Last month, after two elderly residents of the Marysville nursing home where Deanna Price works came down with flu-like symptoms, she also started feeling sick and feared she was infected with the novel coronavirus.
Price, a licensed practical nurse, quickly went to see her doctor, who stuck a swab deep into her nostrils and sent the specimen off for COVID-19 testing. Price hunkered down at her Arlington home to wait for results.
One day went by, then two, then a week — and Price still hadn’t heard a word. Meanwhile, her already short-staffed employer informed Price that she needed to use sick days to keep drawing a paycheck, she said.
But Price, 60 and single, had only eight hours of sick time, no other income and a mortgage payment looming. She filed a workers’ compensation claim, tried to negotiate an extension on her house payment and hoped for the best.
Finally, on March 29 — 11 days after giving her sample — the phone rang. A LabCorp facility in New York had found she was negative for coronavirus, her doctor reported. Price could go back to a job deemed essential by the state.
“I was relieved,” Price said this week. “But it was a very long and frustrating wait. It really shouldn’t take so long.”
During the ongoing public health crisis, hundreds of Washington residents have had the same maddening experience — left to wait for days, even weeks, before finding out whether they’re infected with COVID-19, according to interviews and data.
Long delays in getting test results join a catalogue of shortcomings — from faulty test kits and onerous federal restrictions, to limited laboratory capacity and scarcity of medical supplies — that have plagued the nation’s diagnostic testing response to the coronavirus pandemic.
Laggard test results can cause stress and financial hardships for patients and make it difficult for doctors to guide them in how long to self-quarantine, medical experts said.
Slow tests also can blind public health officials and policymakers to the true extent of disease spread and drain supplies of critical personal protective equipment (PPE) at a time when communities battling outbreaks face shortages of such resources, they said.
Most people who are tested don’t have COVID-19, but hospital emergency departments have to assume they are positive, said Dr. Geoff Baird, the acting laboratory medicine chair at the University of Washington.
“We have to wear masks and gloves and shields until we know for sure. So that turn-around time equals PPEs. For hospitals, it’s crucial.”
“Am I going to kill someone?“
Before the Puget Sound region’s coronavirus outbreak exploded into public consciousness in early March, hospitals and clinics had few options for testing potential COVID-19 samples.
Initially, they were constrained by the Centers for Disease Control and Prevention’s (CDC) rollout of faulty test kits, and could only submit specimens to the CDC’s lab in Atlanta. Later they could send samples to the state Department of Health’s (DOH) lab in Shoreline, before the FDA finally allowed the UW and other private and commercial labs to start testing.
Early on, the UW lab handled the bulk of tests for Washington residents, as well as some for other Northwest states. It also quickly drew a flood of new clients. By mid-March, when the UW lab tested between 2,500 and 3,000 samples a day, it hit a capacity wall and had to turn new clients away temporarily, Baird said.
Around the same time, the Federal Emergency Management Agency (FEMA) teamed with diagnostics giants LabCorp and Quest to make more tests available in communities hardest hit by the pandemic. FEMA opened local drive-thru testing sites in parking lots at the Tacoma Dome, Everett’s Memorial Stadium and elsewhere.
“The initial directive was the samples taken at the FEMA sites had to go to the big lab companies,” said Baird, referring to Quest and LabCorp. “They were forbidden from sending [samples] to us.”
Quest and LabCorp became overwhelmed by the massive influx of samples, but nonetheless continued to take samples from local hospitals and clinics.
About that time, Heather Wade, 50, a commercial real estate loan officer, came down with a cough and fever after a co-worker tested presumptively positive for COVID-19. Wade convinced a doctor to test her at Swedish’s primary care clinic in Ballard.
“At first, they told me four days — that was the normal waiting period,” Wade said.
She holed up in her Shilshole Bay condo, waiting. Her husband, who felt fine, continued running to and from work trying to keep a small travel business afloat, while Wade worried about even going outside for fresh air.
“I live with a lot of elderly people and I was afraid of infecting them,” she said. “It was like, if I push a button in the elevator, am I going to kill someone?”
Four days went by, then six days. Her sample was with LabCorp in North Carolina, which hadn’t tested it, her clinic told her. Finally, after nine days, Wade learned she had tested positive.
But only after her test results finally came back positive did the clock start ticking on her husband’s 14-day quarantine.
LabCorp and Quest each have acknowledged the huge backlogs last month throttled national testing efficiency.
But each company now says it has steadily reduced its logjam of untested samples and can now turn around results in two to three days. Quest reported this week it has halved pending tests from 160,000 to 80,000. LabCorp announced it had eliminated a backlog that, at one time, numbered tens of thousands of samples.
LabCorp spokesman Mike Geller said the company understood “how disconcerting it is to not receive test results in a reasonable time frame,” and that the company is doing “everything we can to improve these time frames.”
Washington’s DOH isn’t formally tracking turnaround times for results. Public Health — Seattle & King County is, for tests on King County patients, but that information is riddled with formatting inconsistencies and other problems, said spokesman Keith Seinfeld.
Generally, the data shows that for the roughly 15,000 tests performed over the two-week period from March 21 to April 3, lab turnaround times averaged one to five days. UW was on the low end, LabCorp in the middle and Quest on the high end.
Dr. Eric Konnick, a UW pathologist and laboratory medicine professor, said the big commercial labs offer inexpensive testing at scale that often attracts hospitals. “They do it cheap, so that’s why a lot of places send samples to them,” he said.
LabCorp charges $51 per test compared to the UW’s current charge of $200, which Baird said recoups only about half of the university’s costs.
Hospitals and clinics deny that lower costs factor into their laboratory choices. Existing contracts and relationships, and few initial testing options amid the surge in demand, drove the early use of LabCorp and Quest, they said.
Overlake Medical Center in Bellevue, after experiencing lag times with the state health department’s lab, sent samples to the UW lab and to LabCorp “as soon as they started taking” specimens “to avoid backlogs with other options,” hospital spokeswoman Morgan Brice said.
Early on, relying on LabCorp and Quest for testing meant sending local samples out of state; LabCorp facilities are in North Carolina and Phoenix, and Quest’s primary lab is in California. As the crisis has worn on, an increasing number of local testing options — including several hospitals’ in-house labs — have helped reduce testing turnaround times, hospital officials said
EvergreenHealth, one of the first local hospital systems to test in-house, prioritized rapid results for only the most critical-needs patients, and sent less urgent cases to the UW or LabCorp, said Jeff Friedman, vice president of operations.
Last month, when LabCorp’s testing took 10 days or more, some patients grew worried, Friedman said. “It was not a huge number, but if they were anxious, we would bring them back in and re-test them and run the tests through the UW to get them their results sooner,” he said.
The carryover from last month’s backlog at the big labs still has implications today for Washington patients. Some of those who got sick two or so weeks ago and managed to get tested are still waiting for results, or only just now receiving them.
Renee Ward, a 27-year-old child care coordinator from Tacoma, said she waited 16 days for results. She quarantined herself at home and mostly missed her work’s critical planning for emergency child care camps for the kids of police, firefighters and other first responders. Ward found out Friday from a MultiCare clinic that Quest had tested her sample: It was negative.
“If it’s this hard to get results,” Ward said, “there’s no way the numbers of cases being reported are accurate.”
“A sinking feeling”
Several local health care systems — Swedish, EvergreenHealth, Virginia Mason, CHI Franciscan and MultiCare — said they are now using a menu of testing options for COVID testing to reduce lag times.
On-site hospital testing is becoming more prevalent, but remains limited by scarcity of some lab materials, including swabs and reagents — the chemical compounds used in testing. Swedish’s hospitals, for example, have “prioritized utilization of reagents for patients with severe symptoms and health conditions,” spokeswoman Mafara Hobson said.
The UW is also expanding its testing capacity and and once again has started accepting more clients. “But if I get 15,000 specimens tomorrow, that’s a problem,” Baird said. “If I can only turn around results in three to five days, we’re not doing a service to the public.”
The lab’s median turnaround time now is about seven hours for UW-affiliated hospitals, and 10 hours for others, he said.
Rapid point-of-care tests that garner results in an hour or less also are showing up at hospitals and labs, but remain limited to the most critical needs.
“Individual hospitals only have dozens available at any one time and the supply chain is tenuous,” Konnick said.
Until testing with quick, consistent results becomes widely available, experts say lag times likely will continue to vary, with slower results exacerbating problems for policymakers and patients.
Even a wait of a few days can be stressful.
When her husband, Kenneth, came down with a violent cough, body aches and a fever, Jessica Prater, of Ephrata, said he was tested at the Columbia Basin Hospital ER. A doctor told them to expect results in three to five days. But the next day, a county health official called to say testing was taking 10 days or more, she said.
“It was just a sinking feeling,” Prater said. “We were trying to self isolate him from the kids, but we only have one bathroom and had to share it.”
As the days went by, “not knowing” took an emotional toll, Prater said.
“My son who is 9, you could see the concern on his face,” said Prater, 43. “I had to be the rock of the family, so I would cry in the shower where no one could see.”
The test results came back negative within a few days, Prater said, but “it felt like much longer.”