A correction to an earlier version of this article has been appended to the end of the article.
Within two to three days, you can get results from your cholesterol test or colonoscopy.
But the speed at which the dangerously infectious COVID-19 virus is detected varies greatly — from an hour to two weeks or more.
As cases climb and supplies plummet, the pandemic is revealing a gulf in the Bay Area testing’s landscape: selective academic labs that are technically and logistically agile, returning results quickly, and facilities that rely on commercial labs with rigid supply chain requirements that can cause results to be significantly delayed.
The waiting game is stressful for anyone who relies on a test to resume their lives and livelihoods.
“It was frustrating for those two weeks not knowing,” said Jackie Erickson, of Los Gatos, who was tested at a CVS drive-thru site in San Jose before taking her sick and elderly mother to an important doctor’s appointment. She helped her mother before her results were returned — all the while, fearful of infection.
Even as politicians brag about the growing availability of tests, that’s not what matters, say epidemiologists. It’s the wrong metric.
What’s important are quick results, they say. That’s because the virus needs only moments to spread and five days, on average, to make you feel sick. People are most infectious about two days before and three or four days after they get symptoms — and may unwittingly spread the disease.
With long delays, “our testing often amounts to just ‘theater,'” said epidemiologist Dr. Michael Mina at Harvard University’s Department of Immunology and Infectious Diseases. It wastes money. And efforts to trace contacts of confirmed cases are nearly futile.
What’s happening? All over the world, labs are scrambling to find supplies at nearly every link of the supply chain, from the chemical reagents and plasticware to the actual machines that process tests. Four companies — Cepheid, Hologic, Abbott and Roche — dominate this machine market and require brand-name components.
“There are supply chain shortages for essentially everything,” said Dr. Steve Miller, director of UCSF’s Clinical Microbiology Laboratory. Manufacturers ration what’s sent to each lab, he said.
“Every institution is left to fend for themselves,” he said. “It’s like a competition. We’re all after the same supplies.”
The most profound shortage right now is tiny plastic pipette tips, which are critical for dispensing liquids onto a small plate to search for viral DNA.
“The companies that manufacture testing machines, supplies and equipment are struggling to meet the growing global demand, and currently they are not able to keep up,” said Dr. Stephen Parodi, infectious disease specialist and clinical lead for Kaiser Permanente’s coronavirus response.
Across the nation, turnaround times for test results have doubled in the last few weeks, he said.
Some of the worst waits for results are at labs at public retail outlets such as CVS. Such places send the tests in bulk to centralized labs owned by just a few commercial processors such as Quest Diagnostics and LabCorp. These processors use just one or two types of instruments, so they’re locked in to using proprietary chemical kits and other tools. They run tests in batches and may be located far away.
As a result, these sites have backlogs — even as they continue to accept new business from the surge of healthy asymptomatic people.
Commercial labs perform 2.5 million tests a week, half the nation’s total, “but results are very delayed and of little utility,” former CDC director Dr. Thomas Frieden said on Twitter. “They charge but the public doesn’t benefit. Tests performed per day is a very misleading indicator.”
County labs are also typically dependent on public or commercial labs with limited flexibility. For instance, Santa Clara County’s Department of Public Health lab – a small facility that provides high-priority testing for outbreaks in group settings — delivers results within 72 hours. But the Valley Medical Center lab, which processes tests from county hospitals, clinics and “pop up” sites, until recently took four to five days to get results, with some findings not returned for nine days.
Kaiser, which serves millions of members, has built a new 7,700-square-foot lab in Berkeley to process thousands of COVID-19 tests each day. Parodi said that most tests are processed at Kaiser’s existing lab, and results are ready in two or three days although they can take longer depending on demand and testing capacity. Less urgent cases, which can be sent to other labs, can take longer, he said.
Currently, some members say it can take nearly two weeks to get results, posing risk of transmission even though they may not have symptoms.
While waiting 12 days for results from Kaiser Richmond, Laura Paull worried about the isolation of her 93-year-old father “sitting alone in his apartment, day after day, with a book open on his lap. When I was finally able to visit, his energy level perked right up.”
But at academic medical centers such as Stanford and UCSF, responses can be lightning fast.
They have several advantages. Their tests are done on campus and, if needed, can be processed immediately. And they can limit who they accept, focusing on people with the greatest need. Only when supplies are adequate do they extend their reach. Stanford helps Valley Care, El Camino, Sequoia and Seton hospitals. UCSF partners with Marin General and John Muir hospitals, as well as some public clinics and the public health departments of San Francisco and San Mateo counties.
Dr. Paul Bayard turned to UCSF after he got weary of waiting up to two weeks for a commercial lab to report results for his patients at the East Bay-based clinic network called La Clínica. Now, with results within one to two days, La Clínica offers quick drive-through testing.
These academic labs have the money to buy many types of instruments, so they’re not at the mercy of one manufacturer. Additionally, they’ve built relationships with different vendors, so they can take advantage of whatever supplies are available.
Stanford’s lab, which conducts 24-hour specimen processing, has multiple workflows, instruments and supply chains, said Dr. Ben Pinsky, director of the Clinical Virology Laboratory for Stanford Health Care.
“We have tried to diversify, making sure we have alternatives,” he said. “There’s always some sort of redundancy in our suppliers. If we have any issues, we have backups.”
UCSF has seven different methods for COVID-19 testing and plans to add two more, said Miller. It also has backup supply chains. For instance, when UCSF starts to run low on the pipette tips of their Hologic Panther test system, it looks for alternative suppliers. If it can’t find them, it shifts to a test that the CDC developed.
“It’s all very complex,” said Miller. “It has allowed us to cushion the supply chain ‘shocks,’ to avoid interruption.”
Academic labs also have well-connected friends. When UCSF ran short on swabs, it turned to longtime donor Marc Benioff, who, as CEO of the cloud computing firm Salesforce, had extensive business contacts in China. Salesforce found and ordered hundreds of thousands of swabs.
But even their model can’t sustain the entire nation, Miller said. New and improved test technologies need to be made available to everyone.
“There’s infinite demand,” said Miller. “It is not going to be solved by our lab expanding capacity.”
Daniel Wu contributed to this report.
Correction: July 29, 2020 An earlier version of this story omitted some information about the length of time it takes for Kaiser Permanente to return COVID-19 test results from in-house labs. Depending on demand and testing capacity, some test results can take longer than two to three days.
