Coronavirus: Why is testing so backlogged and fragmented?
Even as California’s confirmed COVID-19 cases swelled beyond 10,000 on Thursday, nearly six times as many tests still await processing.
“Those labs are overwhelmed by the demand,” Gov. Newsom said at a Thursday press briefing, where he announced that nearly 60,000 tests have yet to be completed. “The backlogs are not necessarily getting better in real time.”
What’s the real number of Californians who are infected? The question comes at a crucial time, when families are trying to decide who needs isolation and treatment. It’s hard to manage what you can’t measure.
If California’s true infection rate reflects what’s been seen in the NBA – where Kevin Durant, Rudy Gobert, and at least eight of 75, or 13%, contract players have tested positive – we’d see 5.2 million California cases.
If we’re instead more like Italy, with a 0.12% infection rate, we’d have 48,000 cases. California’s current infection rate – 10,000 for 40 million residents – puts us closer to 0.025%.
But that’s just a guess. Because of limited testing, we have no way of knowing the true number of cases.
The state’s health officials have not yet received a compilation of total test results – both positives and negatives – from the academic institutions, state labs, commercial labs and private sector point-of-care labs that do testing, said Newsom.
And even now, weeks into the epidemic, testing is still largely done on people with pronounced symptoms or those who have been in contact with people with confirmed diagnoses.
Why is this so hard, in a nation that prides itself on technology?
While there’s been a proliferation of new tests hitting the marketplace, such as at-home tests and rapid tests for point of service testing, they’re produced by multiple vendors, each with different and as-yet-unmeasured accuracy. And many aren’t available to patients.
Private companies dominate the country’s testing capacity. The existing commercial labs haven’t been able to keep up with demand. The sharp influx of test orders has outpaced capacity, Quest, which processes tests around the country and was seen as the fix for the faulty tests initially sent out by the CDC, said on Thursday. The company currently has a backlog of 115,000 tests – from California and other states, as well — at its 12 labs.
“Just the sheer size of our country means that the number of tests we need is very, very high, compared to other countries that are much smaller,” said Dr. Michael Mina, an epidemiologist at Harvard University’s Department of Immunology and Infectious Diseases.
“Per populace, the number of laboratories that we have to run these tests does not necessarily scale linearly with our population,” he said.
To speed things up, Quest recently switched to using a highly automated, high-throughput test created by the Swiss manufacturer Roche. But many specimens collected earlier in March for its initial test now cannot be used in its new equipment.
“We cannot change the test type test once it enters the lab. We need to process it the way it’s ordered,” a Quest spokesperson Kimberly Gorode said on Thursday.
To make matters worse, our testing system is fragmented, said Mina.
“One of the major problems that I see is that we have no way to centralize things in this country — short of declaring martial law and giving a tremendous amount of power to the federal government, which is obviously something that this country is not used to, nor desires for the most part,” he said.
“We’re very fragmented. And so what that means is that every lab that has tried to get this test up and running has kind of had to start from scratch in a way and sort of do it on their own,” he said.
For example, some healthcare facilities offer drive-through testing, but that service does not necessarily mean speedier test results. It takes four to seven days to receive results from Kaiser Permanente’s service, while Stanford Medicine will notify patients within 24 hours. Other medical centers, urgent care and primary care centers that offer tests can take anywhere from two to six days to get results.
On the other end of the spectrum is Hayward’s Fire Department, which went directly to a private lab and set up an efficient drive- and walk-up testing site that gets results in as little as six hours.
“There is no major ability to scale up and pool resources across the population,” Mina said. “That’s different from places like South Korea or China, where they’re able to really draw people in and really create massive organized efforts.”
Here is a list of some Bay Area facilities that offer testing:
Kaiser Permanente has drive-through testing at its San Francisco Medical Center on Geary Boulevard and other locations, but it declined to specify where because patients have to be referred by their doctor. After being referred, the patient will receive a time and location for drive-through testing. You must be a Kaiser member. It takes four to seven days to receive results.
Stanford Medicine has drive-through testing for patients who have been referred by a physician. The patient makes an appointment to go to the drive-through test at Stanford Express Care’s Hoover Pavilion location in Palo Alto, seven days a week, from 9 a.m. to 6 p.m. Patients are notified of results within 24 hours.
UCSF is testing hospitalized patients, emergency department patients and other patients who have passed a screening for symptoms. Patients who are not hospitalized should speak to their doctor first. A doctor’s order is required. Only UCSF employees and UCSF patients are being tested right now due to limited testing supplies.
John Muir Health is doing testing at four urgent care centers in the Bay Area: Berkeley, Brentwood, Pleasanton and Walnut Creek. Patients should call their primary care physician first, and if they don’t have one they should call an urgent care center. Patients must have an order from a John Muir Health-affiliated doctor to get a test. Once approved, each patient will receive an appointment at one of the urgent care centers, ideally the one closest to them. Testing is also available for high-risk patients at John Muir’s Concord and Walnut Creek emergency departments if they meet screening criteria and have respiratory symptoms. Results take four to five days.
Carbon Health, a San Francisco-based chain of primary care and urgent care clinics, is doing testing at its urgent care locations in the Bay Area and Los Angeles. There are nine locations in the Bay Area. For location addresses and hours, go to https://carbonhealth.com/locations. A doctor’s order is not needed, but Carbon Health urges patients to first use the free online coronavirus risk assessment screening tool before seeking a test. You do not have to be a Carbon Health patient to seek a test; any California resident can get one. It takes three to six days to get results.
Forward, a San Francisco-based network of primary care centers, is offering testing for its members at its locations in Northern and Southern California, New York and Washington, D.C. Its Northern California clinic is in San Francisco’s Financial District. Patients are encouraged to first use the remote assessment feature in the Forward app so a care team can assess who may have the virus. Those whose remote assessment indicates they are most in need are scheduled for testing. It is available for Forward members only, but the company expects to expand the service to non-Forward members later this week. Results come back in 36 to 48 hours.
Hayward Fire Station 7, 28270 Huntwood Ave., 510-293-8617, is offering free testing, giving priority to first responders, health care workers and people who meet certain criteria, including symptoms of fever and shortness of breath and recent travel. Results come back in as little as six hours, or in most cases the next day.
One Medical, the San Francisco-based chain of primary care centers, is doing testing for its members who meet testing criteria in San Francisco, the East Bay, South Bay and North Bay. Patients must first be assessed by a virtual care team. If they are found to be a good candidate for testing, a doctor must approve the order before giving the patient a location and time to have a sample collected. Results come back in two to three days.
Sutter Health is conducting drive-through testing in some locations. Only patients with a doctor’s order can get tested. Patients experiencing symptoms must schedule a video visit or call their doctor to receive guidance and see if they meet the criteria for testing. People with mild or moderate symptoms are asked to stay home to reduce further exposure.
Verily, the life sciences arm of Google, is conducting tests in Santa Clara, San Mateo and Sacramento counties and Lake Elsinore (Riverside County). The initiative, called Project Baseline, requires people to go through an online screening before getting tested; the physician network PWNHealth approves testing and provides post-test consults. Nurses and other health care personnel from the health tech company Hawthorne Effect and Elligo, a research firm, do the specimen collection. Tests are processed by Quest, and results can take several days.
In addition to large companies like Quest Diagnostics and Labcorp, 22 public health labs in California are now processing samples for COVID-19. These labs include the California Department of Public Health’s Laboratory in Richmond, Alameda, Contra Costa, Humboldt, Long Beach, Los Angeles, Monterey, Napa-Solano-Yolo-Marin (located in Solano), Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Clara, Shasta, Sonoma, Tulare and Ventura County public health laboratories. More public health labs will soon be able to test samples for COVID-19.
Who has access and why aren’t more Californians being tested?
Californian doctors largely follow the CDC guidelines about who is eligible for testing:
https://covid19.ca.gov/testing-and-treatment/#top
Seek treatment by calling your doctor for a phone evaluation if:
you have difficulty breathing (shortness of breath)
you feel like symptoms (such as fever and cough) are getting worse rapidly
you are unable to care for symptoms at home
If you need to go to the hospital, call ahead so they can prepare for your arrival. If you need to call 911, tell the 911 operator you’re experiencing coronavirus symptoms so the ambulance provider can prepare to treat you safely.
Testing is being prioritized for people who:
have coronavirus symptoms AND
have one of these risk factors:
are hospitalized,
are a resident or staff of long-term health and correctional facilities OR
work in a healthcare facility, OR
are in prison OR
are over 60 years old, have a compromised immune system, or have serious chronic medical conditions.