The COVID-19 pandemic has enveloped the globe starting with the first case that was reported in December of 2019 in Wuhan, China. Mask mandates, quarantine orders, travel restrictions, contact tracing, and multiple vaccines have not contained the pandemic yet. Currently, the World Health Organization (WHO) reports that there are over 216 million confirmed cases and over 5 million deaths due to COVID-19 worldwide. Clinical laboratories have been on the frontlines of fighting this pandemic for almost two years. Several labs saw a negative impact on testing volumes initially due to the downstream effect of cancelled or delayed medical procedures and appointments. Additionally, given the exponential demand for COVID-19 testing, many labs shifted resources to offer COVID-19 testing. However, this sudden implementation of COVID-19 testing also caused a shortage in supplies, equipment, and reagents which proved to be a logistical challenge.

The COVID-19 pandemic was declared in March of 2020 by the WHO, which is when local and national governments started instigating sudden and drastic policies to combat the spread of the virus. Medical offices and laboratories needed to quickly carry out new safety protocols. Stricter cleaning procedures, physical barriers, personal protective gear (PPE) for staff, in addition to operating at a reduced capacity were some of the changes. Furthermore, most medical facilities implemented telemedicine and postponed routine or optional surgeries which impacted patient volumes. Many medical centers were overwhelmed with patients being evaluated and treated for COVID-19 and had to shift resources accordingly. This perfect storm had a negative downstream effect on clinical labs initially.

As a result of less non-COVID testing ordered by healthcare providers, the second quarter of 2020 showed a precipitous drop in laboratory specimen volumes across multiple specialties. Smaller labs reported a 40-90% reduction in testing volumes while some in vitro fertilization labs shut down completely. Larger “big box” labs reported an overall drop of over 40%, which included COVID-19 testing. For example, pathology and toxicology were down 50%; HIV testing was reduced by 45%; genetic tumor testing was off by 30%; and non-invasive prenatal screening for fetal chromosome conditions dropped by 20%.

As lab testing demand was reduced, COVID-19 testing and COVID-19 related testing surged. COVID-related testing includes tests that are used in the management of patients affected with COVID-19. For instance, cytokines including interleukin-6, angiotensin II, procalcitonin and lactate dehydrogenase are biomarkers associated with poor prognosis for patients with COVID-19. These tests spiked considerably compared to pre-pandemic levels.

The exponential demand for COVID-19 and related testing proved to be challenging for many labs. Some larger labs may have already had the equipment on hand to ramp up these tests. However, smaller labs needed to purchase equipment to have this testing available. At the beginning of the pandemic, nobody could predict the demand for COVID-19 testing would last. Some laboratories needed to commit a substantial amount of time, space, and resources without knowing if they could cover their expenses. Regardless of equipment needs, there was a strain put on reagents and supplies needed for COVID-19 and related testing. Lack of supplies proved to be challenging.

By the end of 2020, many of the larger labs had recovered. Revenue for both LabCorp and Quest were markedly higher in 2020 compared with 2019. Additionally, different COVID-19 variants have mutated causing surges in outbreaks globally, thus; the demand for testing follows. Although 2021 is not over, both labs report an increase in revenue compared to last year. It is difficult to predict how lab test ordering patterns in 2022 will compare with the two previous years.

With the sudden drop in overall testing volumes in 2020 and the lasting recovery that began later in that same year, some may question if laboratory testing was over-utilized prior to the pandemic. Indeed, ordering unnecessary laboratory tests is not a novel concept and is well-documented in the literature. However, the COVID-19 pandemic caused a massive disruption in medical practice, which severely impacted laboratory testing ordering patterns. Furthermore, the pandemic caused medical practitioners to re-evaluate how they practice medicine including determining what tests were truly necessary for patient care. Many healthcare providers switched to telemedicine which reduced or delayed the number of blood draws in the office.

The COVID-19 pandemic has changed the way physicians practice medicine on a global scale, which has tremendously affected the clinical lab industry. The demand for COVID-19 and related testing continues as new variants are identified and there are regional outbreak hot spots. Although the current pandemic has led to the shutdown of some smaller labs, it seems that larger labs have recovered from the initial shock of the first six months of 2020. As we approach the two-year anniversary of the first documented case of the COVID-19 pandemic, hopefully labs have adapted to be nimbler and agile so they may successfully face the unknown challenges of the future.



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