Testing, testing: Labs, supply chain overwhelmed by coronavirus surge and diagnostic demand
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As coronavirus infections surge in the United States to nearly 50,000 positive tests daily, demand for testing is skyrocketing. And, several months into the pandemic, the country again faces critical shortages of testing machines, chemicals and specialty equipment.
The items in short supply go by fancy names — chemical reagents, viral transport media, RNA extraction kits — but Alex Greninger at the University of Washington’s virology lab simply refers to “plastics” and “juices.”
“Sometimes it’s a plastic, it’s a tip, a cartridge,” Greninger said. “Sometimes it’s a system fluid. I just call them juice, because it’s a liquid.”
At his lab and others across the country, reagents, which are used in chemical analysis, are the weakest links in the supply chain. How many reagents Greninger has dictates how many tests his lab can run. The materials arrive daily.
“You’re looking for the tracking numbers to ensure that those [testing supplies] actually went out … to handle the samples that are going to come in tomorrow.”Alex Greninger, University of Washington clinical virology lab assistant director
“Oftentimes it is actually literally just in time,” he said. “The day before, you’re looking for the tracking numbers to ensure that those actually went out somewhere to show up the next morning, to handle the samples that are going to come in tomorrow.”
Other labs report shortages of machines to run large numbers of tests. Shortages have led test sites to shut down in Sacramento, California, and Omaha, Nebraska. In New Orleans on Monday, one lab closed after two minutes when it ran out of tests. To some degree, demand for tests is simply overwhelming supply, as daily testing has ballooned sixfold since March.
Requests for tests are surging not only because infections are spiking. Large corporations and universities seeking to reopen in the fall are putting additional pressure on the system, as are sports leagues seeking to restart. Monday, at least three Major League Baseball clubs canceled workouts when COVID-19 tests did not return in time.
Nationwide, the big commercial labs report that non-urgent tests are taking longer, up to six days to turn around on average. That’s unacceptable to many public health practitioners.
“If you have a student who lives in a dorm and they are positive, you need to know immediately so you can isolate them,” said Fyodor Urnov, molecular biologist and head of diagnostic testing at the University of California, Berkeley, Innovative Genomics Institute. “Five days later, just because of the way dorms work, they will have frankly infected everybody else they live with.”
“Five days later … they will have frankly infected everybody else they live with.”Fyodor Urnov, University of California, Berkeley, Innovative Genomics Institute
Urnov describes sourcing testing materials as a “Wild West,” with every lab for itself. He argues for a centralized, national system to buy materials at scale and distribute them across the country based on population and need.
“If you happen to be a patient of a large, well-staffed health-care organization, you can get the test,” he said. “If you happen to live in a socioeconomically disadvantaged community, even in a part of the world that’s affluent as the San Francisco Bay Area, your access to testing is much lower. “
The testing challenges have renewed calls for the federal government to take over the handling of logistics and manufacturing of products.
“That might involve [the government] taking over some of these companies and having them dedicated to developing the types of testing we need to meet demand,” said David Pride, pathologist and infectious disease specialist at the medical center of the University of California, San Diego. “In San Diego, you can get a test. The next town over, you can’t get a test. I certainly believed that by this point in the pandemic, those things would have solved themselves. They clearly have not.”
But where exactly are the bottlenecks nationwide? Clinical labs report testing data to federal agencies, but many complain of having no visibility into the system.
“Transparency doesn’t exist, so I don’t even know who to reach out to.”Jordan Laser, Long Island Jewish Medical Center
“I personally have very little insight as to what data is being used for the allocation of supplies,” said Jordan Laser, medical director at Long Island Jewish Medical Center and chair of professional relations at the Association of Molecular Pathology. “The transparency doesn’t exist, so I don’t even know who to reach out to.”
The challenges come as the pandemic spreads across much of the country. Only Washington, D.C., and the state of New Hampshire are seeing cases decrease, and eight states are seeing cases maintain their levels, according to The New York Times database. Statistically, the virus is spreading everywhere else.
“Supply availability is uncomfortable, and it’s summer,” said Kelly Wroblewski, infectious disease director at the Association of Public Health Laboratories. “The worry is that when we get to fall, when respiratory viruses historically circulate more, that we will be in a worse position than we are right now.”
Currently around 600,000 Americans are tested each day, although some public health specialists say the number needs to ramp up to 20 million to enable the U.S. economy to fully reopen.
COVID-19 Economy FAQs
What’s the outlook for vaccine supply?
Chief executives of America’s COVID-19 vaccine makers promised in congressional testimony to deliver the doses promised to the U.S. government by summer. The projections of confidence come after months of supply chain challenges and companies falling short of year-end projections for 2020. What changed? In part, drugmakers that normally compete are now actually helping one another. This has helped solve several supply chain issues, but not all of them.
How has the pandemic changed scientific research?
Over the past year, while some scientists turned their attention to COVID-19 and creating vaccines to fight it, most others had to pause their research — and re-imagine how to do it. Social distancing, limited lab capacity — “It’s less fun, I have to say. Like, for me the big part of the science is discussing the science with other people, getting excited about projects,” said Isabella Rauch, an immunologist at Oregon Health & Science University in Portland. Funding is also a big question for many.
What happened to all of the hazard pay essential workers were getting at the beginning of the pandemic?
Almost a year ago, when the pandemic began, essential workers were hailed as heroes. Back then, many companies gave hazard pay, an extra $2 or so per hour, for coming in to work. That quietly went away for most of them last summer. Without federal action, it’s mostly been up to local governments to create programs and mandates. They’ve helped compensate front-line workers, but they haven’t been perfect. “The solutions are small. They’re piecemeal,” said Molly Kinder at the Brookings Institution’s Metropolitan Policy Program. “You’re seeing these innovative pop-ups because we have failed overall to do something systematically.”
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