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What if a major radiation incident happened during a pandemic?-Considerations of the impact on biodosimetry

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Purpose Based on the experience of biodosimetry laboratories during the COVID-19 pandemic, the purpose of this paper is to describe the challenges of providing biodosimetry service in the event of a major radiation incident during a pandemic. This includes describing some of the preparations and planning made by biodosimetry laboratories and special challenges in maintaining a state of readiness while adhering to safety protocols and balancing the need to assist with the COVID-19 response where possible. Experiences of several biodosimetry laboratories will be described and lessons learned will be outlined that could be applied to any large population-scale emergencies. Conclusions There are many challenges that arise when maintaining capacity and capabilities for biodosimetry when faced with a global pandemic such as COVID-19. The key is to be prepared for anything within reason. This includes, but is not limited to, maintaining flexibility, shifting and reorganizing deployment of staff between pandemic response and biodosimetry needs, strengthening networks to be able to provide assistance to other laboratories, managing staff in the face of possible infections and preparing protocols for the handling of potentially infected biological samples according to regulatory requirements. By implementing these recommendations, international biodosimetry networks can be prepared to address large-scale radiological incidents within the context of a pandemic and ensure the safety of biodosimetry personnel as well as victims in such dual emergencies.
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International Journal of Radiation Biology
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/irab20
What if a major radiation incident happened
during a pandemic? – Considerations of the impact
on biodosimetry
Harold M. Swartz, Ruth C. Wilkins, Elizabeth Ainsbury, Matthias Port, Ann
Barry Flood, François Trompier, Laurence Roy & Steven G. Swarts
To cite this article: Harold M. Swartz, Ruth C. Wilkins, Elizabeth Ainsbury, Matthias Port, Ann
Barry Flood, François Trompier, Laurence Roy & Steven G. Swarts (2021): What if a major
radiation incident happened during a pandemic? – Considerations of the impact on biodosimetry,
International Journal of Radiation Biology, DOI: 10.1080/09553002.2021.2000659
To link to this article: https://doi.org/10.1080/09553002.2021.2000659
Published online: 17 Nov 2021.
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COMMENTARY
What if a major radiation incident happened during a pandemic?
Considerations of the impact on biodosimetry
Harold M. Swartz
a
, Ruth C. Wilkins
b
, Elizabeth Ainsbury
c
, Matthias Port
d
, Ann Barry Flood
a
,
Franc¸ois Trompier
e
, Laurence Roy
f
, and Steven G. Swarts
g
a
Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA;
b
Consumer and Clinical Radiation Protection Bureau,
Health Canada, Ottawa, Canada;
c
Public Health England Centre for Radiation, Chemical and Environmental Hazards, Oxford, UK;
d
Bundeswehr Institute of Radiobiology, Affiliated to the University of Ulm, Munich, Germany;
e
Department for Research on Dosimetry, IRSN,
Fontenay-aux-roses, France;
f
Department for Research on the Biological and Health Effects of Ionising Radiation, IRSN, Fontenay-aux-roses,
France;
g
Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
ARTICLE HISTORY Received 30 July 2021; revised 21 October 2021; accepted 25 October 2021
Introduction
In this paper, we consider the issues associated with and the
potential impact on biodosimetry, i.e. screening for medic-
ally significant exposure to radiation, if a major radiation
incident were to happen during a pandemic. We focus on
those aspects that are likely to have greatest impact and/or
to require modifying usual practice, because of the simultan-
eous needs to address the problems and synergistic risks
that may occur. In particular, from the point of view of car-
rying out effective biodosimetry, we consider what will be
the special challenges and how to plan and prepare to meet
those challenges.
While this paper reports on the preparations (or the lack
thereof) that biodosimetry laboratories made for handling a
possible radiation incident during the COVID-19 pandemic,
the lessons and inferences that we draw will be applicable to
the co-occurrence of a radiation incident and other types of
pandemics as well as other large population-scale
emergencies.
1
Premise of this paper: Major assumptions
and context
Assumptions:
The risk of another pandemic occurring is very high but
with unpredictable incidence, distribution, and impact
(Wister and Speechley 2020).
A radiation accident, i.e. not deliberately instigated, could
coincidently occur during a pandemic.
Due to factors that contribute to increased social and
economic instability during a pandemic, there is an
increased risk of a deliberate, i.e. malicious, radiation
event co-occurring during a pandemic (Counter-
Terrorism Committee Executive Directorate
(CTED) 2021).
Biodosimetry laboratories and personnel, with their
expertise in testing in the context of carrying out rigor-
ous security and safety protocols, are likely to be called
upon to help meet the needs associated with pandemic
testing and treatment (Kulka et al. 2018). This was
clearly seen during the COVID-19 pandemic particularly
in government funded or affiliated laboratories including
Public Health England (PHE), Institut de
Radioprotection et de S^
uret
e Nucl
eaire (IRSN),
Bundeswehr Institute of Radiobiology (BIR) and
Bundesamt f
ur Strahlenschutz (BfS), where biodosimetry
specialists, individuals with transferable skills including
project management, emergency response communica-
tion and laboratory techniques, were redeployed to focus
on the pandemic response.
Based on these assumptions, it is desirable to develop
advanced plans for how to (re)deploy biodosimetry resour-
ces (both facilities and personnel). These resources will be
needed to carry out their primary responsibility to conduct
biodosimetry testing during a radiation event (especially a
large scale incident) as soon as they are needed, while
potentially also continuing to safely and securely carry out
testing and other responsibilities during a pandemic.
If the number of individuals at risk of radiation exposure
during a pandemic is small, then it is likely that the
responding team will be able to adequately deal with the
challenges, without needing to prioritize tasks or modifying
protocols for treating patients during a pandemic (Kulka
et al. 2018).
If, however, the number of individuals potentially
exposed to radiation levels that could lead to the acute radi-
ation syndrome (ARS) is too large to be accommodated in
the available health care facilities, then it will be very
important to have a means to identify those potential vic-
tims who are at highest risk for having clinically significant
effects of radiation in order to triage them to receive med-
ical attention. Then the capacities will depend on the staff
CONTACT Ruth C. Wilkins Ruth.Wilkins@hc-sc.gc.ca Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada.
Copyright ß2021 Taylor & Francis Group LLC.
INTERNATIONAL JOURNAL OF RADIATION BIOLOGY
https://doi.org/10.1080/09553002.2021.2000659
available given that the pandemic may have caused a reduc-
tion in staff or resources available to carry out biodosimetry
to support the medical management with dose estimates.
In either small- or large-scale radiation events, modifica-
tions to usual practices may be necessary because of the
potential for irradiated victims to be ill from the agent pro-
ducing the pandemic. The medical and laboratory personnel
may need to modify their usual emergency procedures in
order to avoid getting ill or spreading the infection that is
causing the pandemic. Biodosimetry will be a paramount
need, and planning should take into account how to deploy
biodosimetry experts and facilities who may face conflicting
expectations and/or modified procedures and reduced staff
if an incident occurs during a pandemic.
Brief summary of radiation biodosimetry
Biological and physical retrospective biodosimetry uses well-
established techniques to assist in triage and management of
individuals suspected of being exposed to ionizing radiation
following a radiation accident or incident (Ainsbury et al.
2011; ICRU 2019). The techniques are based on radiation-
induced changes in the person themselves, either physical
changes (e.g. the generation of long-lived free radicals in
teeth or fingernails) or biological responses to radiation
damage (e.g. changes in white blood cells such as the gener-
ation of chromosomal aberrations, changes in blood cell
count or changes in levels of gene expression) (Jaworska
et al. 2015; Kulka et al. 2018).
However, because of the perceived low risk of a mass cas-
ualty radiation event, these capabilities are not routinely
available onsite (or even in the country as a whole in some
cases), especially in the amount needed in the event of a
large radiation incident. There are some national efforts to
stockpile biodosimetric resources and to identify key persons
to utilize them when needed. Furthermore, for some of these
techniques for which only a small number of laboratories
worldwide are equipped to carry out these measurements, in
recent years a large effort has been focused on networking
between the different countries and regions, in order to
have an adequate capability to respond to such an incident
(Kulka et al. 2018). To date, however, such plans have rarely
taken into account the co-occurrence of a radiation event
and a pandemic.
Overview of planning for triage following a
radiation event that occurs during a pandemic
Although this manuscript is very much informed by our
perspective as biodosimetry experts and the COVID-19
2
pandemic, it is important to realize that it is quite likely
that, in one form or another, the virus and its derivatives
will persist at significant levels for many years, with surges
and ebbs. Also, there are likely to be other infectious agents
that will arise and lead to widespread risk. Moreover, the
risk of having a simultaneous occurrence of a radiation
event in the midst of an active COVID-19 or similar epi-
demic is sufficiently likely so as to warrant planning for
how the pandemic would impact how radiation biodosime-
try would be carried out.
The presence of a pandemic at the time of a radiation
event would impact biodosimetry on several different and
interacting levels, including:
Reduced availability of staffing and reduced readiness of
the emergency response network, because of diversion of
expert personnel, illness, or requirements to minimize
staff interactions and/or a shortage of consum-
able supplies.
This occurs because of the overlap in the expertise
required to prepare to test for radiation exposures and
COVID-19 but also in the overlap in wider transferable
skills required for any emergency response including man-
agement and communication skills. All employees of PHE in
the UK, for example, hold multiple emergency responsibil-
ities, depending on their expertise. Because of the overlap in
skill sets, at least some members of biodosimetry teams are
likely to be deployed to assist with national COVID-19
responses. Due to the rareness of biological, chemical, radio-
nuclear or even mass casualty incidents, some countries
have decided to pool their biological/medical preparedness
activities within one institution. Some nations have opted
not to consider the risk of a co-incident pandemic in their
preparation for possible radionuclear events (NATO
research task group, personal communication, August and
September 2020). This consolidation, while potentially effi-
cient, also has the potential to decrease the ability of these
abovementioned countries to respond to a radiation event in
the midst of a pandemic. Therefore, some groups have
started to give consideration as to how and how soon teams
can be redeployed back to their original radiation emergency
response roles and how the resulting gaps in COVID-19
response can be filled, should a radiation accident occur.
Planning for this possibility will be required to take into
account the individual resources and needs of the country
or region.
Potential changes in the validity or practicality of some
types of radiation biodosimetric assays, due to changes in
the biological responses to radiation when the person is
infected with the virus; conversely, tests for the presence
of the virus may be impacted by having been exposed
to radiation.
While some of the assays such as the chromosome based
and physically based dosimetry techniques are unlikely to be
impacted by changes due to COVID-19, other assays such
as genetic and metabolically based assays theoretically could
be impacted, particularly if markers are related to the
immune response (Rogan et al. 2020; Park 2021; Rios et al.
2021). However, even though we believe that COVID-19
infection does not significantly affect chromosome-based
assays, this could be completely different for other infectious
diseases leading to a major decrease or loss in function of
peripheral lymphocytes (Baeyens et al. 2010). Even when
2 H. M. SWARTZ ET AL.
there is a known systematic effect on the marker for a given
test, testing may be further complicated by needing to test
for the presence of the virus. These considerations in turn
highlight the need to determine which types of tests or pro-
cedures may actually be affected by the virus, which may in
turn determine which biodosimetric tests should be used if
there is a pandemic. In a similar light, tests for the presence
of the virus may be impacted by having been exposed to
radiation. Therefore, the effects of radiation exposure on the
performance of various viral testing methods will need to be
assessed in order to identify those test methods whose out-
comes are sufficiently refractory to an individuals exposure
to radiation. It is also important to note that such reassess-
ment may need to be carried out rapidly, in response to the
particular characteristics of the emerging threat, which may
not be possible to predict in advance.
Changes in the rigor and safety procedures for carrying
out biodosimetry, because of concerns about exposure to
the infectious agent.
Additional, externally imposed regulations or established
laboratory specific precautions for handling potentially
infected samples could impact biodosimetry at several levels,
e.g. it may reduce the rate at which samples could be proc-
essed or, in some cases, prevent the sample from being ana-
lyzed. Particularly, during a radiological emergency, it is not
practical to determine the infectious status a potentially radi-
ation exposed individual prior to sampling and some labora-
tories would not be able to receive samples of unknown
viral status even with COVID-19. This would be even more
pronounced for possible infectious agents needing biosafety
level three or four facilities. At the regulatory level, concerns
over spreading the pandemic could severely impact the abil-
ity to ship samples to other sites in a network, especially
across international boundaries, e.g. medical shipments may
be required to be irradiated, thereby ruining the sample
for dosimetry.
Within an individual laboratory, procedures will vary
depending on the source of the sample, for example blood
or saliva samples for biological biodosimetry or teeth for
physical retrospective biodosimetry (e.g. Electron
Paramagenetic Resonance (EPR), luminescence) and how
the virus is transmitted. If the tests require obtaining blood
or saliva samples, there may need to be special handling
procedures at the point of obtaining samples as well as how
to handle them in the laboratory, especially if the virus is
blood-borne. On the other hand, techniques such as saliva
for assessing radiation-induced changes in gene expression
(Ostheim et al. 2020) or in vivo EPR to measure teeth
(Williams et al. 2011) for biodosimetry may require special
procedures to protect operators and to avoid transmission to
future subjects, especially if the virus is spread by air-
borne means.
Some labs might have protocols that apply to all samples
regardless of source or virus associated with the pandemic
(e.g. the laboratory protocol may assume that any blood
sample has the potential to contain an infectious agent)
while others may have sample-specific or victim-specific pre-
cautions (e.g. if the blood or saliva sample is from a person
unlikely to be infected, such as someone vaccinated against
COVID-19, no special precautions may be needed; however,
when there is no definitive information about virus status,
the sample may need to be treated as potentially infected).
The resulting difficulties might shift decisions as to what
biodosimetry tests should be utilized. The required extra
steps would not only impact throughput but also could
increase the cost of the biodosimetry tests.
In the case of a highly transmittable and blood borne
virus (e.g. Ebola), some assays such as Dicentric
Chromosome Assay (DCA) or Cytokinesis-Block
Micronucleus Assay, which need a culture of viable blood,
would not be executable within a standard radiobiology
laboratory due to health and safety regulations. In such
cases, all tests that are severely affected or impossible to
conduct, due to the necessity of inactivating the virus within
the sample, would be unusable. The subsequent reduced
availability of viable assays for biodosimetry is an additional
reason to develop and stockpile supplies for several different
assays and methods and not limit the preparedness to a very
narrow set of diagnostic procedures that are viable only
under more idealcircumstances.
There is the potential for an increased health risk of sub-
jects from simultaneously having an active infection and
being exposed to significant amounts of radiation.
It is important to note that, due to a number of potential
commonalities between infectious responses and radiation
exposure (including, for COVID-19, immune dysregulation),
the impact on illness could be additive or potentially syner-
gistic (Rios et al. 2021). The possibility of poorer outcomes
on people dually exposed could place added requirements
on biodosimetry to detect such multiplicative effects and/or
to provide results more quickly so that those at higher risk
could be prioritized for medical care.
The need based on explicit orders from government offi-
cial for increased readiness for a radiation event occur-
ring during a pandemic because of the heightened risk of
malicious attacks, to take advantage of governments and
health care specialists being distracted by having to deal
with the virus and its concomitant societal disruptions,
such as on the economy.
Terrorists might well conclude that this would be an eas-
ier opportunity to carry out a malicious action since the
focus of international and national attention is on the pan-
demic and many types of personnel are diverted to deal
with it. They also might recognize that the resulting terror
and disruption from a radiation event would likely be
heightened and the response would be delayed and other-
wise complicated by the simultaneous need to deal with the
risks from both the pandemic and radiation event. The vul-
nerabilities include the potential for computer or security
sabotage as well as radiation terrorist events. It also might
INTERNATIONAL JOURNAL OF RADIATION BIOLOGY 3
be easier to recruit people into terrorist activities due to the
societal economic and humanitarian impacts of the pan-
demic (Counter-Terrorism Committee Executive Directorate
(CTED) 2021).
Experience during the COVID-19 pandemic
The following summary of some of the changes and adjust-
ments made by dosimetry laboratories during the COVID-
19 pandemic is based on an informal survey by the authors
from many individuals and laboratories within the bio-
dosimetry community.
Increased vigilance for the increased risk of terrorism.
Many institutions conducting biodosimetry were asked to
ensure their institutions were maintained in a heightened
state of readiness due to an increased risk of terrorism.
This was required while simultaneously minimizing the
number of onsite staff to adhere to the COVID-19 proto-
cols of the workplace. They, and other institutions
involved in responses to radiological emergencies, were
asked to be prepared to respond to such an event within
their area of responsibility at any time. In order to fulfill
this duty, clear organization and rigorous preparedness is
required to avoid complete shutdown even in the event
of infection of the staff (Bundeswehr, personal communi-
cation March, 2020).
Preparations to remain fully capable of responding to
radiation emergencies, while dealing with the restrictions
on personnel and activities that were part of the general
limitations of activities to minimize spread of
COVID-19.
Measures taken by laboratories included local separation
of groups of personnel (to minimize cross contamination
and maximize the ability to function as teams), partial
shutdown of laboratory activities, on-call standby of all
personnel 24/7, deferral of all non-essential operations
while maintaining equipment in a state of readiness to
respond, stockpiling reagents and assay specific consum-
ables and personal protection equipment (PPE) in antici-
pation of shortages, establishing remote access for
analysis (e.g. using remote connections to automated
metaphase finders for scoring), and an early and all-
embracing implementation of hygiene policies including
defining appropriate social behavior such as social dis-
tancing, minimizing social gatherings etc., organizing
workspaces to create appropriate social distancing, and
providing medical preparedness activities, ranging from
early test strategies up to psychological support. All these
efforts were included in and supported by a governmen-
tal response plan, or an intra-ministry action plan, at the
various different international laboratories (U.
Oestreicher, personal communications, June 23, 2021; A.
Balajee, personal communication, June 28, 2021).
Efforts were redirected from usual responsibilities of
responding to radiation events, to respond to COVID-19.
Illustrating the requirement for and complexity of need-
ing the same public health experts and laboratories to
handle both types of crises, the World Health
Organization (WHO) conducted a survey in 2021 of its
BioDoseNet laboratories in which laboratory directors
were asked about their laboratorys preparedness and
ability to perform biodosimetry during a pandemic such
as COVID-19. Of 62 responding laboratories, represent-
ing 42 countries, about 53% of respondents indicated
that they had considered the changes and challenges of
conducting biodosimetry in the case of dual emergencies.
Their changes involved developing new protocols to
improve safety measures of handling potentially infected
samples (e.g. increased use of PPE), updating equipment
and facilities with improved biosafety features, such as
establishing processes for scoring remotely. Forty percent
of the respondents stated they could still accept bio-
dosimetry samples as usual for analysis. Eighteen percent
stated that they would not be able to accept any bio-
dosimetry samples for analysis during a pandemic, with
the remaining 42% able to receive a reduced number.
The main precaution reported to handle this situation
was the need to minimize the risk of infection to labora-
tory staff by having improved protocols for blood sam-
pling and handling; half of the respondents reported
already having these protocols in place (submit-
ted manuscript).
Although the need for these protocols would not be con-
sistent with known pathways for transmission of the
COVID-19 virus, they may be relevant for other types of
pathogens. Also, however, it is likely that many dosimetry
laboratories have established procedures that treat all blood
samples as potentially infected and handle them accordingly.
Most of the laboratories (76%) stated that they did not have
the expertise, capability and capacity to assist with other
diagnostic testing. Of those that did, molecular genetics and
polymerase chain reaction (PCR) was the most common
expertise described. Although some laboratories mentioned
that they have been recruited to deal with the COVID-19
response, these laboratories also stated that they would be
released from these duties if biodosimetry analysis were
required (submitted manuscript).
Emergency centers must be prepared to respond to any
emergency situation, regardless of the occurrence of simul-
taneous events or another crisis. A recent example is the
activation of the French National Nuclear and Radiological
Emergency Center at IRSN following the contaminated for-
est fires in Ukraine. This incident, although resolved other-
wise, could have led to a potential release of radioactive
materials into the atmosphere in the spring of 2020, i.e. dur-
ing the national COVID-19 lockdown.
Such multi-emergency scenarios are indeed plausible and
therefore require planning to mobilize personnel and main-
tain the activities of the emergency center regardless of the
duration of any concomitant crises. As occurred in this
example, preparations for handling both types of emergen-
cies may necessitate keeping personnel locked up 24/7 on a
secure sitea significant logistical problem that must be
anticipated in preparedness planning.
4 H. M. SWARTZ ET AL.
The importance of networking
Even if a pandemic is global or almost global, any concur-
rent radiation event is likely to be relatively localized.
Hence, the importance of active networking in radiation
emergency preparedness cannot be overstated (Kulka
et al. 2018).
The WHO BioDoseNet network in 2021 was comprised
of over 80 laboratories, which were distributed globally, with
varying levels of capacity to conduct biodosimetry and
readiness to respond to an imminent emergency. To date,
this network, along with smaller regional networks, has
enabled extensive harmonization to occur, from sharing of
protocols to conducting inter-laboratory comparisons.
For example, during the active stages of the COVID-19
pandemic, the RENEB network organized and conducted a
large international biodosimetry exercise. More than 40 lab-
oratories and more than 100 researchers from all over the
world took part, including several authors of this manu-
script. Although the analysis of this exercise is incomplete at
the time of preparing this manuscript, preliminary results
suggest that, at least at the status of the pandemic in mid-
2021, biodosimetry laboratories could continue to function
and international shipments of samples between laboratories
would be possible with no more constraints than usual. In
early 2020 it would have been impossible to conduct this
exercise due to shutdowns within the participating laborato-
ries, special orders to manage the pandemic, or a shortage
of consumables.
Furthermore, the current experience with networks sug-
gests that collaborations between laboratories enable the
development of new biodosimetry methods (e.g. those using
PCR), which could result in dually-prepared laboratories, i.e.
with the ability to conduct COVID-19 testing as well as bio-
dosimetry. This capability would be especially helpful if the
laboratory is assisting in a dual event, where victims being
tested for radiation may also have been exposed to the pan-
demic agent. It would also increase the flexibility of these
laboratories to assist in either type of emergency. Networks
need to continue to provide shared training and expertise
with its members, which will strengthen the capacity of the
international biodosimetry network. This will enable labora-
tories to come to the assistance of others, which may be in a
heightened status of pandemic conditions at the time of a
radiation incident and less able to deal with it (Kulka
et al. 2018).
Conclusions and recommendations
Given the history of pandemics throughout human history,
the recurrence of pandemics is expected but with unpredict-
able incidence and impact. There is a possibility for concur-
rent radiological incidents during a pandemic, which, for
the most part, are expected to consist of small radiation
incidents of one or two cases, as was witnessed during the
current COVID-19 pandemic in several laboratories includ-
ing PHE, IRSN, Bfs, the Radiation Emergency Assistance
Center/Training Site and Health Canada (personal commu-
nication). However, there remains the possibility of more
impactful, larger radiological scenarios occurring during a
pandemic that arise from malicious acts or large scale acci-
dental release events. In these large-scale radiological situa-
tions occurring within a pandemic, the ability to address the
radiological emergency will be adversely affected due to lim-
itations placed on personnel, resources, and processes as a
consequence of the pandemic. However, the impact of these
limitations can be reduced through advanced planning and
preparation. Based on the experience gained during the cur-
rent COVID-19 pandemic and past radiological incidents,
we make the following recommendations:
In the ideal situation, within reason, be ready for any-
thing! Flexibility in addressing radiological emergencies
within pandemic emergencies requires knowing the capa-
bilities and limitations of biodosimetry laboratories in
addressing the situation.
Plan to reorganize/release staff as needs shift between
support of pandemic and radiation dosimetry response.
Develop operational plans to prevent or minimize con-
tact with contagion within lab personnel, including isola-
tion protocols.
Maintain a reserve of personnel or laboratory networks
in a position to fill in for those who become ill from
exposure to the contagions or are directed toward
addressing testing needs in the screening of infected
individuals.
Establish which labs are able to receive human samples
based on biosafety level of the pathogen, recognizing that
not all labs are able to work with potentially infec-
tious samples.
Establish protocols to address appropriate level of biosaf-
ety level of infectious agent, including protocols defining
proper containment equipment and engineering, as well
as stock piling of personal protective equipment appro-
priate for the biosafety level of the pathogen.
Establish procedures to address limited availability of
reagents and consumables in the event that supply chains
are impacted by pandemic.
Establish shipping protocols specific to pathogen biosaf-
ety. Shipping of samples may be impacted by pandemic
or the biosafety level of the pathogen. Additionally,
where possible, protocols defining proper and effective
inactivation methods of pathogens within human samples
are needed for both the shipper and receiver for sample
transport, especially for contagions with biosafety levels
of 3 or greater.
Plan to seek help from wider network of response-ready
partners. Networks need to continue to provide training
and sharing expertise to continue to increase the strength
and capacity of the international biodosimetry network.
By implementing these recommendations, international
biodosimetry networks can be prepared to address large-
scale radiological incidents within the context of a pandemic
and ensure the safety of biodosimetry personnel as well as
victims in such dual emergencies.
INTERNATIONAL JOURNAL OF RADIATION BIOLOGY 5
Notes
1. There is a related white paper in preparation by the same
authors reporting the lessons learned from the biodosimetry
communitys actual participation in planning and
responding to COVID-19. This report, in contrast, focuses
on the possibility of there being the dual need for
biodosimetry laboratories and experts to help with a major
radiation incident and a pandemic.
2. COVID-19 is used throughout the rest of the paper in a
generic sense of referring to a world-wide infectious based
pandemic, unless otherwise specified.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
The authors reported there is no funding associated with the work fea-
tured in this article.
Notes on contributors
Harold M. Swartz, M.D., Ph.D., is a Professor in the Radiology
Department, Geisel School of Medicine at Dartmouth, Hanover,
NH USA.
Ruth C. Wilkins, Ph.D, is the Chief of the Ionizing Radiation Health
Sciences Division and a Research Scientist at the Consumer and
Clinical Radiation Protection Bureau of Health Canada,
Ottawa, Canada.
Elizabeth Ainsbury, PhD, is a Radiation Protection Scientist with
Public Health Englands Center for Chemical, Radiological and
Environmental Hazards, Chilton, Didcot, Oxford, UK.
Matthias Port, MD, PhD, is an Associate Professor of Radiobiology.
He is a Senior Researcher as well as Head of the Bundeswehr Institute
of Radiobiology, Genomics I, Munich, Germany.
Ann Barry Flood, Ph.D., is a Professor of Radiology and Health Policy,
Geisel School of Medicine at Dartmouth, Hanover, NH USA.
Franc¸ois Trompier, Ph.D., is an Engineer and Researcher in the
Department for Research on Dosimetry, IRSN, Fontenay-aux-
roses, France.
Laurence Roy, Ph.D., is a Research Scientist in the Department for
Research on the Biological and Health Effects of Ionizing Radiation,
IRSN, Fontenay-aux-roses, France.
Steven G. Swarts, Ph.D., is a Research Associate Professor in the
Department of Radiation Oncology at the University of Florida,
Gainesville, FL USA.
ORCID
Harold M. Swartz http://orcid.org/0000-0001-6057-6587
Ruth C. Wilkins http://orcid.org/0000-0002-9621-477X
Elizabeth Ainsbury http://orcid.org/0000-0001-8076-6978
Matthias Port http://orcid.org/0000-0002-8496-5883
Ann Barry Flood http://orcid.org/0000-0002-4035-3084
Franc¸ois Trompier http://orcid.org/0000-0002-8776-6572
Laurence Roy http://orcid.org/0000-0003-2237-6095
Steven G. Swarts http://orcid.org/0000-0002-9211-2805
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6 H. M. SWARTZ ET AL.
... In general, the simultaneous occurrence of a radiation event in the midst of an active COVID-19 or similar epidemic would likely have very significant impacts on how radiation biodosimetry would be carried out. The impact would be on several different and interacting levels, not least of which would include (Swartz et al., 2021): impacts on the emergency response network including availability of members of the network or other expert personnel and access to facilities or a shortage of consumable supplies; the potential for heightened risk of malicious attacks, including computer or security sabotage or multiple radiation or other terrorist events, to take advantage of everyone being distracted by dealing with the virus and its societal disruptions such as on the economy; potential impacts on the validity of radiation biodosimetric assays due to interferences with the biological responses when persons infected with the virus are also exposed to radiation; potential concerns about contamination of samples and individuals with the virus. ...
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