The testing capacity of the Covid-19 was strained by the surge in demand

As Covid-19 cases multiply in the United States, the epidemic threatens laboratory directors in six states, threatening to exceed testing capacity in facilities that have spent months and millions of dollars developing their capabilities.

Dr. Geoffrey Baird, who oversees all Covid-19 diagnostics as executive chairman of the University of Washington’s laboratory system, said he spent an estimated $ 30 million earlier this year to build his laboratories, which now have 1,500 employees. one-tenth of this was focused on Covid-19.

But even this operation struggles with overvoltage management.

“It’s unimaginably huge, that’s the amount we’re doing, but it’s still not enough compared to demand,” Baird said. “Reducing demand is honestly the most effective way to manage supply.”

Laboratory directors in four states said that known suppliers of equipment and kits for different test platforms produce as much as their existing physical facilities allow and therefore limit the allocations that can be sold to each laboratory.

Several also said that these restrictions also have a secondary effect on diagnostic tests for other diseases, thanks to the ever-changing picture of even the most basic test materials, including chemical reagents and plastic pipette tips used by thousands of laboratories. consistent sample sizes.

Laboratory executives say even the supply and supply of these simple laboratory tools limits the boundaries of their staff, testing systems, and clinical caregivers.

“We see a lack of supply chain around many of our tests,” said Dr. Robin Patel, director of the Infectious Diseases Research Laboratory at the Mayo Clinic in Rochester, Minnesota. “In many cases, it has nothing to do with SARS-CoV-2 testing, which is complicated, very inefficient, and also affects patient care.”

According to several laboratory officials, this meant that tests were performed too slowly or that patients were proportionate due to suspicion of the disease, including gastroenteritis, sepsis, gonorrhea, and chlamydia.

Dr. Kathleen Beavis, professor of pathology and director of quality laboratories at the University of Chicago, said a recent overwhelming study has meant that urine samples from patients suspected of having a sexually transmitted disease have been sitting in their lab for too long to be used to control meningitis. required component was not available, which delayed diagnosis.

“I feel like it’s a mole,” he said. “And honestly, some things go through cracks, especially when there’s exhaustion between your co-workers.

“I think we’re really suffering from morale and fatigue, and without the infrastructure we usually have to deal with some of them,” Beavis said. “I’m just wondering how long they can continue to do it.”

The fact that these care gaps can limit testing opportunities is “definitely scary,” said Dr. Gary Procop, director of clinical virology at the Cleveland Clinic. – This is not a pleasant life for the laboratory manager now.

He oversees testing of Covid-19 at the Cleveland Clinic’s 1,200-bed specialty hospital, as well as hundreds of other patients in hospitals and family health centers in the same system, most of them in Ohio. He said he has essentially built a whole new lab for the coronavirus and often has to make sure all six test platforms hum at the same time just to meet demand.

But even its facility employs Procop’s “test triagy” candidates and prioritizes patients receiving emergency care over others for the fastest turnaround platforms and minimizes access to testing for asymptomatic patients.

And this torturous form — in the hospital lab rather than in the emergency room — may become increasingly necessary in the coming difficult weeks, amid the repeated insistence of federal and state authorities that regular community testing is the only way to overcome the pre-vaccination crisis. arrive.

Several officials said shipments to their labs during the summer were reduced by manufacturers or diverted to parts of the U.S. where facilities were under even greater pressure due to Covid-19’s patient needs. And as the national situation deteriorates, many laboratories have introduced a form of pooling of tests – allowing multiple patient samples to be tested simultaneously so that they can burn too quickly due to limited supplies.

But in areas with high Covid-19 frequencies, this type of pool test can become numerically ineffective.

“With a prevalence of about 10 percent, our pooling strategy breaks down because the pool is too much positive,” Baird said.

This left Baird to make a difficult request, especially for those who have no symptoms and want to associate with friends or gather with their families during the holidays.

“Now we ask people, you know, please don’t go testing,” he said.