Updated 1:27 p.m.
Nicole Stefko and her wife have been staying close to home these past few months. Stefko, 35, does the groceries because her wife has a heart condition that compromises her immune system. But beyond that, the Sacramento couple sticks to their neighborhood.
So when Stefko took their sick pitbull/boxer mix, Charlee, to her veterinarian last month, she was a little worried about the waiting room. A few days later, she received an email from the vet’s office explaining she’d had a possible COVID-19 exposure.
“We would have both liked to have been tested, just out of precaution,” she said.
When they tried to make appointments — first through Project Baseline and later through CVS and their doctors — they were told appointments were unavailable or that they didn’t need to get tested.
“Even me going out and possibly bringing something back in causes a great deal of anxiety,” Stefko said. “I had possibly been directly exposed, and to not be able to get a test was really frustrating.”
Many Californians have posted on social media and written to CapRadio with similar complaints, still unable to access testing nearly four months after statewide quarantine began. Capacity for COVID-19 tests varies between counties depending on demand, staffing, lab space and other factors.
While testing was more widely available a few weeks ago before cases began to rise, experts say the system is now strained due to the increase in demand and an ongoing shortage of supplies used to collect and process samples.
“COVID-19 has just been a challenge because it’s been so widespread, it’s a pandemic, so it’s creating a need for greater resources,” said Michelle Gibbons, executive director of the County Health Executives Association of California. “Initially everybody thought public health departments all have labs, and we could stand up testing pretty easily.”
What it really takes, she said, is collaboration between labs, suppliers, community sites and hospitals. And any one of those pieces falling out of place can compromise county health departments’ ability to track the virus’s spread.
A Record Number
At a Monday press conference, Gov. Gavin Newsom talked about testing capacity as a point of pride. It’s come a long way since April, when health officials statewide were only able to run 16,000 tests per day.
“We tested 127,000 people on Saturday, which was a record number of people we’ve tested,” he said. “Testing’s going up, and the positivity rate is also going up.”
The positivity rate is the percentage of tests that come back positive, and experts say it’s a more accurate way to track spread than just looking at the total number of cases. Two weeks ago 4.9% of tests were coming back positive, now that rate is 6.8% — a 39% jump.
Some local health officials say the rising rates and the state’s push to run more diagnostic tests has presented new challenges.
“At the state level, the testing has increased significantly which is a good thing,” said Dr. Teresa Frankovich, health officer for Humboldt County. “But it’s clearly putting a strain on the supplies and on the capacity of the laboratories. We feel it at the local level because it affects our turnaround time.”
For counties that contract with corporate testing labs, such as Quest Diagnostics or Labcorp, the increased demand for testing can bottleneck the system. Gibbons, of the health executives association, said labs that are struggling to process tests on time are opting to give counties fewer test kits.
Quest Diagnostics reported on June 25 that testing capacity was stretched thin on a national level due to the following factors:
- increasing spread of the virus across much of the United States
- patients being tested before undergoing procedures in hospital settings
- demand from additional sectors, such as federally qualified healthcare centers, nursing homes and prisons
- orders from community events held in collaboration with government agencies and corporations
- organizations bringing employees back to work
At that time, Quest said its testing turnaround time was one day for high priority patients and two to three days for the general population. In an updated statement Monday, the company said its turnaround for non-priority patients was four to six days.
Some hospitals have attempted to establish their own testing and processing sites to fill the gap. Representatives from Kaiser Permanente said in a statement that the health system has purchased large testing machines and test kit supplies, and built dedicated lab space for COVID-19 tests so that they can diagnose both symptomatic and asymptomatic patients.
University of California medical centers have also expanded lab capacity to shoulder some of the demand for testing, and many hospitals have established drive-through testing sites, though these do not address the processing bottleneck.
Supply Chain Constraints
On Saturday, California Health and Human Services Secretary Dr. Mark Ghaly announced that laboratories should prioritize testing for people with COVID-19 symptoms, people who are in hospitals or long-term care facilities and people in institutional settings.
“As more states begin to scale their testing capabilities, new constraints are materializing within the supply chain,” he wrote in a statement. “Simultaneously laboratories are becoming overwhelmed with high numbers of specimens, slowing down processing timelines.”
Ghaly wrote that these delays could present “significant challenges” in California’s ability to isolate those who are sick and cut transmission rates.
Those challenges have already surfaced in Sacramento, where county officials temporarily closed five of their six community-based testing sites, citing a shortage in the chemical solution used to transport test samples to the lab.
Community leaders said these walk-up sites were some of the only accessible options for low-income residents who may lack a primary care physician, or a vehicle to get to drive-up locations.
In Yolo County, spokesperson Jenny Tan said supply chain issues have not hindered their testing capacity or plans to expand it, but that could change.
“As there are more breaks [in the supply chain], the more it can impact us in terms of testing,” Tan wrote in an email. “We may not see the impacts right away, but we will likely see them within the next few weeks.”
Close Contact
Renee Conner, a 39-year-old Sacramento mother, started to feel ill last Tuesday. She immediately tried to get a COVID-19 testing appointment at CVS, but was told they were full.
The next day she walked into her doctor’s office and received a test, and two days later received a positive diagnosis.
“And that’s when I started notifying everybody,” she said. “I was lucky ... but everybody else around me has had a harder time getting tested because they didn’t have symptoms, and they have to wait days to get the results.”
Some experts say in an ideal world, anyone who is exposed to someone with a COVID-19 diagnosis would promptly get tested, whether or not they’re exhibiting symptoms, in order to reduce the likelihood that they would spread the disease to others.
But Dr. Bela Matyas, health officer for Solano County, says there isn’t actually a need for widespread testing if people follow public health recommendations.
He says for people who’ve been exposed to COVID-19, a test result shouldn’t be the determining factor in their behavior. If they feel sick, they should stay home, he said. If they don’t feel sick, they should also stay home.
Belas says even if asymptomatic people who’ve been exposed went out in a face covering and stayed six feet from others, their likelihood of spreading the virus would be slim.
“If you’re doing the proper behavior, [testing] doesn't make any difference,” he said. “That’s one of the ironies. People are so sold on the concept of testing they’re not thinking logically.”
He said testing should be reserved for senior homes, prisons and other institutions where people live in close quarters.
Still, many epidemiologists say there’s a need to make widespread testing available, both to reduce spread and to track the prevalence of the virus, the way health departments track tuberculosis or the flu. And many people are unable to stay home because they cannot work remotely.
An analysis of current COVID-19 testing capacity from Harvard University and NPR shows state testing levels are consistently falling short of what would be needed to mitigate the spread of the virus.
For people who’ve had close contact with a COVID-19 patient, the U.S. Centers for Disease Control and Prevention recommends quarantining at home for 14 days. The agency defines close contact as:
- being within six feet of someone who has COVID-19 for at least 15 minutes
- providing care at home to someone who is sick with COVID-19
- having direct physical contact with the person, such as a hug or a kiss
- sharing eating or drinking utensils
- being sneezed or coughed on by the person
People with COVID-19 are thought to be most contagious in the early stages of their illness.
Conner is still recovering from COVID-19, and she’s still unclear on how she contracted it. She posted a social media video about her experience in hopes of inspiring people to take the virus seriously.
“I get that there’s a shortage of tests,” she said. “At this point, people should just stay in if you find out you’ve been in contact with someone. Just stay home and monitor yourself.”
That’s what Nicole Stefko and her wife have been doing since their possible exposure at the veterinary office. They were never able to make a testing appointment and they haven’t gotten sick, but Stefko says she’s worried about passing the disease to someone else in the event that they’re asymptomatic carriers.
“Even the peace of mind of having been able to get a test would have made all the difference in the world, I think, in squashing some of those anxieties around that.”
Their self-imposed quarantine will be over this weekend.
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