SARS-CoV-2, the coronavirus that causes the infectious disease COVID-19, is wreaking havoc worldwide.
Pathologists, physicians who specialize in making diagnoses, ordinarily keep a low profile when it comes to patient care. But in dealing with the current pandemic, they are taking the lead and delivering critical laboratory testing when it is needed most.
The key for many pathologists is distancing from hospital laboratories and performing their diagnostic analyses at home, using sophisticated digital imaging technology.
These specialists typically work in laboratories with other health professionals to handle tissue specimens, including those suspected of coronavirus infection. Many pathologists have been training to fight this virulent enemy their entire careers.
Pathologists are being credited for swiftly adopting viral testing, at the point of care in emergency rooms, intensive-care units and now at field test centers in their communities. They continue to work tirelessly to address the pandemic’s rapidly changing demands, ramping up newer tests such as serology, helping to prepare convalescent plasma for potential therapy, and supplying data for epidemiologic surveillance.
Even though pathologists don’t routinely meet with patients, they are at risk of SARS-CoV-2 infection, as this virus can stick to surfaces and be transmitted by direct contact. Infection is a real concern in pathology labs that process high volumes of patient blood, fluid and tissue samples daily.
As COVID-19 cases inundate hospitals, non-infected individuals such as cancer patients still require routine care, including diagnostic pathology services. The best way for pathologists to continue caring for patients — while dealing with staffing shortages, quarantining, minimizing exposure to infected patients or colleagues, and adhering to state lockdowns — is to perform their clinical work remotely, at home.
After President Trump declared a national emergency, many providers adopted telemedicine to care for their patients while protecting themselves and their staff.
Prior to the current crisis, pathologists were restricted from producing primary diagnoses remotely by Centers for Medicare & Medicaid Services regulations, which are mandated by the Clinical Laboratory Improvement Amendments (CLIA).
They require pathologists to work within facilities that hold a CLIA license. On March 26, at the urging of the Digital Pathology Association and other pathology and allied groups, CMS temporarily suspended these restrictive CLIA rules. Many pathologists are now providing remote diagnostic services, using traditional microscopy or digital technologies.
Digital imaging technology has been used by some pathology labs for more than two decades. Some of these systems are FDA-cleared for rendering primary diagnoses, in addition to consultative diagnoses.
Today’s advanced systems produce high-resolution digital whole slide images that untether pathologists from traditional microscopes in labs and hospital offices, enabling them to work wherever they set up their computers.
This remote care, or telepathology, can yield more timely diagnoses, as pathologists can work at any time of day, without wasting time on lab commutes and hospital infection-control processes.
Of course, with remote sign-out of cases, pathologists still are required to adhere to sound practices, assuring that all processes are approved, validated, documented, safe and in compliance with HIPPA security guidelines.
Hospitals that had already validated their digital pathology systems have begun supporting pathologists working from home. It will be important to track how this unfolds, because when SARS-CoV-2 is finally tamed and life returns to normal, it may no longer make sense to return to the outdated rule of restricting pathologists to the lab setting.
Most likely, the current emergency-driven use of remote digital pathology will affirm that using this technology to support remote pathology sign-out is easy to implement, delivering equal or improved patient care, with genuine economic advantages.
By accelerating the adoption of digital pathology, today’s pandemic is likely ensuring that the pathology community will be better prepared for the next global threat.
