “No One Said it Would Be Easy,” Jan. 22, 2021, Becker’s Hospital Review, Michael Dowling, President and CEO of Northwell Health, wrote, “We will be living in a world preoccupied by COVID-19 and vaccination for many months to come … And the stark reality is that the vaccination rollout will continue well into the summer, if not longer, while at the same time we continue to care for hundreds of thousands of Americans sickened by the virus. Despite the challenges we face now and in the coming months in treating the disease and vaccinating a US population of 330 million, none of us should doubt that we will prevail.”

“To achieve that,” McKinsey notes, “we will need to see significant progress on the epidemiological end point … Favorable findings on natural and cross-immunity would help accelerate timelines.

“Five additional criteria will also contribute to the transition to a form of normalcy—the more of these that are achieved, the faster the milestone is likely to be reached:

  • “Continued improvement by governments in the application of public-health interventions (such as test and trace) that don’t significantly limit economic and social activities.
  • “Compliance with public-health measures until we achieve herd immunity.
  • “Accurate, widely available, rapid testing that effectively enables specific activities.
  • “Continued advancements in therapeutics (including pre- and post-exposure prophylactics) for and clinical management of COVID-19, leading to lower infection-fatality ratios—substantial progress has already been made through a combination of effective drugs, such as Dexamethasone and Remdesivir, and changes in clinical management.
  • “Public confidence that there aren’t significant long-term health consequences for those who recover from COVID-19.”

Finally, McKinsey notes that “Both the epidemiological and normalcy ends to the COVID-19 pandemic are important. The transition to the next normal will mark an important social and economic milestone, and herd immunity will be a more definitive end to the pandemic. In the United States, while the transition to normal might be accomplished sooner, the epidemiological end point looks most likely to be reached in the second half of 2021.”

It is not clear when clinical laboratories and pathologists will know for certain when the pandemic’s end point has been reached. Predictions coming from sources such as McKinsey’s latest report may be as close as we get to a crystal ball view of the pandemic’s future.

—Donna Marie Pocius

Related Information:

When Will the COVID-19 Pandemic End?

International Study How Many People Will Take COVID-19 Vaccine

Pandemic Will Not End for Anyone Until it Ends for Everyone

No One Said It Would Be Easy

Airlines Are Partnering with Health Companies and Clinical Laboratories to Implement At-Home COVID-19 Testing Prior to Flights

Because air travel volumes are low, experts believe it is timely to develop COVID-19 testing systems and gain insight on which protocols are most effective

As the COVID-19 pandemic surges on, several international airlines now require customers to complete at-home COVID-19 testing before they can travel. This is triggering unusual business practices. For example, one airline allows its passengers to use frequent flier miles to purchase mail-in COVID-19 test kits.

Frequent Flyer Miles for COVID-19 Testing

Across the United States, Hawaii has one of the lowest rates of infection, partly thanks to the state’s strict quarantine regulations. In a state, however, that depends on tourism for its economic health, the pandemic has caused serious financial difficulties. In an effort to prevent spread of the coronavirus while also encouraging tourism, Hawaiian Airlines now offers “Pre-travel COVID-19 Test Options” on its website.

To be allowed to skip the state’s mandatory 14-day self-quarantine before arriving on the islands, flyers can take a pre-travel coronavirus test with the following conditions:

  • The test must be from a state-approved testing provider.
  • The test must be administered no more than 72 hours prior to the scheduled departure time of the final leg to Hawaii.
  • For trans-pacific travel, test results must be received prior to flight departure.

Additionally, the airline accepts frequent flyer miles to pay for mail-in COVID-19 tests. In exchange for 14,000 HawaiianMiles, a passenger receives a test kit in the mail. The kit features a video call during which a healthcare professional guides the consumer on taking a saliva sample. The user then ships the sample to a qualified clinical laboratory. Results are returned electronically within 24 hours of the lab receiving the sample.

Hawaii’s COVID-19 portal states, “The state of Hawaii will ONLY accept Nucleic Acid Amplification Test (NAAT) from a certified Clinical Laboratory Improvement Amendment (CLIA) lab test results from Trusted Testing and Travel Partners” that are participating in the state’s pre-travel testing program. Honolulu and Maui are the only two arrival airports allowed. A negative result must have come from a test performed within 72 hours prior to the final leg of the passenger’s trip to Hawaii, according to the portal.

“A negative pre-travel test is an alternative to two weeks in self-isolation for arrivals to the archipelago,” the UK’s Independent reported.

JetBlue and Vault Health Partner to Offer COVID Testing to Airline Passengers

In another instance of an airline getting involved in at-home testing, JetBlue (NASDAQ:JBLU) is partnering with Vault Health to offer at-home testing. The process is similar to the Hawaiian Airlines program. However, rather than purchasing the test with frequent flyer miles, JetBlue offers polymerase chain reaction (PCR) tests at a discount.

Business Travel News reported that passengers must provide a confirmation code while ordering the $119 test from Vault Health’s webpage. “Vault provides a kit for an at-home saliva test, and users administrate it while on a video chat supervised by Vault to ensure the test is done properly. The user sends it overnight to a clinical laboratory and the results are provided within 72 hours,” Business Travel News stated.

Joanna Geraghty of JetBlue
“We continue to hear from health officials that [COVID-19] testing is incredibly important in the fight against the coronavirus, and we want to make sure our customers have options for testing, especially prior to travel,” said Joanna Geraghty, President and Chief Operating Officer, JetBlue, in a press release. “As more and more regions reopen, many are requiring test results to enter. Now with easier testing options, those safety requirements may not be a deterrent for travel, but rather provide greater public health and peace of mind with little inconvenience.” (Photo copyright: Spectrum News NY1.)

In “Coronavirus Testing Before Flying Could Become the Norm as Airlines Try to Boost Confidence and Woo Travelers,” the Washington Post reported, “There is no common standard, so it has been left to airlines and airports to design their own SARS-CoV-2 testing programs and for travelers to sort out requirements for their particular destination.”

In addition to airlines such as Hawaii Airlines and JetBlue instituting programs for coronavirus testing, some airports are as well. Tampa International Airport, for example, test-piloted a voluntary testing program for all arriving and departing passengers from October 1st to October 31st. The airport partnered with BayCare, a 15-hospital Tampa area healthcare network, to provide both rapid antigen and PCR tests.

“Testing services will be offered on a walk-in basis … seven days a week from 8 a.m. until 2 p.m. The pilot will be open to all ticketed passengers who are flying or have flown within three days and can show proof of travel. The PCR COVID-19 test costs $125 and the antigen test costs $57,” a press release stated.

Tampa Airport CEO Joe Lopano told the Washington Post, “This could be—especially if adopted by other airports—another way to instill confidence.”

COVID-19 Testing by Retailers Expanding as Well

Travelers aren’t the only people who need testing. Some employers also are requiring negative tests before employees can return to work.

In “Costco Begins Selling an At-Home Self-Collection COVID-19 Test Kit; One of 12 Kits That Have Received FDA Emergency Use Authorization,” Dark Daily reported on retail giant Costco’s (NASDAQ:COST) response to increased demand for COVID-19 testing by offering direct-to-consumer, at-home test kits to its members. The kits sell at two price points: $129 for a “basic” kit, and $139 for a kit that includes “Video observation for travel.” The more expensive test is accepted by Hawaii for its Trusted Testing Partner Program.

As with all at-home kits, the consumer collects their own specimen and sends it off to a qualified clinical laboratory for processing. AZOVA, a telehealth company, supplies the kits to Costco for resale and provides a smartphone app where customers can check and display the test results.

P23 Labs’ TaqPath SARS-CoV-2 assay is the test being used, which, according to P23, “has a 98% sensitivity and 99% specificity,” Business Insider reported.

When COVID-19 Testing Fails

Of course, coronavirus testing isn’t 100% guaranteed. The Independent reported in November that a passenger on a Dubai to New Zealand flight who had tested negative prior to flying, was, in fact, positive for coronavirus and had infected seven other passengers during the flight. New Zealand’s Institute of Environmental Science and Research conducted and published a study following the incident, titled, “A Case Study of Extended In-Flight Transmission of SARS-Cov-2 En Route to Aotearoa New Zealand.”

The researchers found that “All seven SARS-CoV-2 genomes were genetically identical, with the exception of a single mutation in one case, and all genomes had five signature mutations seen in only six other genomes from the >155,000 genomes sequenced globally. Four of these six related genome sequences were from Switzerland, the country of origin of the suspected index case.”

They added, “By combining information on disease progression, travel dynamics, and genomic analysis, we conclude that at least four in-flight transmission events of SARS-CoV-2 likely took place.”

At-home test kits for COVID-19 are here to stay. That large businesses in multiple industries are now partnering with COVID-19 test developers and clinical laboratory companies to accomplish testing of customers and employees means independent labs that process coronavirus testing can look forward to increasing COVID-19 testing business.

“We need to be using the time now, when [travel] volumes are relatively low, to test the systems and gain insight on which protocols are most effective,” Mara Aspinall, biomedical diagnostics professor at Arizona State University, President and CEO of the Health Catalysts Group, an investment and advisory firm, and former President/CEO of Ventana Medical Systems (now Roche Tissue Diagnostics), a billion-dollar division of Swiss pharmaceutical and diagnostics manufacturer Roche, told the Washington Post.

—Dava Stewart

Related Information:

‘Swap Frequent-Flyer Miles for COVID Test’ Says Airline

Negative COVID-19 Test Result Required Prior to Departure to Avoid 14-Day Quarantine in Hawaii. Tests ONLY Accepted from TRUSTED TESTING AND TRAVEL PARTNERS

JetBlue to Give Passengers At-Home Covid-19 Testing Access

JetBlue to Offer At-Home Pre-Travel COVID-19 Tests

JetBlue and Vault Health Partner to Make At-Home COVID-19 Tests More Widely Available to Customers

Coronavirus Testing Before Flying Could Become the Norm as Airlines Try to Boost Confidence and Woo Travelers

TPA Launches First in the Nation COVID-19 Testing for All Departing and Arriving Passengers

Domestic U.S. Travel Advisories

American Airlines Expands At-Home Coronavirus Testing

COVID: Passenger Infected Four Others on Flight After Testing Negative, Report Says

A Case Study of Extended In-Flight Transmission of SARS-Cov-2 En Route to Aotearoa New Zealand

Costco Begins Selling an At-Home Self-Collection COVID-19 Test Kit; One of 12 Kits That Have Received FDA Emergency Use Authorization

Houston High School Student Starts Lab Business and Takes COVID-19 Rapid Antigen Testing on the Road with Mobile Clinical Laboratory

Taft Foley, III, says he got the idea for the mobile lab after waiting on a COVID-19 testing line that went ‘around the entire building’

In a remarkable example of ingenuity and observation, Texas high school student Taft Foley, III, is bringing COVID-19 testing to underserved patients, wherever they may be. He launched a medical lab company, then developed a mobile clinical laboratory which performs rapid antigen tests that can detect the presence of antigen in about 15 minutes.

Foley—who recently became an EMT after graduating from the Texas EMS Academy—designed his mobile medical lab to use Quidel Sofia SARS Antigen FIA tests (nasal swabs). Results are sent to patients by text or e-mail. Foley also works with CLIA-certified Baylor Genetics Laboratories on COVID-19 (SARS-CoV-2) RT-PCR molecular testing, which gives his customers results in 24 to 48 hours, Forbes reported.

Foley, who is 18-years-old and an Eagle Scout, said he got the idea to launch the mobile COVID-19 testing business after he went for a coronavirus test and had to wait on a line that “wrapped around the entire building,” ABC13 reported. “I said to myself, ‘There needs to be a better way,’” Foley told ABC13.

Forbes reported that Texas Mobile Medical Labs allocates a portion of test fees paid ($100 to $150/test) to help provide tests to the homeless and others who need them, such as veterans and senior citizens.

“The (majority of) tests have been done at businesses who appreciate our mobile capabilities. We arrive and test all employees onsite and have their results back in 15 minutes,” Foley told Forbes.

Taft Foley, III and his medical lab van
After raising $60,000 through events and sale of personal items, Taft Foley, III (above), purchased a van and rapid antigen tests, reported The Kinkaid Falcon. “I think that that idea is hopefully going to galvanize a lot of good things, because we as humans, we’re good at learning from one another. If my idea is good enough to inspire others to create their own businesses and ideas for the betterment of the community, then I’m all for it,” Foley told the Falcon. (Photo copyright: Texas Mobile Medical Labs.)

Other States with Mobile COVID-19 Testing

Texas is not the only state where savvy entrepreneurs like Foley and health agencies are offering mobile COVID-19 testing.

In May, Florida Gov. Ron DeSantis announced Statlab Mobile, a COVID-19 mobile laboratory out of Miami that tests people in skilled nursing and long-term care facilities and other areas of the Sunshine State.

“We believe this will be a game-changer (in long-term care),” DeSantis told the Miami Herald.

“The idea was to bring help to those who are vulnerable, those who can’t otherwise get the kind of medical information they would otherwise love to have,” Bryan Wilson, Statlab Chief Executive Officer, told Patch, which noted the tests are free.

Statlab Mobile van
Statlab Mobile (above) can perform about 3,500 Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV coronavirus tests per week, according to the Florida COVID-19 Testing website. Statlab works with Florida’s Division of Emergency Management, the National Guard, and contracted nurses to conduct coronavirus testing throughout Florida. (Photo copyright: Statlab Mobile.)

Mobile COVID Testing in Other States

Mobile medical laboratories are being deployed to help handle surges of COVID-19 cases in Massachusetts, New Jersey, and Arizona, as well.

In Massachusetts, testing vans operated by American Family Care (AFC), an urgent care provider, started heading out in November to schools and businesses state-wide with a goal to test at least 100 to 150 people daily for COVID-19, according to The Reminder.

The vans are staffed by medical providers who test people with Abbott’s BinaxNOW COVID-19 Ag Card, AFC told The Reminder. The rapid antigen test offers results in 15 minutes.

In September, Dark Daily reported that the US federal Department of Health and Human Services (HHS) awarded a $760 million contract to Abbott for 150 million rapid antigen tests to aid in detection of COVID-19 as workplaces and schools reopen.

“We’ve had several companies who would like to schedule their employees to be tested on a regular basis. But they also want to be able to make sure that if there is a potential contamination within their businesses, they have a resource to utilize to make sure they can test people right away,” Jim Brennan, Owner/CEO of Medvest, LLC, AFC urgent care’s parent company, told The Reminder.

And in Phoenix, a COVID-19 mobile medical van provides testing to underserved communities. The City of Phoenix, along with staff from the Vincere Cancer Center, use Quidel’s Sofia SARS Antigen FIA test at public and private locations and at family services centers, AZ Central reported.

Clearly, mobile COVID-19 testing labs are here to stay. They serve seniors and vulnerable populations challenged to access clinical laboratory testing at traditional locations and at COVID-19 drive-through sites. And on larger scales, mobile medical laboratories have become key resources to address coronavirus case surges and to conveniently test people at businesses and schools to help identify symptomatic individuals who should be quarantined.

Clinical laboratory managers may be impressed by how quickly mobile testing companies and entrepreneurs form partnerships with public health agencies toward making COVID-19 tests available to all at places where people live and work.

—Donna Marie Pocius

Related Information:

Houston Teen Launches Mobile COVID-19 Testing Lab

Texas EMT, 18, Opens Mobile COVID-19 Testing Lab

Taft Foley III, 18-Year-Old, Makes Mobile COVID-19 Testing Lab

TAFT Foley, ’21, Creates Mobile COVID-19 Testing Center

DeSantis Announces New COVID-19 Antibody Testing, Sanitizing and Lab on Wheels

Fast Coronavirus Lab Results in Florida Through Statlab Mobile

AFC Deploys COVID-19 Mobile Testing Vans in Community

Free Phoenix COVID-19 Mobile Testing Van Gives Results in 15 Minutes

U.S. Government Purchases 150 Million COVID-19 Antigen Tests from Abbott Laboratories for $760 Million; Only CLIA-Certified Laboratories Can Do Testing

Mount Sinai Researchers Find That Antibodies Produced in Response to COVID-19 May Provide Long-term Immunity Against the Coronavirus

ELISA tests at Icahn School of Medicine contradict earlier studies which found that antibodies developed to combat the SARS-CoV-2 coronavirus are short-lived

Medical laboratories at the forefront of the COVID-19 pandemic will be intrigued to learn that antibodies produced by the body to combat the coronavirus infection may actually provide long-term immunity, contrary to previous studies that found otherwise.

A recent study from the Icahn School of Medicine at Mount Sinai found that the protection may be more robust than previously believed. This may surprise many clinical laboratory scientists and clinical pathologists. Since the outbreak of the pandemic, multiple studies have been published with conflicting findings about the strength of the immune response to SARS-CoV-2 and the length of immunity provided after an infection.

In a Mount Sinai news release, however, Florian Krammer, PhD, microbiologist and Professor of Vaccinology in the Department of Microbiology at the Icahn School of Medicine at Mount Sinai, and a senior author of the paper, said, “While some reports have come out saying antibodies to this virus go away quickly, we have found just the opposite—that more than 90% of people who were mildly or moderately ill produce an antibody response strong enough to neutralize the virus, and the response is maintained for many months.”

The researchers published the findings of their study—which was based on an internally-developed antibody test—in Science.

The study concludes, “Although this cannot provide conclusive evidence that these antibody responses protect from reinfection, we believe it is very likely that they will decrease the odds ratio of reinfection and may attenuate disease in the case of breakthrough infection. We believe it is imperative to swiftly perform studies to investigate and establish a correlate of protection from infection with SARS-CoV-2.”

Florian Krammer, PhD
Florian Krammer, PhD (above), runs the Krammer Laboratory in the Department of Microbiology at the Icahn School of Medicine at Mount Sinai in New York. He noted that the longevity and neutralizing effects of antibody response are “critically important to enabling us to effectively monitor seroprevalence in communities, and to determining the duration and levels of antibody that protect us from reinfection.” Antibody response, he added, is also “essential for effective vaccine development.” (Photo copyright: Icahn School of Medicine at Mount Sinai.)

Details of the Icahn School of Medicine Study

The study arose from an effort by Mount Sinai to identify potential donors for a convalescent plasma therapy program. Beginning in late March, the health system used an enzyme-linked immunosorbent assay (ELISA) to screen thousands of individuals for presence of antibodies to the spike protein in the SARS-CoV-2 virus. The virus uses the spike protein to bind to a receptor in host cells, the researchers noted, making it “the main, and potentially only target for neutralizing antibodies.”

Screened patients either had confirmed cases of COVID-19, as determined by a polymerase chain reaction (PCR) test, or suspected cases, “defined as being told by a physician that symptoms may be related to SARS-CoV-2 or exposure to someone with confirmed SARS-CoV-2 infection,” the researchers wrote. The Mount Sinai health system also offered the test to employees.

Samples from each person were diluted in five discrete titers (concentrations) ranging from 1:80 to 1:2880, and each was tested for detectable presence of the antibodies. This allowed the researchers to categorize the samples as low, moderate, or high:

  • Low titers: 1:80 or 1:160
  • Moderate titers: 1:320
  • High titers: 1:960 or >1:2880

Between the start of the program and early October, the health system screened 72,401 people, of whom 30,082 tested positive for at least the lowest levels of antibodies. Among those who tested positive, a large majority fell into the moderate or high categories:

  • 1:80: 690 (2.29%)
  • 1:160: 1453 (4.83%)
  • 1:320: 6765 (22.49%)
  • 1:960: 9564 (31.79%)
  • 1:2880: 11610 (38.60%)

The researchers also wanted to see whether the antibodies offered actual protection against the virus. So, they selected 120 samples and ran a quantitative microneutralization assay. In the lowest of the three categories, 50% of the samples showed neutralizing activity. That rose to 90% in the moderate category and 100% in the high category.

Finally, to determine how long protection might last, the researchers recalled 121 plasma donors for additional tests at two different points during the study. The researchers reported a slight drop in antibody levels about three months after onset of symptoms, and then a larger drop after five months. But antibodies were still present in most samples.

“It is still unclear if infection with SARS-CoV-2 in humans protects from reinfection and for how long,” the researchers wrote. “We know from work with common human coronaviruses that neutralizing antibodies are induced, and these antibodies can last for years and provide protection from reinfection or attenuate disease, even if individuals get reinfected.”

Previous ‘Conflicting’ Research

As previously noted, other studies raised doubts about the longevity of the antibodies produced by the body’s immune system. For example, the Mount Sinai researchers cited a study from China published in Nature Medicine that looked at the immune responses of 37 symptomatic patients and an equal number of asymptomatic individuals with laboratory-confirmed cases of the COVID-19 disease. In the latter group, 40% had no detectable levels of IgG antibodies after eight weeks.

The study also found a decrease in neutralizing antibodies in 30 of the asymptomatic individuals (81.1%) and 23 of the symptomatic individuals (62.2%) over the same period.

However, the Mount Sinai researchers pointed out that the antibody test in the Chinese study targeted a different protein. “The same paper also reported relatively stable (slightly declining) neutralizing antibody titers, which shows much higher concordance with our present findings,” they wrote. “Thus, the stability of the antibody response over time may also depend on the target antigen.”

A different study from England saw a 26% decline in antibodies over three months, CNN reported. That study, conducted by Imperial College London and Ipsos MORI, a market research firm, was based on responses from more than 365,000 randomly selected people who had self-administered a lateral flow antibody test.

But the seemingly conflicting studies from New York and the UK may not be contradictory, CNN reported. “People’s bodies produce an army of immune compounds in response to an infection and some are overwhelming at first, dying off quickly, while others build up more slowly. Measurements that show a waning antibody response in the first months after infection might be measuring this first wave—but there’s a second team building its forces in the background.”

In the same CNN report, Ania Wajnberg, MD, Director of Clinical Antibody Testing at Mount Sinai Hospital and co-author of the Icahn Mount Sinai study, said, “The serum antibody titer we measured in individuals initially were likely produced by plasmablasts—cells that act as first responders to an invading virus and come together to produce initial bouts of antibodies whose strength soon wanes.”

She added, “The sustained antibody levels that we subsequently observed are likely produced by long-lived plasma cells in the bone marrow. This is similar to what we see in other viruses and likely means they are here to stay. We will continue to follow this group over time to see if these levels remain stable as we suspect and hope they will.”

Does this mean that most people who get infected with the COVID-19 coronavirus will retain an immunity to the disease? Maybe. In the Icahn Mount Sanai study, Florian Kramer wrote, “More than 90% of people who were mildly or moderately ill produce an antibody response strong enough to neutralize the virus, and the response is maintained for many months.”

Thus, clinical laboratories engaged in serological testing may be asked to perform follow-up antibody tests to see if we do indeed create long-term immunity to COVID-19. Further, pathologists and medical laboratory scientists will want to follow future studies published in peer-reviewed journals to see if the findings of the Mount Sinai study are replicated at other sites.

—Stephen Beale

Related Information:

Most People Mount a Strong Antibody Response to SARS-CoV-2 That Does Not Decline Rapidly

Robust Neutralizing Antibodies to SARS-CoV-2 Infection Persist for Months

In Study of 30,000 Mild-To-Moderate COVID-19 Patients, Antibody Responses Can Persist for Five Months

Immunity to Coronavirus Lingers for Months, Study Finds

British Study Shows Evidence of Waning Immunity to COVID-19

Clinical Laboratories Need Creative Staffing Strategies to Keep and Attract Hard-to-Find Medical Technologists, as Demand for COVID-19 Testing Increases

Critical shortages in medical laboratory workers and supplies are yet to be offset by new applicants and improved supply chains. But there is cause for hope.

Medical laboratory scientists (aka, medical technologists) can be hard to find and retain under normal circumstances. During the current coronavirus pandemic, that’s becoming even more challenging. As demand for COVID-19 tests increases, clinical laboratories need more technologists and lab scientists with certifications, skills, and experience to perform these complex assays. But how can lab managers find, attract, and retain them?

The Johns Hopkins Coronavirus Resource Center reports that as of mid-October more than one million tests for SARS-CoV-2 were being performed daily in the US. And as flu season approaches, the pandemic appears to be intensifying. However, supply of lab technologists remains severely constrained, as it has been for a long time.

An article in the Wall Street Journal (WSJ), titled, “Help Wanted at COVID-19 Testing Labs: Coronavirus Pandemic Has Heightened Longstanding Labor Shortages in America’s Clinical Laboratories,” reported that to address staff shortages “labs are grappling at solutions,” such as:

  • using traveling lab workers,
  • automation,
  • flexible scheduling, and
  • salary increases.

Still, qualified medical technologists (MT) and clinical laboratory scientists (CLS) are hard to find.

Demand for COVID Tests Exceeds Available Clinical Lab Applicants

“I can replace hardware and I can manage not having enough reagents, but I can’t easily replace a qualified [medical] technologist,” said David Grenache, PhD, Chief Scientific Officer at TriCore Reference Laboratories, Albuquerque, N.M., in the WSJ.

Another area where demand outstrips supply is California. Megan Crumpler, PhD, Laboratory Director, Orange County Public Health Laboratory, told the WSJ, “We are constantly scrambling for personnel, and right now we don’t have a good feel about being able to fill these vacancies, because we know there’s not a pool of applicants.”

In fact, according to an American Association for Clinical Chemistry (AACC) Coronavirus Testing Survey, 56% of labs surveyed in September said staffing the lab is one of the greatest challenges. That is up from 35% in May.

Are Reductions in Academic Programs Responsible for Lack of Available Lab Workers?

Recent data from the US Bureau of Labor Statistics (BLS) show 337,800 clinical laboratory technologists and technicians employed by hospitals, public health, and commercial labs, with Job Outlook (projected percent change in employment) growing at 7% from 2019 to 2029. This, according to the BLS’ Occupational Outlook Handbook on Clinical Laboratory Technologists and Technicians, is “faster than average.”

“The average growth rate for all occupations is 4%,” the BLS notes.

Medical laboratories have the most staff vacancies in phlebotomy (13%) and the least openings in point-of-care (4%), according to an American Society for Clinical Pathology 2018 Vacancy Survey published in the American Journal of Clinical Pathology (AJCP).

Becker’s Hospital Review reported that “Labor shortages in [clinical] testing labs have existed for years due to factors including low recruitment, an aging workforce, and relatively low pay for [medical] lab technicians and technologists compared to that of other healthcare workers with similar education requirements.

“In 2019, the median annual salary for clinical laboratory technologists and technicians was $53,000, according to the US Bureau of Labor Statistics. The skills required for lab workers also are often specialized and not easily transferred from other fields.”

At the “root” of the problem, according to an article in Medical Technology Schools, is a decrease in available academic programs. Laboratory technologists require a Bachelor of Science (BS) degree and technicians need an associate degree or post-secondary certificate.

Lisa Cremeans, MMDS, CLS(NCA), MLS(ASCP), Clinical Assistant Professor at University of North Carolina
“(The programs) are expensive to offer, so when it comes to cuts and budgets, some of those cuts have been based on how much it costs to run them. That, and they may not have high enough enrollments,” said Lisa Cremeans, MMDS, CLS(NCA), MLS(ASCP), Clinical Assistant Professor at University of North Carolina at Chapel Hill, in the Medical Technology Schools article. (Photo copyright: University of North Carolina.)

AACC has called for federal funding of these programs, which now number 608, down from 720 programs for medical laboratory scientists in 1990.

“The pandemic has shone a spotlight on how crucial testing is to patient care. It also has revealed the weak points in our country’s [clinical laboratory] testing infrastructure, such as the fact that the US has allowed the number of laboratory training programs to diminish for years now,” said Grenache, who is also AACC President, in a news release.

Creative Staffing Strategies Clinical Labs Can Take Now

Clinical laboratory managers need staffing and related solutions now. As Dark Daily recently reported in, “Three Prominent Clinical Laboratory Leaders Make the Same Prediction: COVID-19 Testing Will Be Significant Through 2020 and Throughout 2021,” prominent clinical labs are gearing up for dramatic increases in COVID-19 testing. This e-briefing was based on a 2020 Executive War College virtual session that covered how labs should prepare now so they can prosper clinically and financially going forward. That session can be download by registering here.

The final session of the 2020 Virtual Executive War College, titled “What Comes Next in Healthcare and Laboratory Medicine: Essential Insights to Position Your Clinical Lab and Pathology Group for Clinical and Financial Success, Whether COVID or No COVID,” took place on Thursday, Oct. 29, 2020. Given the importance of sound strategic planning for all clinical laboratories and pathology groups during their fall budget process, this session is being provided free to download for all professionals in laboratory medicine, in vitro diagnostics, and lab informatics.

To register for free access:

How Some Clinical Labs are Coping with Staff and Recruitment Challenges

The Arizona Chamber Business News reported that Sonora Quest Laboratories in Tempe earlier this year launched “Operation Catapult” to help with a 60,000 COVID-19 test increase in daily test orders. The strategy involved hiring 215 employees and securing tests with the help of partners:

Meanwhile, students in the UMass Lowell (UML) medical laboratory science (MLS) program, see brighter skies ahead.

“The job outlook even before COVID-19 was so amazing,” said Dannalee Watson, a UML MLS student, in a news release. “It’s like you’re figuring out a puzzle with your patient. Then, we help the doctor make decisions.”

Such enthusiasm is refreshing and reassuring. In the end, the SARS-CoV-2 pandemic and the resultant demand for clinical laboratory testing may call more students’ attention to careers in medical laboratories and actually help to solve the lab technologist/technician shortage. We can hope.

—Donna Marie Pocius

Related Information:

Help Wanted at COVID-19 Testing Labs

AACC COVID-19 Testing Survey: Full Survey Results

The American Society for Clinical Pathology’s 2018 Vacancy Survey of Medical Laboratories in the United States

Labs Squeezed for Staff to Meet COVID-19 Testing Demand

Medical Lab Scientist: Interview Clinical Worker Shortage

AACC Urges Congress to Fund Lab Training Programs to Prepare U.S. for Future Pandemics

Sonora Quest Pulls Out All Stops to Put Arizona in Front of COVID-19 Testing

Diagnostic Labs Eager to Hire UML Medical Lab Science Majors

Three Prominent Clinical Laboratory Leaders Make the Same Prediction: COVID-19 Testing Will be Significant Through 2020 and Throughout 2021

Expert Panel—What Comes Next in Healthcare and Laboratory Medicine: Essential Insights to Position your Clinical Lab and Pathology Group for Clinical and Financial Success, COVID or No COVID

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