Beyond the laboratory: how COVID-19 reshaped specimen collection, testing workflows, and diagnostic algorithms

Introduction: The SARS-CoV-2 pandemic forced a radical expansion of essential public health laboratory services that went beyond basic testing. This perspective highlights key shifts in laboratory function, specifically toward decentralized testing, self-sampling, less invasive specimen types, point-of-care devices, and novel surveillance strategies. Areas covered: The surge in testing demand favored decentralized solutions, including rapid lateral flow tests, due to their flexibility, speed, and affordability. However, several challenges arose from the variable diagnostic accuracy of rapid self-tests and alternative specimen types when compared to reference laboratory-based molecular assays using nasopharyngeal swabs. For instance, the use of self-collected saliva, which is often preferred by patients, was hindered by a lack of internationally standardized processing protocols. A post-pandemic rebound in the circulation of respiratory pathogens other than SARS-CoV-2 was likely driven by both immunity debt and increased testing, including of less severe cases, commonly performed through more costly multiplex respiratory panels. Expert opinion: Moving forward, while over-the-counter self-tests for common respiratory viruses are now common, stricter regulatory oversight and improved data connectivity are essential. Local decision-makers must weigh the trade-offs between broad testing access and clinical performance, and implement robust diagnostic stewardship programs for acute respiratory infections.