WASHINGTON – US labs are buckling under a wave of coronavirus testing, creating processing delays that experts say are undermining the pandemic response.
With the count of confirmed infections in the US At nearly 4 million on Wednesday and the increase in new cases, bottlenecks are creating problems for workers who stay out of work while waiting for results, nursing homes struggle for keeping the virus out and for the labs themselves while dealing with a crushing workload.
Some labs take weeks to return COVID-19 results, exacerbating fears that symptom-free people may spread the virus if they don’t isolate themselves while they wait.
“There has been this obsession with ‘How many tests do we do per day?'” Said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention. “The question is how many tests are being done with results that return within a day, where the tested individual is quickly isolated and his contacts receive an immediate warning.”
Frieden and other public health experts have asked states to publicly report test response times, calling it an essential measure to measure progress against the virus.
Delays in testing in the US occur when the number of confirmed people who are infected worldwide exceeds a staggering 15 million, according to data compiled by Johns Hopkins University. The United States leads the world in cases and deaths, which have exceeded 142,000.
New York, once the American leader in infections, has been overtaken by California, though that is in part due to strong evidence in a state with more than double New York’s population.
Guidelines issued by CDC recommend that states that lift virus restrictions have a test response time of less than four days. Recently, the agency issued new recommendations against the reevaluation of the majority of COVID-19 patients to confirm that they have recovered.
“It is clogging the system,” Admiral Brett Giroir, assistant secretary of health, told reporters last week.
Zachrey Warner knows this very well.
The 30-year-old waiter from Columbus, Ohio, was sent home from work on July 5 with a high fever a few days after he started feeling sick. He went to a test five days later at the request of his employer.
Almost two weeks and a missed pay period later, he finally got his answer on Wednesday: negative.
Although Warner said that most symptoms, such as fever, diarrhea, chest tightness and body aches, stopped a few days after the test, he was not allowed to return to work without the result.
“It was frustrating that I missed so much work because the tests took me forever,” said Warner. “It is what it is … (but) I’m glad to be negative and happy to be able to return to work this week.”
Beyond the economic damage that testing delays can cause, they also pose significant health risks.
In Florida, which reported 9,785 new cases and an increase in the death toll to almost 5,500, nursing homes have been under the order to screen all employees every two weeks. But long delays in results question the point.
Jay Solomon, CEO of Aviva in Sarasota, a senior community with a nursing home and assisted living facility, said the results took up to 10 days to return.
“It’s almost like, what are we accomplishing at the moment?” Solomon said. “If that person is not quarantined in those 7-10 days, is he spreading without realizing it?”
Test results that come back after two or three days are almost useless, many health experts say, because by then the window to track the person’s contacts to prevent further infections has essentially closed.
“Response times, particularly across the South, are too long,” said Dr. Deborah Birx of the White House coronavirus task force on Fox.
Birx said the United States had shorter response times in April, May and early June, but that “this increase and this degree of cases is so widespread compared to before,” he said.
Dr. Leana Wen, a professor of public health at George Washington University, said it is reasonable to tell people waiting for test results to isolate themselves for 24 hours, but the delays have been unacceptable.
Can you imagine telling a parent with young children to isolate themselves for 10 days or more without knowing they really have COVID? I mean, that’s ridiculous. That’s really absurd, “said Wen.
US officials have recently called for scans to be increased to include apparently healthy Americans who may be unknowingly spreading the disease in their communities. But Quest Diagnostics, one of the nation’s largest test chains, said it can’t keep up with demand and that most patients will face waits of a week or more to get results.
Quest has urged healthcare providers to reduce testing for low-priority people, such as those without symptoms or any contact with someone who tested positive.
As testing has expanded, so have requests for masks and other measures to keep infections low. Ohio, Indiana, Minnesota and Oregon became the last to announce mandatory statewide mask orders on Wednesday.
The United States tests more than 700,000 people per day, up from less than 100,000 in March. Trump administration officials note that about half of the tests in the US are performed on rapid systems that give results in about 15 minutes or in hospitals, which generally process the tests in about 24 hours. But last month, that still left about 9 million tests going through labs, which have been plagued with limited chemicals, machines and kits to develop COVID-19 tests.
There is no scientific consensus on the rate of testing required to control the virus in the US, but experts have recommended for months that the US test at least 1 to 3 million people a day.
Health experts gathered by the Rockefeller Foundation said last week that the US should scale to assess 30 million Americans a week by the fall, when school reopens and the flu season are expected to further exacerbate the spread of the virus. The group recognized that this will not be possible with the laboratory testing system.
The National Institutes of Health have organized a “shark tank” contest to quickly identify promising rapid tests and have received more than 600 applications. The goal is to have new testing options in mass production for the fall.
Until then, the backbone of testing in the US remains in several hundred labs with high-capacity machines capable of processing thousands of samples per day. Many say they could be processing many more tests if it weren’t for the global shortage of tests for chemicals and other materials.
Dr. Bobbi Pritt of the Mayo Clinic in Rochester, Minnesota, says that the hospital’s machines run at only 20% of their capacity. Lab technicians run seven different COVID-19 test formats, switching back and forth based on availability of supplies.
At Emory University Hospital in Atlanta, laboratory workers pressure test manufacturers weekly to provide more kits, chemicals, and other materials.
“There is no advance planning, we just do everything we can and cross our fingers to get more,” said Dr. Colleen Kraft, who runs the hospital’s testing laboratory.
___
This story has been corrected to show that the CDC has issued guidelines that recommend against repeating tests for patients recovering from the coronavirus.
___
Webber reported from Fenton, Michigan, and Sedensky reported from Philadelphia. Associated Press writers Kelli Kennedy in Fort Lauderdale, Florida, Michelle R. Smith in Providence, Rhode Island, and medical writer Mike Stobbe in New York contributed to this report.
___
The Associated Press Department of Health and Science receives support from the Department of Scientific Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.
.
