What COVID-19 has showed us about the importance of molecular pathology

I started 2020 with a sense of excitement about what lay in store for me professionally. Amongst other things (including the prospect of writing and submitting my PhD thesis and returning to clinical training), my first draft chapter for the Future of Pathology report was nearly complete, focusing on the importance of molecular pathology. As part of a panel of pathologists, we chose this and three other topics on the basis that these were priority areas too critical to be ignored if we are to truly transform cancer diagnostics in the future.

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Dr. Clarke

Dr. Clarke

With a rise in cancer cases and a decline in the pathology workforce, we agreed as a panel that bold steps had to be taken to ensure pathology thrives and that cancer patients are provided with the care and treatment they need. Molecular pathology is key to this, as we can unlock personalised medicine through greater understanding of a patient’s tumour, and we can improve their outcomes as a result.

But then the global coronavirus pandemic began, and our priorities were shaken up like never before.

While passionate about molecular pathology, my first duty as a doctor is to care for patients’ greatest needs. As the pandemic unfolded, I was quickly diverted to support efforts to manage cases of COVID-19 at the Nightingale Hospital in London. Given my previous experience of working in the post-mortem aspect of pathology, I was appointed as a deputy mortuary manager of the hospital. This was a big responsibility which is often forgotten; people who have died also need attention. I also experienced the pandemic from the other side, catching the virus myself (although fortunately remaining asymptomatic). However, it was a privilege to work with such a dedicated team, united in our efforts against the virus across all healthcare specialties.

During this time, I have maintained my conviction that molecular pathology merits greater attention to future-proof our pathology services. As we have collectively learned to manage the COVID-19 pandemic, the health service is now starting to bring attention back to cancer services, including cancer diagnostics. Like many pathologists and cancer professionals, I am all too aware that throughout this time, patients have still had to live with, and suffer from, cancer.

With the Future of Pathology report, we wanted to kickstart a conversation with healthcare leaders and the managers and administrators in our hospitals. We wanted to open a door and say, ‘let’s work together’ to improve cancer diagnostics.

I want a big part of this conversation to be about molecular pathology and for everyone to know how important it has been to understand and tackle COVID-19. It’s a different disease, but by better understanding it, we can also understand how molecular pathology can address the challenges we face in cancer.

With COVID-19, molecular pathology is central to our understanding of and response to the disease. Genetic sequencing of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has enabled the validation and continued refinement of diagnostic assays. It is also contributing to the development of potential vaccines.

Further, the large amount of genomic material being generated and shared internationally is giving us insights into how the disease is evolving and spreading. This, in turn, informs treatment choice and broader local and national management strategies.

As is the case with cancer, genetic profiling of COVID-19 is key to finding answers to questions around the differences in disease susceptibility according to age, gender, and ethnicity. Additionally, genetic profiling can identify different mutations and help to answer questions around disease progression and outcomes.

Building on our knowledge: our genomic surveillance of other coronaviruses, such as MERS and SARS-CoV, have contributed to our understanding of the origins and biological characteristics of SARS-CoV-2. Going forward, genomic analysis will be central in our search for an understanding of how the virus is transmitted between animals and humans.

All this knowledge makes a difference to healthcare decision making at all levels from international, national, and regional policy decisions, to healthcare managers, healthcare professionals, and the individual patient.

Now, I call on all pathologists to take the Future of Pathology report to colleagues in your department and invite healthcare leaders to better understand the work you are doing. From this, they can support you and see the value of molecular pathology across the board.

To healthcare leaders directly, I say, please download and read the report and its recommendations.

There is no better time than now to relook at our services and use this period of intense change and pressure to reinvent them for the better.

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