The long testing turnaround times are making it impossible for the United States to replicate the central strategy used by other countries to effectively contain the virus — test, trace and isolate. Like catching any killer, speed is of the essence when it comes to the coronavirus.
“Instead of going from one step to the next, it’s like you’re already stumbling right out of the gate,” said Crystal R. Watson, a public health expert at Johns Hopkins University. “It makes contact tracing almost useless. By the time a person is getting results, they already have symptoms, their contacts may already have symptoms and have gone on to infect others.”
After attending a funeral, Atlanta Mayor Keisha Lance Bottoms (D) and her family got tested June 29 as a precaution. No one in her family had developed symptoms.
A week later, her test results still hadn’t come back, but her husband started feeling ill. So they got a different, rapid test through Emory University. Within hours, Bottoms learned that she, her husband and one of the couple’s four children had all become infected.
It wasn’t until the next day that their initial test results finally arrived. They showed that when the family first got tested, only one of them, the child, had the virus. While they waited for their test results, the boy possibly passed it to his parents.
“It really speaks to the failure of testing in this country right now,” Bottoms said in an interview Friday. “Had we known we had an asymptomatic child in the house, we would have immediately quarantined and taken all the precautions.”
Instead, the mayor’s husband, Derek Bottoms, 56, turned feverish and fatigued and experienced night sweats. He lost 20 pounds in a week, Bottoms said.
More efficient testing — such as in South Korea, where results are often given the next day — might have prevented the Bottomses from getting the virus. But such turnarounds seem out of reach in the United States because of a lack of federal coordination, supply shortages and surging demand as outbreaks in some states spiral out of control.
Since the beginning of the pandemic, the United States has been plagued by testing problems. In the past four months, testing capacity expanded dramatically; roughly 40 million tests have now been conducted. But the federal government never fixed fundamental infrastructure problems, experts say.
“Instead of building that out, our federal response was to do the very least possible. So each time the system is stretched now, it breaks down all over again,” said Ashish K. Jha, who directs the Harvard Global Health Institute. “It’s frustrating because . . . it’s not like, ‘Oh my god, we just figured out we need to do testing.’ We’ve literally been talking about this for months.”
Coronavirus tests must be covered by insurance under the Cares Act, and free tests are available at the federal, state and local level. As demand has surged, it has created backlogs and choke points at almost every step of the testing chain.
“It’s not shortages of any one thing. It’s now spot shortages of all of them,” said Scott Becker, chief executive of the Association of Public Health Laboratories. “Clinical labs need more swabs, chemical reagents, viral transport media, test kits, machines to process the tests, staffing to run the machines.”
Compounding the problem are logistical delays: collecting and transporting the rising number of samples and returning the results to people and health agencies so they can start contact tracing — a process that involves seeking out the web of people who came into contact with someone who is infected.
In Yuma County — a rural swath of southwest Arizona where infections have soared — leaders say they need testing more than ever but are struggling to get it done.
Amanda Aguirre runs a group of nonprofit clinics and said delayed results and test kit shortages are thwarting attempts to fight the virus. The week of June 29, her clinics tested up to 1,000 people a day, she said. The following week, the number plummeted to about 500.
“Arizona is a hot spot, and it cannot stop testing,” she said. Right now, about a quarter of tests in Arizona are coming back positive, an indication that many other infections are going undetected.
Aguirre said she believes long wait times for results — up to 14 days — have discouraged many from getting tested.
Nearly every step of the testing supply chain has failed Aguirre. In mid-June, the LabCorp warehouse that her group contracts with ran out of test kits. Weeks later, it was a delivery company failing to distribute tests as quickly as needed, she said.
On Thursday, Aguirre dispatched a clinic staffer to drive more than 100 miles to a rendezvous point in the desert to pick up 2,000 badly needed test kits from a LabCorp representative who had driven an hour and a half from Phoenix. Her test sites wouldn’t have been able to stay open otherwise, she said.
“I feel totally alone,” Aguirre said. “We’re trying to bring health to our community, and our hands are tied.”
Trump administration officials Friday said testing has improved dramatically and blamed state and local officials for some missteps.
In a statement, the testing czar appointed by President Trump, Assistant Secretary for Health Brett Giroir, blamed some problems “on mismanagement and miscommunication at the state level, and a lack of flexibility to use resources.” He noted that compared with mid-March — when daily tests numbered in the tens of thousands — “we are currently completing over 600,000 tests per day, and last week reached over 700,000 in one day, clearly demonstrating our efforts toward a million tests per day by the fall will be achieved.”
Giroir was appointed in March to focus exclusively on testing but resumed his responsibilities this month at his regular job at the Department of Health and Human Services.
HHS spokeswoman Mia Heck said turnaround times at large commercial laboratories are “generally increasing.” In about half of states, she said, it takes two to three days on average to get results, and in 24 states, it takes three to four days. Only two states have average turnaround times as long as four to five days, she said. But that does not include further delays in getting the results to patients.
Heck said the Trump administration is investing in increasing testing at patients’ points of care, such as nursing homes and physician offices, which would alleviate the burden on labs.
The nation’s largest commercial lab companies said increased demand has lengthened turnaround time for results. Quest Diagnostics said results across the country are taking three to five days on average; LabCorp said it is taking four to six days.
But because testing is being conducted by a mix of commercial, public and hospital labs, the average waiting time is not known with precision state by state.
“Some labs have indicated that their turnaround time could be as long as 10 days,” said Jason Mahon, a spokesman for the Florida Division of Emergency Management. Statewide, more than 11 percent of tests in Florida are coming back positive, but in hard-hit Miami-Dade County, it’s 1 in 3.
What’s still missing and urgently needed is a federally coordinated plan “assessing our testing capacity and identifying bottlenecks, forecasting what our future testing needs would be,” said Jennifer Nuzzo, a senior scholar at Johns Hopkins University’s Center for Health Security. Without that, Nuzzo said, the U.S. response remains “a kind of janky flotilla, that, you know, is put together with gum and duct tape.”
This week, eight organizations representing those working in U.S. labs sent a letter to Vice President Pence pleading for help with test supplies.
One of those groups, the American Association for Clinical Chemistry, said it raised those same concerns last month in a call with Giroir, who said he had designated an official in each state to oversee the test supply chain and promised to give the organizations a list of those officials so they could direct pleas for help to them.
But the group never received that list and has not heard back from the administration.
“Instead, we’re all still competing against each other like the Hunger Games for critical supplies,” said David Grenache, president-elect of the association and chief scientific officer of a lab in New Mexico.
In response to questions, the Trump administration did not acknowledge shortages of testing supplies exist. HHS spokeswoman Heck said, “At this time, HHS and FEMA are meeting all state testing needs.” HHS noted that the federal government has sent many testing supplies to states, and that states are responsible for distributing them to labs.
Some hospitals have begun producing their own chemical reagents — substances used to conduct laboratory tests — because they can’t find any on the market, experts say. States and cities have resorted to negotiating directly with foreign governments for supplies. And vast disparities have emerged in Americans’ access to testing and the speed with which they receive results.
The federal government needs to develop a central database of supplies and commit to paying for tests, said Carlos del Rio, an epidemiologist at Emory University. In a report Thursday, Democrats on the Senate Committee on Health, Education, Labor and Pensions made a similar recommendation.
Sarah Cobey, an epidemiologist at the University of Chicago, said that if university and hospital labs could get funding to ramp up testing locally, delays that stem from shipping samples to commercial companies throughout the country would be eliminated.
Seattle, for instance, partnered with the University of Washington and has been able to maintain free, unrestricted testing with one- to two-day turnaround times.
Others are advocating for faster approval of rapid-result tests by the Food and Drug Administration, even if they are not as sensitive as nasal swabs. A group from the University of Colorado at Boulder and Harvard University recently released research, not yet peer-reviewed, finding that test frequency and turnaround time is more important than accuracy when it comes to broad disease surveillance.
“We’re really only going to get effective when we get into two-, one- or even half-day turnaround,” lead author Daniel Larremore said. But, he said, “The United States is not at the point with our testing where we can do any real surveillance and screening.”
Experts express concern that the lagging test times could discourage people from getting tested and practicing social distancing.
“If you’re waiting to go back to work and test results are taking seven to eight days, getting people to stay home is really hard. You worry about people saying what’s the point of even getting tested. That would be disastrous,” said Saskia Popescu, an epidemiologist at the University of Arizona.
Jaline Gerardin, an expert in disease modeling at Northwestern University, said she believes that “nationally, we’d likely save tens of thousands of lives” if test turnaround times were shortened.
In the absence of a coordinated federal response, Harvard’s Jha said, states should band together — in European Union-like blocs — to solve supply problems.
“As a region, you could pool your dollars, sit down with national and international suppliers and tackle the problem,” Jha said. “That said, there’s probably a limit to what states can do. We as a country are just not designed to have absentee federal government.”
As bad as the testing lags seem now, experts warn, they will almost certainly worsen in the fall once flu season hits.
“You’re going to see so many more symptomatic people, who won’t know if they have the flu or coronavirus and are going to need testing for both,” said Kelly Wroblewski, infectious-disease director at the Association of Public Health Laboratories. “We’re expecting a coming crush of tests, even more than we’re seeing now.”
Reis Thebault contributed to this report.