When area medical practices started to close down in early March due to COVID-19 concerns, Adrienne Clark, a registered nurse, got on the phone with her friends in the healthcare business. She asked if any of them had extra throat swabs and viral culture media, the nutrient-rich liquid needed to keep a virus alive during transport to a testing lab.
“They were like, ‘Oh yeah, we do—why?,’” she says. She explained those relatively common materials were all that was needed to test for COVID-19. But many providers were either unaware of the simplicity of sample collection or unwilling to do the testing in their office, and the supplies were languishing in supply closets unused. Now, many of them have been donated to Clark’s concierge medical practice, Qualified Quacks LLC. Clark sees between 10 and 15 people a day in the course of the house calls she makes on a fee-for-service basis; beginning this week, she has swabbed four to five symptomatic people a day for COVID-19, sending their samples to a Quest lab for testing. “Evaluating doesn’t mean you’re necessarily going to get swabbed, but we will evaluate anyone—and that’s one of the things that doing house calls allows us to do,” she says.
To avoid overwhelming labs, Clark and other Georgia providers are deploying the test carefully, using it only when it can guide treatment and quarantine precautions. That’s a different approach to testing than most Americans are used to—and a different approach than other states are taking—but really, everything in the last two weeks has been different than what most Americans are used to. As a result of our collective crash course in public health, most of us now know what “social distancing” means, and the conversational use of “contact tracing” may be at an all-time high. And a large number of people now understand that widespread testing for COVID-19 is something we don’t have—but should have had for a while.
Testing for the microbe at the heart of an infectious epidemic is a critical part of reducing that microbe’s damage. When public health officials know who’s infected and who isn’t, they don’t have to guess at who needs quarantining. Sure, they can just tell the entire population of a city or state to quarantine themselves—and in many cases, they have—but if you’ve seen the videos of spring breakers crowding Florida beaches, you know that’s often ineffective. Testing gives quarantine instructions weight and authority.
Testing also gives doctors and scientists a lot of information about how a germ behaves within a certain group of people. Imagine that a certain microbe makes 50 of a city’s residents pretty sick, but we know 100,000 residents have been infected—we’d worry a little bit, but we probably wouldn’t cancel life as we know it. However, if we knew that only 100 residents had been infected, we’d react with much greater concern. Without widespread testing, it’s hard to know how to react.
Based on data from countries where testing has been more robust, we know we need to worry about COVID-19. However, because differences between countries’ populations and health care systems might be related to how lethal the disease is, it would be extremely useful to know how lethal the disease has been in this country specifically.
Still, testing for COVID-19 remains unevenly distributed throughout the U.S. and relatively scarce in Georgia. The reasons are complicated: early on, there were problems with a test developed by the Centers for Disease Control and Prevention (CDC). Over the weeks it took to solve those problems, bureaucratic bottlenecks at the Food and Drug Administration caused delays in developing other versions of the test. And while many private companies are now developing several versions of a COVID-19 test and even deploying them broadly within certain localities, the materials they need to scale up production and use of those tests have been in low supply due to high demand worldwide.
Emory University’s laboratory is among many nationwide that have a working COVID-19 test of their own. And while the state health department is reportedly working on a partnership with the university that could expand testing, there may be practical obstacles to overcome: on March 14th, an Emory scientist tweeted a list of supplies his lab would need to conduct COVID-19 testing. Message directly if you can help, he wrote, “and I’ll set you up with contact point.”
It is unclear why state and local public health officials are not scaling up distribution of these tests on a large scale, although the general lack of government resources to handle the scale of the current response probably has something to do with it. Lauren Bricks, COO of the Sandy Springs-based Ipsum Diagnostics, says her lab has developed the capacity to do 1,000 to 1,200 COVID-19 tests per day and on Friday applied for emergency use authorization from the FDA. However, calls to the state public health department, the mayor’s office, and the governor’s office to offer her lab’s capacity have gone unanswered. “I do want to believe that it’s because they’re so overwhelmed,” says Bricks.
In the case of COVID-19, testing does not actually guide treatment—and implementing widespread testing efforts consumes money and manpower while also increasing the risk of transmission to the healthcare workers performing the test and other people sharing the same space. The suspected density of cases in any area helps determine the testing strategy local public health officials design. Friday, for example, in New York City, where there are more than 5,000 confirmed COVID-19 cases, public health officials released guidance discouraging testing people unless they are sick and hospitalized, suggesting that in situations of wide local spread of the virus, public health authorities are pivoting away from testing. The same day, however, the Georgia Department of Health dispatched a team of epidemiologists to investigate a cluster of COVID-19 deaths in Albany, suggesting state and local public health officials think there is still potential to curtail local spread.
At press time for this article, about 170,000 COVID-19 tests had been conducted in the U.S. Other countries scaled up at a much higher clip: South Korea, for example, has tested more than 270,000 people since February, despite having a population one-seventh our size. More than 120 other countries have been testing thousands of people each day using a test developed for the World Health Organization, and while the U.S. could have saved weeks of dithering and delay by adopting this test up front—or even by switching to this test when the delays became evident—it did not. (Although the reasons for that are unclear, they may be largely political.)
Currently, between the CDC and state public health labs nationwide, about 3-5,000 tests are being done every day. Private, commercial labs are scaling up testing, too: LabCorp has announced it now has the capacity to perform 20,000 tests daily across three labs nationwide, and Quest expects to achieve this capacity, also spread across three labs, by next week. More than 3,000 tests have been done so far in Georgia, about 2,300 of them in a commercial lab.
In the meantime, Georgia’s public health officials have asked clinicians to reserve the test for those most vulnerable to severe illness in the event of an infection (such as elderly people and people with chronic underlying health conditions), those at risk of spreading the infection to vulnerable people (like healthcare workers and first responders), and hospitalized people.
Unlike many other tests healthcare providers order, the nasal swab needed to test for COVID-19 isn’t collected at an outpatient lab—it’s collected either in a clinic or, as of this week, at one of 18 drive-through specimen collection sites around the state, where people prioritized for testing could get swabbed for testing using one of hundreds of LabCorp and Quest kits reportedly purchased by the state. People will only be tested at these drive-through sites if they’ve been prescreened by a healthcare provider and have a referral.
The Georgia Department of Health has encouraged people with mild cold symptoms to isolate themselves at home until their symptoms go away. However, people with more severe symptoms should call their doctors or an urgent care center, where staff can determine whether the next steps should involve testing for COVID-19, the flu, or other common infections.