Delays in testing impede virus fight
It’s harder to track, treat cases, curb the spread
A Tucson man waited 27 days for his COVID-19 test results. His test was negative, meaning he isolated from his family for two weeks for nothing.
A man in Phoenix has been waiting for 12 days for test results because he needed to show his dentist he was negative within 10 days of a dental procedure. It’s now essentially impossible for him to get a timely test and results in order to qualify for the procedure.
Arizonans routinely are waiting more than a week to get their test results for COVID-19.
It’s not just personally inconvenient for those waiting for results: The delays hinder the state’s ability to effectively contact trace and isolate cases and contacts, making it difficult to adequately control the spread of the virus.
The keys to cutting off new cases included testing both symptomatic people and those who may have been in contact with positive cases. Because there is known asymptomatic spread of the virus, testing should include people without symptoms. After testing, positive cases should isolate and notify their contacts so that they can get tested and isolate as well.
But that process is breaking down in Arizona, in part because of the slow results.
A person waiting for results may not isolate themselves from others. If people learn weeks later that they were positive, their contacts cannot be notified until after the results. Those contacts may not have been isolating, potentially spreading the virus to others.
There’s no hard and fast rule for how soon results should come back, though all seem to agree: the sooner, the better — for both waiting patients and for controlling the spread to others.
Gov. Doug Ducey said Thursday the state would ramp up COVID-19 testing after weeks of insufficient testing during Arizona’s rampant spike in cases. New efforts seek to expand supplies
and bandwidth for people wanting to get tested and to boost processing capacity so that results can come back faster.
Plans announced Thursday include more testing and processing by Sonora Quest Laboratories, and pushing a saliva-based test created by Arizona State University to the general public. The plans aim to put more testing options in underserved areas, such as west and south Phoenix.
Delays affect everything
Dr. Cara Christ, the director of the Arizona Department of Health Services, said the state is working to add testing sites, secure supplies to improve turnaround times and bring in new providers who can conduct tests.
“There’s a lot that we’re doing to increase our lab capacity so that it improves the turnaround time because we’ve been really frustrated, from a public health standpoint, with the length that it takes for people to get their results,” Christ said.
Christ said people ideally should get test results within 24 to 48 hours in order for public health responses to work effectively. A quick turnaround means people are more likely to isolate if they are positive, and contacts can be reached sooner by health officials, she said.
“If you’re not getting that result for five days and you feel completely fine or maybe you just have a little bit of mild symptoms, you might think to yourself, ‘Oh, it’s OK if I run out to the store or I go to work today,’” she said.
Delayed results have a “cascade effect” on public health response, said Will Humble, executive director of the Arizona Public Health Association. People don’t know if they’re positive, so they don’t change their behavior. Counties don’t know until much later who the positive cases are, hindering effective contact tracing and case investigations.
“If the labs were coming back five to six to seven days after the sample was taken, it doesn’t matter how good the contact tracing capacity is, it doesn’t matter how good and efficient they are at following up, the infections would have already spread to their coworkers and family members and roommates by then because very few people isolate between the time their sample is taken and they get their test results back,” Humble said.
Maricopa County, which has struggled to keep up robust contact tracing as cases have grown exponentially, said its public health department is regularly receiving lab results five to 10 days after people are tested.
“That means people have potentially been spreading the disease for a week or more and cases have no idea they are infected,” spokesman Ron Coleman said in an email. “Contacts have often already developed disease by the time we learn of the positive result. In addition, we aren’t receiving contact information for about 15% of cases meaning investigators spend valuable time trying to find people.”
Coleman said the earlier the public health department receives positive test results, the earlier they can begin contact tracing.
“The long wait times completely negate our ability to do contact tracing in a manner that would be effective,” said Kacey Ernst, an infectious disease epidemiologist at the University of Arizona.
Since COVID-19 transmission is so rapid, cases must be quickly notified if they’re positive so they can self-isolate and their contacts can quarantine after being exposed, Ernst said in an email. When results take a week or two to come back, more transmission will have already occurred, she said.
Ernst said people who know they’ve been exposed and are starting to show symptoms should slow the spread by telling the people they’ve been in contact with so they, too, can take precautions.
“Until these bottlenecks can be resolved, we have to rely on each other’s good will and open communication,” Ernst said.
Some waiting weeks for results
Robert Rezetko has been frustrated for weeks as he waited for his COVID-19 test results. The 52-year-old independent scholar started feeling sick with symptoms common for the disease after a trip to a crowded, largely unmasked grocery store and got tested soon after at an urgent care facility in Tucson. That was June 9.
He finally received his results — negative — on July 6, 27 days later.
His results arrived Saturday at the urgent care. They were so backed up that they hadn’t been able to review it yet, he said. He called, and the provider checked and told him his results.
For two weeks after the test, Rezetko lived in his casita, which he uses as an office, away from his wife and kids, because he wasn’t sure if he had it and wanted to be as safe as possible.
“I spent two weeks in isolation for nothing,” he said via email on Monday.
“Those two weeks in isolation should have been a few days, or maybe a week, or just minutes if quick testing had been available!”
Brett Barry, a 55-year-old Phoenix mentalist, needs a negative COVID-19 test result in order to get a tooth implant from his dentist. He had a tooth pulled in January and was supposed to get the implant in April, but the pandemic delayed that.
Now, he can finally get the procedure, as dental appointments have resumed. But his dentist requires a negative result within 10 days of a procedure.
He got tested June 24, with his dental appoint set for June 30. Getting an appointment at a CVS clinic was difficult, with appointments booked several days out.
Barry has now been waiting 12 days. His appointment for the implant came and went. He’s not sure how he can even get a result in 10 days considering the delays Arizona is seeing for results.
“I couldn’t get the procedure,” he said. “I had to cancel the whole thing.”
Turnaround in getting test results has been an issue at nursing homes and assisted-living facilities in Arizona, which have been hit hard by cases and deaths from the disease.
The nonprofit Beatitudes, near 19th and Glendale avenues, is one of the larger senior care communities in the Valley with 650 residents and 425 employees. Beatitudes has been around for 55 years and offers independent and assisted living, memory care and skilled nursing.
Michelle Just, Beatitudes Campus of Phoenix president and CEO, said a recent mass-testing blitz organized by the state took at least seven days for results to come back. In some cases, staffers have had to wait 10-to-13 days for results.
The long waits equate to time “lost to fight the virus,” she said.
The Centers for Disease Control and Prevention say testing in nursing homes should aim for a turnaround time of less than 24 hours “in order to facilitate effective interventions.”
Why the delay?
With rapid increases in tests completed statewide, test processors have been backlogged as they work to process incoming swabs and return results.
Sonora Quest Laboratories, which has processed about three quarters of all diagnostic tests done in Arizona, said its turnaround time for results has increased and now takes an average of six to seven days, said Jessica Pridonoff, a spokeswoman for the company. Earlier
in the pandemic, it took fewer than two days for patients to get their test results.
“This may vary due to the significant demand in our state,” she said in an email.
With new funding from the state for more processing equipment, Sonora Quest aims to get its result turnaround time down to 24 hours in the weeks ahead.
From March 17 through May 31, Sonora Quest received an average of 2,443 diagnostic test orders per day. In June, demand more than tripled to an average of more than 8,000 orders per day, according to Pridonoff.
With help from the state, Sonora Quest will be able to process 35,000 diagnostic tests per day by the end of July and 60,000 tests per day by the end of August.
There are other large and small test providers in the state. It is unclear what their turnaround times are currently.
Sonora Quest already has relationships with many big providers in the state, which makes it difficult to be nimble or switch to other providers, Christ, the state health director, said.
The Federal Emergency Management Agency denied multiple requests for a mega-COVID-19 testing site in Phoenix, according to Mayor Kate Gallego.
Gallego said her office has asked FEMA to implement a large-scale, drive-thru testing site — as they’ve done in other cities, including Houston — multiple times since the earliest days of the novel coronavirus pandemic. Christ and a spokesman for Gov. Doug Ducey said FEMA is providing significant support to the state; it’s just not coming in the form of mass-testing sites.
What Arizona is doing to improve
Christ said people could see improvement in testing availability and turnaround times as soon as this past week.
Among the efforts the state is taking, according to Christ:
● Securing a new machine and reagents used for testing for Sonora Quest, which has said it needed these materials to conduct testing faster.
● Working with Arizona State University to expand its saliva-based testing to the general public.
● Using other testing providers, such as LabCorp, to do testing in congregate settings so as not to overburden Sonora Quest.
Working with federal partners to get more testing supplies, like reagents and rapid test kits.
● Christ said some testing sites are expected to increase capacity this week, including Banner Health’s testing site at the state fairgrounds, which plans to increase from 1,000 tests per day to 2,000. Embry Women’s Health, in Mesa, also plans to increase its capacity significantly, she said.
Ducey announced expanded efforts on the front-end of testing with new free test locations in Maryvale and south Phoenix that will be funded and run by the federal government. Those two areas have seen especially high demand for testing in the past few weeks.
The sites will test up to 5,000 people per day for 12 days of “surge testing,” Ducey said.
U.S. Rep. Ruben Gallego, D-Ariz., said Monday that at his request, Walgreens added a testing location at 705 E. McDowell Road in Phoenix, providing more testing in a centralized area in his congressional district.
The lack of adequate testing and slow turnaround times calls into question why the state was not prepared for a surge in demand upon reopening.
The state had excess demand during its testing blitz in May, Christ said. The state had one weekend during the blitz when they had 17,000 available tests, but they weren’t reaching that demand, she said.
“I think it was just the increase in the cases, along with the increase in people wanting to get the tests,” Christ said. “We have been working with Sonora Quest, but I think also on top of that increased demand, the rest of the country also started seeing some of that increased demand for testing and so the reagents became an issue as well.”
Daniel Ruiz, Ducey’s chief operating officer, said the state is now averaging about 18,000 tests per day.
“I think with some of the partnerships that we have in place and are working toward announcing in the near term, we’re going to be able to increase that even further,” Ruiz said.
“People have potentially been spreading the disease for a week or more and cases have no idea they are infected.” Ron Coleman Spokesman for the Maricopa County Department of Public Health
Demand for testing grows
Demand for testing continues to increase in Arizona, where the new coronavirus has been spreading rapidly in recent weeks.
Lines snaked around free testing sites in south Phoenix and Maryvale recently, showing the high demand for testing in underserved communities. Some waited for hours in their cars in the heat to get tests.
“Today, demand is through the roof,” Ducey said of diagnostic testing at a Thursday news briefing.
Christ said the state is working to identify providers that can go into these underserved areas. The state is providing Equality Health, which ran the Maryvale testing sites, with personal protective equipment and funding. She said the state is working with another provider to get increased drive-thru testing in the West Valley.
People in need of testing sometimes jump from provider to provider, trying to find available tests amid supply shortages at some sites and full bookings at others.
Some people report giving up on getting tested after waits proved too long. Others were able to get tested easily and quickly.
Ernst, at the University of Arizona, said, “in short, demand is increasing and supply is diminishing.”
Although testing has significantly increased since late May, it has not kept pace with the rise in community transmission of COVID-19, nor has it always kept pace with the demand for tests. Labs, hospitals, collection sites and test processors have all felt the strain.
During the past three weeks, Arizona’s cases increased by 176% and tests increased by just 79%.
Nearly one in five tests has come back positive in the last few weeks, indicating that there is not enough testing and that the virus is widespread in the community.
Arizonans can preregister for testing at locations statewide at azdhs.gov/co vid19testing to reduce wait times.