As the number of COVID-19 confirmed cases has been increasing worldwide, the importance of adopting early detection measures increases in urgency. Within this context, public health laboratories have been playing a critical role in responding to COVID-19.

To highlight this issue further, on Tuesday, September 29, 2020, EMPHNET conducted a webinar titled “The Role of Public Health Laboratories and Testing in the COVID-19 Response”. The webinar shed light on the crucial role played by public health laboratories in responding to COVID-19. The discussion revolved around the different types of available tests for diagnosing COVID-19 and their performance.

The session was led by three health experts namely: Professor of Microbiology and Immunology, University of Jordan and Consultant Clinical Pathologist, Department of Laboratory Medicine, Jordan University Hospital, H.E Prof. Azmi Mahafzah; Director of Clinical Microbiology Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Prof. George F. Araj; and Assistant Professor, Department of Microbiology and Immunology, Georgetown University and member of the Center for Global Health Science and Security, Dr. Erin M. Sorrell. The webinar was facilitated by Disease Control and Prevention Team Leader, GHD|EMPHNET, Dr. Tarek Al-Sanouri.

Dr. Al-Sanouri started the session by introducing the current situation regarding COVID-19 testing, available kits, and testing strategies in the region. He also highlighted the role of labs during COVID-19, especially regarding case identification, diagnosis, and confirmation of COVID-19 cases. He then presented the speakers and introduced the webinar’s focus.

H.E. Prof. Mahafzah started his presentation by mentioning that the number of COVID-19 confirmed cases globally has surpassed 30 million and that the rate of confirmed cases has also increased in Jordan as of September 27, 2020. He then described the SARS- CoV-2 as a pleomorphic, enveloped, positive single-strand RNA, which ranges in size from 80mm- 160mm with distinctive morphology, and he proceeded to explain more about the morphology of the virus and what family it comes from. He then went on to explain the types of specimens used in the diagnosis of coronavirus stating that they are mainly respiratory specimens although the virus can also be detected from blood and stool. H.E. Prof. Mahafzah stated that there is a chance for the readings to reveal false-negative and false-positive results, that is why it is essential to have quality control in place.

In his presentation, Prof. Araj stated that the immune system comes with two major arms: the cell-mediated and the humoral one, in addition to other regular immune macrophages and monocytes that innate immunity. He then spoke about the infectious doses of different agents and their routes, stating that the exact infectious dose for COVID-19 remains to be determined. He highlighted the fact that wearing face masks prevents and minimizes the infectious viral dose. Prof. Araj then explained that the detectable virus level is determined by the PCR. He also added that the duration of PCR positivity can prolong for weeks, mostly due to having a non-complete virus. In this regard, Prof. Araj further explained that at times, a person is not picking up the virus, but picking up parts of the virus. He added that one needs to rely on what has been assessed and published due to the withdrawal of many tests that give misleading results, thus further misleading the diagnosis and the work of physicians.

The third presenter, Dr. Sorrell, explained that diagnostic and public health laboratories are essential for providing early warnings of disease outbreaks at the local, national, and regional levels. She added that achieving accurate, reliable, timely, and safe diagnostic and confirmatory testing from all levels of the laboratory network requires the continuous implementation of a laboratory quality management system at all levels. Dr. Sorrell also added that the world is facing many test challenges, one of the challenges is finding the absolute key number of tests that should be held on a daily, weekly, and monthly basis for each country, region, and state.
She further highlighted that challenges include constrained financial and human resources, lack of reliable transportation routes and laboratory networks at the subnational level, the lack of integrated data management and reporting systems, and the existence of numerous test kits of variable quality yielding different results. She added that to face these challenges, the creation of successful pooling samples for PCR testing, the integration of rapid antigen tests for surveillance, the initiation of testing programs to the size of a state’s epidemic are all recommended.

A discussion session facilitated by Dr. Al-Sanouri followed the presentations. The discussion session focused on relevant and important questions asked by the participants. Two hundred and forty-nine persons attended the webinar, deeming the seventh webinar in the “EMPHNET WEBi Series” initiative a success.