Molecular testing to meet the twin challenges of COVID-19 and seasonal flu

The increased capacity of new molecular diagnostics instruments could be the key to helping Australian pathology laboratories deal with COVID-19 and influenza testing surge periods in the future. In Queensland, Pathology Queensland's (PQ) Statewide Director Dr. Patrick Harris gives insights into how the instruments offer a new way of looking at public health challenges and allow scientists to feel confident about their laboratory's capacity to diagnose many different diseases.

A positive outcome from the public health measures to reduce the spread of COVID-19 has been the effective suppression of seasonal flu. Influenza cases have all but fallen off a cliff, with only 512 laboratory-confirmed cases in Australia as of September 2021, a stark contrast to the 214,377 confirmed cases and 486 deaths seen in 2019. Almost half of this year’s influenza cases have been recorded in Queensland, with little clue as to why.

With the impending opening of international and state borders, influenza experts are concerned that complacency and waning herd immunity due to fewer people receiving the flu vaccine could lay fertile ground for a bumper flu season soon.

Coronavirus and influenza have similar symptoms, alongside several other circulating viruses such as rhinovirus and RSV. Knowing which virus is presenting in a person at a given time is paramount to an effective and timely public health response.

COVID-19 is expected to circulate in the community alongside the flu, with Dr. Harris raising his concerns about the pressure that the twin epidemics of a novel flu strain and coronavirus could place on diagnostic testing capacity across the state, stating it "would be a bit of a nightmare."

Laboratories across PQ's network have stepped up to the immense task of handling "thousands and thousands of [COVID-19] samples … every day," which seems worlds away from the peak of 500-sample per day testing capacity that some of the laboratories had during the 2009 swine flu pandemic.

What has changed to allow for PQ's ability to test samples to increase so significantly? Dr. Harris says that newer molecular diagnostics instruments have allowed laboratories to increase their productivity with minimal scientist hands-on time.

The COVID-19 pandemic has amassed significant investment in molecular instrumentation. The development of new, automated instruments has "really changed the narrative" he said.

They have made molecular rapid testing more available to regional laboratories where multi-skilled scientists are more common, showing that the instruments can be managed successfully and competently.

Not only will the instruments be useful amid a pandemic, but post-pandemic they offer an opportunity to improve turnaround times for many other pathology tests.

Dr. Harris says that ultimately this will provide results closer to the patient beside and change the clinical timeframe, further signifying pathology's role as the "fundamental, core business of healthcare".