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What Is Needed to Fix California’s Coronavirus Testing?

California’s backlog means some people wait two or more weeks before receiving their COVID-19 test results, long past the point of efficiency. To improve, the state needs a balance of policy, technology and behavioral changes.

(TNS) — The ability to get tested for the coronavirus, and get test results quickly, has been one of the most unpredictable and frustrating parts of the nation’s pandemic response.

While some people are getting test results back within a day, others as recently as last week were waiting two weeks or more — way past the window of time when a positive test result can be used to find a sick individual’s contacts to trace and contain spread.

There’s been some improvement in recent days, with times tightening in some areas. But the fact is that testing availability has fluctuated dramatically during the pandemic, and it may again.

The situation went from being nearly impossible to get tested at the start of the pandemic, because hospitals and medical clinics did not have had enough tests, to much-improved by late April through early June, when testing supply stabilized and the Bay Area flattened the curve. During that period, demand for testing was relatively low, and the medical and lab system could collect specimens and process tests in relatively short order.

But by late June, as the summer surge began to take hold in the Bay Area, testing in many parts of the region faltered. As more and more people sought testing, turnaround times for test results stretched to nearly three weeks for some patients — though the most seriously ill patients were typically able to get results within a day.

Last week, turnaround times began improving. Quest Diagnostics, the largest lab provider in many regions, says it is now reporting test results in two to three days. Napa County, which earlier this month was seeing wait times of up to 19 days, is now seeing wait times of two to three days, health officials said.

So what needs to be done to prevent future testing backlogs in the event of another surge? The Chronicle sought input from local health officials and laboratory directors on what it would take to improve testing for the long haul. They zeroed in on a mix of policy, technology and human behavior.

National strategy to distribute testing supplies to labs with fastest turnaround times. Labs across the country are competing for the same limited supplies of reagents, plastic pipette tips and other parts and chemicals needed to perform coronavirus tests. And there is little transparency for why some labs are getting more supplies, or supplies more quickly than others, said several health officers and lab directors. “It’s become a little bit of a Wild West,” said Dr. Ori Tzvieli, deputy health officer for Contra Costa County. “There’s not a coordinated strategy. That’s been frustrating.”

Many academic labs have the ability to turn tests around faster than commercial labs, but they appear to be lower down on the priority list to receive supplies from manufacturers, said Dr. David Lubarsky, CEO of UC Davis Health. Those supplies should be going to labs that can do tests in 24 or 48 hours, he said. “It seems commercial labs are getting the lion’s share of supplies, which is like throwing them into the ocean,” he said.

California’s testing task force is working to build out the supply chain for swabs, collection kits and other supplies, and has issued a survey to local public health departments and academic labs to assess supply limitations to ensure all labs are being used at full capacity, according to the California Department of Public Health.

Reduce reliance on large commercial labs, instead using labs that can get results faster: Health care providers and publicly funded testing sites should be sending specimens to labs that have faster turnaround times, experts said. Because large labs like Quest and Labcorp have long been the standard lab services providers for hospitals and clinics, they were among the first that states, counties and health care providers turned to for coronavirus testing. But they became overwhelmed by the demand.

The state has worked with its testing contractors — Optum and Verily, which operate dozens of state-funded testing sites — to identify additional labs, said a spokeswoman for the California Department of Public Health. Verily, which sends tests to Quest, plans to bring on two additional large labs this month, a company spokeswoman said. Experts stress the need to continue spreading tests around to other labs run by academic institutions or private companies. Some of this is already underway.

In the Bay Area, for instance, labs at San Francisco’s Chan Zuckerberg Biohub and UC Berkeley’s Innovative Genomics Institute (IGI) are processing tests within 24 to 48 hours for county public health departments and vulnerable populations in the East Bay. San Francisco’s city testing program found early success in securing fast turnaround times by contracting with Color Genomics, the Burlingame firm whose lab is turning tests around in 24 to 48 hours. Other counties, like Alameda and Marin, later began contracting with Color as well to get faster results. And Contra Costa County recently approved contracts with additional private labs that have promised turnaround times of two to three days. “Having multiple contracts with multiple labs will allow us to be nimble and flexible regarding which labs we send tests to, and not reliant on a single or a couple labs if they experience testing delays,” Contra Costa County Health Officer Dr. Chris Farnitano said during a Tuesday update to the Board of Supervisors.

Develop faster tests for surveillance, and deploy them widely: Antigen tests are gaining traction among researchers as one potential way to test large numbers of people quickly, without gumming up the lab system. The vast majority of coronavirus testing is currently done through PCR testing at labs. This type of test detects the presence of the virus’ genetic material (RNA) and has long been considered the standard for testing for respiratory viruses. Antigen tests detect viral proteins through a less involved, faster and cheaper process that can report results on the spot within minutes, rather than sending the specimen to a lab, which can take days. But they are less sensitive than PCR tests. Some epidemiologists say the tradeoff may be worth it because antigen tests would enable far more people to get tested frequently, get results back fast, and likely still catch most cases. Some envision a day when people can get an at-home test, and then test themselves every morning so they know if they are negative and can go to work or school, or positive and should stay home.

“I don’t see another solution at the moment,” Dr. Michael Mina, a Harvard epidemiologist and proponent of rapid antigen testing said last week during UCSF Medical Grand Rounds, a weekly meeting of medical experts. “This is simple technology. ... This is the kind of thing we shouldn’t be asking: ‘Do companies have them ready to build at the point?’ We should be saying, ‘How do we get the federal government to use all their might and resources to start making these?’ And for a fraction of the cost of the most recent stimulus bill passed for coronavirus response, we can have every American using one of these every single day for a year.”

Antigen tests are not yet widely used. In July, federal health officials began shipping millions of the tests to nursing homes across the United States, including more than a dozen in the Bay Area. There are two antigen tests that have received FDA Emergency Use Authorization, made by Becton Dickinson and Quidel, and both can only be done for symptomatic people. If the data on antigen testing turns out to be good and the FDA authorizes their use for asymptomatic people as well — opening the door for daily at-home testing — “that could be a game changer,” said Nam Tran, who oversees coronavirus testing at UC Davis Medical Center.

Experts also say saliva tests — which similarly are not yet widely used, except by some professional sports teams to test players and staff — also hold promise. UC Berkeley’s IGI in late July began a research study on saliva tests, administering them to thousands of UC Berkeley students, faculty and staff to see if the test is sensitive and specific enough to use in a clinical setting. If it is, it could greatly increase access to testing since saliva is easier to collect than having a health care professional do a nasal swab. And it could potentially be done in people’s homes, making testing more frequent and accessible.

Rethink who needs to get tested: The early narrative around testing was to test everyone, regardless of the severity of symptoms and even if they did not have symptoms, since many people with the coronavirus are asymptomatic. But that’s part of the reason testing demand is overwhelming supply, said Solano County Health Officer Dr. Bela Matyas. Testing should be limited to people when knowing the result will affect their treatment plan, such as hospitalized patients, and for surveillance in nursing homes and prisons where the risk of spread is highest, Matyas said. The so-called “worried well” shouldn’t bother getting tested, at least not when the testing system is overwhelmed, and neither should mildly symptomatic people — they should simply assume they have it and self-quarantine for 10 days, he said. That would help clear up the backlog.

Adjust human behavior: Local health officials have identified social gatherings of friends and family, where households mix, to be one of the most common ways the coronavirus is spreading. If people practiced social distancing and mask-wearing more consistently in these settings, it would drive down demand for testing by driving down the disease rate in the population. “All of the control is in our own hands if we exercise control,” said Matyas. “If we practiced some level of social distancing in our social interactions with family and friends, we’d control the outbreak and thereby control the testing problem. But that’s not an easy thing for people to connect the dots on. ... It’s a low-tech, cheap solution.”

©2020 the San Francisco Chronicle. Distributed by Tribune Content Agency, LLC.

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