Ebola laboratory preparedness at frontline hospitals: can we or can't we?

Frontline hospitals are required to care for patients with suspected viral hemorrhagic fever (VHF), yet guidance on laboratory preparedness remains fragmented and incomplete. We conducted a multidisciplinary risk assessment of our institutional capacity to perform routine diagnostic testing for VHF persons under investigation (PUI), focusing on the feasibility of using automated core laboratory instruments. Our assessment revealed substantial gaps between CDC guidance (which permits core lab testing) and the practical ability to implement it safely. Public health mandates for VHF preparedness have not been accompanied by granular guidance on biosafety, laboratory infrastructure, or regulatory clarity necessary for implementation. Community hospitals, which would benefit most from safely using their existing automated core laboratory instruments, lack the infrastructure, staffing expertise, and clear guidance to do so, while well-resourced tertiary centers are often best positioned to develop dedicated point-of-care testing (POCT)-based workflows. Federal and state authorities must provide explicit, validated examples of acceptable mitigation strategies for testing using core lab instrumentation and reconcile conflicting recommendations across guidance documents. Without such authoritative clarity, frontline hospitals cannot confidently meet their mandated VHF preparedness obligations.