In Italy, lessons learned for lab testing

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Dr. Lippi: This virus caught us totally unprepared. We had some kind of reminder with SARS almost 20 years ago, but that was limited to 700 deaths. We have been saying to our hospital administrators and policymakers that cutting down the resources and working at the minimal viable standard would be trouble, not for working in our daily routine but for facing these challenges. This is a virus, but the same situation can happen with an earthquake or a tsunami. What we should learn from this lesson is that working at the minimal viable standard is not enough. This is a lesson we cannot forget.

You say in your paper that the suggested network of regional clinical laboratories in turn highlights the need for “better and wider harmonization of laboratory results and information.” Can you tell me more about that?
Dr. Plebani: Harmonization is mandatory. We have to make the laboratory information comparable. That means that different labs in different parts of the world should ensure the comparability of the laboratory results and information—as well as the same preanalytical procedures and the same postanalytical reference intervals, decisions, and units. This is a great effort. Scientific societies in the U.S. and international societies should be more interested in this project.

Are there any other lessons we should learn from this pandemic to be better prepared next time?
Dr. Lippi: Everything is a good lesson. We had some troubles because we didn’t have so much experience in dealing with this virus, so we had to start everything from the beginning. For instance, I had to send as many as eight of my technicians to the virology department to manage manual processing of the specimens due to the lack of automation. I had to downsize part of my laboratory to supply the personnel to virology. The lesson we have learned is that we probably should have more technology and be more prepared to face this challenge.

Dr. Plebani: I totally agree. This is a lesson that laboratory medicine should not be in silos in which there is clinical chemistry or hematology or microbiology or virology. We have to work as a department. In this case, my clinical biochemistry lab needed to work in the molecular field, and in a few days, we were able to provide more than 800 molecular tests per day. Our technicians now realize that by moving from the virology unit to the clinical biochemistry unit, they can learn and improve the way to perform tests and enable better management of the workflow and workload.

Dr. Lippi: What we have learned from this disease, paradoxically a viral disease, is that all the biochemical and immunochemistry tests are strongly driving the clinical decision-making.

Dr. Plebani: This reinforces the idea that this outbreak creates a fantastic opportunity to make much more visible the new value of clinical laboratory medicine, not only for patient monitoring but for patient management and for the clinical decision-making process. We cannot miss this opportunity.

What has the response to your article been?
Dr. Lippi: We have received a large and positive feedback, as attested to by the impressively high number of downloads and citations—nearly 20 in less than two months. This perhaps reflects the fact that the concepts we put forward in our article are actually shared by the worldwide community of laboratory professionals.