Las Vegas’ latest challenge on coronavirus front: Lagging test results


Erin Schaff / The New York Times

A lab technician prepares COVID-19 specimens for testing at a Quest Diagnostics facility in Chantilly, Va., April 8, 2020. Just weeks after resolving shortages in swabs, researchers are struggling to find the chemicals and plastic pieces they need to carry out coronavirus tests in the lab — leading to long waiting times.

Sun, Aug 2, 2020 (2 a.m.)

COVID-19 testing was limited in March at the outset of the pandemic to patients showing virus symptoms because of a worldwide shortage in kits. The need for mass testing was a crucial early step in containing the virus.

Now, some five months later and with the tests readily available, a new problem has emerged: Getting test results in a timely fashion.

The sheer quantity of tests — more than 10,000 are administered each day statewide — has overwhelmed Las Vegas-area labs to cause reporting delays of at least a week in some extreme instances because there aren’t enough workers to manually label, report and test specimens, officials said.

A lag in results means residents could be walking around unknowingly as a carrier of the virus, even if they are showing no signs of the illness. About 10% of those tested in Nevada are positive for the virus, which has seen an increase in daily cases by 1,000 for the last three weeks.

“In order for our testing to work, we have to slow the transmission of disease in our community. We have to decrease the demand for testing, and that will allow us to get results more quickly,” said Dr. Brian Labus, the UNLV epidemiologist.

The Southern Nevada Public Health Laboratory is operating at capacity in testing 800 to 1,200 swabs per day, lab director Joseph Benson said. Benson said national commercial laboratories, like LabCorp, do their testing mechanically with fewer people involved, while smaller labs need more staffing.

“We have to have trained technicians to manipulate the specimen and prepare it for the machine then read what’s coming off of it, so it’s a lot more manual in smaller laboratories,” Benson said.

At the Nevada State Public Health Laboratory, which handles all of the tests outside Clark County, the wait time for results can also be delayed, said Mark Pandori, the lab’s director. Hospitalized individuals and first responders might get their test results the same day, whereas those getting tested at a community clinic might have to wait upwards of five days, he said.

Labs are scurrying worldwide to adjust to the demand, exhausting the supply chain for plastic ware, chemicals and the machines used to process tests.

The Southern Nevada Public Health Laboratory has brought in five additional staff members and has plans to hire more technicians. It is also waiting to receive new equipment, which will double the number of swab tests processed each day.

Benson said a new virus test is in the works that will allow the lab to test for both flu and coronavirus on the same specimen, which will be helpful when flu season starts in the fall. Benson said the new equipment will also make patient diagnoses more accurate because the flu and coronavirus have the same symptoms.

“That’ll be really important in about six weeks or two months,” he said.

Swab collection

The most common COVID-19 test is polymerase chain reaction, which detects the direct presence of coronavirus through a nasal swab or a nasopharyngeal swab. False positives are not common in polymerase chain reaction, but false negative results can be as high as 30%, Labus said.

Also, the test won’t detect the virus if a patient gets tested too early after exposure, he said.

The nasopharyngeal swab is inserted to the base of the skull for a collection of specimens from the surface of the respiratory tract. “If their eyes water and they give you this certain face where their eyes get really big, you’re in the right spot,” Benson said.

The nasopharyngeal swab yields more accurate results, Pandori said.

“If you had 100 people who are truly infected and positive on an (nasopharyngeal) swab, and you tested them by nasal swab, you’d find 94 out of 100 of them to be positive. Therefore, you’d miss six cases,” Pandori said.

An antibody test doesn’t determine whether a patient has the active virus. It only determines whether the patient was infected with coronavirus in the past by revealing the body’s immune response, Labus said.

Where to test

Federal law requires private insurance, Medicare and Medicaid to cover COVID-19 tests without a cost to the patient. Those can be conducted at a hospital or urgent care facility with a patient experiencing symptoms, or ordered by a primary care physician to be conducted at a private lab, such as Quest Diagnostics.

For those without insurance, many free options are available locally.

Free testing sites have been established by the Southern Nevada Health District in all corners of the region, including at the health district’s main office at 280 S. Decatur Blvd. An appointment is required.

Drive-thru testing is available at the Texas Station parking garage in partnership with University Medical Center. Make an appointment here. UMC also has drive-thru testing at the UNLV Tropicana parking garage.

All Saints Episcopal Church, in partnership with the health district and Southern Nevada Community Health Center, is also offering free tests. The church is located at 4201 W. Washington Avenue. Pre-register here.

The Mesquite Fire Station has testing for Mesquite, Bunkerville, Moapa Valley and Mohave County residents from 7 a.m. to 9 a.m. Tuesdays and Thursdays. Make an appointment here.

A listing of valley-wide testing sites is available here. Retail chains such as Walmart and CVS also has established testing sites, which vary in requiring an appointment or referral.

The test eventually could be taken in the comfort of your home.

The U.S. Food and Drug Administration is working to help commercial developers get tests to market that you could use at home and buy over the counter like a pregnancy test. Screening at home would allow people to test themselves before visiting an at-risk relative or attending an event.

“These types of tests will be a game changer in our fight against COVID-19 and will be crucial as the nation looks toward reopening,” FDA Commissioner Stephen M. Hahn said in a statement.

Like a pregnancy test, an over-the-counter COVID-19 test wouldn’t be as accurate as one conducted in a lab. But “the tremendous benefits of broader access to simple and fast testing options generally outweighs this risk,” according to the FDA statement.

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