COVID-19 testing backlog causes treatment delays

A national bottleneck of COVID-19 testing supplies — including the chemical reagents used in most commercial laboratories — is causing significant delays in test results across North Carolina, including the western part of the state. 

“We know more work is needed to get faster turnaround times for tests,” said Dr. Mandy Cohen, the state’s secretary of health and human services, at a July 21 press conference. “Our commercial labs are swamped with samples from around the country, and our hospital labs are still struggling with supplies.” 

Pardee Hospital in Hendersonville regularly sends COVID-19 tests to labs at the UNC Medical Center in Chapel Hill and the Mayo Clinic laboratory in Rochester, Minn., explains Dr. David Ellis, chief medical officer, but wait times are now up to three and five days, respectively. 

Pardee also conducts on-site rapid tests distributed by California-based Cepheid, which take the hospital roughly two hours to process. Unfortunately, the reagents needed to test these samples are allocated on a weekly basis through the UNC Health Care System and are very limited, Ellis notes, with Pardee receiving supplies for approximately 30 tests each week. 

Moreover, Ellis says, rapid COVID-19 tests are less reliable than the standard tests, which use a technology that amplifies the virus’s genetic material so infections are easier to detect. He recommends that those with a negative finding on a rapid test get a second, slower test to confirm the result.

“We very much steward how we use these [rapid] tests,” Ellis says. “We do them for people who are being admitted to the hospital or for certain situations. We’ve never had enough to use them on everybody that we’ve needed to test.”

Without a lab-confirmed COVID-19 test, Pardee cannot provide any COVID-19 treatments to suspected patients, Ellis says. UNC Health Care, which provides Pardee’s supply of the antiviral medication remdesivir, and Mayo Clinic, which supplies Pardee’s convalescent plasma, both require documentation of a positive COVID-19 test to administer treatment. 

“If we’re waiting for several days on a positive test for somebody who is hospitalized, they may be in the hospital for some number of days before we can actually treat them with these medications,” Ellis explains. 

Dr. Jennifer Mullendore, Buncombe’s interim health director, said at a July 23 press conference that she had not heard of any treatment delays from county health care providers. “It makes sense, logically, that you’d have to have proof that someone has COVID before you could do some of the COVID-specific treatments, but I have not heard that expressed as a concern by anyone,” she said.

Mission Hospital performs COVID-19 tests on hospitalized patients via in-house labs, meaning treatment decisions are not delayed, says spokesperson Nancy Lindell. She notes that Mission sends outpatient tests to Burlington-based LabCorp, which can take four to 10 days to provide results. 

Long wait times are also impacting personal protective equipment supplies. Until a patient’s COVID-19 status is known, Pardee staff interact with new arrivals as though they had the coronavirus, Ellis says. A several-day delay in test results means several days’ worth of PPE is used treating patients who may not be infectious, burning through more masks, gloves and gowns than necessary. 

Buncombe County is also struggling to secure testing supplies: On July 22, county health officials announced they would temporarily stop offering community-based COVID-19 testing, in part due to wait times of a week or longer for results.