Within two to three days, you can get results from your cholesterol or colonoscopy test.
But the rate at which the dangerously infectious COVID-19 virus is detected varies greatly, from one hour to two weeks or more.
As cases rise and supplies plummet, the pandemic reveals a chasm in the Bay Area testing landscape: selective academic laboratories that are technically and logistically agile, that return results quickly, and facilities that rely on Commercial labs with rigid supply chain requirements that can cause results to be significantly delayed.
The waiting game is stressful for anyone who relies on a test to resume their lives and livelihoods.
“It was frustrating not knowing that during those two weeks,” said Jackie Erickson of Los Gatos, who had a test done at a CVS self-service site in San Jose before taking her sick and elderly mother to an important appointment with the doctor. She helped her mother before her results were returned, all the time, fearful of infection.
Even when politicians brag about the growing availability of evidence, that’s not what matters, epidemiologists say. It is the wrong metric.
What matters is the quick results, they say. This is because the virus only takes a moment to spread and five days, on average, for you to feel sick. People are most infectious about two days before and three to four days after they have symptoms, and they can spread the disease without realizing it.
With long delays, “our tests often amount to simply ‘theater,'” said epidemiologist Dr. Michael Mina of the Department of Immunology and Infectious Diseases at Harvard University. Money is wasted. And efforts to trace contacts of confirmed cases are almost futile.
What’s going on? Throughout the world, labs are struggling to find supplies at nearly every link in the supply chain, from chemical reagents and plastics to the actual machines that process the tests. Four companies, Cepheid, Hologic, Abbott and Roche, dominate this machine market and require brand name components.
“There is a supply chain shortage for just about everything,” said Dr. Steve Miller, director of the UCSF Laboratory for Clinical Microbiology. Manufacturers ration what is sent to each laboratory, he said.
“Each institution has to fend for itself,” he said. “It is like a competition. We are all looking for the same supplies. “
The deepest shortage right now are small plastic pipette tips, which are critical for dispensing liquids in a small plate to search for viral DNA.
“Companies that make test machines, supplies and equipment are struggling to meet growing global demand, and currently cannot keep up,” said Dr. Stephen Parodi, infectious disease specialist and clinical leader in the response to the coronavirus in Kaiser Permanente.
Across the country, response times for test results have doubled in recent weeks, he said.
Some of the worst waits for results are found in laboratories at public outlets such as CVS. These locations send the tests in bulk to centralized labs that are owned by a few commercial processors such as Quest Diagnostics and LabCorp. These processors use only one or two types of instruments, so they are locked to use proprietary chemical kits and other tools. They run batch tests and can be located far away.
As a result, these sites are lagging, even as they continue to accept new business due to the rise of healthy, symptomless people.
Commercial labs perform 2.5 million tests a week, half the nation’s total, “but the results are long overdue and of little use,” said former CDC director Dr. Thomas Frieden , On twitter. “They charge but the public does not benefit. The tests performed per day are a very misleading indicator. “
County labs also often rely on public or commercial labs with limited flexibility. For example, the Santa Clara County Department of Public Health now takes nine days to return the results.
Serving millions of members, Kaiser is building a new 7,700-square-foot laboratory in Berkeley to process thousands of COVID-19 tests every day. Parodi said most of the tests are processed in Kaiser’s existing laboratory and that the results are ready in two to three days. Less urgent cases, which can be sent to other laboratories, may take longer, he said.
Currently, some members say it can take almost two weeks to get results, posing a risk of transmission even though they may have no symptoms.
While waiting 12 days to get the results from Kaiser Richmond, Laura Paull was concerned about the isolation of her 93-year-old father “sitting alone in his apartment, day after day, with an open book on his lap. When I finally got to visit, his energy level perked up. “
But at academic medical centers like Stanford and UCSF, responses can be very quick.
They have several advantages.Your tests are conducted on campus and, if necessary, can be processed immediately. And they can limit who they accept by focusing on the people in greatest need. Only when supplies are adequate do they extend their reach. Stanford helps Valley Care, El Camino, Sequoia and Seton hospitals. UCSF partners with Marin General and John Muir Hospitals, as well as some public clinics and San Francisco and San Mateo counties public health departments.
Dr. Paul Bayard turned to UCSF after getting tired of waiting up to two weeks for a commercial laboratory to report his patients’ results to the East Bay-based network of clinics called The Clinic. Now, with results within a day or two, La Clínica offers rapid driving tests.
These academic labs have the money to buy many types of instruments, so they are not at the mercy of a single manufacturer. In addition, they have established relationships with different suppliers, so they can take advantage of available supplies.
The Stanford laboratory, which runs 24-hour sample processing, has multiple workflows, instruments and supply chains, said Dr. Ben Pinsky, director of the Clinical Virology Laboratory at Stanford Health Care.
“We have tried to diversify, making sure we have alternatives,” he said. “There is always some kind of redundancy in our suppliers. If we have any problems, we have backups. “
UCSF has seven different methods for COVID-19 testing and plans to add two more, Miller said. It also has backup supply chains. For example, when UCSF begins to run out of pipette tips from its Hologis Pathway test system, it looks for alternative providers. If you can’t find them, switch to a completely different instrument, called the CDC Trial.
“Everything is very complex,” said Miller. “It has allowed us to buffer ‘shocks’ in the supply chain to avoid disruption.”
Academic labs also have well-connected friends. When UCSF ran out of swabs, he turned to donor Marc Benioff, who has long as CEO of cloud computing firm Salesforce had extensive business contacts in China. Salesforce found and ordered hundreds of thousands of swabs.
But even his model cannot sustain the entire nation, Miller said. New and improved test technologies must be available to everyone.
“There is infinite demand,” said Miller. “It will not be solved by the expandability of our laboratory.”
Daniel Wu contributed to this report.
