The future of public health microbiology has arrived

I've read the 2021 article written by David Betts, Randolph Gordon, Claire Boozer Cruse, and Alison Muckle Egizi entitled "The future of public health". It says that there are six mutually reinforcing dimensions in the future of public health; among which are health equity, the robustness and responsiveness of the workforce, a shared value proposition, shared real-time data, funding towards the promotion of disease prevention and wellness promotion, and ecosystem of public health laboratories that have a universally correct data.

While listening to the discussions during the annual California Association of Public Health Laboratory Directors (CAPHLD) meeting, I was blown away by the technical advances that had occurred and what the state's public health laboratories could do in such a short amount of time and with limited resources. I also became under the impression that the future of public health has arrived.

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Here, I point out some of the dimensions in the future of public health and why I think that the current operations of the laboratories indicate that that future is here. 

Robustness and responsiveness of the workforce

COVID-19 is a perfect example of how microbiologists have risen to the occasion. An influx of nasal swabs needed to be tested, and results reported as fast as possible. Some staff members got repetitive stress injuries caused by doing thousands of COVID-19 tests per week. The public health laboratories shifted to robotics to prevent these injuries from worsening. Staff then learned how to use the robots so that they can continue to respond to their communities' needs. 

Shared data and resources

The CAPHLD annual meeting is a venue where public health laboratory directors can meet and exchange information. On top of that, they have weekly meetings to discuss issues and potential solutions. And then there's an online tool that laboratorians can use when they're in a pinch. If they lack culture media because of unexpectedly high submissions during a given week, they may use that tool to find where they can borrow the culture media they need. If a laboratory is in need of structural repair and must shut down its physical space during renovation, the online tool can also be handy in giving information about where to route specimen submissions. This ability to share data and resources ensures continuity of operation for all the public health laboratories.

A shift of underlying philosophy from reaction to prevention

A lot of the work being conducted by microbiologists tends to be reactive. For instance, a hospital noticed that newborns in its intensive care units were simultaneously getting sick with the same illness. To determine if this was an outbreak or a group of unrelated events, the microbiologists turned to whole genome sequencing of samples from the newborns, the healthcare workers caring for them, and the environment where they were being treated. If the newborns and their healthcare workers were infected with the same strain, there's an outbreak; however, if different strains were obtained from the infants, they might be looking at many isolated cases. The next course of action (the reaction) would typically be treating the newborns' infection as soon and as effectively as possible, reassigning the infected healthcare worker to a different task to prevent infecting the infants, and reviewing the proper use of personal protective equipment.

But then, some talks suggested a paradigm shift from reaction to prevention.

Over one of the lunches served during the CAPHLD meeting, I had a chance to sit beside someone from the Office of Emergency Services. He talked about using chaos theory to predict what the next crisis could be and, from there, work on how to prevent it. On the other hand, one of the presentations during the meeting was about the Legionella outbreak in Napa County. The presenter talked about the need to take preventative steps so that pools of stagnant water—potential breeding grounds for Legionella sp.—from aerosolising and getting inhaled by people (thereby preventing outbreaks).

Lobbying for resources and funding

I learned that CAPHLD partners with different organisations that allow CAPHLD's concerns and priorities to be heard by legislators and policymakers. In fact, CAPHLD has a liaison officer who handles the bulk of this work. Some laboratory directors have been involved in preparing technical notes or even drafts of pieces of legislature. A strong partnership with legislators has made it possible for the laboratories to hire new staff and procure state-of-the-art equipment, particularly with the COVID-19 pandemic (in which the laboratories have seen a tremendous increase in the number of tests being performed, with pretty much the same turnaround times).