America’s testing system is once again strained and labs are struggling to keep pace as coronavirus rages faster than ever in the South and West.
From Florida to California, large and small labs running 24/7 can’t process samples quickly enough from millions of Americans tested every week. That means COVID-19 test results are delayed a week or longer in hot spot communities, undercutting public health efforts to track, isolate and prevent spread.
The number of daily tests reached an all-time high of more than 719,000 on July 3 and averaged nearly 640,000 each day this past week, according to data from the COVID Tracking Project.
Testing centers in Sunbelt cities such as Tallahassee, Florida, and Phoenix routinely attract long lines and at times must turn away people. Other than hospital patients, whom labs are prioritizing, delays are widespread in the South and West at drive-thru and walk-up testing centers, urgent care, doctor’s offices and government-supported testing sites.
“We are seeing across the board this very significant increase in demand,” said Julie Khani, president of American Clinical Laboratory Association, which represents the nation’s largest commercial labs. “That demand in many cases is now exceeding the number of tests that the labs can perform in a single day.”
The absence of testing to detect SARS-CoV-2, the virus that causes COVID-19, left the nation unprepared in February and March as the deadly virus swept across the United States. The nation regrouped, Congress authorized billions and private sector labs jumped in to provide widespread clinical testing that public health labs could not complete on their own.
But as states have reopened, millions of Americans want to get tested amid a resurgent virus. New cases surpassed 63,000 for the first time Thursday, pushing total cases past 3.1 million and more than 133,000 deaths, according to Johns Hopkins University.
Assistant Secretary for Health Admiral Brett Giroir, who oversees the Trump administration's testing efforts, acknowledged this week the nation's testing system is nearing limits and commercial labs are taking longer to compete non-emergency COVID tests.
“We did anticipate that the lab capacity would at some point in time come close to reaching a max,” Giroir said on a call with reporters. “I’m not saying it’s at a max now, but we’re certainly pushing the frontiers.”
Giroir said new "point of care" testing platforms, which deliver quick results at doctor's offices and clinics, should add 10 million to 20 million tests each month by September. In the meantime, he urged Americans to demonstrate “personal responsibility” by wearing masks, distancing from others, hand-washing and shielding vulnerable people such as older adults or those with underlying health conditions that put them at greater risk.
Commercial labs envisioned a demand spike when they joined the coronavirus testing effort and urged White House officials to adopt strict test-ordering criteria so the most vulnerable people get tested first, Khani said.
Labs have worked to expand testing capability, but there are limits. They must secure testing materials such as chemical reagents, swabs and pipettes from suppliers that serve labs worldwide. And they also need to acquire the machines that perform high-volume tests.
"We know we have a responsibility to deliver those results as quickly as possible," Khani said. "That’s why we’re doing absolutely everything we can to continue to expand out testing capacity and increase our ability to perform tests."
'A little apocalyptic'
In Florida’s capital of Tallahassee, hundreds of people line up outside every day in the summer heat at Florida A&M University’s football stadium, the site of the city’s only public testing center.
Shannon Novey and her family arrived there at 7:15 a.m. Thursday, almost two hours before the center opened and found more than 80 people already in line ahead of them. By the 9 a.m. start time, there were 200 to 250 behind them.
“We were 84, 85 and 86,” said Novey, an area attorney who wanted to be tested before an upcoming trip that includes older relatives most vulnerable to serious illness. She’d called around to doctor’s offices and clinics, but tests either were not available or an appointment couldn’t be made for days.
The scene at the stadium was “a little apocalyptic,” Novey said, with everyone in masks and security controlling the crowd and enforcing physical distancing. The county health department staff and National Guard troops running the testing site were kind and resourceful, she said, using old-fashioned carbon paper to make copies of people’s contact information and implementing a texting system to allow people to check in and wait out of the line.
Including a 45-minute impromptu tailgate in the parking lot, it ultimately took 3½ hours for the family to be tested. As they were leaving at 10:40 a.m., more people were arriving. The site can conduct up to 500 tests a day.
“If you have a time-sensitive need for a test and aren’t actively exhibiting symptoms, it's really your only option, and that’s a little bit scary,” said Novey, who learned Friday night their tests were negative.
“I’m grateful to the workers and troops running the site and feel fortunate to have a publicly available free option but also incredulous that this is the state of the art for care in the capital city of the state in the center of the epidemic outbreak.”
In Arizona, the nation's hottest COVID-19 hot spot, long lines snake through drive-thru testing centers with people waiting hours in triple-digit temperatures. Phoenix Mayor Kate Gallego, a Democrat, has clashed with Trump administration officials, but federal officials vowed to support another mass-testing site there, reported the Arizona Republic, part of the USA TODAY Network.
Stanford Prescott, a school board member in Phoenix, came down with a cough, sore throat and fatigue in early June. After his symptoms lingered for eight days and worsened with shortness of breath, he called his primary care doctor, who recommended a test.
Unable to get a testing appointment at a drug store or a local hospital system, he visited an urgent-care center with dozens of patients ahead of him. He got tested two days later. The nasal swab tests took minutes to administer, but he did not get results for another 16 days, he said on social media.
Getting test results also delayed
Such long testing delays are not unusual in metro Phoenix. Most COVID test results take eight to nine days, according to the website of Sonora Quest, the region's largest commercial lab. Sonora Quest is a joint venture of Quest Diagnostics and Arizona's largest hospital system, Banner Health.
The “unprecedented demand” for COVID-19 tests has extended average turnaround times across its massive territory, Quest Diagnostics said.
The company has prioritized tests for patients in hospitals and acute surgery and health care workers with symptoms. For other patients, the average turnaround time was four to six days as of Monday, up from an average of three to five days as of June 29.
Quest, which serves about half of the nation's doctors and hospitals, said demand for COVID tests surged 50% over a three-week period in June and continues to rise, especially in the South, Southeast and Southwest. The lab can now process 120,000 tests each day and plans to add another 30,000 tests by the end of July.
Similarly, LabCorp said "until recently" it could deliver COVID-19 test results within a day or two.
"But with significant increases in testing demand and constraints in the availability of supplies and equipment, the average time to deliver results may now be four to six days," for non-hospital patients, LabCorp said Wednesday.
Slow results in assisted-living settings
While hospitals are still receiving fast test results, the same is not true for another vulnerable group: nursing homes and long-term care facilities. An American Health Care Association and National Center for Assisted Living survey found nearly nine in 10 homes reported test results are taking two to four days to complete. Test results are delayed five or more days for 24% of homes, the survey found.
“The amount of time it is taking to receive testing results is hurting the ability of long term facilities to fight the virus," said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living.
Richard Brown, 88, moved into a small Scottsdale, Arizona, care home in December and settled well with other residents and caregivers. An avid runner, cyclist and mountain hiker, he maintained an impressive level of fitness as he aged.
When daughter Linda Brown moved him into his new home last winter, she had bronchitis and a high fever, an illness her father caught but quickly shrugged off.
Last week, he became ill and could not rally to health despite a course of antibiotics, a steroid, a nebulizer breathing treatment and oxygen. He was sent to a Scottsdale hospital where he was tested and diagnosed with COVID-19. Doctors there administered plasma treatments, the antiviral drug remdesivir and the steroid dexamethasone – a common treatment course for COVID patients. It wasn’t enough. He died Monday.
Linda Brown does not know how he became infected. While the virus is widespread in metro Phoenix, the home has not allowed visitors since March. The caregiver couple who operate the home tested negative, and tests are pending on other residents.
He was never tested for the virus at the home, and now she wonders whether routine testing might’ve caught his infection earlier.
“Everything I’ve read, the earlier you catch it and initiate treatment, the better,” Brown said. “That is why I’m frustrated these homes are not required to test regularly. Anyone who goes in or out should be wearing a mask. Anybody. And they are not. They weren’t.”
Testing strategy questioned
Testing and delivering timely results is critical to slow the spread of the virus. People who get a test but must wait a week or longer for a result don’t know whether they have the disease. It also delays public health efforts to isolate infected individuals and trace their contacts to prevent further spread, experts said.
Dr. Joshua Sharfstein is vice dean of public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health.
“If it takes days and days to get a result, additional transmission may have happened before contact tracers get involved,” Sharfstein said.
Atlanta Mayor Keisha Lance Bottom said this week it took her eight days to get results for her family's tests. She tested positive for the virus, so did her husband and one of their children. Had she received test results more quickly, "we could have immediately quarantined," she said Wednesday on Twitter.
We FINALLY received our test results taken 8 days before. One person in my house was positive then. By the time we tested again, 1 week later, 3 of us had COVID. If we had known sooner, we would have immediately quarantined. Perhaps the National Guard can help with testing too.
— Keisha Lance Bottoms (@KeishaBottoms) July 8, 2020
Sharfstein says the nation’s testing crunch is in part due to the lack of a clear federal plan.
“We’re suffering for not having a clear federal strategy,” he said. “What we wind up having is every testing center for itself.”
The Centers for Disease Control and Prevention has set federal testing guidelines, but it does not have enforcement power.
The Trump administration required each state to submit its own testing plans to meet testing goals in May and June. Federal officials critiqued the plans and required states resubmit the testing plans by Friday to detail how they would meet testing goals for the rest of the year.
In May, the CDC awarded $10.25 billion to states, local governments and territories to fund testing plans. The federal government procures and sends testing supplies such as swabs to every state once a week, Giroir said.
In addition to critiquing state plans and securing testing supplies, the U.S. Department of Health and Human Services this week said it would set up temporary surge testing sites in Baton Rouge, Louisiana; Edinburg, Texas; and Jacksonville, Florida. With the help of a vendor, each site aims to perform 5,000 free tests a day over five to 12 days.
Despite the rapid spread of the virus and mushrooming demands for tests, Giroir said the nation's existing testing identified the communities now facing significant outbreaks. But he emphasized the testing alone will not solve the pandemic.
Until the nation develops a vaccine that is safe and effective, individuals must take action to help slow the virus, he said. That means practicing social distancing and protecting the vulnerable.
"The technology is not here to test every single person every single day," Giroir said. "The most critical factor is going to be personal discipline. It’s the physical distancing. Wear a mask. Avoid crowds ... that is absolutely critical and is the most important thing we can do right now across the country."
Contributing: USA TODAY national enterprise editor Jennifer Portman
Alltucker is on Twitter as @Kalltucker and email at firstname.lastname@example.org
This article originally appeared on USA TODAY: Long lines for COVID tests, stressed labs delay results as cases surge