COVID-19 testing delays and pathology services in the UK.

Richard Horton is critical of the UK Government for not following WHO's advice for COVID-19 testing at a much earlier stage of the pandemic and for not securing supply chains for pharmaceuticals, protective equipment, and appropriate human resources.

Following the 2003 severe acute respiratory syndrome outbreak and the 2012 Middle East respiratory syndrome outbreak, it was inevitable that with global population growth, overcrowding in many low-income and middle-income countries, increased cheap air travel, and failure to stamp out wet and live animal markets, new coronaviruses would emerge and spread rapidly. The UK should have prioritised the development and availability of better technology to detect new viruses and manage their spread.

10 years of austerity have left the UK National Health Service inadequately resourced and ill prepared. During the reorganisation of pathology services, recommended by the 2008 Carter report, many hospital laboratories have disappeared with the introduction of so-called hub and spoke models. This has been at the expense of what had previously been a high-quality service for diagnosis, surveillance, and epidemiology. Furthermore, there has been a failure to stockpile laboratory consumables and reagents, despite shortages during the 2009 H1N1 influenza pandemic. What is particularly inexcusable is the shortage of swabs to take samples from patients and health-care workers during the current COVID-19 pandemic. Our reliance on China as a global supplier for such supplies has compromised the UK's COVID-19 response. Many manufacturers, suppliers, and hospital services are inevitably finding it difficult to meet the demand for testing of both patients and staff.

The centralisation of pathology services into a hub and spoke model has resulted in the hub being located at a site distant to some acute services. The reduction in the number of senior scientific staff to reduce costs has failed to increase enthusiasm for what should be an exciting and attractive career for both doctors and scientists. The geographical and intellectual separation of service and academic activities precludes an interactive approach to diagnosis, management, and research. In many medical schools, there has been a reduction in pathology teaching in the undergraduate curriculum, such that students are not interested in some of the major developments in medicine.

The Royal College of Pathologists and the other pathological societies should be more vocal in recognising the importance of their disciplines. It is disappointing that other specialties that are dependent on pathology have not spoken up to express their views at a local or national level in the face of damaging reorganisation and cuts in pathology.

In short, the disciplines that manage infections, microbiology, and virology, have been undervalued and under-resourced for a long time. Only if things change will we be able to improve responses to new infections.