Reynolds “Ren” Salerno, PhD, is Director of the Division of Laboratory Systems at the Centers for Disease Control and Prevention. A lot has happened since our last published conversation in Lab Matters in pre-pandemic 2019. We checked back in to hear his reflections on the past year and what lies ahead for DLS and public health laboratories.
Q: 2020 was a historic year. What lessons should our nation’s public health laboratories glean from events of the past 12 months, and what’s important to keep in mind as they enter the second year of the pandemic response?
There are too many lessons to list here, but the most important is an old lesson that bears repeating: public health laboratories are the tip of the spear in the nation’s response to a public health emergency. Our public health laboratories performed remarkably during 2020—under relentless demands and enormous pressure. But, not surprisingly, the historically challenging landscape for our public health infrastructure—including the laboratory system—made it difficult to quickly and easily overcome many of the challenges associated with responding to a pandemic.
I think it’s also critical to highlight the essential link between public health laboratories and clinical laboratories. The traditional boundaries between health care and public health have fallen by the wayside as we all work together to respond to COVID-19. There is an opportunity to improve our systems to ensure that clinical laboratories and public health laboratories can seamlessly work together during a public health emergency.
I want to assure the public health laboratories that we at CDC will continue to work as hard as we can to support everything the public health laboratories are doing to help us respond to this unprecedented pandemic. CDC notices and appreciates the contributions of public health laboratory professionals—you are real-life heroes.
Q: We’ve seen greater collaboration and coordination between the public health and clinical laboratory communities during the SARS-CoV-2 emergency. How can we sustain that collaboration and what other opportunities exist to foster further engagement?
In 2018, CDC established a Memorandum of Understanding (MOU) with the American Clinical Laboratory Association (ACLA), the Association of Public Health Laboratories (APHL), and the Council of State and Territorial Epidemiologists (CSTE). The signatories to this MOU meet regularly to strengthen relationships and improve processes for more effective engagement. The signatories have leveraged their ongoing collaboration to respond to COVID-19, and I think there is an opportunity to further expand the ways we work together.
As we move forward, we need to think about opportunities to formalize the relationships and strengthen the interactions between public health laboratories and clinical laboratories, particularly during public health emergencies. In some states, this public-private engagement already works very well. In states where the connection is not as developed, CDC and APHL can work together to identify and overcome potential barriers to collaboration.
Additionally, we need to expand this public-private collaboration and coordination specifically to advance laboratory quality and safety, informatics and data science, and training and workforce development. If we can optimize these fundamental laboratory systems functions across clinical and public health laboratories, the nation’s overall laboratory system will be able to mount a more robust response to future public health emergencies.
Q: In addition to supporting the COVID-19 response, what are the other priorities for DLS for the year ahead?
Our division continues to support the agency’s Laboratory and Testing Task Force for the COVID-19 response, as well as other parts of CDC’s response to the pandemic. Perhaps not surprisingly, our division’s priorities fall into what we think of as the foundation of every clinical laboratory: improving informatics and data science, strengthening laboratory quality and safety systems, and expanding training and workforce development.
For informatics and data science, our goal is to advance electronic laboratory data exchange between clinical and public health laboratories, especially for test ordering and result reporting (ETOR). In addition, we continue to work on improving data exchange specifically for the Laboratory Response Network (LRN). For quality and safety systems, our Next-Generation Sequencing (NGS) Quality Initiative is definitely a priority. We’re also focused on improving biosafety preparedness for non-traditional laboratories—such as nursing homes, pharmacies, correctional facilities, and drive-through testing sites—that perform point-of-care testing and have played a pivotal role in COVID-19 pandemic response efforts. We will continue to expand our work to develop and disseminate virtual reality laboratory training courses and improve our outreach about laboratory preparedness courses to the clinical laboratory community.
Finally, we’ll continue to identify opportunities to directly support and engage with clinical laboratories during a response. Examples of this work are our national Clinical Laboratory COVID-19 Response Calls and our Laboratory Outreach Communication System (LOCS), both of which functioned as critically important communication channels for CDC and the laboratory community during 2020. We will continue to leverage these opportunities to connect directly with public health and clinical laboratories to share best practices, challenges, and successes we encounter as we join forces to respond to the COVID-19 pandemic.
Q: Considering the challenges on the horizon, what training needs do you see as essential to ensure that our public health laboratory workforce is fully equipped?
CDC has a long-standing cooperative agreement with APHL, and our partnership has resulted in the development and dissemination of a variety of training materials to support the public health laboratory workforce. We’ve worked together to develop and disseminate both live and on-demand eLearning courses, webinars, and seminars, and I’m excited about the work we’ll do together in the future.
As the testing and reporting community expands, we will need to collaborate with the Centers for Medicare & Medicaid Services (CMS) and other partners to deliver coordinated education and training resources on topics of interest, such as point-of-care testing and personal protective equipment (PPE). We must continue to strengthen the necessary interconnection between clinical laboratories, public health laboratories, and CDC laboratories. Working together to develop relevant, on-demand education and training tools, resources, and networks will further empower the clinical laboratory workforce to rapidly and effectively respond to evolving needs and gaps.
Q: Managing data and reporting results has become increasingly important since last year. How can we make laboratory data more usable and accessible to support response and surveillance over the long term?
We need to understand where the gaps and challenges exist, not just in technology but also in policy—for example, multi-state reporting requirements. Can we streamline and harmonize test result reporting? Can we build a seamless mechanism for both clinical and public health laboratories to report test results and relevant epidemiological data to health departments? In addition to continuing to advance electronic laboratory reporting, it is essential to promote and develop informatics solutions that allow for multi-directional electronic data flow between clinical and public health laboratories—ideally integrating patient demographic data from the electronic health record into laboratory test ordering and result reporting. We must acknowledge that the laboratory system is the backbone of all medical informatics, especially during a response to a new or re-emerging disease. Data modernization of our nation’s laboratory informatics systems must be one of public health’s highest priorities.
Q: What do you wish the American public knew about public health laboratory scientists and their work?
I wish the American people better understood how critical public health laboratory scientists are when the nation must respond to a health emergency, as well as the important role they play in day-to-day public health surveillance.
Q: What’s one thing you love about your job?
I get to work with incredibly impressive, outstanding people both inside and outside CDC who are all committed to improving patient care, public health, and health equity.
Ren Salerno is the Director of the Division of Laboratory Systems at the US Centers for Disease Control and Prevention (CDC). He is also the Designated Federal Official of the US Clinical Laboratory Improvement Advisory Committee. Prior to joining CDC, Ren was a Senior Manager for Biological Sciences and Technologies at Sandia National Laboratories. Ren has been in the field of laboratory safety, security, and risk management for more than 20 years. He is co-author of Laboratory Biosecurity Handbook (CRC Press, 2007), and co-editor of Laboratory Biorisk Management (CRC Press, 2015). He was the lead author for the International Organization for Standardization’s technical standard 35001 on laboratory biorisk management (ISO, 2019). Most recently, he served as the co-lead for CDC’s Laboratory and Testing Task Force for the COVID-19 Response. He received his PhD from Yale University in 1997.
Ren is pictured above with one of his four children.