As we discuss reopening schools this fall and face having many college students descend on the area, the availability of testing is a big concern. Right now, people are facing many hours of waiting for the “rapid” test or having the standard test (also often requiring long waits) and potentially waiting a week or more for results.
How can we control this pandemic with such long waits for test results? Contact tracing is useless if it can’t be done until more than a week after someone’s already gotten sick. People without sick leave can’t afford to stay home for a week while waiting for results if they aren’t too sick to work.
If you’ve gone for testing in the past few weeks, what was your experience?
You nailed it, Meredith. My wife and I, who spend several weeks each summer on Martha’s Vineyard, decided to arrange for free testing at the regional high school. After waiting on hold on the telephone to speak with someone, I managed to book an appointment for a few days later…so far, so good.
The test went quickly and was easy to do. Unfortunately, ten days have passed, and the results have yet to arrive. As neither of us has symptoms, the tests weren’t a medical necessity. Still, everyone on the island is encouraged to be tested. Now I am curious to learn the results though they won’t mean much after so many days.
Many colleges have made arrangements with private testing services. Colby College in Maine is spending $@5M on their testing plan. Their CFO said they want to provide a safe environment for their students and also give comfort to their local community. It seems like some colleges have very robust plans to test their students. It looks like most of the colleges in our region fall into that category. HHS Secretary Azar has encouraged colleges to develop their own testing labs especially the larger research universities so that the overall system is not jammed. So I think the colleges are approaching this thoroughly but the overall testing capacity in the U.S needs to increase so that test results for the general population can be received in a timely manner.
An article just appeared in the Washington Post saying, “In the absence of a national testing strategy for the novel coronavirus pandemic, six governors have formed a first-of-its-kind purchasing compact they hope will pressure companies that make rapid-detection tests to quickly ramp up production.” Massachusetts is one of the six states.
I get some of my specialized care at the West Roxbury VA. It’s been great. Attentive and fully engaged doctors and staff. A much needed reality check to horror stories you hear about the VA and the evils of “Socialized Medicine”. I had a cough a month or so back and called to cancel an appointment. The attendant asked me a few questions and I was referred to a nurse who asked me if I was well enough to come in for a COVID19 test. I said I was and had the test the following morning. A very elaborate system in place to make certain I didn’t come into contact with any VA personnel except for the tester. The results came back the next day. Thankfully, they were negative.
I’d normally put my name on a post, but I’ll hold it back to speak more freely.
I work on testing efforts here in Massachusetts, and the key to a reasonable testing program is to contract with private labs. Here, the Broad Institute is the major one, and most colleges in the area (including Colby) are going to be using the Broad’s capacity, which is guaranteeing results in less than 24 hours. The Broad’s capacity could increase Massachusetts testing capabilities by an order of magnitude.
At some point, that capacity will be filled, and then things get dicey. There are a few other companies in the area spinning up capacity, which will hopefully get opened by the fall. One such company is hoping to bring capacity online for half a million tests a day, which would represent about half of what the entire country is doing today.
The economics of a test program are tough – wholesale tests from private labs are as something like $25-35, depending on volume. Then there’s the logistics of setting up a test site, which can be another $10-30 per test, depending on volume. Then there’s the professional support, since all tests currently require a clinician to be present, to order the test, to provide follow-up for positive cases, and trained observers to watch (or administer) the swabbing. If you need to ship the samples afterward, you can be in the $75-150 per test range all-in.
We’re learning a lot more about things, but right now the rapid tests, the antigen tests, and the antibody tests are approximately worthless. They have enough false negatives that you can’t make real clinical decisions as a result of them. So for now, we have to rely on PCR.
There are two big hopes in bringing down the cost steeply:
1. Sample pooling – the ability to test (for instance) a classroom at a time, in one test tube, and determine whether there’s any positivity in the whole class. If everyone in the school is negative, you might only need to run a couple dozen tests, rather than hundreds. If someone is positive, you run a test only for the individuals in the class that had a positive result. The science on sample pooling for covid is looking promising, but that doesn’t mean the labs will have the logistics worked out. But if it did get sorted, you might be talking about something like $5-10 a test.
2. Self-collection of samples – if people can collect their own samples, you might not need all the infrastructure for a test site. This is around the corner, and might make full-service testing something like $40-50 rather than $75-150.
If you’re NPS, the costs of a program can be pretty daunting. But pooling and self-collection seem likely to be a reality in the mid-to-late fall, so my organization has been encouraging partners to delay opening for a while to wait.
There are lots of folks looking to make a few bucks on this (and some nonprofits along the way), and there are lots of little places to generate margin. Unfortunately, that makes it really hard to stand up a K-12 test program, but I’m hoping we can find a way.
@Bob – unfortunately, wait times for tests and results have increased over the last month or so. Demand has increased for a variety of reasons, including people needing test results to go on vacation or return to work after being ill (with more workplaces now open).
I’m afraid the evidence that I’ve seen reported in the NYT and elsewhere points to failed openings in general. I don’t believe schools will be able to successfully open, regardless of efforts. In Newton, those kids that don’t have Internet would be best served by a direct subsidy. It’s going to be a really tough year for parents.
And kids.
I’ve only read about failed schools and summer camp openings.
My son took a whole day off from work, trying to get a test to no avail. This, after calling around to various testing sites and being told when to arrive, only to be turned away yet again. He then decided to arrive at a testing site at 6AM – an hour before it opened to ensure that he could get a test. By the time the site opened at 7AM, about 15 people were in line.
This is completely unacceptable in a state that expects to open schools in about three weeks. What happens when a student/teacher/staff shows respiratory symptoms – perhaps a cold, allergies, the flu, or COVID? Under current circumstances, without easily accessible testing, anyone exhibiting typical symptoms will have to remain out of school for 14 days. Easily accessible testing with rapid results needs to be put in place statewide ASAP.
To control the virus we need to have efficient testing. 24-48 hours test results and contact tracing – otherwise no successful opening of schools and economy.