5 million infections in US
No national strategy, not enough capacity
As the nation averages 60,000 new infections and 1,000 deaths per day, COVID-19 testing delays still force labs to prioritize who can be checked.
David Rohlfing, a Queens resident and high school English teacher, attended outdoor picnics, an outdoor bar and a Black Lives Matter protest earlier this summer. Though he did not feel sick, he wanted to get tested for COVID-19 before visiting his sister in Connecticut.
On July 6, he was tested at a New York City-run site and was told results could take a week. He checked a patient testing portal every day. On July 23 – 17 days after he took the test – he learned he did not have the disease.
Now Rohlfing wonders whether there will be enough testing when he returns to the classroom in September. He wants a guarantee he can take a test with quick results if he interacts with an infected student or staffer. If there is no such assurance, and testing has not improved, he might not go back to class.
“I’m not going to do it,” he said. “I will join any effort to not open the schools if that part of the piece is not in place.”
The slow turnaround time for patients like Rohlfing could harm efforts to curtail outbreaks. Professional athletes and private businesses that purchase lab testing can get access to quick tests. Teachers, students and others who rely on traditional retail clinics or doctors’ offices, however, might wait days for results.
Federal officials and private labs acknowledge they must prioritize the nation’s limited supply of coronavirus tests for hospitalized patients, health care workers and other high-risk individuals.
But many Americans worried about contracting the sometimes deadly virus often must wait in long lines and several days for results.
Without a national plan on how to best allocate hundreds of thousands of COVID-19 tests each day, there simply is not enough capacity now to screen Americans who might unwittingly pass the virus to others.
And some warn the problem will be further strained when universities and K-12 schools resume classes, more companies bring employees back to the workplace and influenza testing spikes this winter.
Dr. Howard Koh, a professor at Harvard T. H. Chan School of Public Health and former Department of Health and Human Services Assistant Secretary during the Obama administration, said the testing shortage has created a pattern of unequal access.
“Some privileged parts of our country are getting daily access and others have no access at all,” Koh said. “We’re never going to solve this pandemic until we give everybody access, particularly high-risk groups. That’s the public health principle we always try to follow.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said testing delays are “totally unacceptable” and need to be fixed.
Speaking at a forum hosted Wednesday by the Harvard public health school, Fauci said in some communities “the gap between the time you get the test and the time you get the result, in some respects, obviates the reason why you did the test ... We’ve got to correct that.”
The federal government wants to expand testing on several fronts, including more “point of care” machines that can
“We’re never going to solve this pandemic until we give everybody access...” Dr. Howard Koh, a professor at Harvard T. H. Chan School of Public Health
deliver results in minutes at a clinic or doctor’s office. The National Institutes of Health has launched a $1.5 billion, Shark Tank-style competition called Rapid Acceleration of Diagnostics to bring capacity up to 6 million daily tests by December.
Some want federal regulators to loosen oversight of rapid tests, similar to pregnancy tests, that can be taken at home and deliver immediate results, albeit without the sensitivity, or accuracy, of lab tests.
States also are taking more control. Louisiana, Maryland, Massachusetts, Michigan, North Carolina, Ohio, Utah and Virginia this week announced a pact with The Rockefeller Foundation to each purchase a half-million rapid antigen tests from two manufacturers.
The nation’s labs have never been asked to test such a large portion of the population, especially those without symptoms.
“We don’t design tests normally for people who aren’t experiencing symptoms,” said Kelly Wroblewski, the Association of Public Health Laboratories’ director of infectious disease. “It’s not normally who you target when you’re planning to test people.”
But as officials race to expand testing, Assistant Secretary for Health Adm. Brett Giroir acknowledged not everyone will get results at the same time. Some patients must be prioritized.
“We are going to have more prioritization in the future,” Giroir said last week in a call with reporters. “There are certain people. I am not going to say it’s an unnecessary test, but, you know, if you have to have a test to go on vacation somewhere, that’s not the same priority as a nursing home or a person in the hospital.”
The varying turnaround times might be a symptom of a fragmented lab system. Public health labs are focused on tracking diseases in any given communities. Large commercial labs deliver accurate results to properly diagnose patients. And private labs can provide specific services to their customers.
“Because of the way the laboratory system is structured in the U.S., there is this ability to buy capacity for large corporations,” said Wroblewski, with the Association of Public Health Laboratories. “It does make it challenging to develop a thoughtful, strategic plan when you have this fragmented system that serves all these different goals.