As states begin to loosen COVID-19 restrictions and businesses and schools consider reopening, testing is repeatedly cited as a key component in mitigating risk and returning to a new normal.
Many labs in the United States are still reporting a shortage of the supplies and personal protective equipment needed to test patients for COVID-19, according to an ongoing survey conducted by the American Association for Clinical Chemistry. Without these resources, experts say labs across the country are unable to meet the growing demands and provide critical results for making decisions about isolation and contact tracing.
"We surveyed over 100 laboratories and asked them multiple questions to try to find out where people were struggling, thinking that supply issues have likely been managed but in fact they were not," Dr. Carmen Wiley, AACC's president, told ABC News.
The AACC, which oversees clinical laboratories across the country, found that more than 50% of labs were still unable to obtain enough supplies in May, such as swabs to collect samples and chemical reagents and testing kits to perform COVID-19 PCR diagnostic testing. Making matters worse, 40% of the labs were unable to obtain the PPE needed for scientists to perform the testing safely.
In April, the AACC reached out to Dr. Deborah Birx, the United States coronavirus response coordinator, with similar concerns. In a letter, the AACC asked that the task force address supply chain issues by creating a system through which labs can report their supply levels and by mobilizing federal government resources to increase production and allocate resources.
Now, the association has reached out yet again to Birx with new survey results showing that these issues persist.
"We actually just heard back from Dr. Birx that she wants to meet with us to understand the survey and lab shortages," said Wiley.
Wiley characterized the survey's results as "shocking," adding, "It's been several months that we entered into this pandemic and the fact we are still having basic supply issues is very concerning."
The College of American Pathologists has conducted surveys that reported similar findings.
"The shortages of transport media, swabs and reagents are very much with us," said Dr. Patrick Godbey, president of the College of American Pathologists. "We don't manufacture enough. The demand is going up and will continue to go up."
In one of the hospitals he works at, located in southern Georgia, Godbey anecdotally shared that the institution asked for "120 test kits a week only to receive 20 last week."
Testing capacity is critical for two reasons. First, to see if patients with symptoms actually have coronavirus. Second, to see if their contacts who do not have symptoms have coronavirus. Especially in the latter case, test results help determine whether individuals should be isolated to prevent further spread of symptoms. When testing supplies are unavailable, doctors and labs must make difficult decisions about who to test and who not to test. In these cases, they end up testing fewer individuals than the Centers for Disease Control and Prevention recommend.
According to Wiley, testing is crucial in understanding who is infected, how the virus may spread and how to treat patients. Godbey echoed these sentiments but added that testing is not a substitute for recommended public health preventative measures.
As states enter the next phase and loosen restrictions, there will be a greater need to test individuals, screen for disease and contact trace for close contacts. This operation can only run smoothly with adequate supplies and quick turnover of results.
"It is extremely important to do a large percentage of these tests locally because thats where the patients are," said Godbey.
In her local community in Washington state, Wiley said limited supplies are forcing hospitals to prioritize whether to screen inpatients or people undergoing surgeries. When it comes to contact tracing, they typically must send samples to a large reference lab. Transport time can delay results for multiple days. Quick turnover of results is critical in tracing new cases and preventing infections from continuing to spread in the local community. Having answers quickly also allows health care providers to more strategically allocate limited personal protective equipment, hospitals beds and isolation rooms.
"We know the answer isn't simple. We need the task force and Dr. Birx to investigate why we are still experiencing these supply issues," said Wiley. "One we understand why, we can design and implement a plan on the federal level that organizes these supplies so that they can be allocated at the state and regional level."
Eden David, who studied neuroscience at Columbia University and is matriculating to Icahn School of Medicine at Mount Sinai later this year, is a member of the ABC News Medical Unit. Stephanie E. Farber, M.D., is currently completing her final year of plastic surgery residency at the University of Pittsburgh Medical Center and is a medical contributor to the ABC News Medical Unit.