Why Your COVID Test Results Take That Long

Jan. 14, 2022 — As the Omicron variant has swept throughout the U.S., now blamed for greater than 98% of COVID-19 infections, the demand for testing at labs has skyrocketed — particularly since residence antigen exams are scarce.

On the rise, too, are complaints from take a look at takers, who echo this anxious query:

What’s taking so lengthy for outcomes?

Promised turnaround instances of 24 to 48 hours are stretching to a number of days, as individuals surprise if they need to isolate or keep on with their common schedule.

The elevated quantity is a serious purpose, in fact, however not the one one.

“You’d be stunned by what the time delays are,” says Dan Milner, MD, chief medical officer for the American Society for Clinical Pathology, a corporation for lab professionals.

The journey of the nasal swab — from the gathering level to the take a look at outcomes arriving by textual content or e-mail — is extra concerned and sophisticated than most individuals understand, Milner and different consultants say. The many steps alongside the way in which, in addition to staffing and different points, together with outbreaks of COVID-19 amongst lab workers, can delay the turnaround time for outcomes.

First, the Volume Issue

National statistics in addition to each day tallies from particular person labs mirror the growth in take a look at requests.

On Jan. 11, the typical for COVID-19 exams within the U.S. reached practically 2 million a day, a rise of 43% over a 14-day interval.

By Jan. 12, Quest Diagnostics, a medical laboratory with greater than 2,000 U.S. affected person areas, had logged 67.6 million COVID exams since they launched the service in 2020. That was a rise of about 3 million since Dec. 21, when their whole was 64.7 million.

At the UCLA Clinical Microbiology Lab, greater than 2,000 COVID exams are processed each day now, in comparison with 700 or 800 a month in the past, says Omai B. Garner, PhD, director of medical microbiology for the UCLA Health System. And he doesn’t assume demand has peaked.

In Tucson, AZ, at Paradigm Site Services, which contracts with native governments, companies, and others to supply testing, 4,000 exams a day are finished, in comparison with a each day tally of 1,000 in early November, says Steven Kelly, CEO.

Beyond quantity, there are different obstacles that thwart the supposed turnaround time.

Swab Collection, Pickup, Transport

“People misunderstand the complete course of,” Garner says. One massive false impression is that the swab is analyzed proper on the level of assortment. That’s normally not true — with some fast (and dear) PCR take a look at websites generally the exception.

Once the nasal assortment is completed, the specimen is sealed in a tube, then despatched to a lab. It is perhaps taken by courier to an area close by lab, or it could be shipped a lot farther away, particularly if it’s collected in a rural space.

“Someone may very well be swabbed and the swab must exit of state,” Garner says.

And even a swab that is transported by courier to an area testing lab might take longer than anticipated, if visitors is heavy or the climate turns unhealthy.

En route, temperature management is vital, Kelly of Paradigm says. “Samples must be saved on the proper temperatures.” Couriers typically retailer the specimens in coolers to move them.

Arrival on the Lab

Once the swab arrives on the lab, the samples must be logged in.

Next, how rapidly it will get examined is determined by the quantity of exams obtained on the identical time — and what the lab capability is, considering workers and tools to investigate the specimens.

Lab staffing is one other issue. As the demand for exams has elevated, laboratories are having a tough time including sufficient workers. Requirements differ from state to state, Garner says, however these analyzing the exams should be medical lab scientists with coaching and expertise. And like different companies, laboratories are coping with staff who contract COVID-19 and should depart work to isolate.

Potential lab staff should additionally cope effectively in a high-pressure state of affairs, says Kelly. His firm has employed 30 extra staff previously 3 weeks, bringing the whole to 160. Some work 7 days every week.

Testing tools — or the dearth of it — may decelerate the method.

While Garner says he is typically requested if faux testing labs are popping up, he says he isn’t conscious of any. And it is simple sufficient to verify a lab’s credentials.

Legitimate labs are licensed beneath CLIA — the Clinical Laboratory Improvement Amendments of 1988. Under CLIA, federal requirements apply to all U.S. amenities or websites that take a look at human specimens to evaluate well being or to diagnose, stop, or deal with illness. The CDC has a CLIA Laboratory Search Tool to search for a lab by title to verify its certification.

States may additionally present data on certification and different testing particulars. For occasion, California’s COVID-19 Testing Task Force publishes its lab checklist, detailing areas, variety of exams finished weekly, and common turnaround instances.

Analysis on the Lab

Labs do two varieties of exams to detect COVID-19. Antigen exams detect sure proteins within the virus.

“Lab-based antigen exams will not be that a lot completely different” from the fast residence exams, Milner says. There is a management line and a take a look at line used to detect the virus.

The PCR (polymerase chain response) exams detect genetic materials of the virus.

“RNA will get extracted from the pattern and is purified through our extraction instrument,” says Mariah Corbit, compliance supervisor at Paradigm Laboratories.

Special chemical compounds and enzymes are added. A PCR machine referred to as a thermal cycler performs a collection of heating and cooling steps to investigate the specimen. The PCR know-how permits scientists to amplify small quantities of the RNA from the specimens into DNA, which replicates till any virus current is detected.

One of the chemical compounds produces a fluorescent mild if the virus is within the pattern. That sign is detected by the PCR machine.

The PCR take a look at may present an thought of how a lot virus the particular person has, says Chris Johnson, MD, medical director of Paradigm Site Services.

Once the evaluation begins, it is doable to estimate how lengthy outcomes take, Milner says.

The longest evaluation is for the PCR take a look at, which varies from lab to lab however typically requires about 1.5 to 2 hours, he says. The antigen take a look at evaluation ”takes 20 minutes on the most,” Milner says.

In the case of the fast PCR exams, which promise leads to 1-2 hours and even much less however can price $300, the processing time could also be modified to get outcomes sooner, Milner says. And typically, a optimistic end result reveals up sooner than a detrimental. “If you might be studying it in actual time, you may get a optimistic end in 20-Half-hour and report it out.”

Facilities providing the fast exams could also be doing solely COVID testing and could also be processing the exams on the identical website, Milner says, permitting for the sooner turnaround. “If they’re CLIA-certified, the standard of that take a look at must be OK,” he says.

A lab’s definition of turnaround time for the non-rapid exams could differ from that of the particular person awaiting the end result. Quest Diagnostics, as an example, says its turnaround timeline begins on the finish of the day on which the specimen is collected and ends on the finish of the day on which ends up are reported.

Verifying Results

A optimistic result’s reported as such, as is a detrimental. “There is not any affirmation testing,” Garner says. “This is why labs must run dependable exams.”

But the take a look at is repeated if the unique end result isn’t conclusive, Garner says. And if it is not conclusive a second time? “We launch it as indeterminate,” and one other take a look at may be ordered.

Once finalized, the outcomes are despatched through textual content or e-mail.

Long-Term Solutions

With no slowdown in demand anticipated within the close to future, long-term fixes are wanted.

“From a lab standpoint, we’re all so annoyed we do not have the infrastructure and capability to fulfill the necessity,” Garner says. “In basic, now we have not constructed the testing infrastructure wanted to combat the pandemic.”

At the start of the pandemic, he says, when demand first ramped up, “we must always have seemed on it as a must construct the infrastructure.”

Meanwhile, lab administrators understand how vital well timed outcomes are, however will not sacrifice pace for accuracy. “We need to be sure that it is finished proper,” Kelly says.