Supplies Shortages Continue to Bedevil COVID-19 Testing Efforts

What was true at the beginning of the public health emergency remains true today: laboratories simply cannot obtain the supplies they need to deliver desperately needed COVID-19 molecular testing in a timely manner. And a new survey from the College of American Pathologists (CAP) points to a new problem: staff burnout. Here are the grim details. High Test Numbers Belie Gaps in Supply vs. Demand  This is not about politics but the June 30 press briefing by assistant secretary of health Admiral Dr. Brett Giroir showing that 550,000 to 600,000 tests are being conducted each day, as compared to only a few thousand per day in March, do not do justice to the true situation. The fact is that if laboratories were capable of delivering all the COVID-19 tests that were needed when they were needed, those numbers would be much higher. Exhibit A: During his July 22 press briefing to go over the company’s second quarter earnings, Quest Diagnostics’ chairman, CEO and president Steve Rusckowski noted that Quest labs were currently capable of running 130,000 molecular SARS-CoV-2 tests per day and expect to increase that total to 150,000 over the next several weeks. Those numbers sound very impressive. But there is more to the story. Rusckowski continued by noting that this step-up in testing is still not enough to keep up with rising demand. The current average turnaround time for SARS-CoV-2 testing of high-priority patients is around two days and no less than seven days for non-priority patients. As anybody who has been through the experience can attest, seven days is an eternity when awaiting COVID-19 testing results. The CAP Survey The June CAP online survey of CAP surveyed 3,723 laboratory directors sheds light on what is causing the shortfall in COVID-19 testing. The chief culprit remains lack of testing supplies. Thus, of the 306 respondents, 70% of whom are based in hospital departments:

• 64% said they are having trouble acquiring reagents for platforms and test kits, only a slight improvement over the 69% who reported difficulties in April;
• 60% cited problems acquiring nasopharyngeal swabs for collection and transport of patient samples, and transport media, as compared to 66% in April; and
• 43% reported difficulties obtaining SARS-CoV-2 testing instruments, which is actually above the April total of 42%.

Significantly, 70% of respondents said they could be doing more testing if they had the needed supplies, as opposed to 79% who reported this in April. In other words, the capacity is there, but the supplies are not.  The Burnout Factor  While the shortage of laboratory testing supplies has been well documented, the impact of the pandemic on laboratory staff has gotten less attention. In addition to facing COVID-19 exposure on a daily basis, pathologists and staffers are undergoing furloughs and pay cuts, as the virus decimates demand for anatomical pathology services. Key findings from the CAP survey:

• 63% reported cuts in pathologists’ pay;
• 43% reported reductions in hours; and
• 36% reported increased burnout among pathologists.

Takeaway Yes, COVID-19 testing numbers are higher but they are nowhere near where they need to be. The source of the problem appears to be not so much lack of capacity as lack of supplies. The CAP survey suggests that laboratories have the COVID-19 testing platforms and personnel they need but cannot ramp up that capacity to provide testing because they do not have enough reagents, swabs or transport media. And until the supplies bottleneck problems are resolved, testing will continue to fall behind demand.  

Strapped with COVID-19 Testing Supplies Shortages, Laboratories Ask White House for Help On July 8, a group of eight organizations representing U.S. laboratories sent a letter to Vice President Mike Pence urging the government to find remedies for supply chain obstacles to performing COVID-19 tehttps://www.amp.org/AMP/assets/File/advocacy/Laboratory%20Supplies_Letter%20to%20Pence.pdf?pass=67sts. “Our members are on the front lines responding to the public health crisis,” the letter begins. Since COVID-19 testing began, “they have experienced significant difficulty acquiring the supplies— test kits, nasopharyngeal and mid-turbinate swabs, transport media, and personal protective equipment (PPE)—needed to perform COVID-19 testing.” The letter notes that labs have even been getting faulty or unusable equipment, including swabs from the Strategic National Stockpile. Without proper testing supplies and PPE, laboratories will continue to struggle to meet the demand for COVID-19 testing and assistance in tracking its spread, according to the letter. The assistance requested: 1. Supply Chain Contacts Information First, the letter asks for a list of the names and contact information for individuals in each state who are overseeing the supply chain for testing supplies and PPE for the federal government. “Many of our members report that they are unable to identify or initiate contact with these individuals,” the letter explains. 2. Transparency of the Supply Allocation Process The other request is “visibility into the process of supply allocation, demonstrating that the supplies being distributed at the state level are being allocated in a way that reflects the greatest need to effectively address COVID-19 in the U.S.” According to the letter, labs need to understand in real-time, resource availability and reagent and supply quantities for planning purposes. The federal government should take a leading role in increasing transparency about the availability of these materials from both government and commercial manufacturers. The letter signatories include the: American Association of Bioanalysts; American Association for Clinical Chemistry; American Medical Technologists; American Society for Microbiology; Association of Public Health Laboratories; Association for Molecular Pathology; College of American Pathologists; and National Independent Laboratory Association.