Lab workers face unprecedented supply issues in coronavirus testing ramp-up

Experts say the lack of supplies like nasal swabs isn't "normal," and makes it impossible for labs to meet demand

By Nicole Karlis

Senior Writer

Published April 21, 2020 7:23PM (EDT)

A health worker conducts COVID-19 tests at a drive-thru coronavirus testing site (AP Photo/John Raoux)
A health worker conducts COVID-19 tests at a drive-thru coronavirus testing site (AP Photo/John Raoux)

As of Tuesday morning, slightly over 4 million people have been tested for coronavirus in the United States, according to the COVID Tracking Project. If the U.S. aspires to safely reopen the economy by early June, a report released Monday by Harvard University's Edmond J. Safra Center for Ethics says the U.S. needs to have the capacity to manufacture and deliver more than that in a single week.

Specifically, the report said that the U.S. would need to grow its capacity to be able to test 5 million people per week to reach the projected June goal. Moreover, these experts think 5 million tests a week might not be enough.

"This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy," the authors wrote.

Regardless, some state governors are already eyeing ways to reopen their economies, despite a lack of assurance that testing, a critical part of protecting public health, is at a sufficient point to meet a future rise in cases. Indeed, testing is part of a three-pronged approach — testing, tracing and isolating — to reopen the economy while simultaneously containing the virus.

There are multiple reasons, political and economic, that the U.S. lags behind in its ability to test compared to peer nations. President Trump has punted the testing problem to state governors, some of whom took matters into their own hands. Gov. Larry Hogan of Maryland acquired 500,000 tests from South Korea, stating that the administration "made it clear" that "we have to go out and do it ourselves."

Incongruously, the U.S. has one of the most developed economies in the world. So why has it been so hard for states to acquire and administer tests?

Dr. Robin Patel, President of the American Society for Microbiology, told Salon in an interview that the U.S. had to play catch-up very fast. 

"The reason why this is challenging for SARS-CoV-2 is that this is a new virus and we did not have any tests for it before it arrived to us . . . . everything had to be developed, and that does take some time," Patel said. "And there continue to be changes in what's 'needed' in terms of testing as the amount and types of testing change, so it's a very fluid situation . . . . in some ways asking this question today may yield a different answer than tomorrow or yesterday because it is changing, and I think that's important to keep in mind."

But wasn't there enough time? It has been nearly four months since the country's first known coronavirus case was reported in Washington state, and over six weeks since the first stay-at-home orders rolled out to slow the spread of the virus. As of today, April 21st, 803,575 cases have been reported in the country and over 43,663 have died from COVID-19.

Yet from early February, the U.S. was already behind in its testing capacity. As the Washington Post has reported, part of what kept U.S. officials from getting ahead in developing tests was that the Centers for Disease Control and Prevention (CDC) initially shipped flawed tests to labs that were contaminated. Two months later, there are reports of people who say they still can't get a test.

Another part of the delay to scale up is the complexity of the test itself, and specifically how different parts of it are created by different private companies — a flaw innate to capitalist societies that reject state-owned enterprise wholesale, and rely entirely on the private sector to fulfill the basic function of a welfare state. 

"When people say they can't get ahold of testing kits what it usually means is they can't get ahold of the commercial kit to get the samples from the patients," George Pantalos, PhD, a professor of cardiovascular and thoracic surgery and professor of bioengineering at the University of Louisville, who has been working on a team to create swabs to make up for the shortage, told Salon.

Pantalos explained that those testing kits have five parts: a biohazard bag, instructions for use, a vial and a cap for transport, a special reagent, and a swab to pick up the secretion behind the nasal cavity. "If you don't have any one of those five things, you can't proceed with the process," Pantalos said.

Patel said many labs struggle with this, and that it's common for labs to find out about the lack of availability of supplies very close to the time of running the test. This can result in specimens sitting on a shelf until supplies arrive.

"So options are either to move then the specimens to say another laboratory for testing or wait until the supplies come in and sometimes we don't know when that's going to happen," Patel said. "Or what a lot of labs have done — and this is very inconvenient and inefficient — is to bring on multiple platforms so that if one of them is short on reagents, you can move all your testing onto another."

Patel said this is not normal.

"I'm being told I can only get so many reagents, and this is pretty unusual to face that type of situation," she said. "Normally the calculation would simply be how many tests can you run on a particular instrument over time? And if the demand exceeds that, another instrument is brought in. It's not so easy right now."

When asked why labs are being told that, Patel said: "It's not completely clear."

"That is the communication we are receiving from companies," she said. "It's not completely clear, it must relate to simply the number of reagents and the number of instruments that each company has available. But how decisions are made regarding that is not clear."

Mike Weist, a Communications Business Partner at Roche, who manufactures coronavirus tests — meaning the reagents, plastic consumables, specimen transport media and instruments to run them — told Salon in an emailed statement that in part due to the FDA Emergency Use Authorization, it has been able to deliver a volume of more 400,000 tests per week to US laboratories, but that "demand continues to outpace supply."

"No one company could come close to fulfilling the growing global need for tests," Weist said.

Could this mean that more efficient tests need to be created? Possibly. But considering how much time it took to ramp up the tests in the first place, the U.S. likely doesn't have the time to start over. "There are solutions to this if this is just a distribution problem," Patel said. "I honestly don't know that we know that."

Meanwhile, lab workers are facing frustrations over this bottleneck.

"We, in clinical microbiology have really been working, well, very, very hard since the beginning," Patel added. "Unfortunately because of all these supply issues, we continue to have to do and redo and revamp our testing so that we can make sure that the tests are there as much as is possible for our patients," she noted.

By Nicole Karlis

Nicole Karlis is a senior writer at Salon, specializing in health and science. Tweet her @nicolekarlis.

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