Everyone seems to want to talk about testing these days. The administration talked about testing when it, with much fanfare, rolled out it’s plan to reopen the country. “There’s plenty of testing”, they told us, we just needed to find it. They even did the leg work for us, providing governors around the country with the phone numbers of various labs that had unused capacity. Imagine that, we were scrambling to find more COVID-19 tests, when all over the country, lonely lab techs sat idling on their lab stools, staring at bunsen burners like modern day Maytag repairmen. The thing is, when they say capacity, it isn’t exactly the same things as ability. My high school guidance counsellor used to tell me all the time that I had the capacity to accomplish much more. And look how that turned out.
Yes, capacity exists, and I’ve written previously about how unused ventilators could be moved around the country when hospitals had a need. But ventilators and laboratories, I’m told by various somewhat intelligent people, are very different. Very very different. Labs for one, are made up of predominantly cinder blocks and have a tremendous number of people inside. Ventilators have no living things inside save for the 4 or 5 mice that make it run. Also they have wheels. So yes, there’s lots of capacity, but what good is that capacity if it’s on the other side of the state from me? The unused lab to which I send my COVID-19 test may take 2 to 3 days to provide a result. In the meantime, a patient is sitting in self quarantine at home, waiting for the results. That’s now 3 days of lost productivity, 3 days of worrying, 3 days of finding child care, multiplied by, oh I don’t know, let’s just say fifty thousand or so tests per day. When the country reopens, people need to be able to get tested quickly, efficiently, cheaply, and accurately. Right now I can’t that we even have one of those things.
Update on testing in my community.
In my last update I told you that things were looking up, as we had gotten Cepheid’s rapid test, which takes 45 minutes. It went well for about 10 days, but then our supplies of the test cartridges started to run low. Cepheid has not been able to keep up with demand, presumably they have prioritized hot spots to be supplied with more tests, and NC is not a hotspot. So while we’re still using this test for inpatients, we use a LabCorp test for ED patients not being admitted. On a bright note, the LabCorp COVID-19 test turnaround has come down to 2 days from its previous ludicrous time frame of 8 days. While that’s a positive development, it is still too slow.
Outpatient testing continues to remain beyond the horizon. We simply don’t have the PPE to spare for it. NC DHHS reports that as of today the state has a 1 day supply of N95 masks.
In the President’s most recent home shopping network episode on 4/27, he announced that testing would double in one month, home testing kits would become available, and reliable antibody tests would be available too. The President has the capacity to talk a whole lot and make a lot of promises, let’s see if they actually turn into action.
Deep Ramachandran, M.D. is a Pulmonary, Critical Care, Sleep Medicine physician, founding CHEST Journal Social Media Editor, and co-Chair of ACCP Social Media Work Group. He blogs at Caduceusblog. He is on twitter @Caduceusblogger.