Our Race Against COVID 19
Dr.Barnali Das, MD, DNB, PGDHHM.
Consultant, Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Chair, American Association of Clinical Chemistry (AACC) India Section.
Executive Member, Scientific Division, IFCC.
College of American Pathologist Inspector & NABL Assessor
The role of laboratory physicians has been challenged many times in the past. Therefore, in the constant quest to validate our role in the pandemic, I thought to provide snippets of our journey during the last two years of how we are playing crucial roles in improved clinical outcomes by routine laboratory biomarkers.
Coronavirus disease 2019 (COVID-19) is a global threat to healthcare and patient safety, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is clear that the laboratory physician will play an essential role in this crisis.
Processes are now streamlined in Laboratory Medicine to ensure the provision of reliable and timely test results, and appropriate alliance with the brain-to-brain loop, thus enhancing the quality of care and patient safety. We tried to play an active role in the standardization and harmonization of tests, methods, cut off and laboratory practices during the pandemic.
We realized that the critical role of laboratory medicine in this pandemic extends far more than the etiological diagnosis of COVID-19. Routine laboratory monitoring of COVID-19 patients through testing is critical, for assessing disease severity and progression, as well as monitoring therapeutic intervention. The routine biomarkers play an essential role in patient admission protocol, assessment of staging of disease according to severity, prognostication, patient monitoring, and therapeutic guide.
We have evaluated the role of routine laboratory biomarkers and observed statistically significant abnormal values of biochemical and immunoassay parameters: C Reactive Protein (CRP), Procalcitonin (PCT), Lactate Dehydrogenase (LDH), D-Dimer, Interleukin 6 (IL6), Ferritin, Blood Gases, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Serum Albumin, Total Bilirubin (T Bil), Creatinine, High sensitive Troponins (hSTnI or hsTnT) and B type natriuretic peptides (NT ProBNP or BNP) in COVID 19 patients; those who are admitted with rRT-PCR positive test results at Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute in Mumbai (1,2)
The ongoing pandemic of COVID-19 is characterized by respiratory illness and diverse systemic clinical presentations, which in turn are reflected by routine laboratory abnormalities, based on the severity of disease presentation. The main laboratory changes encompass an array of increased inflammatory biomarkers, coagulation parameters, tissue-specific tissue injury indicators (liver, kidney, cardiac), and derangement of the complete blood count. Based on the severity of the disease, the host's inflammatory response to the virus may lead to a cytokine storm that can cause multi-organ damage. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly deranged in patients in the critical stage of COVID-19. In hospitalized patients, there should be close monitoring of biomarkers for potential progression to the critical stage of the illness and fatality.
We realized that we need to build diagnostics & healthcare ecosystems, critical now more than ever. There are roles of all stakeholders diagnosticians, clinicians, nursing, biomedical team, procurement team, administration, IVD sector, accreditation, and regulatory bodies in the diagnostic ecosystem. COVID-19 has hit the healthcare and patient care sectors. There is a need to create awareness among the chronic patient group (Cardiac, Cancer, Diabetes, and general illness) about the need to get their periodic blood tests which might be pending due to the COVID pandemic.
The road map for laboratory medicine therefore will involve strategies for harmonizing, communicating, and integrating with all stakeholders, in order to formulate guidelines for assisting in the correct measurement, diagnosis, and management of diseases.
There is a strong need to create a sustained technology policy and supply chain policy framework through a thrust on innovation and allocation of resources for fast-pacing the development of the IVD sector. A strong diagnosis technology model needs to be formulated which will ensure that technologically advanced healthcare is available to all sections of the population.
We also need to bridge the supply–demand gap: The challenges in the testing process worldwide suggest focusing on the opportunities and bridging the supply–demand gap. Involvements require different levels of investments: both short-term measures and long-term measures for incremental improvements in the diagnostic care domain.
My Journal during COVID Pandemic:
‘Life isn't black or white, it's all sorts of shades of grey.’
Life flies by, and it's easy to get lost in the blur. The pandemic has robbed us of all the joy of socializing. But it gave us time to read, introspect and give back. While I was penning down this article at 5.30 am, I realized I’m not able to write much about my evolving journey during this pandemic. I had 22 more pending ‘to-do’ lists in my morning journal, a few papers popping up to read before sending emails to the authors as editor-in-chief, and many more technical, administrative, and personal checklists. I suddenly felt jittery. I saw a bookmark in one of my books kept in the pile. It was ‘Atomic Habits’, one of my favourite read nowadays. I opened that page and read that line again & again: ‘1% better every day’. I got the courage to collect my thoughts and proceed.
Our lives are different, our life perceptions are different, and the inner and outer journey is different for each one of us.
Life's most persistent and urgent question is, '"What are you doing for others?"
Martin Luther King, Jr.
It's very important for us to understand that we are interconnected and we need to give back whatever little we can, especially when the going gets tough. Since March 2020, being a part of the COVID task force; I troubled many of you, to help people with advice and resources, sometimes in these difficult times. You extended your benevolence to help people, even from my home town too. In fact, many of you have supported me unconditionally, breaking so many barriers.
But it also taught me different perspectives and different shades of life. The pandemic has undoubtedly changed my outlook towards life.
I can now contemplate on my life journey: ‘Find work you love and work that matters, and do it as honestly as you can.’
There is one Bengali folk song by Lalan Fakir,
“Who are dwelling in your house, oh mind, you don't know”. This is so true. Our life is not just vast, it is truly enchanting.
Let’s accept that vastness of life and seek that openness to have more sunlight, more and more candor. My heartfelt wishes for the New Year.
May 2022 heal those ailing, bring help and aid to those struggling to survive for resources, and provide strength to those who lost their loved ones. May it continue to save our frontline heroes and our family. May it teach us resilience and empathy for all of mankind. May we all become stronger than before to fight against this pandemic with new strains taking over.
Some of the references of publications and news articles:
- Evaluation of the Role of Routine Laboratory Biomarkers in COVID-19 Patients: Perspective from a Tertiary Care Hospital in India. Indian Journal of Clinical Biochemistry, 2021; 36(4): p473–484.
- Cardiac biomarkers in patients with COVID-19.Indian Journal of Medical Biochemistry, 2020; 24(2): p43–49.
- AACC Clinical Laboratory News (CLN): From Routine Analytes to Cytokines: Diagnosticians Deliver Value to COVID-19 Diagnosis, Management, and Risk Assessment.
- Express Healthcare: Routine lab markers in COVID 19 patients: Chasing the storm in Indian perspective.
- Medical Buyer: Resilience is the key to decode lab diagnostics during COVID.
- Dainik Jagran: News Article in Hindi.
- IndiaMedToday Cover story: Covid 19 Laboratory Diary: This too shall pass.
- Express Healthcare: A race against time: Chasing Procalcitonin biomarker in early sepsis diagnosis.
- Times of India 1st Page (All over India edition & Mumbai edition): Hospital test worth Rs 200 can rule out heart attacks.
- Hindustan Times: Heart attacks going undiagnosed in women?
About the author:
Dr Barnali has come a long way but she is still so full of dreams and aspirations for the future.“If you put passion and dedication in your work, it will give meaning to your life,” she philosophizes.
Dr. Barnali Das, MD, DNB, PGDHHM, is the consultant of the Laboratory Medicine department playing the role of in-charge of Biochemistry, Immunology, and Toxicology sections at Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, MumbaiShe received her MBBS degree from Lady Hardinge Medical College (LHMC), Delhi and MD, DNB degrees from Maulana Azad Medical College (MAMC), Delhi. She did her management training from IIT Bombay and IIM Indore. She is also adjunct faculty at Kasturba Medical College, Manipal, MAHE. She is currently an Executive Member, Scientific Division, International Federation of Clinical Chemistry & Laboratory Medicine (IFCC) and Chair, American Association of Clinical Chemistry (AACC), India Section. She serves as NABL Assessor & College of American Pathologist Inspector.
Before joining her current position, she served as faculty at the T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, and Consultant Clinical Biochemist at SRL Ranbaxy, Mumbai. She is Editor of Practical Laboratory Medicine (PLM), Elsevier, and Editor in Chief for AKI Special Issue, PLM. She is also on the editorial board and reviewer board of a few other reputed international & national journals.
Dr. Barnali recently received the "Seth G. S. Medical College & KEM Hospital Oration Award" from Padma Shree Dr. Mammen Chandy, Director of Tata Medical Centre, at the 47th ACBICON at Science City, Kolkata. We congratulate her for her significant contribution to the advances in Clinical Biochemistry. Dr. Barnali is recipient of three oration awards and five international and eight national awards from College of American Pathologist (CAP Inspector Excellence Honour), American Association of Clinical Chemistry (Outstanding Speaker Award), Univants of Healthcare excellence Global Achievement Award by IFCC, AACC; International Federation of Clinical Chemistry & Laboratory Medicine (IFCC Development of Quality Competence in Medical Laboratories- DQMCL Award), Asia Pacific Federation of Clinical Biochemistry (Young Scientist Scholarship), Reliance Group Corporate Social Responsibility (The Woman of Substance Award), ACBI (Dr. T. N. Pattabhiraman Oration Award, Pitabus Jamuna Burma Memorial Award and Dr. C. Sita Devi Award) and AMBI (Dr. Ajit Singh Saini Oration Award and also Brig. Ramesh Sinha Memorial Certificate & Gold Medal from AMBI), “Diagnostic Leadership Award in Achiever Category” from Indian Express Group, Zee Business National Healthcare Leadership Award in ‘Woman Leadership Category’. Recently she has received ‘Global Investigator Award’ in LMCE KSLM Laboratory Medicine Congress & Exhibition 2021 & 62nd Annual Meeting, October, 2021. She is recipient of ‘2021 The White Knight Award, Healthcare Heroes of India’ by Metropolis Healthcare and ‘Custodians of Humanity Award 2021’ by IGHM for COVID task force work. She has received as “Best Docs Mumbai 2021 & 2020” in the General Pathology field in the magazine ‘Outlook’ and “Top Doctors Mumbai 2021 & 2020” in the ‘India Today’ August issue. Her biography is featured in a book named “And So Can You” (where 17 successful doctors share their inspiring stories).
She has many research Publications in international & national journals (like Clinical Chemistry, European Thyroid Journal, Clinical Biochemistry, Indian Heart Journal, IJCB and IJMB etc.). Her work featured in many news articles in the Times of India first page, Hindustan Times, Dainik Jagran, Express Healthcare, CLN News, IFCC enews and many other magazines.