Enhancing laboratory testing capacity: strategies for pandemic preparedness.

The COVID-19 pandemic revealed a critical weakness in the public health infrastructure for pandemic response: insufficient testing capacity to control the spread of disease. Overwhelmed by surging demand, testing laboratories could not keep up, leading to long turnaround times for results. This paper builds on previous research that identified constraints on laboratory capacity, to propose strategies for enhancing testing capacity with minimal investment. Three key strategies are explored: pooling specimens, flexible allocation of liquid handling machines, and flexible staff scheduling. The strategies are analyzed to determine their benefits and applicability in relevant COVID-19 testing contexts: the latter in a manual operation (such as in Nepal) and the others in an automated operation (such as in a U.S. university lab). All three strategies can effectively increase laboratory capacity, but require targeted investment: for instance, pooling can paradoxically increase turnaround times without sufficient liquid handling and qPCR capacity; we identify two investment options to mitigate this risk. More broadly, our findings underscore that the “devil is in the details”: performance is highly sensitive to specific operational factors such as staff schedules and machine configuration. Tools and guidelines for implementing improvement strategies are provided, including optimization models to determine efficient schedules and guidelines for resource allocation. The paper demonstrates that there are several potential paths to increase preparedness of testing facilities for current and future epidemics.