Why so hard to be tested for coronavirus? Not enough swabs and confusing government guidelines Mar 24, 2020 at 8:22 am

Patients hoping to learn if they are infected with coronavirus continue to be stymied by bottlenecks before they can learn the truth about their health. Lab delays, mask and swab shortages, and changing guidelines have created a chokepoint, even as epidemiologists urge much broader testing to slow the spread of the coronavirus that has already turned life upside down in the Seattle area and much of the world. Mask, gown and testing swab shortages COVID-19 testing is brief and straightforward: A nurse sticks a six-inch cotton swab up a patient’s nostrils, then twirls it. But the test depends on specialized equipment, from the swabs themselves to chemical reagents used in the lab to the all-enveloping clothing that nurses wear to administer the test.

Medical providers have been struggling to get their hands on personal protective gear and swabs. Collection drives have popped up and those with sewing chops are sewing masks for doctors and nurses. Medical workers testing people for coronavirus require the “intensive” use of personal protective equipment, said Keith Jerome, head of the University of Washington’s virology department. “There's lots of masks and gowns and extra gloves and things that really get used very fast and very intensively in that situation.” Jerome said he has worked with colleagues to identify additional swab types that would work for COVID-19 testing and give nurses the ability to use other options once they run out of the primary swab. The U.S. Food and Drug Administration has provided guidance on alternative swab types, he said. Dr. Aileen Mickey, chief medical officer at EvergreenHealth, said her hospital has been able to keep up with demand for tests and, for now, is able to ramp up supplies as the number of cases rises. “At some point, though, the limiting factor will be the test kits, the number of swabs we have and the ability of the lab to be able to perform the tests,” she said.

Lab turnaround time Jerome, the virologist, said his department was one of first few places that could test for COVID-19. Demand exploded about a week ago. Soon, there were more requests than the lab was able to handle. Turnaround time sat at 36 hours. Commercial labs began to offer their own testing, alleviating some of the strain felt by the lab, but not the strain felt by those waiting on their test results. The lab urged health care providers to send their tests to commercial labs, which they did--so much so that the UW lab’s output dropped to just over 1,000 tests on Sunday, from 3,000 tests on Friday.

“We've sort of overshot where we needed to be, and some of the local hospitals have been sending things, again, to some of these commercial labs, when we could be doing them here,” Jerome said. He said university officials spent the weekend calling local hospitals to let them know that its lab did have the capacity to do more tests and return results in as little as 12 hours. “The last thing you want to do is have the capacity to do testing that’s not being useful,” he said. Increased demand for drive-through testing at EvergreenHealth swelled the turnaround time there from a three-day wait to five to seven days, said pulmonologist Aileen Mickey, chief medical officer for the medical group in Kirkland. James Martin, chief medical officer for Swedish Medical Group, echoed this sentiment.

“[Turnaround time has] been not as good as we would like,” Martin said. “And that's been for a variety of reasons, but LabCorp has really stepped up and is trying to address that.” The North Carolina-based firm announced last week that it would double its nationwide testing capacity by the end of the week to 20,000 tests a day. Swabs that were being sent to North Carolina from Seattle for testing are now being directed to LabCorp’s Arizona location instead, shortening the travel time. Testing delays are more than just an inconvenience: Some patients can’t leave hospitals until they get their results, so the wait can worsen the crunch on hospital beds as the COVID-19 pandemic worsens. “Right now, if you're in a nursing home and you've got respiratory illness, they're sending you to the hospital, and you might really just have a cold,” Cassie Sauer with the Washington State Hospital Association said. “And we're waiting for multiple days to get those tests back in many cases, so you can't discharge those folks.”