Within two to three days, you can get results from your cholesterol test or colonoscopy.
But the speed with which the dangerous infectious COVID-19 virus is detected varies from an hour to two weeks or longer.
As cases climb and supply plumages, the epidemic is revealing a gap in the Bay Area trial landscape: select educational laboratories that are technically and logically agile, results return quickly, and facilities that Rigorous supply chains depend on commercial laboratories for requirements that can produce results. There can be considerable delay.
The waiting game is stressful for anyone who relies on a test to resume their life and livelihood.
“It was disappointing for the two weeks that were tested at the CVS drive-through site in San Jose before taking his sick and elderly mother to a doctor’s appointment,” said Jackie Erickson of Los Gatos. She helped her mother before the results arrived – all the time, out of fear of infection.
Even politicians brag about the increasing availability of tests, not what matters, epidemiologists say. This is an incorrect metric.
They say important results are quick results. This is because the virus needs only moments to spread and five days, on average, to make you feel sick. People are most infected about two days before and three or four days after symptoms – and the disease can spread unknowingly.
With long delays, “our testing often consists of just ‘theater’,” Harvard University immunology and epidemiologist for infectious diseases Dr. Michael Mina said. This wastes money. And attempts to locate contacts for confirmed cases are virtually fruitless.
What is happening? Around the world, laboratories are scrambling to find supplies at almost every link in the supply chain, from chemical reagents and plasticware to actual machines that test the process. Four companies – Cepheid, Hologic, Abbott, and Roche – dominate this machine market and require brand-name components.
Director of UCSF’s Clinical Microbiology Laboratory, Drs. “There is essentially a lack of supply chain for everything,” said Steve Miller. Producer rations are sent to each laboratory, he said.
“Every institution is left to itself,” he said. “It’s like a competition. We are all after the same supply. “
The most profound drawback right now is the small plastic pipette tips, which are important for the delivery of fluid onto a small plate for the discovery of viral DNA.
Infectious disease specialist and clinical leadership for Kaiser Permanente’s coronovirus response, Dr. Stephen Parody, said, “Companies making test machines, supplies and equipment are struggling to meet growing global demand, and they currently maintain it Are not able to keep. “
Across the country, exam results have doubled in the past few weeks.
The worst waits for results are in laboratories at public retail outlets such as CVS. Such places only send tests in bulk to centralized laboratories owned by some commercial processors such as Quest Diagnostics and LabCorp. These processors use just one or two types of devices, so they cease to use proprietary chemical kits and other devices. They run tests in batches and can be located far away.
As a result, these sites have backlogs – even as they continue to accept new business from a boom of healthy asymptomatic people.
CDC Director Dr. Thomas Frieden said on Twitter that commercial laboratories perform 2.5 million tests a week, half the nation’s total, “but the results are of great delay and little utility.” “They charge but the public does not benefit. Tests done every day are very misleading indicators.”
County labs typically rely on public or commercial laboratories with limited flexibility. For example, the Department of Public Health of Santa Clara County now takes nine days to return results.
Kaiser, which serves millions of members, is building a new 7,700-square-foot laboratory in Berkeley to process thousands of COVID-19 tests each day. Parodi said that most of the tests are processed in Kaiser’s existing laboratory, and results are ready in two or three days, although they may take longer depending on demand and testing capability. He said that fewer urgent cases, which could be referred to other laboratories, could take longer.
Currently, some members say that it can take about two weeks to get results, even if they do not have symptoms, there is a risk of transmission.
Waiting 12 days for the results of Kaiser Richmond, Laura Paule worried about her 93-year-old father’s separation by saying she was sitting alone in her apartment day after day, with a book open in her lap. When I was finally able to travel, his energy level went up. “
But at academic medical centers such as Stanford and UCSF, responses can be rapid.
They have many advantages. They are tested on campus and, if necessary, action can be taken immediately. And they can limit what they accept, focusing on those in greatest need. Only when supplies are sufficient do they expand their reach. Stanford Valley Care helps El Camino, Sequoia and Seton hospitals. UCSF also partnered with Marin General and John Muir Hospitals, as well as some public clinics and public health departments in San Francisco and San Mateo counties.
Dr. Paul Baird turned to UCSF when he was instigated after waiting for two weeks for a commercial lab to report results for his patients in an East Bay Bay-based clinic network called La Clinica. Now, with results within one to two days, La Clinica offers quick drive-through testing.
These educational laboratories have money to buy a range of equipment, so they are not at the mercy of one manufacturer. Additionally, they have built relationships with various vendors, so they can take advantage of whatever supplies are available.
Director of Clinical Virology Laboratory for Stanford Health Care, Drs. Ben Pinsky said that Stanford’s lab, which operates 24-hour sample processing, has multiple workflows, equipment and supply chains.
“We have tried to diversify and ensure that we have a choice,” he said. “There is always redundancy among our suppliers. If we have a problem, we have a backup. “
There are seven different methods for testing the UCSF COVID-19 and plans to add two more, Miller said. It also has backup supply chains. For example, when UCSF starts running low on the pipette tips of its hologram pathway test system, it looks for alternative suppliers. If it cannot find them, it turns into a completely different instrument, called the CDC assay.
“It’s all very complicated,” Miller said. “This has allowed us to overcome supply chain ‘shocks’ to avoid disruptions.”
Educational laboratories also have well-connected friends. When UCSF ran low on the swab, it turned to longtime donor Mark Benioff, who had extensive business contacts in China as CEO of cloud computing firm Salesforce. Salesforce found and ordered hundreds of thousands of swabs.
But even his models cannot sustain the entire country, Miller said. New and improved testing techniques need to be made available to all.
“There’s infinite demand,” Miller said. “This is not going to be solved by our lab expansion capacity.”
Daniel Wu contributed to this report.