By: David Geller, CPCU, SCLA
A September 2020 collaboration article from the National Institute of Health (NIH) suggests that widescale testing is a key tool that can be used to help contain the spread of COVID-19. The NIH notes in the piece that nearly half of all SARS-CoV-2 infections “are transmitted by people who are not showing any symptoms.” The ability to test asymptomatic individuals could reduce their chances of experiencing more severe symptoms, as well as spreading the virus to others.
A mitigation strategy that expands the scope of testing from symptomatic to asymptomatic individuals could dramatically increase the number of tests needed.
That may not be so easy because, according to a recent report from the Wall Street Journal there is a shortage of key chemicals, known as reagents, that are used to develop and administer COVID-19 tests.
Due to the growing shortage, different hospitals around the country are being forced to restrict their testing, despite the continued spread of the virus. Here are a few examples, per the WSJ:
- Morris Hospital and Healthcare Centers, located about 55 miles from Chicago, only has the capacity to conduct a third of the testing it was doing this past summer. Only patients who are exhibiting COVID-19 symptoms are being tested.
- Riverside Health System, which includes five hospitals and ten nursing homes in Virginia, has reduced the number of tests it conducts by nearly 20%.
- Advocate Aurora Health, which operates 26 hospitals in Illinois and Wisconsin, stopped its community testing programs as a result of the shortage.
Of note, Advocate Aurora Health, per the WSJ, is attempting to adapt to this shortage by launching “pooled testing, which, per the FDA, “increases the number of individuals that can be tested using the same amount of resources.” A separate Wall Street Journal article notes that this technique dates back to World War II to screen for syphilis. The article explains that:
the [pooled testing] process works by combining several patient samples and testing them together. If the result is negative, all are cleared. If positive, in the simplest version, each pooled sample is then run individually to determine which are positive.
In low-prevalence, high-risk settings such as nursing homes or universities, this process allows labs to test more people with fewer resources, enabling wider, repeatable screening, laboratory experts say.
While pooled testing offers some potential to compensate for a testing shortage, the article notes that hot spot regions may have little use for it, given that a high rate of positive results could limit the pooling’s efficiency.
Additionally, back in April, the Nebraska Public Health Laboratory reportedly implemented pool testing, but had to stop when the positivity rate exceeded 10% - this threshold was a provision reportedly established in the lab’s agreement with the U.S. Food and Drug Administration (FDA).
According to the WSJ, 67% of labs are struggling to get both reagents and test kits. This represents a jump from earlier in the summer. In late June and early July, 58% of labs were having trouble obtaining test kits, and 46% experienced issues with acquiring reagents.
Some factors that may be contributing to these shortages are the reopening of schools and increased testing that corresponds with that, as well as the large number of Americans still being inflicted with COVID-19.
Also expressed as a concern in the WSJ article is the looming arrival of flu season; most flu tests reportedly rely on the same components, equipment, and personnel as the COVID-19 tests, which could potentially create even more demand for tests if COVID-19 persists through the winter months.