One of the nation's most important medical testing companies has acknowledged that it has a backlog of at least 115,000 coronavirus tests, which helps explain why so many desperate doctors and patients haven't been able to get tested.
Quest Diagnostics of Secaucus, N.J., says the backlog occurred because a company lab in San Juan Capistrano, Calif., where the company's coronavirus testing started, got overwhelmed when testing started to ramp up.
"In approximately the first two weeks of providing testing, we experienced a sharp influx of test orders that continued to outpace our growing capacity through March," the company said in a statement.
In mid to late March, Quest expanded testing to two other company labs and started using a new, faster test at 12 sites across the country. That boosted the company's capacity to more than 30,000 COVID-19 tests a day, Quest said, and cut the backlog from 160,000 tests on March 25 to 115,000.
Quest's backlog illustrates problems still plaguing the nation's overall coronavirus testing, which is key to fighting the pandemic.
"It's a huge deal," says Kelly Wroblewski of the Association of Public Health Laboratories. "There was so much promise and fanfare about the commercial laboratories being to take on the bulk of the testing in the country. But the demand is so incredibly high. And the capacity to process and do the testing is stretched incredibly thin."
Quest says it can now turn around tests in four to five days on average, though some tests can be completed in two or three days or even in 24 hours for high-priority patients, such as health care workers and seriously ill, hospitalized patients.
The company's statement said its laboratories are working around the clock to get tests turned around as quickly as possible. It also noted that it is more confident now in its ability to meet demand but that "this crisis is fluid and unpredictable, and so is the demand for COVID-19 testing."
LabCorp, of Burlington, N.C., another big testing company, wouldn't say whether it also has a backlog. But a spokesman did acknowledge in a statement that the flood of testing was causing problems.
"As you might expect, delays in delivering test results are going to occur as incoming specimens can outpace capacity on any given day," LabCorp spokesman Mike Geller wrote in a statement.
The testing problems are hardly limited to private companies. Hospital labs as well as state and local and public health labs are also experiencing backlogs and delays.
"It's a giant mess," Wroblewski says. "There's no way around it."
The problems started when the federal Centers for Disease Control and Prevention required all testing to go through the agency. Widespread testing was further delayed because the test kits the agency distributed were defective. The CDC eventually resolved that problem. And the Food and Drug Administration finally made it easier for other tests to come on line.
But by the time all the labs at hospitals, state health departments and private companies finally got geared up, the virus was already spreading widely. The White House also soon started promising far more testing than was really possible, causing demand to surge.
As a result, all the labs have been scrambling to catch up. Many are short on staff and are constantly running short of supplies, including swabs to collect samples and chemicals to keep samples fresh and to extract and analyze genetic material to look for the virus.
"I've been trying to stay optimistic through this whole response," Wroblewski says. "And hoping that there's light at the end of the tunnel. But I think really we just keep taking it one day at a time and solving the problems we have that day. And doing as many testing as possible that day — and then we do it all over again."
And there's another new twist in the pressure on labs — labs must comply with a requirement that all results be reported to the federal government, which is key to tracking the pandemic. Dr. Deborah Birx from the White House coronavirus task force complained on Thursday that the government was only receiving about 50% of the results.
New, faster tests that can produce results in minutess instead of day are becoming available and should help. But it remains unclear how quickly and widely they will distributed.
"They're kind of trickling in," says Dr. Gary Procop of the Cleveland Clinic. "Our rapid test just went live today. And my email box is filling up with different doctors and different situations who want to use that test. So we're limiting who can have access to the rapid test, because we will run out."
The Cleveland Clinic is restricting the new, fast tests to critically ill patients and, in some cases, to women giving birth so doctors know if they need to be separated from their newborn babies, Procop says.
Health care providers need education about how to prioritize testing, according to the American Clinical Laboratories Association. The group sent a letter to the CDC on Thursday appealing to the agency to issue stronger guidance to doctors about prioritizing testing to those who need it most, such as critically ill patients and health care workers. The group also wants more doctors to clearly label high-priority samples so labs know which tests need to be processed first.
"Without immediate and aggressive education to physicians, hospitals and other providers, as a nation we will be unable to prioritize those most in need," Julie Khani, the group's president, wrote in a letter to CDC Director Robert Redfield.
"We urge the CDC to take immediate and proactive steps to educate providers and the American public about the new guidelines," Khani wrote.
In addition, the group is also appealing for more funding to reimburse stretched labs, including sufficient funds for labs to purchase equipment needed for some of the new tests.