Why the ‘hidden heroes’ of our Covid-19 response are striking

Kendall Hutt
Source: 1News

After two years of pandemic pressure and little to show for it in their pay packets, the “hidden heroes” of our Covid-19 response are demanding change.

Terry Taylor, president of the New Zealand Institute of Medical Laboratory Science (NZIMLS).

About 10,000 allied, public health, scientific and technical workers - which includes the scientists and technicians who process our PCR tests - are planning two 24-hour strikes next month, just as the Omicron wave is expected to peak.

The Public Service Association says compared to other health professionals, allied, scientific and technical public health workers are lowly paid and have poor working conditions.

"Covid was the perfect storm for the profile of laboratories and how undervalued they have been for far too long," says New Zealand Institute of Medical Laboratory Science (NZIMLS) president Terry Taylor.

NZIMLS represents about 4000 medical laboratory scientists and technicians who work in diagnostic labs.

Taylor says even before the pandemic their work was underfunded and staff undervalued and treated poorly.

Medical laboratory scientists test and analyse blood, urine, tissue and other bodily fluids and specimens for the diagnosis and treatment of everything from high blood pressure and iron deficiency to cancers and infectious diseases.

NZIMLS says it diagnoses 70-80% of all patient disorders, specialising one or two of clinical chemistry, haematology, histology, transfusion science, clinical immunology, medical cytogenetics, medical microbiology and molecular diagnostics.

Medical laboratory technicians perform sample collections, specimen handling and laboratory testing under the supervision of scientists or pathologists.

Covid-19 tests an added burden

Taylor, a medical laboratory scientist working in leukaemia and lymphoma diagnostics at Southern Community Laboratories in Dunedin, says Covid-19 has seen laboratory workers and their machines spill over into offices and tea rooms due to a lack of space.

There is more automation involved in the testing process than before, such as machines taking lids off samples, but scientists' and technicians' hands, arms and shoulders still ache after long shifts pipetting, pooling and analysing samples.

Fatigue and mental strain is taking its toll, as scientists and technicians around the country process upwards of 20,000 PCR Covid-19 tests per day on top of the 120,000 other samples they usually receive and do more than 200,000 diagnostic tests on.

In contrast, at the end of March 2020 the average number of Covid tests processed per day was 1777.

The Covid-19 Testing Technical Advisory Group has called them the "hidden heroes" of our successful response to date.

Scientists at Southern Community Laboratories developed a molecular diagnostic test to detect 2019-nCoV - as the virus was then known - before it reached our shores.

The first New Zealand-made Covid-19 PCR test was processed by the Institute of Environmental Science and Research (ESR) on January 22, 2020. By the end of January - 29 days before the country's first case was confirmed on February 28 - a Covid-19 diagnostic test was available and testing could begin.

At the time, ESR clinical virologist Erasmus Smit said the process involved "collaboration across borders, organisations, laboratories and dedicated professionals working extremely hard".

"To develop this test we had to source the right tools and material from overseas in a time of high demand and then validate the test locally through numerous experiments to ensure the quality of the result."

Initially only a handful of labs were able to process Covid tests. Now all regional laboratories have acute Covid PCR point-of-care testing available, Taylor says - both state-funded and private.

'Worried well' tying up resources

Increased demand for testing during the Omicron outbreak - particularly in Auckland and Waikato - has seen tests take longer to process, in some cases more than five days.

The Northern Region Health Coordination Centre (NRHCC) said in mid-February up to 70% of those queuing in Auckland had no symptoms. These "worried well" are continuing to turn up at testing centres nationwide, despite the Ministry of Health saying they don't need to.

Under Phase 3 of the Omicron response, people who aren't asymptomatic or a household contact are discouraged from getting a PCR test. Rapid antigen tests (RATs) will instead be used to "ease some of the pressure on our testing" services, Director-General of Health Dr Ashley Bloomfield said last week.

Symptomatic people and/or asymptomatic close contacts whose RAT is positive will be considered a case and do not need to be verified through a PCR test.

Taylor told Seven Sharp last week the demand for testing is "relentless", fearing labs will be overwhelmed with unnecessary Covid-19 testing, blocking other much-needed tests from being carried out.

Although health authorities have claimed daily PCR testing capacity rose from 39,000 to 58,000 ahead of the Omicron wave, Taylor says this is "unsustainable".

Surge capacity is said to be 77,600 daily tests for up to a week. Taylor believes they could only do 58,000 "for a day".

"If we do collapse, we've warned you, but we're going to give it a good go first."

Dr Deborah Powell, national secretary of lab staff union APEX, said on February 23 capacity had already been reached.

The Ministry of Health that same day said the growing outbreak "has resulted in laboratories no longer being able to pool their PCR testing capacity, which had previously helped reduce pressure in areas with high case numbers".

"There is a current baseline capacity of around 31,000 PCR tests per day."

ACT leader David Seymour says this shows the Government has misled New Zealanders about its testing capacity.

"It's time for Government to stop misleading us about its testing capacity and be open to other forms of testing and technology. Our hardworking lab workers deserve better and so do all New Zealanders."

'Renewal' difficult without improved pay, conditions - union

University of Otago virologist Dr Jemma Geoghegan.

Bryan Raill, APEX's medical laboratory workers president, says it's a "good time" for the Government to address pay equity, staffing levels and wellbeing. He thinks many labs around the country could also do with some "renewal".

"Medical laboratory scientists and technicians have to be fairly rewarded for the training, skill and expertise they bring to the health system. Medical laboratory scientists need a timely, fair and equitable process to determine their worth."

After four years of study and usually a six- to 12-month internship, a person is considered a medical laboratory scientist and mainly works in a diagnostic pathology laboratory. A degree isn't always required to be a technician, NZIMLS saying it's usually an in-house two-year apprentice-style training programme.

'Above and beyond'

The Institute of Environmental Science and Research (ESR) has also seen a "very strong increase in demand" for its services - including genome sequencing, sample reception, shipment, wastewater testing, data collection and support systems.

At the start of the pandemic its Wellington lab was the main focus of the work, but the setup there was replicated in Auckland and Christchurch.

"We ended up working weekends, long nights and through the holidays, something ESR does not typically have to do in our role as the national reference lab," says genomics lead Dr Joep de Ligt.

"This was challenging and we did startle the odd security guard and have some unexpected moments.

"The teams put in an amazing effort and went above and beyond to deliver wastewater results and genomes at incredible turn-around times."

University of Otago virologist Dr Jemma Geoghegan says genome testing has played a "starring role" in the pandemic and has been "front and centre" of New Zealand's response.

Genomics has been able to be used in real-time, rather than retrospectively, and the technology has become more accessible and affordable - but Geoghegan worries more infectious variants of the virus could be circulating in countries without access to such technology.

Long time coming

The Covid-19 Testing Technical Advisory Group, led by Professor David Murdoch, acknowledged the "massive and vital contribution" of laboratories in the country's Covid response and praised staff for their "exceptional" performance in its October review.

But the review panel said to address current and future worker shortages, efforts needed to be directed towards retention and recruitment.

Better remuneration is needed, along with the recruitment of staff from overseas - but Taylor says there is no external pool of qualified scientists waiting in the wings.

The review panel also said the promotion of medical laboratory science as a profession was needed.

Taylor says there is a long way to go around the industry's lack of profile and governance. Labs in New Zealand have no formal national governance.

The report also said investment in automation was also needed.

Base levels of staffing, supplies, tech and test volumes were required to maintain and deliver sustained staff wellbeing.

"We'll get through this," Taylor says.