The troubling realities of slow COVID-19 testing

Many Americans are already aware that, in the initial weeks of the COVID-19 crisis, our nation failed to test broadly. The implications of this grave error will only become clearer with time. Meanwhile, some public officials seem to believe that the country’s testing problems have since been resolved. On the contrary, COVID-19 testing remains a significant and troubling bottleneck. 

Although COVID-19 screening capacity has improved over the past few weeks, laboratory backlogs, limits on test supplies, and slow processing times continue to exacerbate the dire shortages of hospital beds, staff, and protective gear. And each day at hospitals throughout the country, the inability to rapidly and readily test for COVID-19 results in the treatment decisions that require prolonged isolation periods for patients, triage decisions made in the absence of confirmed diagnoses, and disruptions to both routine and urgent care.

 We are internal medicine resident physicians at a large, multi-hospital academic health center. We serve in primary and specialty care clinics, emergency departments, hospital wards, and ICUs. Motivated by our front-line experiences in this pandemic and driven by our Hippocratic obligations to continue providing the best care possible, we are sounding the alarm for faster COVID-19 testing.  

Slow turnaround times for tests have broad implications within hospitals. Care teams must manage all patients screened for COVID-19 as though they actually have the disease. This means full isolation measures with higher staffing ratios and head-to-toe protective gear until tests rule-out patients as uninfected.  

Some patients must wait for important diagnostics, procedures, or treatments for their non-COVID-19 medical conditions to assure that they, and those around them, are not put at risk should they test positive. Health care workers, too, are sent into lengthy quarantine while tests are pending, depleting a workforce that is already in short supply.

Hospitals have had critically ill patients who have gone into cardiac arrest before tests showed they were negative for COVID-19. To administer life-saving care in situations like this, medical teams must don gowns, gloves and masks. Even small delays in resuscitation measures can have life-and-death consequences.  

Slow result times also force care teams to make aggressive medical decisions. For patients who are suspected to have COVID-19 — a disease known to cause rapidly progressive respiratory failure — it is now standard to sedate and insert breathing tubes sooner than we otherwise would. Making swift leaps to invasive procedures and mechanical ventilation without first trying less severe interventions is a major deviation from the pre-COVID-19 norm.  

While we are troubled by COVID-19 testing pitfalls, we are also full of hope. It is inspiring to work alongside brave colleagues who continue to meet the demands of a rapidly changing and increasingly challenging health care environment. And we feel grateful to serve in settings that are well-equipped to keep patients and employees safe. But, in light of the difficulties hospitals confront during this crisis, we worry all the more about centers of care with fewer resources. 

The good news is, we know we can do better; we know what our local and global communities can achieve. Rapid, point-of-care COVID-19 tests already exist in several forms and have been implemented in the facilities in which we work. These tools can yield results in a matter of minutes but are not yet widely available in hospitals across the country. 

What we ask is that our government officials do everything in their powers to guarantee further development and wide dissemination of necessary testing supplies, regardless of whether this involves subsidies to defray costs, policies to expedite production, or grants to foster innovation. We only hope that they recognize our lives are in their hands and that the gravity of this crisis induces them to act swiftly.  

Maggie Salinger, M.D., M.P.P. and Kathleen Pollard, M.D., are internal medicine resident physicians at Duke University Hospital. Views are their own.