COVID-19 test results delayed across North Carolina, nationwide as demand grows

If you’ve recently been tested for COVID-19 in North Carolina, it could take your results twice as long to come back as it would have last month.

Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services, expressed concern this month over “ballooning turnaround times” for commercial testing labs. The average turnaround time was approaching six to seven days, she said—up from two to three days in June.

As coronavirus cases surge across the South and other parts of the country, an increase in testing demand has caused the slowdown at commercial labs, and other testing providers face supply shortages. The delay could have implications for contact tracing efforts, experts said, making it harder to slow the spread of the virus.

Mecklenburg County Public Health Director Gibbie Harris said at a news conference last week that turnaround times had reached five to 10 days at times, though some tests are faster.

“Obviously that’s not actionable data,” Harris said.

She said the county’s testing strategy depends heavily on turnaround time, and the delays could cause them to pull back from testing some groups of people. The delays can also disrupt contact tracing, she said.

Why the delays?

It’s taking longer for large commercial labs, like North Carolina-based LabCorp, to turn around results because they’re receiving more tests than they can process, said Scott Shone, director of the state’s Laboratory of Public Health. It takes time for labs to work through the backlog.

“If you can only test, for example, 100 a day, and you’re getting 200 a day, that backlog builds pretty fast. But we’re talking hundreds of thousands that are going to these labs,” Shone said.

LabCorp was until recently able to deliver test results an average of one to two days after specimen pickup, spokeswoman Pattie Kushner told the Observer in an email Thursday. Now, the company said, it takes as long as three to five days, though it’s faster for hospitalized patients.

The backup began around the Fourth of July weekend, said LabCorp President of Diagnostics Brian Caveney. He attributed the increase in demand for testing to both “personal behaviors around the country” and the reopening of healthcare facilities that test patients for COVID-19 while treating other ailments.

“Supply and demand are at a mismatch, and demand is significantly outpacing supply,” Caveney told the Observer.

Coronavirus cases have soared across the country in recent weeks, with Southern states such as Florida and Texas hit particularly hard. North Carolina saw a state record of 2,481 new cases Saturday, and Mecklenburg County marked its highest daily caseload July 11, when state health officials reported 450 new cases of the virus.

There are also shortages of reagents — chemicals critical to processing tests — at some private and hospital labs, Shone said. When labs don’t have enough reagents, they refer specimens to other facilities with more capacity, which only increases the backup at large commercial labs.

But not all labs are seeing such long times, Shone said. The state’s lab still turns around the vast majority of its results within two days, he said. And Cohen said this month that hospitalized patients could still get results within 24 hours.

Novant Health sends some tests to LabCorp and uses some in-house tests with much faster turnaround times, with more in-house testing in acute settings like hospitals, a spokesperson told the Observer in an email. Symptomatic patients are prioritized for rapid testing.

Charlotte-based Atrium Health has an in-house testing laboratory that can turn around results in under 72 hours, the health system said in a statement.

“The global pandemic has led to a substantial increase in testing demand across the state and country and, as a result, major manufacturers of testing supplies are experiencing shortages,” Atrium said. “We are collaborating with all available resources, including local and national government agencies, to obtain more tests as quickly as possible.”

A nationwide issue

As cases have increased across the country, testing times have as well. Shone estimated Thursday that turnaround times were up to a week at labs nationwide.

“These are not issues that are unique to North Carolina and are happening around the country,” Cohen said at a press conference last week. “States need federal assistance, as we can’t solve these issues alone within North Carolina.”

North Carolina’s neighbors are seeing long turnaround times as well, spokespeople for their state health departments told the Observer. As of last week:

• South Carolina’s state lab has a turnaround time of 24-48 hours from receiving a specimen, but private lab results take several days to a week.

• Georgia’s state lab sees 24-48-hour turnarounds. But health districts whose tests are processed by LabCorp and Quest Diagnostics have five-to-seven-day turnaround times, and Ipsum Diagnostics has a turnaround time of two to four days.

• In Tennessee, it takes county health departments five to six days to call people with results, including a two-to-four day turnaround time at the labs themselves.

In Virginia, commercial labs had an average turnaround time of about six days as of July 5, up from about four days in mid-June, according to a Virginia Department of Health presentation provided to the Observer. Hospital and public health labs had turnaround times of three and 2.6 days, respectively, up from two days in mid-June — but down from four days June 21.

Reducing turnaround times

Jonathan Quick, a global health professor at Duke University, said that to effectively contain the virus, turnaround times for high-end tests need to be under 48 hours — and ideally under 24. He echoed Harris’s concern about days-long turnaround times undermining contact tracing efforts.

“All the horses are out of the barn” at that point, Quick said in an interview.

State guidelines advise people to stay home if they’re awaiting test results and have symptoms, or know or suspect they’ve been exposed to the virus. But Quick said test results are necessary to convince people they need to isolate.

“They’re going to try to convince themselves, ‘Well, I don’t really have it,’” he said. “... So you need that test result to confirm with people, ‘You have the virus, you’ve got to self-isolate. We’re going to work with you on identifying your contacts and letting them know.’”

Cohen announced this month that North Carolina would partner with East Carolina University and Origin Diagnostics to open 300 temporary testing sites in under-served African-American, Latinx and American Indian communities. The partnership would help increase capacity, she said, but she remained concerned about turnaround times.

Shone said officials have established a procurement process to bring new testing to the state. They’re looking for laboratories that have new capacity, he said, so they aren’t sending more tests to LabCorp or Quest.

For its part, LabCorp is working to scale up its capacity to process test results, from talking to suppliers to improving testing methods to hiring new people, Caveney said.

Yet Shone said testing “remains one piece of this whole puzzle.” People need to take measures to stop the spread of the virus as well, he said, like wearing face coverings, distancing and washing hands.

“We’ve got testing and tracing and isolation support, but it’s built on that strong foundation of prevention,” he said. “This is a public health response, and prevention is key.”

This story was originally published July 20, 2020 at 12:13 PM.