“When someone is critically ill, the ability to precisely diagnose what that person has means everything,” says Massachusetts General Hospital infectious disease specialist and pathologist Eric Rosenberg, MD. Pathology — the branch of medicine that specializes in the diagnosis of human disease — is the invisible engine of every hospital. And that’s never been more evident than during the COVID-19 pandemic. As director of Mass General’s Clinical Microbiology Laboratory, Dr. Rosenberg oversees the scientific team responsible for diagnosing infectious diseases — everything from influenza to HIV. At the height of the omicron surge, Dr. Rosenberg’s team performed between 1,000 and 1,500 COVID-19 tests every day. We asked Dr. Rosenberg about how the pandemic has tested his team, how they rose to the challenge of COVID-19 and what the future looks like for microbial detection and surveillance at Mass General.
How has COVID-19 challenged the Clinical Microbiology Laboratory?
This virus was, and remains, a huge test. We found out early on that the entire operation of the hospital relied on our ability and capacity to test for COVID-19. That means not only testing people who are sick, or may be sick, but also testing the staff who treat those people. The volume of testing has been incredible and sustained. To keep COVID-19 front and center, we’ve had to rethink our operation to ensure that everyone tested received their result in a timely manner, while preserving our ability to perform the other microbiologic testing necessary to provide optimal care to our non-COVID patients.
What are some examples of innovative solutions your team has developed?
At the start of the pandemic, the only diagnostic test for SARS-CoV2 (the virus that causes COVID-19) was produced and distributed by the Centers for Disease Control and Prevention (CDC). That meant everyone had to get in line, which put us in a terrible position because patients were already rolling in with what we believed was COVID-19. So, on March 7, 2020, we set out to create our own test. One week later, thanks to the skill and expertise of an incredible group of microbiologists, we were able to offer our own “in-house” test to our sickest patients. Based on its excellent performance, we were one of the first groups to receive emergency use authorization from the Food and Drug Administration (FDA) — beating all the big companies to the punch. It was an incredible achievement.
Another important contribution we’ve made is that we developed a strategy to sequence the genome of each SARS- CoV-2 isolate. This allows us to monitor mutations in real time, track viral variants such as delta and omicron and identify new strains as they arise. We are now one of the leading contributors to the global database tracking the evolution and spread of COVID-19 variants.
What’s the lesson of COVID-19, and how will it shape pathology at Mass General going forward?
In my tenure, we’ve prepared for smallpox, Ebola, drug-resistant bacteria and more. COVID-19 isn’t our first pandemic, and it won’t be our last. The earlier we can detect a threat, the earlier we can intervene. Historically, we’ve relied on the CDC to do that, but we’ve learned from this pandemic that we can do it ourselves. And we should be.
With that in mind, I’d like to see us establish a Center for Advanced Microbial Diagnostics and Surveillance. With the right investment and infrastructure, we could be at the forefront of detecting new biological threats — a sort of “mini CDC” for New England. By maintaining our current large-scale testing capacity and devising the diagnostic tools of tomorrow, we will ensure that we’re ready for the next invisible invader.
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