How the pandemic is affecting the evolution of pathology

“The opportunity that we have been given to work together— academic institutions, healthcare systems, commercial laboratories, biotech and pharma—has been absolutely wonderful. And I hope that this gets to stay, because we cannot confront any of this by ourselves.”
— Dr. Carlos Cordon-Cardo

Dr. Caveney conducts a fireside chat with Dr. Carlos Cordon-Cardo of Mount Sinai Health System

 

Dr. Brian Caveney (left) and Dr. Carlos Cordon-Cardo (right)

Question

Dr. Caveney: What was it like in those early days of the pandemic, with New York City the absolute epicenter of the world in terms of numbers and not knowing exactly what was going on?

Answer

Dr. Cordon-Cardo's:  The first days of the pandemic were very hectic, very difficult, anxiety producing, but we were prepared. Months before the pandemic arrived in New York, we knew that it was not a matter of if, but a matter of when.

We started preparing assays in the research lab, and when the first case arrived in the beginning of March, we were ready to transfer these assays from the research lab into the clinical labs. Some of the first calls that I made were to our laboratories, to the chief medical officer of the City of New York, and to our Labcorp colleagues to make sure that we were going to be able to go into this unknown zone together.

Question

Dr. Caveney: Mount Sinai has long been a world leader in microbiology and immunology research. Tell us about some of the early antibody research into the immune system response to COVID-19.

Answer

Dr. Cordon-Cardo: What we learned during the course of the early developments and into the middle of the pandemic was that producing a staging and a classification of where to put our patients was going to be very critical.

Staging is a process that we use in medicine in order to bring together diagnostic and monitoring tools, with the right test to do at the right time with therapeutic intervention based on the organ damage that we see as the disease moves from earlier stages to more complex disorders. We have done that in cancer, we’ve done that in renal diseases, and in other units, and it gives everybody guidance. The patients feel better if they know that they’re in a stage one or in a stage three. The doctors feel better when they know that in stage two you can bring armamentarium that may be more aggressive and not wait until stage four.

Question

Dr. Caveney: Do you believe that one silver lining from the pandemic is that we will have a stronger public health system and perhaps do more genomic surveillance of pathogens over time? Do you think that monitoring specimens over time will give us a better sense of how these viruses and other pathogens are mutating, and how perhaps the treatment in vaccines need to also change over time so that we can present a better defense to them?

Answer

Dr. Cordon-Cardo: The opportunity that we have been given to work together—academic institutions, healthcare systems, commercial laboratories, biotech and pharma—has been absolutely wonderful. And I hope that this gets to stay, because we cannot confront any of this by ourselves. Even government has its own limitations because as much as they are helping all of us (they also have their labs), they can’t see the patients.

We were able to work with specific laboratories in the state of New York and federally—sharing reagents, sharing blood products, sharing positive cases, sharing organs after doing an autopsy—to better understand what was happening. And working with you, with Labcorp, making sure that we were able to have what was needed, from plastics to specific kits.

We learned how to work as a multidisciplinary team, and we learned how to do it in a very effective, efficient way. So, our community felt safe with assays and laboratory tests that were validated on a very short schedule. I hope that these lessons are here to stay and to help us in potential future developments. Hopefully, we have learned enough now that we can address it if they came in a different fashion.

Question

Dr. Caveney: While the pandemic affected the way all of us work, live and play, it also directly impacted the way pathologists work. Pre-COVID, Labcorp was working with Mount Sinai on a variety of different digital pathology initiatives to digitize the slidemaking process. Do you think that the pandemic will accelerate the transition to digital pathology?

Answer

Dr. Cordon-Cardo: Definitely the pandemic has accelerated how digital pathology has been built, how critical it is; and how helpful it can be. It’s not replacing the pathologist, it’s bringing in tools that allow the pathologist to be more efficient, and also to work remotely. With these new developments, some senior pathologists or members of the pathology community who couldn’t come to work were able to observe from their houses or where they were staying.

While digital pathology was initially approved as a tool for consultation, it has become a tool for primary diagnosis, which it expedited. Rather than sending the slides at a moment that the community was completely disrupted to experts in different fields, we could get a consensus of what’s happening. It was very critical because that was the foundation to use some innovative therapeutic modalities in these patients. We have a new tool that, when wisely used, not only increases the efficiency of the pathologist, but the networking for difficult situations. You can immediately share cases and have a dialogue in order to end at a better place for the patient.

Question

Dr. Caveney:  You’ve said that the healthcare system, the public, the government, and others now realize the importance and the value of an accurate and timely diagnosis at the beginning of clinical care, so that all of the right downstream clinical treatment decisions can be made. Perhaps doctors and others will remember how important pathology and laboratory medicine was during the pandemic and give it its credit.

Answer

Dr. Cordon-Cardo: That’s what we hope, and that’s why we have been attempting to educate the community, colleagues [and] regulatory agencies that lab testing and pathology is at the center of patient management. I think that, in many contexts, pathologists are at the center of patient care, and I think that this pandemic is proving once more that this is the case.

I learned from a father of this country who said at one point that the lawmakers and the policymakers need to hear the technical groups, in this case maybe the physicians, the PhDs in the laboratories trying to understand the disease, the biomedical groups. We are the ones seeing the patients that are sick, the families that have dear ones that are ill. And we need to be able to translate that to society and policymakers as well. It’s part of our mandate to hear what society is asking us and to value the requests.

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