As the U.S. pandemic enters its sixth month, more and more Toledoans are seeking coronavirus tests.
“When we first started, testing was fairly moderate,” said Kate Wesolowski, the building manager and administrator for Greater Toledo Urgent Care. “In the last two to three weeks it has become almost overwhelming.”
“Here at our health center, the phones have rung all day,” said Beth West, Health Partners of Western Ohio’s chief operating officer.
A surge in demand and a shortage of necessary supplies has created a testing backlog, delaying coronavirus test results for many in Toledo and nationwide. Those seeking results are left in limbo for a week or more, unsure if they are infected or not.
But these delays’ impact is not limited to individuals — they also cripple public health officials’ ability to effectively track and control the virus through contact tracing.
Calls to testing locations around Toledo reveal official turnaround times that range anywhere from three to 10 days, and many also have days-long waits to schedule testing appointments.
An automated message for the CVS pharmacy on Byrne Road cautions callers that results can take from six to 10 days or longer. Ms. Wesolowski estimated that Greater Toledo Urgent Care locations in Sylvania, Rossford, Waterville, and Toledo are seeing results in three to five days.
Ms. West said results at Health Partners’ testing locations are taking five days. Darlene Rodriguez, who works in the call center for the Neighborhood Health Association, said their results have been averaging five to seven days, with some taking 10.
But officials have seen testing turnaround times that have lasted even longer.
“We’ve seen anecdotal issues of results taking 14 or more days,” said Eric Zgodzinski, the health commissioner for the Toledo-Lucas County Health Department. “It’s not just five, seven, or 10-day delays. We’ve had a couple of ones where we say, ‘What are we going to do?’ because that’s the same time as [the recommended length of] quarantine.”
Contact tracing for the coronavirus is sort of like racing against world-record runner Usain Bolt — public health officials have to constantly try and catch up to where the virus has already spread.
The purpose of contact tracing, explained Dr. Bill Miller, epidemiology professor and senior associate dean of research at Ohio State University, is to find people exposed to a positive case and ask them to quarantine to prevent further spread. If any of those exposed people test positive, the process begins anew.
“Contact tracing is so important,” he said. “We need to do it well, we need to do it effectively and we need to have people follow the guidelines.”
Many others agree that contact tracing is the best strategy against the virus, although there have been reports of people refusing to answer questions or quarantine if exposed.
Another big problem occurs when that testing is delayed. Public health officials fall further behind in the race and their picture of the virus’s spread becomes ever more outdated.
Professor Joseph Dake, chairman of the School of Population Health at the University of Toledo, said these delays’ effects on contact tracing’s effectiveness should be viewed as a continuum between the best case scenario — a perfect test with instant results — and the 14-day delays that essentially render tracing efforts futile.
“It’s not like there’s a line in the sand where it’s effective and where it’s not,” he explained. “We just want to keep it as tight as possible. But anytime we’re getting beyond three to four days, I’m really uncomfortable from a community perspective.”
The longer the wait time, the more opportunity there is for a tested individual to unknowingly spread the virus to others, increasing the amount of people exposed.
Adding to the problem is the nature of the coronavirus itself. People with coronavirus are most infectious before their symptoms start and at the beginning of symptom onset, which takes an average of five to seven days.
If tests are delayed by a week or more, those who have come into contact with a positive case will already be spreading it to others before they even know they were exposed. Essentially, the coronavirus will have lapped those trying to catch it.
Mr. Zgodzinski also pointed out that after a few days, it can be difficult for people to accurately remember who exactly they were in contact with.
“Try to recall who you were with five days ago,” he said. “That’s tough for anybody.”
One way to mitigate delays’ impact, Mr. Zgodzinski said, is for everyone who gets a test to quarantine while they wait for their result — eliminating their chance of spreading it in the interim.
This is not a one-size fits all solution, however. People are infectious before they feel sick enough to get a test, meaning that they could have passed the virus along even if they quarantine once they start feeling ill.
And as Professor Brian Fink of UT’s School of Population Health observed, not everyone is able to effectively quarantine from work and other obligations once tested — particularly if they have to wait a week for results.
Another possible solution is to use a different kind of test. Most of the diagnostic coronavirus tests done thus far use a technique called polymerase chain reaction, which amplifies the virus’s genetic code. While highly accurate, the amplification process can take hours to perform, contributing to the delays.
The alternative are antigen tests, which look for specific viral proteins and produce results within an hour. Although they produce more false results than PCR tests, their speed would allow for far more rapid and effective contact tracing.
Many health-care providers have been seeking these point-of-care tests for months. Ms. West, the Health Partners COO, said they have been on the waiting list for point-of-care testing since March, and original promises for test-kit deliveries by June keep getting pushed back.
Ohio Gov. Mike DeWine recently announced a partnership with six other states and the Rockefeller Foundation to purchase 3.5 million rapid antigen tests, although the timeline for these tests’ delivery is still unclear.
As students start to return to class, Mr. Zgodzinski said contact-tracing efforts are a “major tool” for curbing the disease inside schools.
“If we’re waiting three to four days to get someone tested and five to six days to get results, it’s almost a battle you can’t win,” he said.
First Published August 16, 2020, 11:30 a.m.
