COVID-19 test delays from overwhelmed commercial labs hit Washington patients in different ways

SEATTLE — When John Lederer came down with mild flu-like symptoms earlier this month, he and his wife got coronavirus tests at a Swedish Medical Center clinic in Edmonds. A doctor stuck swabs deep into their nostrils and told them results would be back in a day or two.

But after several days passed without word, Lederer grew restless. His symptoms had disappeared, and he found it increasingly difficult to heed his doctor’s advice to self-quarantine while awaiting the results, he said.

It took 10 days for Lederer and his wife to finally learn Sunday they’d tested negative. As they waited anxiously, the Swedish clinic’s director called three times to apologize for the delay and explained that LabCorp, the national commercial lab testing the Lederers’ specimens, was overwhelmed by soaring demand as infections have spiked in other states, Lederer said.

“I think the general perception out there is that what’s going on in Texas and Arizona isn’t hurting us here in Washington,” said Lederer, 59. “But it is. Other parts of the country are on fire now and that’s slowing everything down.”

Attempts to meet rising demand by LabCorp and Quest Diagnostics, two major commercial reference labs, have caused massive backlogs of test results, meaning waits of several days or more that are now being felt in Washington. Most people getting tested here continue to get results back within a few days, officials say. But Lederer’s experience is hardly rare.

While Swedish and other large health care networks can turn to in-house labs or other options for the most urgent testing needs, independent and smaller medical practices, hospitals and community clinics — that often serve low-income families, immigrant communities and other at-risk groups — don’t have those alternatives and rely almost exclusively on the big national labs. The delay in test results imposed by those labs can exacerbate the risk of the disease’s spread in communities that have been hit disproportionately hard by COVID-19.

“The patients we work with (…) have challenges to begin with, barriers to access to care, and this is a population that we train to reach out to, because they were neglected in this pandemic,” said Dr. Ricardo Jimenez, chief medical officer for Sea Mar Community Health Centers.

Sea Mar’s clinics, which serve thousands of patients across the state, including people who are homeless and migrant farm workers, say they’ve recently experienced average waits of seven to nine days for results from Quest. Neighborcare Health, a local community health organization that relies on LabCorp, has also reported delays in turnaround times.

Test results that take more than a week can destroy the chance to break the chain of COVID-19 transmission, said Dr. Matt Logalbo, medical director for Country Doctor Community Health Centers, which serves people with low incomes and homeless people in Seattle.

“If test results are taking five to seven days, that’s actually longer than the typical timeframe between someone acquiring the virus and the point where they become most contagious, so it’s by definition a losing battle,” said Logalbo, whose patients have seen such delays.

Lederer, whose job as executive dean of North Seattle College requires him to work on campus amid its limited reopening, added that “waiting days for results makes testing useless.”

“It’s really hard for people to quarantine themselves for that long, especially if they’re asymptomatic and need to go to work to support their families or buy groceries,” he said. “Toward the end, I couldn’t wait that long.”

For low-income workers, it can be even more difficult to wait. They often have the least flexibility in their jobs and are still required to show up for work, Logalbo said.

“There’s a fundamental failure of organization at the top that is leading to unnecessary disease, unnecessary deaths and the incredible societal disruption we’re seeing,” Logalbo said. “The brunt of that impact falls on the patients we’re here to take care of.”

“Ripple effects”

LabCorp and Quest acknowledged in statements this week that spiking cases nationwide have caused a widespread slowdown in test results, with Quest blaming “the rapid, continuing spread of COVID-19 infections across the nation, but particularly in the South, Southwest and West regions” for throttling available testing capacity.

The lab companies — each of which already has performed more than 3 million tests and is now running more than 125,000 tests daily — vowed to accommodate the spiking demand by adding equipment and capacity to perform a combined 300,000 tests per day by month’s end.

The out-of-state reference labs account for about 20% of the test results of Washington’s positive COVID cases, said Reed Schuler, an adviser to Gov. Jay Inslee. Despite some problems, Washington’s lab capacity so far hasn’t been significantly disrupted, with in-state labs, such as the University of Washington Medicine virology lab, able to turn around results “significantly faster,” he said.

“There are a wide variety of potential pinch points for labs, and we know some of the out-of-state labs are experiencing lengthy delays in turnaround times that are impacting some clinics in this state,” Schuler said. “That’s a warning sign.”

He noted the “enormous strain” on testing nationwide may portend problems for Washington in the long term by depleting availability of testing instruments and supplies here.

If left unaddressed by the Trump administration, “these shortages could force us to restrict, even ration testing down the line precisely at the moment we need to expand operations,” Schuler said.

Already, the national testing strain has led to a reduction in some testing equipment and supplies that UW Medicine’s lab has used while performing about 40% of diagnostic testing on specimens statewide.

The UW lab has consistently returned the bulk of its test results within a day. But now, vendors have reallocated to labs in other states a substantial portion of the chemical reagents needed to run tests on one of the UW’s fastest automated testing platforms.

“Thus, we have had to move testing to our less automated, more manual processes that are slower,” said Dr. Geoffrey Baird, interim chair of the UW laboratory medicine department. “This reduces overall daily capacity and thus increases turnaround time and daily backlogs of specimens.”

Baird noted vendors have explained they needed to help fill spiking testing demand in states where COVID has exploded, such as Florida, Texas and Arizona.

“We’re not an island,” he said. “Everything has ripple effects.”

More tests, more needs

Problems with testing have plagued Washington’s response throughout the pandemic, with escalating demand for testing previously swamping LabCorp and Quest in late March. That caused test result lags of days, even weeks in some cases, at clinics across Washington and elsewhere.

But that was early in the crisis, before the variety of testing and lab options that exist today had become widely available. Washington’s testing has rocketed to new heights in recent weeks, at times attaining more than 16,000 tests per day, according to state Department of Health data.

During the first week of June, the number of daily tests performed statewide ranged from about 5,000 to 6,000. By the end of last month, the state cracked the 15,000 mark for the first time, logging its single-day high of 16,601 tests on June 29 and averaging 14,029 tests per day over the five days leading to the July 4th holiday.

The gains attained in overall testing numbers appear to put Washington on track to achieve one of Inslee’s targets, announced in late April, for daily testing statewide to increase up to 20,000 to 30,000 tests per day by the time the flu season arrives this fall.

But testing numbers statewide are deceiving, with access and availability drastically varying from community to community. Scarcity of diagnostic testing continues to hamper parts of Yakima, Franklin, Benton and Spokane counties — hot spots where outbreaks have erupted even as the pandemic’s curve has flattened on the more populous western side of the state.

Latino patients, including some in the Yakima area, make up a large percentage of Sea Mar’s clients — nearly 40% in 2019. Latino patients are now the No. 1 group testing positive for COVID-19 in Washington state, with a whopping 44% of all confirmed cases with race and ethnicity data available despite making up only 13% of the population statewide.

11 days’ wait

Testing delays not only put medical decision-making on hold, but can also hamper the trust Sea Mar has worked to build with underserved populations, said Jimenez, Sea Mar’s chief medical officer. Trying to get people to show up to a clinic, and then having them wait more than a week for results, can create anxiety and discourage people from getting tested.

A Quest Diagnostics spokesperson said that the highest priority patients, including hospital patients and symptomatic health care workers, see average testing turnaround times of slightly more than a day. Turnaround time for everyone else is now more than seven days.

But one Sea Mar patient who came to an outdoor clinic waited 11 days for results, according to Jimenez.

“My medical directors across the clinics are saying this is completely unacceptable,” Jimenez said.