On International Pathology Day, NSW Health Pathology’s A/Director of Public Health Pathology Dr Catherine Pitman and her colleagues consider the impact of climate change on the spread of disease and the implications for public pathology services.
As we know, 70 per cent of all clinical decisions are based on pathology results and most cancer diagnoses start with pathology.
NSW Health Pathology is the largest public pathology provider in the country and has more than 60 laboratories and over 150 collection centres located throughout New South Wales.
Australia and its citizens have access to one of the best pathology services in the world, partly due to the legislated high accreditation standards of NATA, the National Association of Testing Authorities (a not-for profit accrediting body) and the requirements of the RCPA, Royal College of Pathologists of Australasia. It is envied by many nations.
The COVID-19 pandemic challenged us all on many fronts, but it also has given us the opportunity to do better with outbreaks, big and small and adapt to the highly changing environments that we are facing in Australia and globally.
The latest risk modelling from London-based disease forecaster Airfinity suggests there is a 27.5% chance that a pandemic as deadly as COVID-19 could occur by 2033.
An independent Australian review of the COVID-19 pandemic outlined four areas where we as a country could have done better, five overarching lessons and six recommendations to improving our response to the next health crisis in Australia.
Those recommendations are:
– Strengthen crisis preparation
– Establish an expert body and trusted voice eg: an Australian Centre for Disease Control and Prevention
– Improve government decision-making
– Enhance public service collaboration, capability and communication
– Modernise how governments use data
– Build a culture of real-time evaluation and learning in the public sector
The first cases of COVID-19 in Australia were detected on 25 January 2020, concurrently in Victoria (one case) and NSW (three cases) on four returned travellers from Wuhan. The first known cases of community transmission in Australia were detected on 2 March 2020 in NSW.
The first SARS-CoV‑2 genomic sequence was released internationally on 10 January 2020 (ref 1 & 2) enabling the pathway for the development of in-house COVID-19 PCR assays across the world.
How NSW Health Pathology responded
On 22 January 2020, NSW Health Pathology’s Institute of Clinical Pathology and Medical Research at Westmead commenced COVID-19 PCR testing using an in-house PCR test, and the first NSW case was diagnosed on 25 January 2020. The first few PCR-positive cases of SARS-CoV‑2 were retested and confirmed at the VIDRL (Victorian Infectious Diseases Reference Laboratory).
Our Public Health Pathology Service co-ordinated the development of NSWHP testing capabilities under the leadership of then Chief Executive Tracey McCosker and Incident Management Controller Dr Stephen Braye in early 2020. The development of the COVID-19 PCR assays required a fully secure virus isolation facility, virus whole genome sequencing and SARS-CoV-2-specific serology as cases expanded in NSW.
Without these NSW Health Pathology facilities, the development of some of the first pathology assays in Australia would not have been possible. In the first 10 weeks of the pandemic, all testing was provided by the public pathology sector.
NSW Health Pathology was able to provide reliable, scalable, and prompt diagnostic services for COVID-19 diagnostics and has been instrumental in offering unique and public health-related laboratory advice to NSW Health. A unique collaboration with the world-renowned biosecurity facility at the Elizabeth Macarthur Agricultural Institute (EMAI) assisted with the expansion of COVID-19 during surges in 2020 and 2021.
When will the next major public health challenge be? Creating foundational capacity in pathology laboratories is critical to being able to rapidly and effectively contain the next health crisis.
The unpredictability of a changing climate will be a significant challenge. Climate change will not only lead to increased risk of mosquito-borne diseases but also extreme weather, including storm events, flooding, and bushfire. These could all impact health and result in new and changing diseases, which will require agile surveillance and response programs.
We now have new viruses that were not present in Australia before the COVID pandemic, such as Japanese Encephalitis Virus (JEV). With now more than 45 known cases of the disease and seven fatalities in Australia, the outbreak and presence of JEV has had a significant impact on health, as well as significant economic impacts on the Australian pork industry.
Similarly, the global outbreak of Mpox in 2022–2023, required new pathology assays and the capacity to monitor to help protect community health and safety.
Confronting our rapidly changing environments and diseases will require collaboration and commitment by all Australian citizens and organisations. Australia will be in a better position to meet the difficult and complex health challenges ahead if we continue to invest in the first-class pathology services of Australia and embed the learnings from the COVID-19 pandemic.
Authors: Dr Catherine Pitman, A/Director NSWHP Public Health Pathology, Vishal Ahuja, NSWHP Project Officer Public Health Pathology and Prof Dominic Dwyer, NSWHP medical virologist and infectious diseases physician.
1) Wu, F. et al. (2020) ‘A new coronavirus associated with human respiratory disease in China’, Nature, 579(7798), pp. 265–269. doi:10.1038/s41586-020‑2008‑3.
2) Lu, R. et al. (2020) ‘Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding’, The Lancet, 395(10224), pp. 565–574. doi:10.1016/s0140-6736(20)30251–8.