Long lines, delayed results: virus surge overwhelms testing in Georgia

The dramatic surge in coronavirus infections over the past month — the seven-day rolling average of new cases is four times what it was June 15 — has once again overwhelmed Georgia’s testing infrastructure and pushed it to the breaking point five months into the pandemic.

In some states, test kits, swabs, chemical reagents and the machines needed to process tests are again in short supply. National labs have warned of waits of seven days or more to process samples and report results citing unprecedented demand. Some told The Atlanta Journal-Constitution they’ve waited two weeks or more.

Experts said the Trump administration has failed to institute a comprehensive national testing strategy, use federal emergency powers to overcome kinks in the testing supply chain and left states to fend for themselves.

“It takes days to get a test and week or more to get results,” said Dr. Harry J. Heiman, a clinical associate professor at the Georgia State University School of Public Health. “By that time, (results are) not valuable to public health. The time period in which that information would have been actionable is gone.”

The nation is processing more than 700,000 tests each day, more than at any point in the pandemic. But that figure is about half of what Harvard University researchers say is needed to mitigate the virus and about one-sixth of the volume per day needed beat the virus into retreat.

Credit: Ben Gray

Credit: Ben Gray

The 20,000 tests Georgia processed per day from June 28 to Tuesday is only a third what the Harvard study says is needed to mitigate spread in the Peach State, and less than one-tenth what Georgia needs to suppress it, according to an online tool developed by NPR.

Results that are a week old or older, experts say, hamper efforts such as contact tracing needed to quickly identify and isolate outbreaks. And when patients must wait days just to get a test and a week or longer for a result, experts said, it only increases the likelihood of transmission.

“It could be a waste,” said Dr. Megan Murray, a professor in the epidemiology department of the Harvard T. H. Chan School of Public Health. “The whole point is to get information back to people while they still have an opportunity to do something about it. If you don’t know until after the infectious period, it’s not helping you.”

Atlanta Mayor Keisha Lance Bottoms waited eight days for a positive test result earlier this month. The mayor, who was asymptomatic, said she would have self-quarantined if she had known sooner.

A lack of widespread and reliable testing led Georgia and other states to ration tests and order residents to shelter-in-place earlier this year. Capacity has since grown, but not to the scale experts feared would be needed.

In April, when tests were rationed and Georgia ranked near the bottom in testing per capita nationally, Gov. Brian Kemp called the situation “unacceptable.” At a press conference Friday morning, he used the same term to describe the current situation.

“This is simply unacceptable and Georgians deserve better,” Kemp said. “In the coming days we will announce a new regional partner who will expand capacity, adding 10,000 more tests per day and providing faster results.”

He did not name the partner.

Georgia’s top doctor, Kathleen Toomey, the commissioner of public health, blamed long waits on national labs overwhelmed by the national surge in testing demand. She said Georgia is in the same boat as other states.

“When those tests take two weeks to come back or longer, that’s not our fault, but we have to deal with the consequences,” she said. “And I’ve said many times, it’s unacceptable. We’re voting with our feet. We’re getting new labs.”

Cobb & Douglas Public Health, which uses local lab Ipsum Diagnostics, is seeing turnaround times of two or three days, said spokeswoman Valerie Crow. But some results are taking as long as five. Gwinnett, Newton & Rockdale County Health Departments, which use LabCorp, have seen turnaround times grow to five to seven days.

To cut dependence on commercial labs, the Georgia Department of Public Health (DPH) has upgraded processes at its own lab near Decatur, which is not designed to process such high numbers of tests, spokeswoman Nancy Nydam said.

Damon Sgrignoli and his wife, the East Atlanta couple, sought tests following a funeral for his grandfather in Pennsylvania in late June. CVS online appointments were booked. There were no slots at DeKalb Board of Health sites, and DeKalb closed its testing for the July 4th weekend.

Sgrignoli said he was turned away three times from CORE Response testing sites in Fulton when the nonprofit ran out of test kits. His state representative directed him to a church site, but it was closed.

“We just gave up,” he said.

Credit: Ben Gray

Credit: Ben Gray

‘Scrambling’ to find testing

At Georgia independent living facilities, personal care homes and assisted living homes, results that took as little as 24 or 48 hours to get back are now taking six or seven days, senior care industry leaders said.

"All of our members are scrambling to find all the testing they can find that gives results in a timely matter," said Ginny Helms, president of LeadingAge Georgia, an association for not-for-profit and other mission-driven housing and services providers for older adults.

This turnaround time is too slow to stop COVID-19 from spreading through a senior care facility.

“Six days — that’s a substantial amount of time. At that point, the world could have blown up,” said Debi McNeil, president and CEO of Atlanta’s Canterbury Court, which houses seniors at a variety of care levels.

Relief agency CORE Response cancelled after agreeing to test at Canterbury every two weeks, McNeil said. Fulton County Board of Health said they did not have funding to take its place.

Georgia National Guard assistance to conduct testing has all but disappeared, senior care leaders said, and homes have been unable to fill the gap. Rapid testing sites have since shut down, and it can take a week to get an appointment at some drive-thru sites.

It will be impossible to keep Canterbury’s 185 staff members and 260 residents safe without routine, rapid testing, McNeil said. Federal rules require testing of all staff and patients at certain types of facilities every two weeks.

Although this level of testing is not required at Canterbury, McNeil believes she should follow them to keep the facility safe. Previous testing of all residents and staff found eight employees who had no symptoms yet tested positive for the virus. Canterbury was able to quarantine them before the virus spread to residents.

Without timely test results, Canterbury must keep all exposed staffers home for 10 days, which risks staffing shortages. On one shift, three workers had to quarantine at home with pay because they were exposed to others with COVID-19.

Testing alternatives are too costly or inadequate. Insurance pays homes to test for the virus under certain circumstances, but the wait times for results are long and it can take two days to test the entire facility, McNeil said. Alternatives that may be faster could cost $100 or more per test.

“We can’t afford to private pay for tests for every single one of our staff,” McNeil said. “It would bankrupt us.”

9,000 results in limbo

At Fulton County Board of Health sites, residents reported it took as long as 11 days to receive results. Craig Tindall, 57, a semi-retired healthcare administrator, said he called the county repeatedly to get an appointment but was sent to voicemail or was cut off after a 15-minute hold.

Once he scheduled a slot, Tindall was in and out of Fulton County’s Adamsville testing site in about 10 minutes. The flyer workers handed him said results would take two to four days, and to call an agency hotline if they failed to arrive after five business days.

But when Tindall and others called, they spent an hour on hold before the line went dead. It took Tindall eight days to get his negative result.

“That is just way too long,” Tindall said. “There’s no possible way to get on top of this pandemic if people are waiting eight days before getting results.”

Fulton’s problems were the result of difficulties transferring information between the department and LabCorp, the vendor that ran the tests. This delayed some 9,000 test results, which had to be entered into LabCorp’s patient portal by hand, said county health director Dr. Lynn Paxton.

A LabCorp spokeswoman said it is working with the health department to speed up the process.

The delays caused callers to flood the agency, overwhelming its staff. The phone system was programmed to hang up automatically if a call-taker did not pick up the line within an hour. The department has since doubled its number of call-takers and lines, and is rolling out a system that allows residents to set up testing appointments online. That has reduced wait times at testing sites by as much as two hours, Paxton said.

This added capacity should be enough to handle the county’s needs — unless the number of new cases spirals out of control, Paxton said.

“It’s working for the numbers we’re getting in now, but if they double, triple or quadruple, it’s anybody’s guess,” Paxton said.

No national strategy

Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security and an expert on outbreak response, said that while the slowdown in test results is nationwide, it’s unclear what is behind it. In some cases, test reagents, swabs and other supplies are hard to come by, but these problems may not be universal.

“The exact cause of those problems we don’t know fully, because we haven’t actually done a nationwide assessment of the situation. But it seems as though conditions we had earlier are once again showing up,” Nuzzo said.

Months into the pandemic, no one has done a state-by-state assessment of the nation's testing bottlenecks. This is in sharp contrast to other countries that have been more successful combating the spread of COVID-19 by coordinating a national testing response.

“The problem is it’s left to the states — in some cases the cities — and in some cases the hospitals to try to solve problems,” Nuzzo said.

Some states such as Maryland have solicited foreign governments for tests. California is coping by prioritizing who gets tested, moving away from its initial plan to give tests to anyone who wants one. Hospitals unable to purchase key testing components have begun to manufacture their own and stockpile them.

This fractured, state-by-state approach means that there’s not a lot of consistency in how the U.S. identifies COVID-19 cases, Nuzzo said, and leaves states with sound policies at the mercy of those that lack them.

"Not having a national strategy is really hindering us," Nuzzo said.

Heiman, the Georgia State professor, said the Trump administration has failed to use the tools at its disposal to force private sector companies to focus industrial capacity on making test kits, reagents and other materials necessary to create the testing apparatus needed to fight the virus.

“This is exactly what the Defense Production Act was designed for,” Heiman said, referencing the law President Trump did invoke to force manufacturers to build ventilators and N95 masks. The same could have been done of the bio-science industry, Heiman said.

Broken distribution system

Justin Bellante, the CEO of BioIQ, an Atlanta-based tech company that helps employers and insurance companies source testing, said the nation’s testing distribution system is simply broken.

Major players such as LabCorp and Quest dominate the market, but they’re not nimble enough to pivot to wide scale disease surveillance like what is needed for this pandemic.

“That distribution structure is not built for innovation at speed,” Bellante said. “It’s the equivalent of putting a dump truck in a NASCAR race.”

Most COVID-19 testing in the U.S. is known as molecular PCR testing, which takes samples and, over the course of several hours, produces a result. It’s considered the most accurate test available.

Rapid tests by companies such as Abbott Laboratories, also are on the market, but they’re not as widely available. A number of companies are working on point of care or at-home test kits that would produce results as quickly as a pregnancy test, but these also are not widely available and there are concerns about accuracy.

But Bellante said having a diversity of test types is what is necessary to overcome supply chain issues.

Bellante’s company and its partners have developed a broad respiratory panel that would test for COVID-19 and other illnesses at the same time from a single saliva sample.

That diversity of testing types can’t come soon enough, Bellante said. Cold and flu season are quickly approaching, and scientists had hoped a lull in the summer would buy time to beef up the testing supply chain to be ready for the expected onslaught when COVID-19 cases are mixed with seasonal cold, flu and rising pneumonia cases.

“We messed it up the first time, here we are messing it up the second time and the third time is not going to be forgiving when we hit cold and flu season,” Bellante said.

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Credit: undefined

Top chef had enough

Hugh Acheson, a judge on Bravo’s Top Chef and owner of the acclaimed Five & Ten in Athens, Atlanta’s Empire State South and By George, told his Twitter followers Wednesday how difficult it is to run a business without adequate virus testing, venting his frustration at Georgia’s two U.S. senators, David Perdue and Kelly Loeffler.

“hey @SenatorLoeffler @sendavidperdue. WITHOUT RAPID TESTING I CANNOT RUN MY RESTAURANTS, AND THUS EMPLOY 150 PEOPLE IN YOUR STATE. FIX THE TESTING,” he wrote.

In an interview, Acheson said one of his biggest frustrations has been getting testing for his staff and timely results.

Empire State South reopened on Thursday after closing to clean and to ensure employees were tested and could safely return. The Candler Hotel in downtown Atlanta, where By George is based, is likely to remain closed until after Labor Day, and the restaurant won’t reopen until the hotel does, Acheson said.

“The line-ups for rapid (testing) are really long and then results on non-rapid have stretched to five, six, seven, eight, nine days,” Acheson said. If China can figure out how to rapidly test tens of millions of people in a matter of days, he said, why can’t the U.S.?

“The biggest frustration right now across the country is ... friends and chefs who are throwing in towel,” Acheson said.

‘Tired people make mistakes’

The quickening spread of the virus is now also threatening to hobble testing sites themselves.

In DeKalb County, where the health department is testing 10,000 to 12,000 people per week, workers falling ill to the virus have led to staff shortages.

DeKalb District Health Director Dr. Elizabeth Ford said the week of July 5 was “very challenging” after a number of health department staff members became ill themselves, triggering quarantines for coworkers as well.

She said that testing sites had to close early two days last week "because we simply didn't have enough staff to manage."

The situation may only get worse in coming weeks.

Many of the people supplementing regular staff at the county’s COVID-19 call center are students — and will likely be going back to school (in-person or remotely) next month.

"We are really looking for manpower right now and looking for some sources that can assist us when school resumes in August," Ford said.

Ford also defended the district’s decision to pause testing over the recent July 4th holiday.

It was more important to let staffers rest, she said, so they’d be more prepared to deal with the influx of testing that would invariably come after a holiday where folks may not have adhered to social distancing guidelines.

“Tired people make mistakes,” she said.

Staff writer Tyler Estep contributed to this report.

Credit: Ben Gray

Credit: Ben Gray