Why Don’t They Get It?

After having published a Lab Matters article about CDC’s “remarkable feat” in rolling out novel Influenza A H1N1 rapid test kits within three weeks of the first confirmed US cases last year, I was flummoxed to read in The Washington Post that the United States relies “on an outdated, slow method for diagnosing cases of H1N1” and “our diagnostic technologies are difficult, expensive and time-consuming.”

Who would make such a claim?

No less than former senators Bob Graham (D-FL) and Jim Talent (R-MO), co-chairs of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. The pair go on to say, “The really bad news is that we are far more prepared to respond to a flu outbreak than to any other biological event. . . . For most new diseases, the response time would be more like six to nine years.”

Hello?

To get an expert take on the matter, I sent the editorial to one of the most knowledgeable people I know when it comes to H1N1 and other infectious pathogens: Pete Shult, head of the communicable disease division at the Wisconsin State Laboratory of Hygiene. After reading the piece, Pete used phrases such as “totally ridiculous,” “inflammatory” and “flat-out wrong.” Tough language coming from a lab denizen.

Being a thoughtful scientist, Pete was careful to acknowledge problems with vaccine production and to say, “I don’t think anybody would say the response was perfect.”

However, he rightly pointed out that new laboratory-based diagnostic technologies are not likely to be dramatically faster than those now in use and that past public health laboratory responses to emerging pathogens—such as West Nile virus and SARS—were on the order of weeks; not years. The response to monkeypox and the spinach-based E. coli outbreak in Wisconsin, Shult said, was mounted in “days to a couple of weeks.”

Moreover, Shult noted that the H1N1 pandemic has jump-started high-quality molecular testing in hospital labs, even smaller clinical labs in Wisconsin that—I quote—“I never would have guessed in a million years would be throwing themselves into molecular diagnostics.” All of this experience and technology dissemination put the nation on relatively firm footing for future infectious disease outbreaks or, heaven forbid, a bioterror attack.

So, my question to the public health laboratory community is this: What can we do to better publicize our success stories? Yes, public health programs generally—and public health laboratories in particular—are under-staffed, under-funded and in desperate need of better electronic messaging systems. But how can Graham and Talent be so far off the mark?

Staff Burnout in Flu Response: Tips from Montana

At the Montana public health laboratory, we are concerned about staff burnout. We don’t have enough staff cross-trained on the influenza test platforms, and our testing volume is highly variable depending upon the patterns of influenza and influenza-like illness circulating in the state. We are testing a representative sampling of specimens from across the state to detect seasonal influenza when it begins circulating. We anticipate that the volume of testing will increase when it becomes important--based on the different resistance patterns in seasonal influenza A--to know the influenza A subtype.

While I don't have great suggestions for reducing staff burnout, here are some measures that have helped us to cope. We activated a limited ICS structure and dedicated a single call-in line for questions about influenza testing. We also added staff to support critical tasks (e.g., today you will run the testing, process specimens, log in specimens, take telephone calls, etc.) and rotated responsibilities so that no one person had sole responsibility or the same responsibility for days on end. In addition, we stepped up our communications to staff and clinical partners via a weekly influenza update.

Susanne Norris Zanto, CLS(NCA) SM(NRM)Montana Public Health Laboratory