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How COVID challenged us and what lies ahead

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8th November, 2023

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.

What’s next?

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.


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