Dr. James Richard has some tough calls to make. As lab director for the Sparrow health system, his team has been “burning and churning” through more than 85,000 COVID-19 tests since the pandemic began.
The lab is a lynchpin for the region, serving as the central test processing hub for multiple hospitals, clinics, and community testing sites, all sending their samples to Sparrow and depending on their speedy results to track and contain the virus.
But then last week, two things changed.
First, one of Sparrow’s major suppliers, which had been sending as many as 600 tests per day, said that would “no longer be happening” due to shortages, Richard says. Second, demand for test processing went up “astronomically.”
“We went from getting 500 to 700 tests a day, to upwards of 2,000,” Richard says. “And we’ve been trying to stay up with that, but beginning sometime last week, we started getting more orders than what we could fill in a day.
“And so what ended up happening is we now have a significant backlog in our turnaround time. It used to be 72 hours. The current time is 6 days,” he says, although processing “urgent” or “stat” cases is taking close to 24-48 hours. (Those are typically people who have severe symptoms, are going into surgery, or have been admitted to the hospital).
As case numbers rise precipitously (the U.S. is now averaging more than 66,000 new cases each day, based on a 7-day average) demand for testing has also skyrocketed, several Michigan health officials say. Meanwhile, Michigan nursing homes are now required to test staff and residents as often as once a week, and that’s adding strain to local labs, some of which are having to turn would-be customers away. And some health systems and medical providers are now using more of their tests for patients undergoing procedures, rather than the general public.
The trickle down means that even as the state averages almost 27,000 tests per day, more communities, from Pontiac to Petoskey, are seeing growing wait times for test results. And that’s threatening health departments’ efforts to track and contain the virus.
Ingham County Health Officer Linda Vail says quick results from Sparrow helped them contain the recent outbreak from Harper’s bar in East Lansing, which led to more than 170 cases. But now those turnaround times are growing, she says.
“They are reducing their supply, which has them concerned, as well as us,” Vailsays. “We are about to basically begin to have less testing capacity. And I'm going to reach out to the state and figure out how they're going to help us work that out. But I'm not seeing a tremendous amount of it right now.”
After two weeks, test results are “purely academic”
If you can’t get a COVID-19 test result in about 2 days, it’s harder to spot outbreaks, figure out who’s been in close contact to infected individuals, and stop the spread. Effective contact tracing and case investigation depends on speed, says Dr. Russell Faust, Oakland County Health Division’s Medical Director.
“None of that works if your testing is not timely. That is, if you're not getting results back within a couple of days,” he says. “That whole process just becomes academic.”
Currently tests in Oakland County are taking about a week, according to Faust. They’re collecting as many as 1,000 samples a day from residents, but lately the smaller, regional labs tell Faust they’re only able to handle about 200 of those right now, given the increased demand. At least they’re being honest, he says.
“The problem we're having is that with some of the national labs, they're way overcommitted, and they're not being transparent. And they're telling people they're getting results back to them in 5 days. When in fact, we know we have results that are still outstanding past two weeks. And I'm sorry, that just doesn't cut it. We can't do anything about it in two weeks.”
“Tests are taking longer to process, especially for people without symptoms or known risks,” says Susan Cerniglia, spokesperson for the Washtenaw County Health Department, in an email this week. “Businesses or individuals trying to follow guidance to test routinely (for example, every two weeks for people working in-person) are struggling to find anywhere to test and to get results back in a timely manner.”
Some areas, like Kent County, say they’re still getting results within a few days. And the difference may be which labs they’re using to process their test results, says Lynn Sutfin, a spokesperson for the state health department. “The main difference is between out-of-state/national reference laboratories (Quest, Labcorp, Bioreference) and in-state labs,” Sutfin says in an email. “The national labs are facing longer turnaround times. The in-state labs are still running 1 to 3 day turnarounds. So it really depends on which laboratory the test site is partnered with – not where the test site is in [Michigan.]”
But many of those local labs are able to maintain their short turnaround times because they’re turning would-be customers away. That still leaves Michigan residents waiting longer for results.
“We do have some shortages in transport medium and reagents at various labs at various times,” Sutfin says. “It ebbs and flows, depending on the lab and the supplies they are using.”
For Dr. James Richard, the lab director at Sparrow, the increasing demand and the supply shortages mean they’re facing tough choices: turn customers away? Restrict who can get tested? “Right now we are evaluating priority testing not much different than what we looked at in mid-March, when we were able to generate only 60 tests in a day [compared to 1,600 now,”] he says.
And what’s going to happen, Richard wonders, once schools reopen in the fall, and staff and students start needing testing, too?
“The system will be overrun,” Richard says. “The reality of the situation is that I am unable to fathom our ability to test for when schools open, for staff that will need to be tested, with our current capacity within the state of Michigan.”