San Francisco Chronicle

Surge is forcing longer delays on tests, results

- By Catherine Ho

The recent surge of coronaviru­s infections in California is driving up demand for testing and triggering a resurgence in testing delays, forcing many people to wait up to a week to get tested. Others are waiting up to two weeks to get test results back.

These major lags hamper health officials’ ability to quickly identify and contain potential outbreaks. It’s a frustratin­g situation for patients who need fast answers about whether they are infected so they know if they can safely resume activities with friends, family or coworkers.

In countries that are managing the virus better, patients typically get test results back within a day. But that’s fairly rare in the Bay Area these days.

Much of the backlog in the testing system, across the U.S., appears to be linked to the nation’s largest commercial labs, Quest and LabCorp. Both are seeing a dramatic influx of

tests and struggling to process them quickly. The resulting delays are proving to be a repeat of a problem that first surfaced during the early weeks of the pandemic in the U.S.

From late April through early June, the testing situation had improved as the labs increased capacity and some regions, like the Bay Area, managed to flatten the rate of new infections. But lag times began ballooning over the past three weeks as demand for testing soared, straining lab capacity and the supply of tests and chemicals needed to process them.

“It’s abysmal,” Dr. Caesar Djavaheria­n, cofounder and medical director of Carbon Health, a San Francisco company that operates urgent care clinics in California, said of the country’s struggle to test and report results quickly.

Wait times for test results vary dramatical­ly, depending on where people get tested and which labs each health care provider or testing site uses. Bay Area residents are waiting anywhere from just 24 hours at some San Franciscor­un testing sites, to seven days at a local Kaiser location, to nine days at a San Francisco CVS location, according to several people who spoke to The Chronicle about their recent testing experience­s. Some patients who recently sought testing at One Medical, the San Francisco primary care firm, waited a week for a test appointmen­t and were told test results could take up to 14 days.

“It’s just not right,” said Dr. Jay Levy, a UCSF virologist who got tested in late June at a San Francisco CVS and waited nine days for results. The delay forced him to reschedule dental surgery because his dentist required that he have a negative test result before proceeding with the procedure. “The test should be done 24, 48 hours now.”

CVS spokeswoma­n Monica Prinzing said the increase in COVID19 cases in some parts of the country is causing demand for testing to spike, in turn creating backlogs for CVS’ lab partners and delaying the processing of specimens. She said it may take at least five to seven days to get results.

“Our lab partners are working hard to address this issue,” she said. She declined to say which labs CVS uses, but Quest CEO Steve Rusckowski said recently his company is working with CVS to conduct testing.

Test turnaround times have increased significan­tly, particular­ly for tests being done at the large commercial labs, said Djavaheria­n of Carbon Health, which sends most of its patients’ tests to Quest, LabCorp and WestPac, another major lab.

“We started to see the lag creep up in the past two to three weeks as volumes increased and the number of positive patients increased,” he said. “More and more people started to seek care to really try to figure out whether they were exposed or not, or whether their mild symptoms were coronaviru­s or not . ... Subsequent­ly, we’ve had more prolonged wait times for results.”

About six weeks ago, wait times for Carbon Health patients were as fast as one day, and typically two to three days, he said. Today, test results are coming back in two to three days for the highestpri­ority patients — those with symptoms, or first responders — and wait times for lowerprior­ity patients, such as those who do not have symptoms or have mild symptoms, average around seven days.

The labs acknowledg­e test turnaround times are increasing and say they are working to expand lab capacity.

“Since June 29, demand has continued to rise nationwide, particular­ly in the South, Southwest and West regions of the country, outpacing our capacity,” Quest said in a statement. (Quest is based in New Jersey and processes tests at labs across the country.) “As a result, the average turnaround time for reporting test results is now one day for (priority patients) and 46 days for all other population­s.”

Highpriori­ty patients include those who are hospitaliz­ed, and residents and workers at congregate facilities like nursing homes and prisons that are more likely to contract the virus and pass it on to others.

One Medical, which sends the majority of its tests to Quest and LabCorp, is working to open more testing sites and extend weekend hours for sites to accommodat­e more patients, said Chief Medical Officer Dr. Andrew Diamond. The company is exploring whether to work with other labs, such as academic labs or labs run by smaller private companies, to speed up test results. It is also looking into using pointofcar­e tests, which process tests on the spot and report results right away, and do not require specimens to be sent to an outside lab for processing.

Federal testing officials said this week they hope the increased use of pointofcar­e tests will help alleviate lab backlogs. They also expect pointofcar­e tests to be doing up to 20 million tests each month by September.

“This is a critical situation,” Diamond said. “What people are looking to do is know whether they need to modify their behavior. They need to know that quickly.”

Choosing which lab test sites to work with can be the difference between waiting a day and waiting two weeks for results. Two test sites run by the city of San Francisco, for instance — one South of Market, the other near the Embarcader­o — send tests to Color Genomics, a Burlingame company lab that processes about half of the tests done in the city. In June, testing volume tripled but the vast majority of test results, 89%, were released in 48 hours or less, Color said.

Contracts between health care providers and insurance companies make it difficult to have tests done at labs other than Quest and LabCorp because most patients’ insurance plans designate those two labs to be the innetwork lab providers. Djavaheria­n of Carbon Health criticized the arrangemen­t as “antiquated” during a pandemic. That means insurance plans will pay for the test only if it is done at Quest and LabCorp. If patients wish to have their tests done at other labs — such as academic labs, which may be able to return results faster — they would have to pay for it out of pocket, he said.

“I understand they’re all in business and need to negotiate rates, but you’d think there’d be an executive order that says, ‘Hey, any lab that has capacity and is authorized by the FDA is now considered innetwork and it’s covered by insurance,’ ” he said. “Think about the lab capacity that would (free up).”

Limited test supplies are also, once again, posing a problem. Shortages in tests and testing backlogs are forcing Verily, the life sciences arm of Google parent company Alphabet that provides statefunde­d testing in dozens of California counties, to scale back testing in San Mateo County from about 1,000 tests a day to a maximum 500 a day, said County Manager Mike Callagy.

“For the foreseeabl­e future it’ll be a little more difficult to get testing through Verily,” he said at a media briefing Wednesday. “We’ve got people now waiting for testing.”

Callagy encouraged residents to seek testing at private health care providers if they’re unable to book an appointmen­t right away through Verily.

Some county officials have been pressing major hospital systems, including Kaiser, to do more testing, particular­ly for patients who do not have symptoms. In Santa Clara County, the public health system is conducting the majority of tests, and health officials recently ordered hospitals to take on a greater share of the burden. The hospitals are gradually increasing testing, said county testing officer Dr. Marty Fenstershe­ib.

A Kaiser spokeswoma­n said the health system has expanded its daily statewide testing capability to 16,000 to 18,000 tests and is able to test all symptomati­c patients and many asymptomat­ic patients. Kaiser generally provides test results in two to three business days, she said, but that can fluctuate depending on demand, capacity and whether a test is processed at a Kaiser lab or outside commercial labs that take longer to report results. Kaiser sends 10% of its tests in Northern California to commercial labs, often for asymptomat­ic, less urgent cases, she said.

Djavaheria­n said there are some constraint­s on swabs but that it’s not as dire as it was in March. Still, he is concerned that may worsen if the demand for testing continues to spike.

“Our swabs supply is a daybyday thing,” he said. In March, “we were scrambling for every single nasopharyn­geal swab we could find. We’re not seeing that degree of supply shortage, but ... over the past three weeks, it’s really getting scary.”

 ?? Lea Suzuki / The Chronicle ?? Ann Chan (right), physician assistant with Carbon, conducts a COVID19 test at the Native American Health Center in Oakland.
Lea Suzuki / The Chronicle Ann Chan (right), physician assistant with Carbon, conducts a COVID19 test at the Native American Health Center in Oakland.

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