Jan. 14, 2022 — As the Omicron variant has swept across the U.S., now blamed for more than 98% of COVID-19 infections, the demand for testing at labs has skyrocketed — especially since home antigen tests are scarce.
On the rise, too, are complaints from test takers, who echo this anxious question:
What’s taking so long for results?
Promised turnaround times of 24 to 48 hours are stretching to several days, as people wonder if they should isolate or carry on with their regular schedule. The increased volume is one reason but it’s not the only one.
” You’d be amazed at the time delays,” states Dan Milner MD, chief medical officer for American Society for Clinical Pathology. This organization is for laboratory professionals. Experts and Milner agree that the journey of the nasal sample from collection to testing results via email or text is more complicated and involved than most people realize. The many steps along the way, as well as staffing and other issues, including outbreaks of COVID-19 among lab staff, can delay the turnaround time for results.
First, the Volume Issue
National statistics as well as daily tallies from individual labs reflect the boom in test requests.
On Jan. 11, the average for COVID-19 tests in the U.S. reached nearly 2 million a day, an increase of 43% over a 14-day period.
By Jan. 12, Quest Diagnostics, a clinical laboratory with more than 2,000 U.S. patient locations, had logged 67.6 million COVID tests since they launched the service in 2020. That was an increase of about 3 million since Dec. 21, when their total was 64.7 million.
At the UCLA Clinical Microbiology Lab, more than 2,000 COVID tests are processed daily now, compared to 700 or 800 a month ago, says Omai B. Garner, PhD, director of clinical microbiology for the UCLA Health System. He doesn’t think the demand has reached its peak.
In Tucson, AZ, at Paradigm Site Services, which contracts with local governments, businesses, and others to provide testing, 4,000 tests a day are done, compared to a daily tally of 1,000 in early November, says Steven Kelly, CEO.
There are many obstacles that can slow down the turnaround time.
Swab Collection, Pickup, Transport
“People misunderstand the entire process,” Garner says. The misconception that the swab can be analyzed at the point of collection is huge. This is often false, with some expensive PCR testing sites being the exception.
After the nasal collection is complete, the specimen should be sealed in a tube and sent to a laboratory. The specimen can be sent by courier to a nearby lab or shipped further away if it was collected in rural areas.
“Someone could be swabbed and the swab needs to go out of state,” Garner says.
Even a courier delivery to a local lab can take more time than expected if there is traffic jammed or bad weather. Paradigm’s Kelly says that temperature control is essential when en route.
“Samples must be kept at the correct temperatures.” To transport the specimens, couriers often keep them in coolers.
Arrival at the Lab
Once the swab arrives at the lab, the samples have to be logged in.
Next, how quickly it gets tested depends on the volume of tests received at the same time — and what the lab capacity is, taking into account staff and equipment to analyze the specimens.
Lab staffing can also be a factor. Laboratories are finding it difficult to hire enough staff as the demand for tests is increasing. Garner states that although the requirements vary from one state to another, all those who analyze the tests must have clinical laboratory scientists with experience and training. And like other businesses, laboratories are dealing with employees who contract COVID-19 and must leave work to isolate.
Potential lab employees must also cope well in a high-pressure situation, says Kelly. His company has hired 30 more workers in the past 3 weeks, bringing the total to 160. Some workers work seven days a week.
Lack of or inadequate testing equipment can also slow down the process.
Garner said that he has been asked many times if there are any fake testing labs, but he doesn’t know of any. It’s simple enough to verify a lab’s credentials.
Legitimate labs are certified under CLIA — the Clinical Laboratory Improvement Amendments of 1988. Federal standards are applicable to all U.S. sites or facilities that test human specimens for health assessment or treatment. The CDC has a CLIA Laboratory Search Tool to look up a lab by name to check its certification.
States might also have information about certification and other testing details. For instance, California’s COV