As Covid-19 cases surge across the United States, the outbreak is threatening to overwhelm the testing capacity at facilities that have spent months and millions of dollars to ramp up their capabilities, according to laboratory directors in six states.
Dr. Geoffrey Baird, who oversees all Covid-19 diagnostics as the acting chair of the University of Washington’s laboratory system, said he spent an estimated $30 million earlier this year to build up its labs, which now boast a total workforce of 1,500 — a tenth of that hired to focus on Covid-19.
But even that operation is now struggling to handle the surge.
“It's unimaginably gigantic, the amount that we're doing, but it's still insufficient compared to the demand,” Baird said. “Lowering demand is honestly the most effective way to address supply.”
Lab directors in four states said that well-known suppliers of the devices and kits required for different testing platforms are manufacturing as much as their existing physical facilities allow, and so are limiting the allocations they can sell to individual laboratories.
Several also said these limitations were having a secondary impact on diagnostic tests for other diseases, too, thanks to an ever-changing picture for even the most basic testing materials, including chemical reagents and the plastic pipette tips used by the thousand in labs to guarantee consistent sample sizes.
The current supply and demand crunch for even these simple items of lab equipment is pushing the limits of their staff, testing systems and clinical care teams, the laboratory directors said.
“We're seeing supply chain shortages around many of our tests,” said Dr. Robin Patel, director of the Infectious Diseases Research Laboratory at the Mayo Clinic in Rochester, Minnesota. "In many cases, not having anything directly to do with SARS-CoV-2 testing, which is complicated, and highly inefficient and also affecting patient care."
Multiple lab officials said this has meant tests are carried out too slowly, or have been rationed for patients with several suspected illnesses, including gastroenteritis, sepsis, gonorrhea and chlamydia.
Dr. Kathleen Beavis, a professor of pathology and the medical director for quality at the University of Chicago’s laboratories, said the overwhelming number of tests recently meant some urine samples for patients with suspected sexually transmitted diseases had sat in her lab too long to be usable, while a component required to check for meningitis in children had been unavailable, causing a delay in diagnosis.
“I feel like it’s whack-a-mole,” she said. “And in all honesty, some things are falling through the cracks,” particularly as exhaustion sets in amongst her staff.
“We're really suffering, I think, with morale and fatigue, and without the infrastructure that we normally have to combat some of this,” Beavis said. “I just wonder how much longer they can continue to do it.”
The fact that these supply shortages can curtail testing options is “definitely scary,” said Dr. Gary Procop, medical director for clinical virology at the Cleveland Clinic. “It’s not a pleasant life for a laboratory manager right now.”
He oversees Covid-19 testing for the Cleveland Clinic’s 1,200-bed flagship hospital, plus hundreds of other patients at hospitals and family health centers throughout the same system, most of them in Ohio. He said he had essentially built an entirely new second laboratory for the coronavirus, and must often ensure all six test platforms are humming at once just to keep up with demand.
But even his facility employs what Procop labels “test triage,” prioritizing urgent care patients over others for the fastest turnaround platforms, and minimizing testing access for asymptomatic patients.
And this agonizing form of triage — in a hospital’s laboratory rather than its emergency room – may prove increasingly necessary in the difficult weeks ahead, amid the repeated insistence from federal and state authorities that regular community testing is the only way to combat the crisis before vaccines arrive.
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Several officials said that over the course of the summer, shipments ordered to their labs were reduced by manufacturers or redirected elsewhere to parts of the U.S. where facilities were facing even more pressure from Covid-19 patient requirements. And so as the national picture worsened, many laboratories introduced a form of test pooling — allowing multiple patient samples to be tested at once, to save burning through limited supplies too quickly.
But in areas with high Covid-19 prevalence, this kind of pool testing can become numerically inefficient.
“At a prevalence of about 10 percent, our pooling strategy breaks down because too many of the pools are positive,” Baird said.
That's left Baird to make a difficult request, particularly of those displaying no symptoms who want to socialize with friends or gather with their families over the holidays.
“We're asking folks now, you know, please don't go get tested,” he said.