Four months into the coronavirus pandemic, delays in test results continue to hamper efforts at slowing the spread of the virus in Los Angeles County, doctors familiar with the situation and public health officials have acknowledged.
“It’s pretty sad that we find ourselves at this point with all the manufacturing might of the United States and we are still at a point where we can’t see a rapid turnaround of test results,” said Dr. Clayton Kazan, medical director for the Los Angeles County Fire Department — and charged with initiating the county’s coronavirus testing program.
In L.A. County, officials have doled out $53 million, including taxes, to six labs to process 490,250 test kits, a public records request by Southern California News Group revealed. But there can still be delays of up to a week or longer in some cases for results. Average turnaround times are now about 72 hours for the publicly-run sites, according to the Department of Health Services this week.
Turnaround times for private labs averaged better, at about 48 hours per test. However, some out-of-town labs were still taking up to 10 days to return lab results because they must be shipped out of LA County, based on reports this week.
“To still be at this point, four months since the declaration, and we still can’t get a test back in a week from a doctor,” Kazan said. “I thought the government invoked the wartime directive that they could force manufacturers to produce equipment.”
Without fast turnaround times, a coronavirus test could be virtually useless, Kazan said. For an agency such as the fire department, waiting days for test results and putting an employee on sick leave could cost thousands of dollars. For individuals, delays could mean they unknowingly spread the virus.
“Patients want to know so badly if they have it that they are going to places and just paying and not necessarily getting good results,” said Dr. Lawrence Sher with the Palos Verdes Medical Group who is closely involved in testing and vaccine research.
Because of the delay in lab results, commercial clinics have filled the void, conducting rapid testing that is not covered by insurance (and not offered by public agencies).
Antigen tests hit the market
On a recent weekday, the line of people at the Glendale Urgent Care, part of the UrgentMED network, is typical of the pandemic, said Medical Director Dr. Morris Kokhab.
UrgentMED’s 21 locations in Los Angeles and Orange counties began about a month ago offering the Sofia SARS Antigen test that delivers results in about 15 minutes. It’s one of two FDA-approved rapid tests under emergency authorization. But it can have slightly less accurate results than laboratory PCR tests.
The antigen test is not covered yet by insurance, though Kokhab expects it to be soon. It costs $120 to complete.
“For someone who turns out to be negative with no symptoms, they don’t have to do self quarantine,” Kokhab said. “For someone who’s positive they know to self quarantine themselves. It’s really been a life saver and this is the type of testing we need to be able to control the virus.”
UgentMED has had the antigen test for about a month. The test still has some detractors who say it is not accurate enough. Antigen tests typically use an oral or nasal swab that’s less invasive. The test detects a piece of protein from the virus. It’s called a lateral flow test similar to a pregnancy test. The kits, however, have been prioritized for nursing homes, according to Kokhab.
“So now we’re allocated some tests but we’ve had a challenge getting test kits as well,” Kokhab said.
There are several different types of coronavirus tests on the market to know if the virus is present.
The gold standard for coronavirus tests are molecular or PCR tests, experts said, which detect pieces of the novel coronavirus’ genetic material.
The process is somewhat complicated, involving specific equipment — which can often involve shipping specimens, which can decrease the reliability, as well as delays.
Another option is a rapid molecular test — such as the Abbot ID NOW, which offers a reliable laboratory test on-site with results in 13 minutes or less. That test is not yet widely available, though, having been distributed first to hospitals. It should, however, be reaching the commercial testing labs in the weeks to come.
There are also antibody tests mostly used to measure large numbers of people.
All of these tests can create a confusing cloud of choices for consumers, according to Sher, who said people should study what they are getting.
“The lab tests are what you want,” Sher said. “But until these labs can get the machines and the instruments and get the answers back to you in 48 hours they really are not very useful.”
Lab capacity still an issue
The race to increase testing capacity for the coronavirus in the first months of the pandemic resulted in a somewhat chaotic marketplace with little coordination nationally, according to Kazan, who organized the first procurement of testing kits for L.A. County.
Early on, though labs promised fast turnarounds of no more than 48 hours, few companies could live up to their guarantees, Kazan said.
At first, the National Institutes of Health were conducting all the lab tests, up until early March. Soon afterward, the L.A. County Department of Public Health began performing their own tests.
Beginning on March 18, shortly before the state’s “Safer-at-Home” order went into effect, Quest Diagnostics and Labcorp were the first two private companies to partner with government agencies. But the turnaround times were problematic.
“The turnaround time was so unacceptably long that by the time the test came back the person had either exposed other people or they had recovered or gotten critically ill,” Kazan said. “So the test was not very helpful.”
Kazan and his team contracted with four labs — and the county has extended agreements with two more labs since he left his position in April.
Currently, costs vary from lab to lab, ranging from $65 to $146 per test.
Kazan said while they looked at the price, the most important thing was the turnaround times and reliability.
“It was like remodeling your house,” Kazan said. “The money was just flying out of our pockets.”
Kazan said it didn’t have to be this way. There could have been a national effort to produce lab equipment. But that and the federal promises to supply testing kits seemed to fade under the lights of the cameras.
“In the time I was there for that month, we did about 120,000 tests,” he said. “We never saw a federal kit, not once. (President) Donald Trump got on TV in the middle of that time and said he saw the kits and they were beautiful. We never saw a single one.”
Kazan said it was a similar experience when it came to personal protective equipment. The county received some supplies from the national stockpile but those dwindled very quickly.
“We are the U.S.,” he said. “We should be able to do better than this. It seems like they shot the news conference. The photo ops were done and than everything just stopped. It feels like we should be able to do better.”
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4 months into pandemic, turnaround times for reliable coronavirus tests are still an issue - LA Daily News
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