Lessons Learned from the COVID-19 Pandemic to Improve Diagnosis

The National Academies of Sciences, Engineering, and Medicine hosted a workshop, sponsored by the Gordon and Betty Moore Foundation, to examine changes to diagnostic paradigms in response to the COVID-19 pandemic and to consider the lessons learned and opportunities for improving diagnosis within the U.S. health care system. This workshop was part of a series on diagnostic excellence. Below are key themes discussed by workshop participants.

“The COVID pandemic has underlined the critical importance of timely, accurate, and equitable diagnosis.”

— Daniel Yang, Gordon and Betty Moore Foundation

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“Implementing how diagnostic testing is used in our communities, how it’s available, how is it in fact available throughout the world, is a much greater challenge.” 

— Michael T. Osterholm, University of Minnesota

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“The pandemic has illustrated the large gaps that have been there—access, equity, justice. Diagnostics could really be part of addressing health inequities but a lot has to happen for that to occur.”

— Preeti Malani, University of Michigan

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Improving Technology and Care Delivery Innovations

  • Link diagnostic test results to the delivery of appropriate and timely treatment (Bright).
  • Create a multistakeholder consortium to collaboratively define the regulatory pathway and what information is needed at all levels to accelerate the diagnostic approval process (Schachter).
  • Develop multiplex molecular platforms that can differentiate common diseases and scale them to provide greater patient access globally (Bright, Rodriguez, Weber).

“I believe the next step in these home-based rapid antigen tests will be multiplexing. One swab will do the job and inform you if you have RSV or SARS-CoV-2 or influenza or other respiratory pathogens.”

— Rick Bright, The Rockefeller Foundation

“Excellence means an end-to-end system where it is clear who has responsibility for what. You do not have any single points of failure and that all of the systems we talked about—social media, big data, development—all of those things combined ultimately support access and equity.”

— Nicole Lurie, Coalition for Epidemic Preparedness Innovations


Public Health and Policy Opportunities

  • Increase sustainability and investment in public health infrastructure to better manage diagnosis, treatment, and surveillance of infectious diseases (Osterholm, Overhage).
  • Develop a global standardized data system that allows for interoperability across health systems and rapid identification of outbreaks (Bright, Overhage, Rodriguez).
  • Use digital technologies to develop targeted public health messaging that considers rapidly changing information and is responsive to the needs of the public (Merchant).
  • Reinforce the resiliency and agility of global supply chains (Malani, Osterholm, Weber).
  • Expand public–private partnerships that include community input and engagement to develop new diagnostic technologies (Alexander-Scott, Lurie, Rodriguez, Schachter, Weber).
  • Create an independent, unbiased entity that can collect samples, standardize assays, and compare different diagnostic tests to minimize duplication (Bright).

“We are being intentional about ensuring that we are prioritizing those communities that are harder hit through a variety of determinants of health. That notion then impacts policies, supplies, and other decision-making elements that are connected to diagnosis and diagnostics.”

— Nicole Alexander-Scott, Rhode Island Department of Health

“This pandemic also, as I think everyone knows, highlighted many of our global supply chain vulnerabilities. We had never thought before of a shortage of swabs or Tyvek packaging for diagnostic tests. And one of the lessons learned here is we might need to think differently about some of those aspects of our supply chain as it relates to diagnostic testing and self-testing.”

— Kathleen Weber, OraSure Technologies


Emphasizing Patient-Centered Care

  • Increase the accessibility of diagnostic testing to the public (Bright, McKee, Rodriguez, Weber, Webb Hooper).
  • Expand the use of home-based diagnostic tests to improve access to and reduce the costs of diagnosis (Bright, Malani, Rodriguez, Rubin, Weber).
  • Invest in noninvasive sampling methods to expand access to home testing (Bright, Weber).
  • Leverage community-centered approaches to build trust in science and public health (Essien, Trinh-Shevrin, Webb Hooper).
  • Codesign systems and tools with communities to help patients take control of their health care (Lurie).

“I think one really dramatic example of the value of patient input was that as we started noting disparities in the expression of COVID-19, we began to understand that it was multigenerational, crowded households that were at the most severe risk, in part because the elderly were having increased exposure.”

— Rainu Kaushal, Weill Cornell Medicine  

“Place-based approaches, community-centered approaches need to be strengthened. We know that working with trusted messengers and trusted community structures like community-based organizations and faith-based organizations are key to really improving trust in science and engagement around the vaccine as well as clinical trial studies.”

— Chau Trinh-Shevrin, NYU Langone Health

Focusing on Equity

  • Increase clinician cultural competence and awareness (Begay).
  • Enhance data collection on race and ethnicity and improve engagement, recruitment, and retention of racial and ethnic minorities in clinical trials (Begay, Essien, Trinh-Shevrin).
  • Emphasize research transparency to assess whether study populations represent the population affected by the disease (Rubin).
  • Develop effective approaches to address misinformation and disinformation, and build community media literacy capacity (Merchant, Trinh-Shevrin).
  • Enhance diagnostics capability and capacity for global genomic surveillance of key endemic diseases in low- and middle-income countries (Rodriguez).

“Hearing historical truths are difficult … but it is only through truth that we can move forward, and understanding and respecting that these truths are crucial in elevating the health status of Indigenous people.”

— Adriann Begay, HEAL  

“How do we innovate around access to testing and technology for testing so that communities are aware of what resources are available, and thinking about the cost opportunities for communities to be able to engage with those technologies? I think there is a great opportunity to be more innovative and equitable around technology to improve care, especially in the pandemic, and really leverage the community expertise there as well.”

— Utibe Essien, University of Pittsburgh

Identifying Research Priorities

  • Disaggregate data collection, and use innovative approaches to reduce misclassification errors and to improve the quality of data systems (Trinh-Shevrin).
  • Collect social determinants of health and demographic data using standardized measures (Webb Hooper).
  • Develop initiatives to understand and mitigate the challenges associated with home-based diagnostic tests (Bright, Malani, Rubin, Yang).
  • Continue initiatives to understand the long-term effects of COVID-19 to accurately and efficiently improve diagnosis (Kaushal).

“A key point is that disparities in COVID-19 transmission, infection, and death are not because racial and ethnic minority groups are inherently more susceptible to the virus, but because of social inequities that have led to more pre-existing conditions like heart disease, obesity, diabetes, and other comorbidities, as well as social inequities that increase the likelihood of exposures.”

— Monica Webb Hopper, National Institute on Minority Health and Health Disparities

“The other problem, of course, for a practitioner is how do you act on information that a patient collected that you never saw, using a test whose performance characteristics can vary quite a bit depending on who the manufacturer is and how well the patient administered the test. I think we need a lot more guidance on how to use these.”

— Eric Rubin, New England Journal of Medicine

“One of the takeaways for me is that substantial consideration needs to go into how the public investment can support what is happening on the technologic side to really drive more patient-centered diagnosis.”

— Andrew Bindman, Kaiser Permanente

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