During a Tuesday meeting of the White House coronavirus task force in the Situation Room, Vice President Pence and other officials discussed diverting new tests to areas where there are relatively few cases, according to two individuals familiar with the matter who spoke on the condition of anonymity to describe internal deliberations.
They said the administration needs “to figure out the spread in places where we don’t quite understand it now,” according to one of the individuals present. The final consensus seemed to be, “Let’s send it to the South and low density areas.”
The lag in delivering test results is taking a toll on communities across the country, depriving them of workers who can respond to medical emergencies and sowing uncertainty among hospital officials deciding what precautions to take. The competition for machines is so intense that governors and mayors have begun personally calling Abbott executives to negotiate orders.
In beleaguered Detroit, which now has one of the nation’s highest rates of infection and one of the fastest rising death tolls, Mayor Mike Duggan said Wednesday that he secured the cellphone number of Miles White -- the chairman and outgoing chief executive of Abbott Labs -- and woke him up Sunday morning to beg for the test, because he knew the whole country would be calling. He said the fact that he struck a deal for five machines and 5,000 kits would be a “game changer,” allowing firefighters, police and nurses to get back on the job and out of quarantine.
Atop the shuttered Greektown Hotel in the city’s casino district, where some police officers have begun staying overnight this week to avoid the risk of infecting their own families, the message “#DETROITSTRONG” blazes night and day.
Five hundred twenty-five officers in Detroit’s more than 2,500-person police force are quarantined, according to Sgt. Nicole Kirkwood, a spokeswoman. Eighty-five members are expected to return to work by the end of this week, she said, and 91 have tested positive.
Rep. Debbie Dingell (D-Mich.), whose district includes the neighboring city of Dearborn, said in a phone interview Tuesday that some of her constituents are waiting as long as two weeks to get results from tests sent out-of-state and to private companies.
“You need to know whether it’s safe for someone to go out, and we need to keep them safe as well,” Dingell said, adding that local police and fire chiefs are struggling to deal with employees who are isolating themselves while they await test results.
“We can’t afford to wait for another week,” one wrote her.
Abbott spokesman John Koval, whose firm started shipping 50,000 tests a day on Wednesday, said, “We’re working with the administration to deploy them where they will have the greatest impact.” He would not elaborate, but said states across the country had already begun to receive and use them.
Maryland Gov. Larry Hogan (R) said in an interview that his state needs at least 100,000 more tests than it has right now.
“We’ve talked to Abbott. They’re shortly supposed to have a small amount of testing machines out to the states. No governor in America has received any yet,” Hogan said. “They’ve said they are available. They are not yet available. They say, ‘Get on the phone, governors can get all these things.’ I just got off the phone with all the governors, no governors have these things.”
Public health experts say testing is needed everywhere — as much as several hundred thousand a day. “Hot zones need them the most,” said Harlan Krumholz, a cardiologist at Yale Medical School and director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation, “but everyone needs them.”
Joshua Sharfstein, former Maryland health commissioner and now a professor at the Bloomberg School of Public Health at Johns Hopkins University, said any decisions to send them to the South "instead of to hotspots like that would have to be part of a plan with a scientific rationale. And I haven’t seen one at this point.”
In Kentucky, Gov. Andy Beshear (D) has delayed launching mobile testing sites, partly because he doesn’t yet have an adequate supply of tests and personal protective equipment. But he noted in a news conference Tuesday that the turnaround time for tests matters as well, since officials are trying to ensure they have access to a lab outside the state that "can turn it around in enough time to where it can be helpful. We’d like to get reports back in 48 hours.”
That’s not what’s happening now.
In California, the backlog for getting test results is staggering. While approximately 86,100 tests had been conducted as of March 30, about 28,704 results had been delivered and another 57,400 were pending. The numbers include data California has received from commercial, private and academic labs, including Quest Diagnostics, LabCorp, Kaiser, the University of California, Stanford University, and 22 state and county health labs.
Even though widely used test analyses take only four hours, shortages of the large costly machines used for those analyses have caused bottlenecks, forcing patients to wait four or more days for test results.
On March 18, as the pandemic deepened, the American Clinical Laboratory Association appealed in vain to congressional leaders to include $5 billion in legislation to help private laboratories meet growing demand for tests and analysis. Some test providers feared Medicaid might reimburse a fraction of costs. And the laboratory companies are already hurting from a drop in other business. Quest, in a Securities and Exchange Commission filing Tuesday, said it had suffered a 40 percent drop in overall volume during the last two weeks of March, even after including covid-19 testing.
There are now more than a dozen major players in the testing world. The Centers for Disease Control and Prevention has its own labs, but on Feb. 29 it appealed to hospitals and private companies for help. Since then, private companies have churned out as many as 84,000 tests daily, and have accounted for about three-quarters of the 1,064,506 tests completed as of April 1.
The biggest companies that have jumped into covid-19 testing include Roche, LabCorp and Quest, established names in laboratory analysis. They have ramped up quickly, but not fast enough. LabCorp, for example, has the ability to perform more than 20,000 coronavirus tests per day, and has performed more than 250,000 tests overall since the company began testing for covid-19 on March 5. Quest said on March 24 that its capacity would soon reach 30,000. But it still takes either company routinely four to five days to release test results to health care providers.
“This timeframe can vary based on demand, the length of time to transport the specimen to LabCorp’s test facilities, and the prioritization of patients (as defined by healthcare authorities and the White House Coronavirus Task Force, HHS and other health authorities),” Labcorp said in a statement, referring to the Health and Human Services Department.
Scott Becker, executive director of the Association of Public Health Laboratories, said in an email that delayed results are pervasive across private and public labs.
“These backlogs are system-wide issues that point to supply shortages, equipment shortages and shortages of qualified staff," he said. “These tests aren’t like a simple blood test, they are deemed highly complex tests that require skilled scientific staff.”
A state like New York may be turning around tests quicker because it’s prioritized who to test and is receiving more supplies given the severity of the outbreak there, Becker added, but that means other states might receive fewer supplies. "All labs, no matter if they are public health, hospital, other clinical labs or commercial labs, all need the same finite pool of resources.”
Some states, like Oklahoma, are making headway. The state could only process 300 tests in a 24- to 48-hour window, so it began sending tests to Dallas, leading to a three- to five-day turnaround. Two weeks ago it partnered with the University of Oklahoma and Oklahoma State University to process tests, and ordered 10,000 from the company Thermo Fisher,that arrived last Thursday.
Now, Oklahoma “is being allocated a shipment of Abbott’s rapid genetic testing, and we have been told it could arrive as early as this week,” said Shelley Zumwalt, the state’s chief of innovation, in an email.
The new Abbott test involves putting a sample from a nasal swab in a 6.6-pound toaster-size device, which will give results back in five to 13 minutes. The new test will be used only in medical facilities. The company says it will provide 50,000 of the testing kits a day and has distributed 18,000 of the analytical devices.
For primary care physicians, Abbott’s technology is largely out of reach. Gary Bergman, senior physician at Children’s Medical Associates of Northern Virginia, said in a phone interview Wednesday that he and his partners looked into buying one of the firm’s machines, but it would cost between $12,000 and $15,000, and they couldn’t say how many covid-19 tests they could supply or what they would cost.
“It doesn’t pay. It’s not practical," said Bergman, who continue to see sick children and newborns even though business has dipped by two-thirds.
Dozens of firms around the world are working on tests they hope will win an emergency use authorization from the Food and Drug Administration: Abbott’s new test is the second one of the company’s to receive such approval. Together, the number of Abbott testing kits will reach a monthly total of 5 million.
With this latest testing device, Abbott joins other companies coming up with new techniques, marking another small step toward addressing nationwide shortages and bottlenecks. The new test is just one of a wide variety of covid-19 diagnostics under review or which have recently been given approval by the FDA.
Eva Dou in Detroit, Greg Jaffe in Toledo and Andrew Ba Tran in Washington contributed to this report.