CPR News spoke with a number of people with a deep understanding of the key factors that would go into decisions about Phase 2 of dealing with the pandemic after the state exits what Gov. Jared Polis has referred to as the “urgent” stage. They paint a picture of uncertainty, tradeoffs and the need for massive scaling of a health system that has so far struggled to keep up with the pandemic.

Colorado Likely Needs Far More Testing To Get Control Of Coronavirus

For weeks, the pandemic response effort in Colorado and the U.S. has hinged in part on testing, which has lagged badly behind demand. That may be about to change. “We are on a precipice to ramp up” both more standard tests and more rapid tests, said Dr. Michael Wilson, who directs lab services at Denver Health Medical Center, one of the state’s key test labs.

Wilson said he was on call in the second week of April with White House coronavirus response coordinator Dr. Deborah Birx and other lab directors around the country. He said the estimate was “we need to essentially double what we’re doing.” The number of tests conducted daily in the state has fluctuated between around 1,000 reported on April 13 to around 2,700 reported on April 11, although not all negative results are included. The state health department has not shared specific numbers on exactly how many tests it is aiming for.

Hart Van Denburg/CPR News Gov. Jared Polis outlined the three stages that would mark Colorado's exit out of the pandemic at a press conference, April 15, 2020.

Two things have been in short supply, the collection kits and the medium to transport them, which continues to be an issue. Several “manufacturers are scaling up as fast as they can.”

Those manufacturers make tests with names like BioFire and ID Now and they’re capable of turning around tests much faster than before.

“We seem to be right on the edge of more rapid tests,” Wilson said.

The COVID-19 tests he and his lab staff have processed take perhaps eight hours to yield a result. The new tests will bring the turnaround time down to an hour or less, which will make it easier to diagnose patients sooner, helping to inform treatment or hospitalization decisions for doctors.

Wilson’s lab currently does between 150 and 300 tests a day, but the number could be elevated to 500 daily. Usually, two workers a shift can run six machines that process tests in different machines made by different manufacturers.

“If we were running full out, we could do up to 500,” he said.

Those are traditional COVID-19 tests, where they test for the presence of the virus and its genetic material. But tests that look for the antibodies the body produces to fight the virus, a sign someone has been exposed, may also help trace the virus in later stages of an outbreak.

These tests, called serological tests, are on the way too, although their reliability is questioned by some public health experts.

“We are within 2 to 4 weeks” of having good serological tests that can be deployed, Wilson said. “We're cautiously optimistic.”

Chris Neal/Shooter Imaging/For CPR News Medical personnel speak with people waiting in line to get tested for the coronavirus at a drive through testing facility at the La Plata County fairgrounds Friday afternoon. The facility, put on by San Juan Basin Public Health, will test 100 people for the virus.

Dr. Michelle Barron, medical director of infection prevention at the University of Colorado Hospital, said, so far, “The swab test is really quite good in terms of being able to detect active virus.” If you test positive and have symptoms, she said, “you can be pretty certain you have the disease.”

She was more skeptical about the antibody tests.

“The problem with some of the commercially available antibody tests right now is that they cross-react with the common cold coronaviruses,” she said. “So they can't tell the difference. And so you're kind of in this like, ‘Well, does that mean I had a cold?’”

If they can’t reliably detect the virus, people who have not yet actually been exposed may not take the necessary precautions.

A cautionary tale on testing could be seen in recent days in New Jersey. As The New York Times reported, a backlog of cases there was getting worse. People looking to get tested faced lines a mile long at a drive-up test center. There were holdups, from a lack of kits and swabs and chemicals to tell if a sample was positive for the virus. Samples got shipped across the country because local labs were swamped.

“It's a model of how you don't want to do things,” said Dr. Jonathan Samet, the dean of the Colorado School of Public Health. “We need a well-worked-out system.”

The leader of a key doctor’s group said testing and treatment will need to be much better before restrictions can be reasonably lifted. “I think before we can really move to a next phase, we're going to have to greatly expand testing capability,” said Dr. David Markenson, president of the Colorado Medical Society. He described the tests as the “Achilles heel” of the pandemic response, and it would require both surveillance testing and more testing of the sick “to learn which restrictions and in which communities we can start pulling back.”

He also worried supplies of protective equipment, needed by frontline health workers and those conducting tests alike, would continue to plague the response effort. Despite efforts from federal, state and local leaders to secure more, “we still do not have enough PPE.”