SALT LAKE CITY — It was early June and the coronavirus had been spreading in Utah for more than four months, but Michael Bronson suspected his runny nose, congestion and a bad sore throat wasn’t anything more than head cold.
Still, Bronson decided to get tested for COVID-19. As the administrative director of University of Utah Health Community Clinics and manager of its in-car testing program, getting swabbed would also give Bronson the opportunity to “secret shop” the testing procedures his teams had refined the last few months. So Bronson got in a line of vehicles outside of a clinic and waited his turn.
He got his negative results back in about a day, which is below today’s average in Utah and the rest of the country. But as demand for testing increases, so will the turnaround times for the results of those tests, experts say. The delays aren’t just the result of continued shortages of testing equipment and personal protective equipment, but a lack of trained laboratory professionals. And if testing is to continue to scale with the growing pandemic, the needs for supplies and personnel will only grow greater.
“The average test delay is too long,” said Dr. Francis Collins, the director of the National Institutes of Health — the organization that overseas Dr. Anthony Fauci’s National Institute of Allergy and Infectious Diseases — on NBC News’ “Meet the Press” on Sunday.
“Averages around the country, it’s about three days, but in some places it’s as long as a week. And that really undercuts the value of the testing, because you do the testing to find out who is carrying the virus and then quickly get them isolated so they don’t spread it around. And it is very hard to make that work when there is a long delay built in,” Collins explained to NBC’s Chuck Todd.
According to Collins, “point of care” testing — the ability the test samples quickly at the same location where the sample is collected from a patient — would speed up the results process. The systems needed to do this on a national scale are yet not possible, but the science and technology to scale up the point of care testing “look(s) very promising,” Collins said.
But advances in testing equipment won’t alleviate all the bottlenecks preventing expedited results and scale-up mass testing. Trained professionals are also a limiting factor.
University of Utah Health and Intermountain Healthcare are trying to recruit and hire more staff to meet seemly never-ending demand for tests.
“There are only so many trained, critical laboratory scientists out there,” said Dr. Brian Jackson, ARUP Laboratories medical director and associate professor at University of Utah School of Medicine.
Dr. Bert Lopansri, medical director of Intermountain Healthcare’s Central Micro Biology Lab and associate medical director of the Infectious Disease Department, agreed, saying adequate staffing was the most important piece of the testing process.
“This is such a highly complex process with such high volumes,” he added, warning the meticulous and intense work can lead to a quick burnout rate.
Training additional people to work in the testing process has been important for staving off burnout and for scaling staff to meet larger demand. But training comes with its own complexities, as experienced professionals are pulled from the lab to integrate new staff, creating yet another delay while training is done.
“Instead of doing this in a tropical depression, you’re doing in a Cat-5 hurricane,” Lopansri said of training staff during the pandemic.
Mass coronavirus testing involves using a long cotton swab to collect a sample from the back of someone’s nose or throat. That swab is then packaged with others and sent to a lab. At the lab, samples are inspected to ensure they were packaged appropriately and then prepared for a machine that can test multiple samples at once.
The swabbing and preparation process is labor intensive and involves supplies that have been hard, if not impossible at times, for medical professionals and labs to acquire.
“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,” the American Clinical Laboratory Association, said in a press release last week. The association is a not-for-profit that represents private laboratories, like Utah’s ARUP Laboratories.
In the statement, the association said it’s members have performed more than 20 million COVID-19 tests, while tripling testing capacity since the beginning of April. But more is needed.
“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,” they wrote.
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In Utah, Intermountain Healthcare’s senior medical director of Urgent Care, Dr. Anthony Wallin, who also manages Intermountain Healthcare’s curbside coronavirus testing, said the organization meets multiple times a week to discuss testing and supplies, like swabs and protective equipment, needed to run its testing program.
Regarding testing supplies, Wallin said we’re “always about two weeks from getting scary.” The global pandemic has health care organizations competing for supplies internationally.
Intermountain Healthcare staffs 25 different testing locations from Logan to St. George, collecting an average of 3,000 to 4,000 samples a day, according to Wallin. A month ago, a little more than 2,000 tests was normal. In early July, the testing staff set a daily record when they swabbed 3,000 people in one day. “In a month, it went up 50%,” he noted.
Some of the higher volume he attributes to asymptomatic testing. People are now being tested if they come in contact with someone who has tested positive, a way to detect transmission, as are people who will undergo surgery at an Intermountain Healthcare facility.
“Getting the test done within 72 hours is a pretty reasonable goal,” Wallin said. Last week, over 90% of people received in their results in three days, he reported. Intermountain now has the capacity to push results to a digital health app, called My Health+. The app expedites the notification of the results by eliminating the need for an individual phone call.
Volume has consistently stayed above 3,000 daily tests since June 16, Lopansri said, with their current daily average at 3,500 tests processed.
The incorporation of multiple, ever-evolving ways to test for COVID-19 ensures the lab is never at a total standstill when equipment goes down or supplies run short. The lab has also found itself trying to balance speed with accuracy. Lopansri said bottlenecks are built into their lab procedures to induce rigorous quality controls.
“All labs are in the same boat. As the volume for tests and demands go up, it is going to create slower turnaround times,” said Lopansri
University of Utah Health has also seen an increase in testing volume at their five in-car coronavirus testing and and evaluation locations.
“From early June to early July, our daily test volumes doubled,” said Bronson.
In March and April, University Health tested about 400 to 500 people a day. Now, as the states reaches near record numbers on a daily bases, Bronson’s teams average 1,600 to 1,700 tests a day.
A day after getting swabbed, he found it was only a head cold as the test came back negative. The average turnaround for University Health results hovers around 24-48 hours, he said. “Looking at the date on averages, I feel like we’re doing pretty good.”
ARUP, University Health’s laboratory service company, tells clients that test results will be ready within four days.
“In practice, it’s usually a lot faster than that. It’s usually been about a day,” Jackson said for the lab to turn COVID-19 tests. ARUP not only does all the testing for University Health, but also other clients needing lab services, including Intermountain Healthcare.
Generally, when there have been delays, Jackson said, it is when labs receive more tests than they can process in a day. “The bigger the backlog, the bigger the delay.”
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