Since March, my mother has worked twelve- to fourteen-hour days, seven days a week, processing thousands of COVID-19 tests. As one of over 6,700 medical laboratory technologists working in Ontario, she works toward fulfilling the government’s quota of 16,000 tests per day. But my mother is not a stranger to long hours or the threat of dangerous diseases. Like others in her field, she had a front row seat to the 21st century epidemics: SARS, Avian Bird Flu (H5N1), H1N1, and Ebola. But COVID-19 has placed unprecedented pressure on lab techs. The medical laboratory is the heart of Ontario’s testing data. While medical technologists’ work output is featured in government documents and news reports, lab techs have been overlooked by the government and the public throughout the pandemic. The most obvious example is their exclusion from pandemic pay.
Pandemic pay was a temporary $4.00 hourly pay increase that applied to qualifying health care professionals from April to August. The goals of this increase were to “provide support and relief to frontline workers, encourage staff to continue working and attract prospective employees, help maintain staffing levels and the operation of critical frontline services.” Prior to COVID-19, health care workers never received additional compensation for their work in hospitals. Historically, government officials and the public saw healthcare workers’ risk of infection as part of their profession. However, pandemic pay created divisions in hospital spaces by attaching monetary value to the definition of who is – and who is not – an essential health care worker. Medical laboratory technologists never qualified for pandemic pay. The invisible nature of the laboratory, I argue, is caused by two things: the persistence of the patient care model, which views those who interact with patients as the primary caregivers; and the public’s perception of the laboratory as a space separate from medicine.
The medical laboratory became a part of hospitals and public health measures during the 1880s. Laboratory tests represented the rise of science in the modern hospital. Lab work expanded throughout the early twentieth century, as public health boards and hospitals relied on their data for tracing disease outbreaks.1 Medical laboratories were one of the new technological innovations that supported a physician’s diagnosis. Joel D. Howell’s exploration of urinalysis argues that by the 1920s laboratories were an important part of the physician’s diagnostic practice.2 David and Rosemary Gagan’s work on the rise of the modern hospital highlights that the medical profession viewed the hospital as the doctor’s workshop; all departments were there to support physician authority.3 These new technologies created a multilateral healthcare system focused on reinforcing doctors’ abilities to diagnose patients and maintaining their medical authority.
More recent epidemics have also highlighted the essential nature of medical laboratories to public health measures. Following the 2003 SARS outbreak, the federal public health report “Learning from SARS: Renewal of Public Health in Canada” described the hospital laboratory as a “first-line testing facility” during any outbreak and “a court of last resort to standardize and improve testing procedures.” This report argued for hospital laboratories’ active participation in disease surveillance and demonstrated that laboratories provided crucial data for public health officials, the government, and the public to understand how disease spreads. The report also acknowledged the erosion of funding for laboratories across Canada and argued that advanced planning and funding would be required to face the country’s next epidemic.
In 2020, pandemic payment expanded and constrained the definition of who is an essential health care worker. The initial list of employees who qualified for the pay increase included: doctors, registered nurses, registered practical nurses, mental health workers, personal support workers, orderlies, and auxiliary employees (porters, cooks, custodians, housekeeping, and laundry facilities).4 The inclusion of orderlies and auxiliary employees acknowledged that hospitals were not just sites of patient care, but sites of labor. These employees do not usually interact directly with patients, but their labor is important to the overall function of the hospital. It acknowledged the risk these employees faced with their indirect contact with patients. But this list also reaffirmed the public perception that while health care may involve different actors, doctors and nurses are the primary caregivers. Those who occupy an intermediary position, like laboratory technologists, are not viewed as essential health care workers.
Canadian health care, like most healthcare structures around the world, is a patient-centered model. In this model, the doctor and patient work together to combat the patient’s illness. It places those who interact with the patient as the primary caregivers and doesn’t acknowledge that health care is a multilateral system. The medical field has reinforced this model through the rise of medical science and technologies in hospitals, beginning in the early twentieth century with the introduction of laboratories and x-rays in hospitals. Like the x-ray, the medical laboratory was not meant to challenge the doctor’s authority but confirm it. Physicians held onto their medical authority by interpreting and ordering laboratory tests, but it is the laboratory worker who discovers the medical diagnosis of a patient.5 Because laboratory workers occupy this intermediary position, between patients and medical professionals, their labor during the diagnostic process is hidden.6
The public and the government also view the hospital laboratory as a discrete space, with minimal patient contact. We often think of samples being “sent down” to the lab, regardless of a laboratory’s actual location in a hospital. My mother’s lab is located in the basement of the hospital, where a variety of diagnostic departments are housed. These spaces are busy centers of diagnostic medicine, even if they are located several floors below.
Some laboratory technologists do interact with patients. In rural hospitals, laboratory technologists draw patient samples, a job normally reserved for nurses in larger hospitals. Even those who do not take samples are at risk within the lab. The Ontario Medical Association’s letter to Premier Doug Ford illustrates this risk: “Laboratory work generates droplets. Just one droplet may contain a million or so viruses that can contaminate the laboratory worker or the laboratory.” These droplets demonstrate that patient contact goes beyond the hospital room and reaches the laboratory. By interpreting the laboratory as a space far removed from medicine, we are ignoring the daily realities of laboratory technologists.
Employee retention was a key pillar of Ford’s decision to create pandemic payment. It was at the forefront of his first announcement on COVID-19, and Ontario Minister of Health Christine Elliott stated that this payment was vital to maintaining “a safe staffing level, especially in places where it is needed most.” The additional workers who qualified for pandemic pay reflected this statement. By the end of May, security, screeners, store and supply workers, receivers, department attendants, hospital ward and unit clerks, client-facing reception and administrative workers, schedulers, and developmental services workers qualified for pandemic pay. The expansion of auxiliary employees suggested that pandemic pay was less about concrete proximity to patients, and more about keeping these health care spaces functioning.
Conversely, few efforts were made to meet the needs of lab techs. Medical laboratory technologists are not just essential workers during pandemics, they are also an important function of the hospital structure. Lab techs complete approximately 500,000 tests per day. In early May, the Medical Laboratory Professionals’ Association of Ontario (MLPAO) argued that staff shortages made it increasingly difficult to meet the government’s daily testing quota of 16,000 tests. During the summer months, there was no intervention to increase the number of lab techs, and the MLPAO contended that 77% of labs were understaffed prior to COVID-19. The exclusion from pandemic pay has reinforced the perception of laboratory technologists as secondary rather than essential workers. It emphasizes the invisibility of this labor and its workers, especially in terms of gauging exposure and risk.
Ontario is now approaching its second COVID-19 wave, and the government has again promised to increase its testing levels, this time to 50,000 tests per day. The government has invested $1 billion to expand testing and hire more laboratory technologists. Until these spaces are adequately filled, laboratories will continue to be precarious workplaces for technologists both during and after the pandemic.
Pandemic payment and the inequities it wrought within health care will be one of the legacies of COVID-19. Hospitals have become battlegrounds between the have and the have-nots of pandemic payment. COVID-19 has demonstrated that we need to invest in medical laboratories to adequately support patient care and epidemic testing.
- Peter L. Twohig, Labor in the Laboratory: Medical Laboratory Workers in the Maritimes, 1900–1950 (McGill-Queen’s University Press, 2005), 38. Return to text.
- Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Johns Hopkins University Press, 1995), 92. Return to text.
- David Gagan and Rosemary Gagan, For Patients of Moderate Means: A Social History of the Voluntary Pubic General Hospital in Canada, 1890–1950 (McGill-Queen’s University Press, 2002), 7. Return to text.
- This payment also included those who did not work in hospitals. Employees in long term care homes, social services, and correctional centers also qualified. For the purposes of this article I have decided to focus on those who work in hospitals. Return to text.
- Twohig, Labor in the Laboratory, 22. Return to text.
- Peter L. Twohig, “Education, Expertise, Experience and the Making of Hospital Workers in Canada, 1920–1960,” Scientia Canadensis 29, no. 2 (2006): 133. Return to text.