All About Testing: Why COVID Testing Matters, And What Issues Persist In The U.S.

Aug 6, 2020

In some locations, it is hard to get a COVID-19 test. In others, supplies are an issue. And yet in others, it takes so long to get results, by the time they’re available, the person who was tested may have already spread the illness. 

To try to better understand what is going on with testing and why, NSPR’s Marc Albert spoke with Elisabeth Rosenthal, the editor-in-chief of Kaiser Health News, a nonprofit news service covering health care policy. 

Here are highlights from their conversation. You can also listen to the full, extended interview at the top of the page.

Interview Highlights

On if the wait time for test results locally — between 6 and 16 days — is fairly typical across the country

Well, it seems to be, but it's kind of catch as catch can, and that's a big problem. Are you gonna be lucky and get your test result in 24 to 48 hours, which is possible? Or whether you're going to get tested for something that's — you really need a test result for and you won't get the test result back for 14 days, despite often promises that, 'Oh, this is going to be quick.' And that leaves people kind of paralyzed. 

On why it’s so important for the results to come back quickly

It depends what you're using the results for, right. If it's someone who needs surgery the next day, I often joke that the best way to get a quick test is to be scheduled for an elective knee replacement the next day. Because then it's in the hospital's interests to do a really quick turnaround so they can get you into the OR for a high-price surgery. Being admitted to the hospital, you want to know if they're COVID infected, because you want to put them in a certain kind of isolation. 

For critical workers, for example, people who work in a nursing home or assisted living place, you don't want them bringing COVID into the nursing home or assisted living. Schools are about to open, you really want to know if students are COVID free before they infect classes and teachers. 

It's important to have a timely result in some cases, because you need to act on it very quickly. If someone's sick with COVID, they get certain treatment. If they're going to the OR tomorrow, you need to know they're COVID negative. But in other situations, where we do see long delays, it's pretty disastrous, because if you're testing everyone to see whether it's safe to go back to school or safe to go back to work, what are they supposed to do, sit there for 14 days and wait for a result? The alternative is that they go in and as most people, many people now who are getting COVID testing, well, it's gonna be likely negative. But what if it's not, then you've exposed a whole classroom, a whole nursing home. So it's really vital that we get these test times down and standardized. 

On why testing is important even alongside other precautions like distancing and wearing masks 

Yes, it's good to take precautions, but there are levels of precautions, right. I wrote for the New York Times the story about how I had my kids come meet me for a beach vacation, right. And I had them get tested before they came down because they had participated in some protests in New York. And it made sense you know, we wanted them to not have to wear a mask when they were around us. But guess what? One of the test results didn't come back for 12 days. And my son, you know, not a great hardship, but he had to wear a mask, 24/7 in the house. We couldn't eat with him. He couldn't help prepare dinner. So if you're going to visit an older relative or someone who's immunocompromised, you really want to know if you're COVID positive or negative because it will impact the way you behave. 

And likewise, if you work in a nursing home or an assisted living place, it really does impact how you behave. You go to a different level. I mean, if you're positive for COVID, and you work in those situations, you should not be going to work — you know, gloves, masks, hand sanitizers, and everything else, you should not be in contact, because all the precautions we can take, while they're important for those well, probably not positive cases or negative cases, if you are positive, they are not enough. If you are positive, you need to isolate.

On why testing was so limited in the U.S. at the outset of the crisis

The initial reason that this was a new virus and they needed to develop tests. Then there were a series of missteps and bungles. The first test, which we knew worked, were distributed, not to the hotspots, but kind of randomly to federal health centers around the country. Then we found out that one of the reagents in those had been contaminated. Then, you know, a test is not like one thing — you need swabs, you need PPE, you need the right reagents to do it. So it was like saying, 'Oh, yeah, we sent you a computer but we forgot to put in the keyboard.' You needed the whole thing to make it work. It just was terribly coordinated. And part of the problem frankly, is that in many other countries, there's been a national testing strategy that was tightly coordinated and choreographed by the central government. In the US. the administration's answer to this was, every hospital, you figure it out, every state, you figure it out. And it was really an impossible task, because you had these poor, you know, sourcing people in states and in hospitals, often competing with each other for swabs, for reagents, who has the test, and this was as the number of tests was ramping up. So, you know, places that thought, 'Oh my gosh, maybe we will get COVID even if we don't have it now.' They ordered a whole lot of stuff. So New York where there was a lot of COVID couldn't get the amounts they needed. It was really, really a total mess and continues to be, but in different ways. 

Now there's a lot more testing out there. There are a lot of testing sites. It's easier to get a test online. Almost too easy one could argue. But then you can't get the results. So what's the point of having a test? If you don't know what the results are for 10 to 14 days, it's really, really diminished. 

This interview has been edited for brevity and clarity. Click the “play” button to listen to the entire interview.