By Rae Ellen Bichell -
Kaiser Health News
In a recent week, a New Yorker got a free COVID-19 test in a flash with results the next day, while a resident of color had to fork out $ 50 for a test to two towns in his hometown after a frenzied round of shopping at the pharmacy.
A Montana man drove an hour roundtrip to get tested, wondering if this time it would take five days to get the results again.
Although coronavirus tests are much easier to get than at the beginning of the pandemic, the likelihood of getting tested and getting results on time can vary greatly across the country.
A fragmented test system, complicated logistics, technician burnout, and spikes in demand all contribute to potholes.
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“We are still where we were 18 months ago,” said Rebecca Stanfel, the Montana woman who had to wait five days for test results on Helena last month after being exposed to someone with the virus.
Unpredictable waits can be a problem for those trying to plan a trip, go back to school after quarantine, or even receive life-saving monoclonal antibody treatment within the optimal window if they have COVID-19.
The White House said this month it plans to buy $ 1 billion worth of rapid antigen tests to help improve access to hard-to-find over-the-counter kits.
But people also have trouble getting molecular tests, including benchmark PCR tests.
Public health labs are no longer bogged down by bottlenecks in the supply of individual test components, such as swabs or reagents, according to Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories.
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But they are still enduring heavy loads of testing, which she expected would move more to commercial or hospital labs by now.
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Testing labs are also facing worker shortages, as are restaurants, according to Mara Aspinall, co-founder of Arizona State University's biomedical diagnostics program, who also writes a weekly national testing capacity tracking newsletter. and is part of the board of directors of a rapid test company.
"The staff shortage is very real and slows the growth of [testing] capacity," he said.
Something as simple as proximity also continues to dictate how quickly patients get results.
“Northern Maine is a good example.
Anything that is done with the PCR is going to take another day, because you have to fly or drive there, ”Aspinall said.
Even in a place like Longmont, Colorado, close to many laboratories and hospitals, PCR samples from the local mass testing center are airlifted every afternoon to a North Carolina laboratory.
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This massive testing operation has recently moved to its original location at the county fairgrounds, after spending the summer in the parking lot of a small church.
Demand for PCR testing in the county quadrupled, from 600 weekly tests in July to 2,500 in September.
Chris Campbell, director of emergencies for Boulder County Public Health, attributes the large influx to the reopening of schools, increased infections and the difficulty of acquiring over-the-counter rapid tests.
Campbell said it sometimes took residents four or five days to get PCR results, though that has been reduced to two as the contractor, Mako Medical, has once again increased the capacity of its laboratory.
“It is quite inexcusable to have such a long response time.
It affects our ability to stop transmission, ”Campbell said.
"In addition, it has an economic impact on companies, schools and early childhood education centers," he added.
Mako's lab operates 24 hours a day, 7 days a week, and the company uses private jets to expedite shipments, according to COO Josh Arant in a statement.
Although Mako's average weekly delivery time never exceeded 72 hours last month, according to the statement, in recent weeks it has returned the results to area residents an average of 46 hours after collecting the samples.
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Portable devices can eliminate the need to submit samples.
They can perform molecular analysis, including PCR, in less than an hour, a process that typically takes at least four to five hours in a laboratory.
A Washington DC testing truck carries three machines from molecular diagnostics company Cepheid on board, each the size of a printer.
Combined, they can give PCR results to a dozen people in less than an hour, at no cost to examinees.
Still, demand outstrips supply for such rapid molecular tests, in large part due to the roller coaster of cases, according to Doug Sharpe, vice president of lab capital sales for Medline Industries, which supplies coronavirus test components to labs. of all country.
“I don't think anyone thought that we would be sitting here.
We are selling more tests than at the peak of 2020, ”he said.
Chantel Powell undergoes a PCR test for COVID-19 at a testing center in Miami-Dade County, Florida, on Monday, July 26, 2021.Marta Lavandier / AP
Gigi Kwik Gronvall, an immunologist at the Johns Hopkins Center for Health Security who leads the center's COVID-19 testing follow-up, suggested that variability in the time it takes to get results has created a market where companies are competing to deliver. results faster in exchange for more money.
“People are going to pay for that type of guarantee.
There is a possibility that people will be plucked, without a doubt, ”he said.
MedRite offers PCR results analyzed in three hours in New York and Florida for those willing to pay more than $ 200 for each.
The company offers other tests, such as slower antigen and PCR tests, at no cost.
Celeste Di Iorio felt plucked after spending a day driving from pharmacy to pharmacy in Fort Collins, Colorado, looking for a test that would give her an answer in less than three days.
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As a musician, she had been traveling out of state and wanted to know if she could be infectious before attending, among other things, a funeral for a relative who died of coronavirus.
She and her partner ended up finding rapid antigen tests at a pharmacy two cities away.
"We just paid $ 50 for each of these tests, which annoys me," he said.
"Because we've all been out of work for a year and a half, and this state has the money," he added.
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In Helena, Montana, Stanfel has had a PCR test every week for many months because he takes immunosuppressive medications for a rare disease called sarcoidosis.
Her doctors told her to get tested regularly because, although she is fully vaccinated - and has received an additional booster dose - she will most likely need monoclonal antibody treatment as soon as possible if she contracted COVID-19 to prevent it from an early infection "turned into a really bad thing."
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When Stanfel learned that a friend he visited had tested positive for coronavirus, he immediately took a test at her doctor's office.
It took him five days to know that he had tested negative.
Montana's public health laboratory is located in the city of Stanfel, but the volume of testing since early August has regularly exceeded the laboratory's capacity, according to Jon Ebelt, a spokesman for the state health department.
The agency has had to prioritize testing of hospitalized or symptomatic people and send other samples to private laboratories, a process that can lengthen the waiting time for results by up to seven days.
In New York City, where mobile test vans are parked in every borough and in-person home testing is offered, residents report the speed of molecular testing because labs testing their samples are close by.
For example, in Manhattan, Justin Peck returned from a road trip to Canada on a Tuesday night, walked about five minutes to a mobile test van on Wednesday, and had the PCR results on Thursday morning, giving him allowed him to go to work for the first time in 18 months as a dancer in
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Aspinall believes that the flu season is likely to increase the demand for COVID-19 testing as people with similar symptoms will want to clarify which illness they suffer from and this will exacerbate staffing problems.
“We are at a very precarious point.
It is not enough to move forward if the volume of testing continues as I expect it to, "he said.
