Growing COVID-19 outbreaks in various states are depleting testing capacity across the country as people wait several days or even weeks to recover their results, causing another setback to the U.S. response to the pandemic. of months.
Long response times are undermining the fight against the coronavirus, experts say, making efforts to trace contacts of confirmed cases almost futile. That, in turn, potentially leads to more infections that further threaten stress testing capabilities.
“The concern is that it is starting to spiral out of control,” said Marcus Plescia, medical director of the Association of State and Territorial Health Officials.
While public health officials say people should isolate themselves while awaiting their test results, there is little data to indicate how often that happens. Longer response times run the risk of making someone less likely to isolate themselves, especially if they don’t experience any symptoms.
“It really undermines our infection control,” said Plescia. “Someone who has COVID but has less typical symptoms or does not feel as bad may feel that it is probably not COVID and that it will go out in public. And if it turns out that they really do have COVID, they could have infected a significant number of people. “
Large outbreaks in Florida, Texas, California, Arizona and Georgia have overwhelmed private laboratories like Quest Diagnostics and LabCorp, which has led to slower response times. Some states with smaller case numbers are even seeing delays.
While commercial labs have significantly increased testing capacity since the early days of the pandemic, there is still not enough to handle the increased demand.
Congress has allocated $ 25 billion to improve testing and contact tracking, but none of that has gone to commercial labs that are suffering from the effects of testing.
“It’s demand that has changed very, very significantly,” said a spokesman for the American Association of Clinical Laboratories, which represents clinical laboratories like Quest and LabCorp.
“Laboratories generally see a significant increase in demand for testing and limitations in the availability of supplies and equipment.”
Quest Diagnostics, the largest laboratory in the US, says the response time for “priority patients” (symptomatic healthcare workers and hospitalized patients) is approximately two days. The response time for everyone else is more than seven days or up to two weeks.
LabCorp said Monday that the average response time is now between three and five days, although some people have waited longer for its results.
“The value of a test that comes back even five days later is very little,” said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration.
“People are more infectious both during the two days before they get sick, and maybe three or four days after they get sick. So if you are telling someone that they became infected five days after feeling sick, they have already infected most of the people they are going to infect. And those people have also been potentially infected. ”
The delays have had a negative impact on contact tracking, the process that public health officials use to try to break transmission chains by contacting those who test positive and asking them to quarantine while the trackers communicate with their close contacts to test them, also asking them to isolate themselves while they wait for results.
“Some states and communities wonder if there is a bit of futility in trying to keep track of contacts,” said Plescia.
Contact tracing requires rapid test results, especially for COVID-19, which spreads easily and shows no symptoms in a large percentage of carriers. Asymptomatic people can still pass the disease on to others.
“Until you know someone’s test results, you really can’t figure out who their contacts are and contact those people and tell them they may also be infected,” said Plescia. “Many states and local [governments] they are very concerned that they are missing the opportunity so their contact tracking can make a difference. “
The increase in cases and the increased demand for evidence has renewed calls for a national evidence strategy by the Trump administration.
Labs do not yet have enough supplies needed to run high-volume tests, and as demand grows, some labs are discovering that they need more machines that are also in short supply.
President Trump
Donald John Trump More than a dozen people injured in shootings near Chicago funeral home Players of the Cleveland Indians meet with team leaders to discuss the possible name change Pelosi calls the coronavirus the ‘Trump virus’ MORE He briefly addressed the issue on Tuesday.
“We are also working to reduce response time,” Trump said during a White House press conference, but did not elaborate.
“We have done more tests than anyone. Some of the tests, because it is a massive volume, takes longer. Other tests, as you know, are very fast. They are five minute and 15 minute tests and those are the ones I prefer.”
The administration has allowed states to set their own testing targets, despite the fact that some of the largest laboratories have operations across the country.
“Without a doubt, we need a national testing strategy that not only provides each state with the ability to define what’s best for them,” said Heather Pierce, senior director of science policy and regulatory adviser to the Association of American Medical Colleges. .
“States are essential partners, but in terms of understanding the reagent shortage and prioritizing where reagents and test supplies go, that should be done at the comprehensive national level,” he added.
Trump administration officials acknowledged the slower response times in a call with the governors this week, and Admiral Brett Giroir said he would focus more on point-of-care tests that can be done in 15 minutes by the bed. from a patient or doctor’s office.
The Department of Health and Human Services (HHS) plans to ship instruments and point-of-care test kits to 15,400 nursing homes in the U.S., which could free up some capacity in commercial labs. However, HHS noted that it is a one-time shipment, and nursing homes will need to find their own test kits after that.
The Food and Drug Administration also recently approved a Quest request to “pool” the tests, in which samples from multiple patients are combined and then analyzed together rather than individually.
Patients in groups that test positive for COVID-19 are then individually evaluated, while negative groups are eliminated. The goal of group testing is to save time and limited resources.
However, experts say these efforts are unlikely to be helpful in hot spots or settings such as nursing homes or prisons, where the virus spreads at a breakneck pace. The clustering approach could be more useful as a surveillance tool, they said, to quickly identify where new cases are occurring.
Experts believe that some states may need to re-prioritize testing for certain populations, such as hospitalized patients and close contacts of confirmed cases, to decrease response times.
“I think there is no doubt that we don’t have as much evidence as necessary, let’s be honest about it. And therefore we are going to have to prioritize and determine which patients should get them first and which patients should receive which tests, “Frieden said.
“Prioritization can help a lot. Unless we have reduced testing times, we are not going to get ahead of the virus. “
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