The impact of COVID-19 on the haematology laboratory

COVID-19, a disease caused by a virus SARS-CoV-2, was first detected in patients in Wuhan China in November 2019. Since then SARS-CoV-2 has been detected in patients in over 100 countries and has caused a pandemic that has shaken the world economy and almost every country’s individual healthcare system. Not since the H1N1 (“Spanish Flu”) pandemic in 1918 or the Smallpox epidemics before then has an outbreak caused such a significant human response, with lockdowns and practical social behavioural changes (including social distancing, mask wearing and isolation) becoming the new-normal all over the world in 2020. COVID-19 has had an impact on every aspect on modern life and as a result, unprecedented efforts on the political, public, business and individual level have been undertaken to attempt to negate the negative effects the pandemic has had on everybody’s everyday lives.

COVID-19’s toll on healthcare has been widely documented. As well as swelling patient numbers directly from the disease itself, COVID-19 has been demonstrated to have a significantly increased risk of mortality for the elderly and patients who suffer from co-morbidies. These co-morbidies are often haematological in nature, such as diabetes or haematological cancers.

Impact of COVID-19 on the haematology laboratory

COVID-19’s effects on the haematological laboratory are severe. The multivariate problems induced by COVID-19 have cascading effects on a haematology health departments capability to provide care to its patients without inducing further risk; either through increasing potential exposure to COVID-19 or by delaying necessary care. The problems to haematology laboratories can be widely categorised between haematology patient vulnerability, upheaval of diagnostic and treatment delivery and resource sparsity.

The patients the haematology laboratories serve are under the greatest risk of potentially fatal COVID-19 infection. Data surrounding COVID-19 mortality is contested, however one study found that patients with haematological malignancies had a mortality rate of 32% to 61% after contracting COVID-19 compared to 1.4% when compared to the general population. Diabetic patients were too more vulnerable to COVID-19 caused morbidity with type 1 diabetics 3.5 (three.five) times more likely to die than the general population from COVID-19 and type 2 diabetics 2 (two) times more likely.

Minimising the risk of COVID-19 infection in haematology patients has thus become a top priority. In the U.K haematology patients were required to ‘shield’ even after lockdown restrictions were lifted to minimise risk of infection and health departments have struggled to maintain care while limiting contact. The high rate of infection within hospitals has made these efforts even more strenuous. Rates of diagnostics and treatments for haematology patients (in the NHS) are well below pre-pandemic levels: GP requested full blood counts down 71%, specialist referrals down 57%, total haematological cancer diagnoses down 54%, outpatient appointments down 38% (and mostly moved online) and the number of haematology patients given any IV or SC chemotherapy is down 24%. COVID-19’s effect on the ability of haematology laboratories to provide their services has been extremely detrimental because of the difficulty accessing patients.

Another significant impact COVID-19 has had on haematology laboratories is in the attainment of resources. Never has the demand for hospital staff, personal protective equipment (PPE), ICU beds, additional funding and components of viral diagnostic kits been greater than during the COVID-19 pandemic. The demand compared to the supply was at a point of such significance in the early months of the pandemic the U.K government was forced to ration supplies and had to race to boost ICU capacity and increase attainment of necessary resources. As of November 2020 treatments and surgeries for many patients in the U.K are on hold due to the strain placed on the NHS by COVID-19. The lack of resources and reallocation of staff caused by COVID-19 has seriously reduced the capacity of haematological laboratories. Health officials all around the world have voiced concerns around the lack of focus on malignancies, diabetes and other haematological health concerns because of the pandemic. 

2021: how the haematology laboratory can move forward despite the COVID-19 pandemic?

Getting patients safely back into haematology health departments and getting haematology laboratories working back to full capacity is the difficult but necessary goal moving forward. Ignored symptoms, missed appointments and missed treatments for haematology patients will be a severe and deepening consequence of COVID-19 as the delays to haematology laboratories and healthcare access continues. Efforts are moving forward quickly to increase this access.

Rapidly expanding mass testing capabilities are a priority for governments worldwide and for attempting to ensure safe access to hospitals for haematology patients. Daily or regular COVID-19 testing of healthcare staff and inpatients and testing of patients before they enter hospitals for appointments or treatments will be essential to returning hospitals to “as normal”. This with compliance in mask wearing, hand washing and good ventilation can return hospitals to “COVID-19 free” areas. With that vulnerable patients can use the necessary services haematology laboratories provide.

More ambitiously vaccine deployment is set to begin as early as December 2020, with the NHS in the U.K preparing to begin roll-out to their staff and most vulnerable patients then. This, if successful, would be the most significant stride forward for haematology patients and laboratories.

To keep up with the most current information on COVID-19:

• NHS – https://www.nhs.uk/conditions/coronavirus-covid-19/
• WHO – https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• CDC – https://www.cdc.gov/coronavirus/2019-ncov/index.html

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