COVID-19 testing delays require federal action

New Yorkers have been reporting delays in receiving their COVID-19 test results, for the past several weeks. It often takes between seven and 14 days, which is dangerous because it prevents individuals from knowing whether or not they’re infectious for days on end. 

Many patients are reporting that the city’s public coronavirus testing sites, operated by NYC Health + Hospitals, are delivering their test results relatively quickly. But some have waited up to 14 days to get their results back, which the city attributes to pooling its resources with private labs. “Remember the diagnostic test gives you a point in time," New York City Mayor Bill de Blasio said at a press briefing last week. "And you could have a very different reality even a few days later in any situation, but what’s important is to get the test back to people quickly. Again, first thing I’d say to folks: Go to Health + Hospitals because they’ve been able to make those times a lot quickly than some of those private entities.” That advice may work out better for some patients than others: while average waiting times may be lower at publicly run testing sites, there is no guarantee.

The reason for the delays is simple: there’s an increased demand for testing across the country, as the number of coronavirus cases continue to surge. Quest Diagnostics, a national lab that processes 26% of New York City’s COVID-19 tests, said in a statement that the recent number of outbreaks across the country “strained our testing capacity and extended delays for test results.” City MD, a private medical chain that has become one of the largest COVID-19 testing centers in the city, has also noted that there is a delay in testing results due to increased national demands for coronavirus testing.

The crux of the issue, as it was during the height of New York’s coronavirus crisis, is a lack of materials required to process the specimens collected for COVID-19 tests. “We would double our capacity tomorrow … but it’s not the labs that are the bottleneck,” Quest’s executive vice president James Davis told the Financial Times last week. “[It] is our ability to get physical machines and, more importantly, our ability to feed those machines with chemical reagents.”

Test results should ideally be delivered as soon as possible to inform those who may test positive for the virus as soon as possible to reduce their risk of transmitting it to others. Delayed results can also make contact tracing, which is pertinent to containing the virus, less effective. “These tests are essentially a little or even no value if they come back within that kind of a timeframe.” Tom Frieden, former director of the Center for Disease Control and Prevention, told the Financial Times regarding the delayed wait time for test results. "Every day they (patients) wait is another day they need to quarantine, or if they're not, it's another day they could be infecting other people," Dr. Keith Jerome, director of the molecular virology lab at the University of Washington, told NBC News. "If you're getting results within 20 minutes, you can start taking the appropriate actions right away."

A national effort, that will be funded with $1.5 billion of federal stimulus money, is working toward creating rapid-results testing for the coronavirus that would enable patients to get test results within minutes. However, a rapid test may make the complex COVID-19 test – that currently takes several hours to process – less sensitive and deliver less accurate results. 

Cepheid Inc, a diagnostic testing company in California, has created a COVID-19 test that can be processed within an hour, its only issue is a lack of reagents. "If you can wait an hour, you can get really good results," Jerome said. "The issue with those has been just shortages of reagents, and the machine itself is just not available enough that everybody can have one."

Since March, numerous politicians, scientists, doctors and public health officials have been calling upon President Donald Trump to use the Defense Production Act to ramp up production of materials that would enable labs to expedite and more widely deploy testing. And just last week, de Blasio called upon the president to do so. “The president needs to invoke the Defense Production Act, needs to have a nationwide effort to expand lab capacity with federal support, federal direction including producing the chemical reagents needed for the testing," he said during a press conference. "Unless there’s federal intervention, I fear this will be an ongoing problem.”

As fall grows nearer, and individuals become more susceptible to the cold and flu, which have similar symptoms to COVID-19, many diagnostic labs are concerned that they will have even more difficulty keeping up with the demand for COVID-19 tests. “I believe we have to be really thoughtful as we go into the fall. I am concerned about it. But we have to look at it holistically,” Adam Schechter, the CEO of LabCorp, one of the largest private labs in the country told CNBC. “We have to do tests, and we have to have the turnaround time in two to three days to have effective ability to track and trace people that are sick, or have been exposed to people.”