On 10 November 2021, Professor William Rawlinson (AM), Senior Medical Virologist and the Director of Serology and Virology (SAViD) at NSW Health Pathology SEALS Randwick, joined the RCPA to celebrate International Pathology Day (IPD). One year on from his presentation at IPD 2020, Prof Rawlinson reflects on some of his statements from that day, what has changed, what has not changed, and how some things can be moved forward.

“I believe Scientists, Pathologists, and the College, have had a huge role in promoting appropriate testing, lobbying for improved access to diagnosis and research, and supporting the role of vaccination to prevent COVID-19. Last year, we talked about diagnostics and the need for rapid accurate testing, using tools that were freely available to everyone in the community. Now, there have been over 46 million tests for COVID-19 performed in Australia to date. We now routinely use rapid molecular testing platforms that provide an accurate result in half an hour. Furthermore, testing is carried out in remote sites using rapid test platforms, and the general community knows the term Polymerase Chain Reaction (PCR) and mostly what it means.

“Over the last year, a Commonwealth funded program for testing Aboriginal and Torres Strait Islander people using local rapid molecular tests, has been very successful. To date testing of over 46,000 samples at 93 sites in WA, SA, NT, QLD, NSW and VIC has identified 300 infections, reduced the need for aero evacuations and empowered local Aboriginal and regional health services. It has involved local people, public health units, local medical officers, and academic pathologists and clinicians in reducing the effects of COVID-19 on vulnerable populations. It is not the only such program globally, but it is one of the most successful.

“At IPD 2020, we discussed the need for genomic data to characterise outbreaks. Now there are almost five million SARS virus full length sequences uploaded into the global sequence initiative known as GISAID, a public database of virus sequences which are available internationally and freely. There is also a very successful national initiative called AusTrakka that has all states uploading COVID sequences, and the aims of the genomics grants around easier access are being achieved.

“Over the last year, there have been some recent findings and changes in our approach to managing the pandemic. This includes increasing access for people with disadvantage or difficult access to diagnosis; routinely testing new areas for COVID-19, including wastewater or sewage, testing of travellers, and animals; moving treatments forward at a rapid pace; and treating COVID-19 with monoclonal antibody therapy. We also know that household infections are common even when vaccinated – put at 1 in 4 household contacts in some studies.

“All this has been learned in a relatively short period, from the application of political and scientific will to solve what was a non-existent problem two years ago. It is now up to us as scientists and pathologists to work on how to prevent the next pandemics, and to decide what we do to inform this discussion. It is research into pathology and pathological processes, that is going to provide the way out of the pandemic lockdowns, the unnecessary deaths, and the need for restrictions.”