Northwest Arkansas Democrat-Gazette
Labs overtaxed; waits for results of tests overlong
Experts say delay of weeks imperiling pandemic curbs
WASHINGTON — Laboratories across the U.S. are being pushed past their limits as coronavirus tests surge, creating long processing delays that experts say are undercutting the pandemic response.
With the U.S. tally of infections at 3.9 million Wednesday and new cases surging, the bottlenecks are creating problems for workers kept off the job while awaiting results, nursing homes struggling to keep the virus out and for the labs themselves, dealing with a crushing workload.
Some labs are taking weeks to return covid-19 results, exacerbating fears that asymptomatic people could be spreading the virus if they don’t isolate while they wait.
“There’s been this obsession with, ‘how many tests are we doing 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 coming back within
a day, where the individual tested is promptly isolated and their contacts are promptly warned.”
Frieden and other public-health experts have called on states to publicly report testing turnaround times, calling it an essential metric to measure progress against the virus.
The testing lags in the U.S. come as the number of people confirmed to be infected globally passed 15 million Wednesday, according to data compiled by Johns Hopkins University.
The U.S. leads the world in cases as well as deaths, which stand at more than 142,000 nationwide. New York, once by far the U.S. leader in infections, has been surpassed by California, though that is partly because of robust testing in a state with more than twice the population of New York.
Guidelines issued by the CDC recommend that states lifting virus restrictions have testing turnaround times of under four days. The agency recently issued new recommendations against retesting most covid-19 patients to confirm they’ve recovered.
“It’s clogging up the system,” Adm. Brett Giroir, assistant health secretary, told reporters last week.
Zachrey Warner knows it all too 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 began feeling ill. He went for a test five days later at the request of his employer.
Almost two weeks and one missed pay period later, he finally got his answer Wednesday: negative.
Though Warner said most symptoms — including fever, diarrhea, chest tightness and body aches — stopped a few days after he was tested, he wasn’t allowed to return to work without the test results. On Wednesday, he got a call telling him he didn’t have covid-19.
It was “frustrating that I’ve missed so much work due to testing taking forever,” Warner said. “It is what it is … [but] I’m glad I’m negative and happy to be able to get back to work this week.”
TESTING-LAG RISKS
Beyond the economic toll that the testing lags can cause, they pose significant health risks, too.
In Florida, as the state confirmed 9,785 new cases Wednesday and the death toll rose to nearly 5,500, nursing homes have been under orders to test all employees every two weeks. But long delays for results have some questioning the point.
Jay Solomon, CEO of Aviva in Sarasota, a senior-citizen community with a nursing home and assisted-living facility, said results were taking up to 10 days to come back.
“It’s almost like, what are we accomplishing in that time?” Solomon said. “If that person is not quarantined in that seven to 10 days, are they spreading without realizing it?”
Test results that come back after two or three days are nearly worthless, many health experts say, because by then the window for tracing a person’s contacts to prevent additional infections has essentially closed.
Dr. Leana Wen, a public health professor at George Washington University said it’s reasonable to tell people awaiting test results to isolate for 24 hours, but the delays have been unacceptable.
“Imagine, you tell a parent with young children to self-isolate for 10 days or more without knowing they actually have covid? I mean, that’s ridiculous. That’s actually absurd,” Wen said.
U.S. officials have recently called for ramping up screening to include seemingly healthy Americans who may be unknowingly spreading the disease in their communities. But Quest Diagnostics, one of the nation’s largest testing chains, said it can’t keep up with demand, and most patients will face waits of a week or longer for results.
Quest has urged health care providers to cut down on tests from low-priority individuals, such as those without symptoms or any contact with someone who has tested positive.
STATE MASK ORDERS
As testing has expanded, so have mask orders and other measures aimed at keeping infections down. Ohio, Indiana, Minnesota and Oregon became the latest to announce statewide mandatory mask orders Wednesday.
The U.S. is testing more than 700,000 people per day, up from less than 100,000 in March. Trump administration officials point out that roughly half of U.S. tests are performed on rapid systems that give results in about 15 minutes or in hospitals, which typically process tests in about 24 hours.
But last month, that still left some 9 million tests going through laboratories, which have been plagued by limited chemicals, machines and kits to develop covid-19 tests.
There is no scientific consensus on the rate of testing needed to control the virus in the U.S., but experts have recommended for months that the U.S. test 1 million to 3 million people daily.
Health experts assembled by the Rockefeller Foundation said last week that the U.S. should scale up to testing 30 million Americans per week by the fall, when school reopenings and flu season are expected to further exacerbate the virus’s spread. The group acknowledged that will not be possible with the current laboratory-based testing system.
The National Institutes of Health has set up a “shark tank” competition to quickly identify promising rapid tests and has received more than 600 applications. The goal is to have new testing options in mass production by the fall.
Until then, the backbone of U.S. testing remains at several hundred labs with high-capacity machines capable of processing thousands of samples per day. Many say they could be processing far more tests if not for global shortages of testing chemicals, pipettes and other materials.
Dr. Bobbi Pritt of the Mayo Clinic in Rochester, Minn., says the hospital’s machines are running at just 20% of capacity. Lab technicians run seven covid-19 testing formats, switching back and forth depending on the availability of supplies.
At Emory University Hospital in Atlanta, lab workers lobby testing manufacturers on a weekly basis to provide more kits, chemicals and other materials.
“There’s no planning ahead, we just do as many as we can and cross our fingers that we’ll get more,” said Dr. Colleen Kraft, who heads the hospital’s testing lab.
D.C. MANDATE
At the nation’s capital, with coronavirus cases rising, Mayor Muriel Bowser issued an executive order Wednesday making masks mandatory outside homes — an unprecedented step in the nation’s capital.
Bowser said the order would include “enforcement language” detailing possible fines for violations.
After saying they had successfully blunted the infection curve in the city earlier this summer, health officials say the infection numbers have slowly crept upward, reaching triple digits on Wednesday for the first time in weeks.
Limited exceptions to the order, according to material distributed by Bowser’s office, include children under age 3, people “actively eating or drinking,” and people “vigorously exercising outdoors” while not close to anyone else.
The order does not apply to “any employees of the federal government while they are on duty.” That description would appear to exclude President Donald Trump and members of Congress from the mask requirement while working.
D.C. officials said the mask requirement can’t be enforced on federal property. Trump, when asked at a Wednesday afternoon news conference if he would compel federal employees to comply with the mask order, said “we’re going to make a decision over the next 24 hours.”
Bowser also extended the District of Columbia’s state of emergency and public-health emergency declarations through Oct. 9.
AUSTRALIA CASES UP
Elsewhere, Australia confirmed more than 500 coronavirus cases Wednesday, marking the country’s largest single-day increase in cases yet.
Nearly all of the new cases were diagnosed in Victoria state, where infection numbers have recently started to rise, alarming officials. Melbourne, the state’s capital, started a six-week lockdown this month to slow the spread of the virus, but case numbers have continued to increase.
As of Wednesday, people are required to wear masks in public in Melbourne. And if the spread does not get under control, Victoria Premier Daniel Andrews warned Wednesday, an economic shutdown “will run for much longer than that.”
Andrews pleaded Wednesday for people to follow isolation guidelines. Between July 7 and July 21, he said, nearly 90% of people who tested positive in Victoria did not self-isolate between the time when their symptoms began and when they were tested.
More than 50% of people who tested positive in that same period, he said, did not self-isolate between when they were tested for the virus and when they got their results.
“That means people have felt unwell and just gone about their business,” he said at a news conference. “They have gone out shopping. They have gone to work. They have been at the height of their infectivity, and they have just continued on as usual.”
There is “no doubt,” Andrews said, that people not following the guidelines are contributing to the rapid growth in case numbers, and that those who are worried about losing income if they self-isolate can apply for government assistance. Information for this article was contributed by Matthew Perrone, Tammy Webber, Matt Sedensky, Kelli Kennedy, Michelle R. Smith, Mike Stobbe and Ashraf Khalil of The Associated Press; and by Siobhan O’Grady and Jennifer Hassan of The Washington Post.