Virology: a bridge between the laboratory and patient care

Dr Louise Berry is a consultant in infectious diseases and virology at Nottingham University Hospitals. Here she explains her fascination with virology and the vital role it has in diagnostics.

My fascination with viral infections pre-dated my medical career. During my first degree in Cambridge I studied biological anthropology and I was intrigued with how humans interact with each other and the environment in ways that increase their susceptibility to different diseases. After spending several years in the United Nations and charities working on HIV projects, I was hooked on viruses and wanted to understand more about how to diagnose and treat patients and what was next on the horizon for us as a species. I decided to apply for Graduate Entry Medicine and this was the beginning of a 14-year period of training to become a virologist and infectious disease physician.

As a virologist, it sometimes feels that we are always on the verge of another viral outbreak, be it HIV, Zika, measles or Ebola. The size, density and mobility of human populations have provided favourable conditions for the rapid spread of novel viruses. As a trainee I spent several months in Sierra Leone during the 2014–2015 Ebola outbreak. During this time, I gained experience of the rapid deployment of stringent infection prevention and control measures to contain the outbreak and keep frontline workers safe. This experience has greatly helped me to apply this knowledge to the current COVID-19 outbreak.

For some time, we have expected a global pandemic caused by an unknown ‘disease X’ — likely a novel influenza or coronavirus. No one knew the specifics of when, where or what until now. To say that 2020 has been a busy year for microbiology diagnostic services is quite the understatement. As we welcomed in 2020, none of us knew the scale of the pandemic to follow. 

The pandemic has made me even more aware of the role of virologists in bridging the knowledge gap between frontline clinicians and the diagnostic laboratory. 

Being a patient-facing clinician as well as a pathologist gives me the benefit of being able to explain to patients directly the results of their tests. I also have a detailed understanding of how these results have been generated. As a clinician I understand the pressures faced by colleagues trying to decide whether to isolate a patient with possible COVID-19 and the need for rapid results. Working as a virologist within a molecular diagnostic laboratory affords you insider knowledge of the limitations of the molecular tests used to diagnose COVID-19. I am able to explain these to clinical colleagues on the front line. How we act on a result can have huge implications. Over-reliance on a false-negative result when clinical disease is strongly suspected can lead to a lack of appropriate infection control and isolation measures and may lead to onward spread. Conversely, some patients may have persistently positive test results post-infection, which does not represent ongoing infectivity or a need for isolation.

The pandemic has made me even more aware of the role of virologists in bridging the knowledge gap between frontline clinicians and the diagnostic laboratory. To be able to explain both the utility and limitations of individual molecular tests helps colleagues with interpretation of the results generated. In May, I was honoured to be asked to present on the topic of ‘COVID-19: clinical presentation and management’ for a RCPath series of webinars on various aspects of the pandemic. Over 22,000 people have logged in to view these so far. During the last six months the volume and speed of scientific publications on this novel virus has been dramatic and, at times, it can feel overwhelming to try to keep up to speed with this new knowledge. My aim was to try to synthesise the most salient learning points and nuggets of knowledge in an accessible way for a wide range of viewers.

I have been humbled by, and in huge awe of, the huge efforts of my colleagues to introduce these new tests so quickly.

During the COVID-19 pandemic, we as a team, have constantly had to deal with rapidly changing guidance and centralisation of resources, such as molecular testing kits. Despite the many challenges we have faced within the laboratory, in the hospital and on a personal level, there have been some positive changes. As a laboratory team we have learnt to change practice at speed and adapt to the difficulties we have faced. An example of this has been the rapid scale-up of diagnostic tests. When faced with precarious supplies of kits, reagents and swabs for COVID-19 testing, we were able to rapidly set up alternative systems for testing.

I have been humbled by, and in huge awe of, the huge efforts of my colleagues to introduce these new tests so quickly. I also feel the virology team have developed closer working collaborations with university research teams and other disciplines within hospital, for instance the infection control teams. An example of this is the shared learning around outbreaks and developing clear action plans to combat hospital transmission of COVID-19. We have learnt to operate outside of our traditional spheres of working and reach out to the broader clinical community who, more than ever, rely on the microbiology team for diagnostic support and advice.