Five months into the coronavirus pandemic, people in Massachusetts and across the country are often waiting up to a week or more to learn the results of their COVID-19 tests, seriously endangering efforts to contain and control future infections.
The delays are largely being driven by a backlog at some of the nation’s largest laboratories, which process many of the tests from Massachusetts community health centers and businesses. The labs are struggling to keep up with demand caused by surging coronavirus cases in Southern and Western states.
Plentiful and timely lab results are crucial to quickly contain clusters of COVID-19 and to prevent them from mushrooming into larger outbreaks, health experts said Monday. People who are awaiting test results may not always isolate themselves and unknowingly spread more infections.
“If we don’t get test results back in a time frame that enables [isolating infected people and tracing their contacts], it almost becomes pointless to do the test in the first place,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University.
The growing delays take on increased urgency as many schools and colleges plan to reopen in the coming weeks and are relying on aggressive, regular testing of students and staff. Added to this perfect storm — the approaching flu season is likely to further strain the system as people with flu-like symptoms seek COVID-19 tests to rule out that infection.
“I think demand for tests is going to remain high and increase if anything through the fall,” said Dr. David Hamer, an infectious disease expert at Boston University and a physician at Boston Medical Center.
North Carolina-based LabCorp, and New Jersey’s Quest Diagnostics, two of the largest labs nationally processing COVID-19 tests, each said in statements that they have significantly increased capacity since the pandemic’s early days months ago and continue expansion efforts. But they said those increases have not nearly stayed ahead of the recent and fast growing demand.
And even though Quest opened a lab in Marlborough, Mass., in March as part of its effort to expand capacity, it’s not necessarily shortening waiting times here because that lab is also processing tests from across the country, the company said. It acknowledged that the wait for results, both in Massachusetts and nationwide, are averaging at least one week for patients who are not hospitalized or who are health care workers suspected of being infected. Late Monday, the company reported that average turnaround times nationally have worsened, and that a “small subset of patients may experience wait times of up to two weeks.”
Hoping to ease backlogs, federal regulators on Saturday authorized Quest to start pooling its testing samples nationwide, allowing up to four samples to be tested in one batch rather than running each test individually.
If a pool is negative, none of the four individuals is infected with COVID-19. If a pool is positive, it means one or more of the individuals in that pool may be infected. At that point, each of the samples in that pool will be separated out and tested again individually, and infected people will be identified.
Because the samples are pooled, it is expected that fewer tests are run overall, meaning fewer testing supplies are used and more tests can be run at the same time allowing patients to receive their results more quickly in most cases, according to the Food and Drug Administration.
But many local public health officers in Massachusetts have yet to see an improvement in turnaround times, said Sigalle Reiss, president of the Massachusetts Health Officers Association and Norwood’s health director.
“We’re definitely still having a problem,” Reiss said.
“Most of the test results, knock on wood, will be negative because the positivity rate is so low right now in Massachusetts,” she said. “But the anxiety of waiting is just adding to people’s fear right now. With schools reopening, if we don’t have quick turn-around on testing, the system doesn’t work.”
Earlier in the pandemic, the Massachusetts health department reported daily output from many of the labs across the state. But it stopped doing that months ago, and does not include turnaround times in the data it reports daily. Nor did it include any mention of turnaround times in a recent report to federal regulators about plans to expand testing capacity in Massachusetts.
The state health department said in a statement Monday that the current statewide average for turnaround times in Massachusetts in July is 2.2 days and that the state is monitoring the situation. There can be significant variation within that average, though, because it includes both the generally faster facilities that have internal testing capacity and those that rely on backed-up national diagnostic companies.
Some states require tourists to furnish negative COVID-19 tests and some businesses seek regular testing of employees, further contributing to the backlog. Nuzzo, of Johns Hopkins, said policy makers should consider giving priority to people who have COVID-19 symptoms, need to be hospitalized or treated, or have spent time in places where infections rates are high — testing restrictions that were widely used in the earliest days of the pandemic when shortages of tests and related supplies were acute.
“We just need to think through nationally what is the optimal strategy for testing, particularly given that I don’t think our resources are going to ever be fully unconstrained,” she said. ”It’s a bit unrealistic for me to think that everyone can be tested every day . . . and there are going to be some bottlenecks, which is why we really need national answers.”
One bright spot for Massachusetts is that many of its medical and research institutions are better-off than their counterparts in other states that did not ramp up internal test processing capacity in the spring, said Hamer, the BU infectious disease specialist.
But those institutions do not typically process tests for employers and other organizations, so are unlikely to ease their load, he said.
One notable exception is the Broad Institute of MIT and Harvard, which has negotiated testing contracts with several colleges and universities to process thousands of tests daily.
The Broad recently expanded its daily capacity to 35,000 tests and can turn them around in less than 24 hours, a spokesman said in a statement last week. The lab has the ability to ramp up to 100,000 daily if needed, the spokesman said, but declined to comment further on its new college testing program.
The Broad, which opened its testing lab in March, has so far not processed more than about 8,000 tests in a day, according to the website where it posts its daily output.
Dr. Michael Mina, an assistant professor of epidemiology at the Harvard T. H. Chan School of Public Health, said it is well past time for leaders to rethink the nation’s COVID-19 testing system. The current system, which relies on diagnostic tests sent to a lab for processing, was never designed to handle the massive load it now faces.
“We are trying to insert a square peg in a round hole,” Mina said.
Instead, he said, it’s time for leaders to invest time and resources in advancing inexpensive tests consumers can take and process at home, not unlike the finger-prick blood tests diabetics use to keep their sugar levels intact.
“We have the technology, the money, and know-how,” Mina said, “And we have the biggest problem compared to other countries.”