What If We Couldn’t Diagnose Infectious Diseases?

By the bioMérieux Connection Editors
Accompanying interview with Dr. Mark Miller, Chief Medical Officer at bioMérieux

It’s six a.m., and both your electric alarm clock and your furry, slobbery alarm clock have been haranguing you for half an hour to get up. You can hit the snooze button on one, but the other demands to be fed (and let outside). But this particular morning, you’ve woken up with a sore throat after tossing and turning all night, continually sweltering and then freezing.

You stumble out of bed and into your morning routine, pouring kibble into the dog’s food bowl with one hand and balancing a thermometer in your mouth with the other. After a few minutes, the thermometer beeps. 101 degrees. You fire off an email to work letting them know you’re taking a sick day, and then call the doctor.

At the doctor’s office, they suspect you have strep, so they swab your throat and run an in-office test that takes about 30 minutes. It comes back positive. Your doctor prescribes a course of antibiotics to treat your strep infection and sends you home, with an admonishment to take the full course and stay home from work for at least the next 24 hours. Within a couple of days, you start to feel better, and by the time you finish the antibiotics, you’re back to normal and not quite so annoyed with your furry alarm clock for jumping all over the bed at five-thirty in the morning.

Now, replay this scenario, except that the doctor has no way of testing you for infection.  All she has are your symptoms, which are broad enough that they could indicate a range of ailments.  Without diagnostics, she must try to guess what’s making you sick. Her guess may or may not be right, and you may or may not get the right treatment. You may or may not recover.

Fundamentally, doctors are blind without diagnostic tools. “It’s like looking for someone in a cave without any light,” says Dr. Mark Miller, Chief Medical Officer at bioMérieux. “You have no idea where you are.”  That explains why 70% of medical decisions are made based on results from diagnostic testing. Yet, such tests account for only 3-5% of all healthcare spending. That’s an enormous return for a comparatively small investment.

Patients in developed countries, particularly those in highly populated metropolitan areas, benefit significantly from diagnostic testing, but diagnostic tools are frequently difficult to access or completely unavailable to people in rural areas or developing nations. Accessibility depends on a variety of factors, but patient distance to the nearest hospital or clinic and financial resources available to healthcare providers and systems are especially important.

Those of us who live in countries and locations where diagnostic tools are readily available, both at the point of care, and with advanced diagnostics found in laboratories, often take those tools for granted. We focus our attention on treatment instead, as we understandably want whatever is ailing us to be cured. But without diagnostics, treating even basic infections with the appropriate medications becomes difficult if not impossible.

 Similarly, patients in nations with universal healthcare systems often have easier access to diagnostics, because patients’ personal financial situations do not impact their ability to seek medical care.  Conversely, where universal healthcare has not been implemented, patients’ financial situations can prevent them from seeking medical care as well as adversely impact the quality of care they receive.

According to the World Health Organization (WHO), at least half of the world’s population does not have full coverage of essential health services, and about 100 million people are pushed into extreme poverty (defined as living on less than $1.90 per day) because they have to pay for health care.  

However, all UN Member States have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.  The WHO states that, “UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

UHC does not mean free coverage for all possible health interventions regardless of cost, because that would be unsustainable. Instead, the goal of UHC is to give everyone access to good-quality services that address the most significant causes of disease and death. Diagnostics, especially those that test for the most common infectious diseases, are a major part of those services.

In 2018, the WHO released its first edition of a Model List of Essential In Vitro Diagnostics. The list specifies tests recommended for primary healthcare and for facilities with clinical laboratories.  It provides an important framework that countries can adopt and adapt to their needs.  While point-of-care tests used in primary healthcare have become more readily available in developing nations and rural areas, with excellent results, investments in advanced diagnostic tools and laboratories for these communities remain scarce.

According to Dr. Madhukar Pai, Director of Global Health and Professor at McGill University, investment in diagnostic laboratories is critical for continuing improvements in patient health. He notes that, “For too long, the global health community systematically promoted empirical or syndromic treatment for many conditions in low-income settings, because building a reasonable laboratory infrastructure was considered too difficult and expensive.” 

Even today, many governments and donors consider improvement of laboratories to be too expensive and difficult.  “This explains why we struggle to manage conditions for which no good rapid tests exist,” writes Dr. Pai.  “This also explains why health systems with weak laboratory infrastructure cannot detect outbreaks early, nor offer comprehensive diagnostic services that cover a wider range of conditions, including antimicrobial resistance and non-communicable diseases.”

All of that requires essential diagnostics, which can only be delivered through investments to improve laboratory infrastructure and advance our health systems worldwide. Microbes do not adhere to international borders.  Without the appropriate diagnostic tools deployed around the globe, we will continue to struggle with disease outbreaks and with addressing antimicrobial resistance, regardless of where we live.

And that strep infection? It could be resistant to antibiotics, but without diagnostics, you would never know.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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