Testing Labs: Supplies are limited. We can’t go faster if cases keep increasing

With longer and longer times experienced in getting test appointments and then results, RINewsToday reached out to Quest Diagnostics, the largest processing lab in the US, as well as the American Clinical Laboratories Association.

The problem in Rhode Island is not unique. Wait times both to-test and to-results are increasing throughout the United States. Hotspot areas such as Texas, California, Arizona, and Florida, are all doing greater and greater numbers of tests and are mentioned as the key reason timeframes have slowed Texas and Florida, in particular, are testing at levels not anticipated. 

Even in states “doing well” in managing COVID19, recommendations to begin testing asymptomatic people as well as, in the case of Rhode Island, people who work in “high-contact” situations such as hairdressers, gym owners, restaurant workers, etc., are adding to the demand. Testing of groups disproportionately impacted are also adding to the total testing and processing demand.

The American Clinical Laboratories Association had released a statement on the unprecedented demand and significant supply challenges:

“In light of the ongoing spread of COVID-19 in states across the country, many labs are now receiving more test orders than they are able to process in a single day. We have urged ordering providers to prioritize testing for those most in need, especially hospitalized and symptomatic patients. That will help better manage demand for testing while labs continue to perform COVID-19 testing and increase their capacity, which will require adequate supplies and additional equipment.

Since the federal government first cleared regulatory hurdles to expand testing on February 29, ACLA member laboratories have performed over 20 million molecular tests for COVID-19.  We have made significant strides in expanding capacity, which has tripled since early April, and ACLA labs are now performing more than 300,000 tests each day. Our members have been committed from the earliest stages of this pandemic to do everything possible to increase access to testing and have pioneered a wide range of innovative approaches to meet testing demand. From developing and bringing to market new tests to diagnose this evolving virus, to engaging physicians and public health partners around the importance of ordering guidelines and data that must be collected at the point of care, to closely monitoring supplies with diagnostic manufacturers and the federal government, ACLA members have responded with actionable solutions to facilitate patient access to testing.

But we can’t do it alone.  Laboratories, diagnostic manufacturers, ordering providers, public health officials, states and importantly, the federal government – including Congress and the Administration – all have a role to play in addressing the challenges hampering our nation’s response to this public health crisis.

In collaboration with the broader diagnostics community, we are exploring new technologies and testing strategies to maximize capacity for COVID-19 molecular testing, including targeting the use of antibody testing, expanding antigen and other point-of-care testing, and implementing specimen pooling in low-prevalence areas and populations.  ACLA laboratories will continue to bring forward novel approaches to expand testing capacity and work closely with regulatory agencies to maximize their use.

Accurate and reliable testing is one of the most important tools we have to combat this crisis, but what we do with the information yielded by these tests is just as important. Testing is a critical component of a comprehensive and coordinated public health strategy within each community, which also must include other elements such as adherence to mask protocols and social distancing recommendations.

As we work to mitigate the spread of the virus and meet the range of needs facing the country, including the reopening of schools and workplaces, now is the time for the federal government to outline a clear action plan to guide us through this pandemic.  ACLA members will continue to do our part in expanding COVID-19 testing capacity to support the public health needs our nation faces now and in the future.”

From Quest Diagnostics:

Demand for COVID-19 molecular diagnostic testing continues to soar, further increasing turnaround times for test results.

Despite our rapid scaling up of capacity, soaring demand for COVID-19 molecular diagnostic tests across the United States is slowing the time in which we can provide test results. 

We attribute this demand primarily to the rapid, continuing spread of COVID-19 infections across the nation but particularly in the South, Southwest and West regions of the country. Specific drivers of demand include pre-operative patients undergoing procedures in hospitals and surgery centers; high-risk populations, such as those receiving care in federally qualified healthcare centers, nursing homes and correctional facilities; and individuals seeking testing from community drive/walk through events with government agencies and corporations.

We now have capacity to perform up to 125,000 molecular diagnostic tests a day, roughly double our capacity 8 weeks ago. By the end of July, we expect to have the capacity to perform 150,000 molecular diagnostic tests a day.

Despite that dramatic increase, demand for testing is increasing even faster. As a result, our average turnaround time for reporting test results is slightly more than 1 day for our priority 1 patients. However, our average turnaround time for all other populations is 7 or more days.

At Quest Diagnostics, we are doing everything we can to bring more COVID-19 molecular diagnostic testing to patients at this critical time.

However, we are limited in how quickly we can add capacity. For instance, global supply constraints continue to be an issue. While our suppliers of test platforms and reagents continue to be responsive to our need to add capacity, they are limited amid surging demand in the United States and globally. 

To address these challenges, we are seeking to add new technology platforms, among other options. We are also considering additional partners for our lab referral program; through which we forward specimens we receive to other laboratories with open capacity.

Yet, we want patients and healthcare providers to know that we will not be in a position to reduce our turnaround times as long as cases of COVID-19 continue to increase dramatically across much of the United States. This is not just a Quest issue. The surge in COVID-19 cases affects the laboratory industry as a whole.

We realize this situation is complex and not easily fixed. Fortunately, each of us has the power to take steps to reduce the spread of COVID-19. The CDC provides helpful information on how to reduce the spread of the virus on its website.

We are also asking healthcare providers to abide by the prioritization plan we have established and to limit the number of specimens they forward for patients who are low risk.

Priority 1 patients include hospital patients, pre-operative patients in acute care settings and symptomatic healthcare workers. We rely on the healthcare provider to indicate the level of priority of each patient specimen referred to us for testing.

Finally, we want to recognize the remarkable contributions of our Quest Diagnostics colleagues, who have been central to our nation’s pandemic response. They are among the heroes of healthcare, and we are grateful for their willingness to go above and beyond to serve patients during these challenging times.  

In Rhode Island, there are a half dozen or more labs processing tests, including the RIDOH labs. The longest time for results is credited to LabCorps and then Quest. Same day test results for the public are only available in Pawtucket and Central Falls, and only for residents of those cities. The increase in testing groups not previously tested before, as well as removing the Abbott quick test site at the Twin River parking lot have done nothing but overwhelm a system already overwhelmed. The goal of testing everyone who needs – and/or wants – a test may need some revision going forward. Agreed by all parties is test results that take more than a day or so to be returned are next to useless, requiring people to self-quarantine during the wait, and missing early treatment options. Increasing in COVID19 testing also impacts testing for average medical issues such as pre-surgical tests and routine tests ordered by doctors’ offices.