Covid tests and turnaround times are still unequal until the pandemic

In a past week, a New Yorker received a free Covid-19 test in the blink of an eye with results the next day, while a Coloradan had to spend $ 50 on a test in two cities in her hometown after a frantic round of pharmacy hopping. One Montanan drove an hour each way to get a test, wondering if it would take five days again this time to get results.

While Covid tests are much easier to come by than when the pandemic started, the ability to get a test – and timely results – can vary widely across the country. A fragmented test system, complicated logistics, technician burnout and disgusting peaks in demand all contribute to this bumpy ride.

“We’re still where we were 18 months ago,” said Rebecca Stanfel, the Montana woman who had to wait five days for test results in Helena last month after being exposed to someone with the virus.

Unpredictable waiting times can be an issue for those trying to plan for travel, return to school from quarantine – or even receive life-saving monoclonal antibody treatment within the optimal window of time if they have Covid.

The White House announced in early October that it would purchase $ 1 billion worth of rapid antigen tests to improve access to hard-to-find over-the-counter kits. But people also struggle to get molecular tests, including the gold standard PCR tests.

Public health laboratories are no longer hampered by supply shortages of individual test components such as swabs or reagents, said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. But they still carry a huge testing burden that they expected to be shifted more to commercial or hospital laboratories by now.

Testing labs of all stripes, as well as restaurants, are facing labor shortages, said Mara Aspinall, co-founder of Arizona State University’s biomedical diagnostics program, who also writes a weekly newsletter to monitor national testing capacities and serves on the board of directors of a rapid testing company.

“The staff shortage is very, very real and it is preventing people from increasing capacity,” she said.

Something as simple as proximity still determines how quickly test takers get results.

“Northern Maine is a good example,” said Aspinall. “Everything you do with PCR takes an extra day because it has to be flown or driven.”

Even in a place like Longmont, Colorado, near many laboratories and hospitals, PCR samples are air freighted from the local bulk testing facility to a laboratory in North Carolina every night.

This mass test operation recently returned to its original location on the fairground after a summer stay in a small church car park. The county’s demand for PCR testing quadrupled from 600 weekly tests in July to 2,500 weekly tests in September. Boulder County’s Public Health Emergency Manager Chris Campbell attributes the heavy traffic to school reopenings, a surge in infections, and the difficulty of obtaining rapid over-the-counter tests.

The mass testing facility for Covid-19 in Longmont, Colorado recently returned to its original location on the Boulder County Fairgrounds after spending the summer in a small church parking lot. (Rae Ellen Bichell / KHN)

The demand for PCR Covid-19 tests in Boulder County, Colorado quadrupled from 600 tests per week in July to 2,500 per week in September. (Rae Ellen Bichell / KHN)

Campbell said it sometimes took residents four or five days to get their PCR results, although that has dropped to two as the contractor they work with, Mako Medical, has rebuilt its laboratory capacity.

“It’s pretty inexcusable to have such a long turnaround time. It really affects our ability to really stop the transmission, ”Campbell said. “And it also has an economic impact on businesses, schools, and early childhood facilities.”

Mako’s lab operates around the clock and the company uses private planes to expedite shipping, according to a statement from Chief Operating Officer Josh Arant. While Mako’s average weekly turnaround time never exceeded 72 hours in the past month, results have been returned to local residents an average of 46 hours after sampling in the past few weeks.

There are now portable devices that make sending samples superfluous. You can perform molecular analysis, including PCR, in less than an hour – a process that typically takes at least four to five hours in a laboratory. A test car in Washington, DC has three Cepheid machines on board, each about the size of a printer. Combined, they can deliver PCR results to a dozen people in less than an hour without the test takers having to pay for it.

Still, demand outweighs supply for such rapid molecular tests, largely due to the roller coaster of rising falls, said Doug Sharpe, vice president of lab capital sales at Medline Industries, which supplies Covid test components to labs across the country. “I don’t think anyone thought we were sitting here,” he added. “We’re selling more assays than we did at the peak in 2020.”

Gigi Kwik Gronvall, an immunologist with the Johns Hopkins Center for Health Security who leads the center’s tracking of Covid tests, suggested that the variability in the duration of results created a seller market when companies see results by a certain point can deliver. “People are going to pay for that kind of guarantee,” she said. “There is this potential for people to be fleeced, for sure.”

MedRite is offering three hours of analyzed PCR results in New York and Florida to those willing to pay more than $ 200 per person. The company offers other tests such as antigen testing and slower lab-based PCR tests at no cost of its own.

Celeste Di Iorio felt discouraged after driving from pharmacy to pharmacy for a day in Fort Collins, Colorado, looking for a test that would give an answer in less than three days. As a musician, she had traveled outside the state and wanted to know if she was contagious before attending a memorial service for a relative who died of Covid, among other things. Two cities away, she and her partner finally found rapid antigen tests in a pharmacy.

“We only paid $ 50 a piece for these tests, which pissed me off,” she said. “Because we are unemployed every year and a half and this state has the money.”

A sign informs customers at Walgreens Pharmacy in Helena, Montana, on October 5, 2021, that home sales of Covid-19 tests will be rationed. (Matt Volz / KHN)

In Helena, Montana, Stanfel had a PCR test every week for many months because she was taking immunosuppressive drugs for a rare condition called sarcoid. Her doctors told her to get regular tests because even though she is fully vaccinated – and given an extra “booster” dose – she would likely need monoclonal antibody treatment as soon as possible if she contracted Covid to prevent early infection “turn into something really bad.”

When Stanfel learned that a friend she had visited later tested positive for Covid, she immediately got tested in her doctor’s office. It was five days before she found out she had tested negative.

The Montana Public Health Laboratory is located in the city of Stanfel, but State Department of Health spokesman Jon Ebelt said the volume of tests has consistently exceeded the laboratory’s capacity since early August. As a result, they have had to prioritize tests from hospitalized or symptomatic individuals and send other samples to private laboratories, a process that can extend the waiting time for results up to seven days.

In New York City, where mobile test vehicles are parked in each district and personal in-home testing is offered, residents report fast turnaround time for molecular testing because the labs that analyze their samples are nearby.

In Manhattan, for example, Justin Peck came back from a road trip to Canada on a Tuesday night, walked about five minutes to a mobile test car on Wednesday, and had PCR results Thursday morning that could clear him just in time to go to work for the first time in 18 months as a dancer in “The Phantom of the Opera” on Broadway.

Aspinall said flu season is likely to lead to increased demand for Covid testing as people with Covid-like symptoms seek answers to the cause of their illness, making existing staffing problems worse. “We are at a very precarious point,” she said. “It is not enough to continue if the test volume continues as I expect.”

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