Medical Examiner

Why There Are Suddenly Not Enough COVID Tests

It’s not just the Thanksgiving rush.

A Utah National Guard member wearing PPE inserts a swab in the nose of another member in PPE to test for COVID-19, with others wearing PPE in the background
The U.S. testing infrastructure has been struggling to keep up. George Frey/Getty Images

Americans hoping to celebrate some semblance of a normal Thanksgiving this year are turning to testing in droves, hoping—often naively—that a negative result will clear them to meet with friends and family. The rush for tests is now putting a strain on the country’s already-flagging coronavirus response infrastructure. There have been reports coming out of testing sites around the country that line wait times are stretching for hours. The labs that process the tests have been running low on supplies, and turnaround times for results are beginning to lengthen. Public health experts worry that this pre-Thanksgiving spike in testing demand could portend an even more hectic winter, as the third wave of the pandemic seems to be arriving just in time for the holiday season.

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This demand surge is fairly recent and likely due to Thanksgiving as well as the current record-breaking eruption of coronavirus cases. In mid-October, labs were reporting that the nation’s then-recently expanded testing capacity had far exceeded the number of people who actually wanted to get tested. Public health officials and biotech companies were urging more people to get tested so that there would be enough data to track the spread of the virus. At the time, roughly a million people were getting tested per day. Now, a month later, an average of more than 1.5 million people are getting tested per day, which is greater than double the rate in July. Long lines, at times forcing people to wait three or four hours, are the most visible consequence. Public health officials in Denver have had to close down multiple testing sites just an hour or so after opening due to capacity limits and concerns that the long lines would be a traffic hazard. Lines consisting of hundreds of cars have been spotted in Olympia, Washington, and Los Angeles.

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What’s less visible is the run on resources that the sharp rise in testing demand has precipitated. The nationwide shortage of the pipette tips used for transferring liquids during test processing, which has been an on-and-off issue since the beginning of the pandemic, is once again intensifying. Labs are now seeing increasing delays and cancellations of their pipette orders as manufacturers are struggling to keep up. The Department of Health and Human Services invested $33 million in the Swiss pipette company Tecan to improve domestic manufacturing capabilities in October, but the fruits of that initiative won’t emerge until next fall. Supplies of reagents, the chemicals that can detect the virus, are also running low. Ryan McNamara, a postdoctoral fellow at the University of North Carolina at Chapel Hill who has been conducting diagnostic procedures and research with the testing program there, notes that the flow of supplies has improved since the beginning of the pandemic, but that sudden shortages are still common. “Sometimes it seems like things are going well, and then out of nowhere you find out we don’t have any more. You’re like, ‘Are you kidding me?’ ” he said of reagents. “In a way we’ve almost become a little numb to it. We just expect there to be hiccups or shortages along the way.”

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McNamara has also been seeing a lot of burnout among staff who administer and process the tests. The technicians and researchers who deal with testing have been working nonstop since last spring, when the coronavirus began infecting large numbers of people in the U.S. According to McNamara, tight budgets and the surge of cases from the summer’s second wave have demoralized a lot of people who are critical to the nation’s testing infrastructure, and now they’ll have to face a grueling holiday season and winter. Indeed, respiratory illnesses like the coronavirus and the flu tend to spread more rapidly in the colder months, and there are concerns that people will take more risks and congregate inside to avoid the inclement weather. “Everyone’s burned out already, but a lot of us have been preparing for this,” he said. “All the way back in April we knew that the fall and winter was going to be a disaster.”

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Testing will be an important component of the country’s response to the th­ird wave of cases, which began in September. However, there are too many cases for the U.S. to rely solely on its resource-strapped testing system, so other measures like distributing PPE and social distancing will be key as well. It’s also a mistake for individuals to rely solely on testing to make it through the colder months, especially if it’s meant to determine whether they can see family and friends for the holidays. Coronavirus tests have been known to produce false negatives, and the results only offer people a snapshot of their infection statuses when they took the test. “No diagnostic test is 100 percent. Also, testing is one moment in time, so just because you tested negative on Wednesday doesn’t mean you won’t be positive on Thanksgiving,” said Saskia Popescu, an epidemiology professor at the University of Arizona. “The problem is that testing feels like this very tangible thing that you can do, and I get it, but it’s only one piece.” In order to prepare for her own Thanksgiving, Popescu has been adhering to a strict quarantine for two weeks prior and getting tested on the 11th day of isolation, since a vast majority of people will test positive by then if they’ve been infected.

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As the country weathers this wave, it’s worth it for individuals to think about being strategic when it comes to testing so as not to overtax the system. “I’m all for screening, but we need to be realistic about the amount of work it takes to run every test and the volume of tests we’re being asked to do,” said McNamara, who also noted that many institutions are spending a lot of money on the tests as well. In D.C., test administrators have recently begun to ask people to provide insurance information so that health insurance companies can take on some of the costs. And in Washington state, Community Health Association of Spokane is asking people not to seek testing with its clinics unless they are exhibiting symptoms or have been exposed.

It’s a tough balance to calibrate: Testing provides valuable information, but at the same time the process is resource-intensive. Long lines and supply shortages aren’t the rule everywhere, so you should check what local health officials and clinics are advising. But whatever the case, remember that testing is only one part of how to weather this latest pandemic wave. Masking and distancing are as important as ever, and unlike tests, they’re not reliant on municipal budgets, laboratory labor, and plastic supply chains.

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