“I help take care of my grandparents, so [it was] important to get tested,” said Michael, who asked to be identified by his middle name. “[I had a] headache, sniffles and some aches.”
After all that, Michael got a $110 bill because when he was laid off, he lost his health insurance. Had he been able to wait, he would’ve paid nothing.
Such is the calculus ordinary Pennsylvanians make as increasing demand and surging COVID-19 infections mean they must wait longer to schedule tests on the front end and even longer to get results on the back end.
And the patchwork system of testing that emerged out of the first surge this spring resulted in vastly different outcomes depending on where people live, how they get tested and what their economic circumstances are.
A dental hygienist in Bucks County was able to get tested the same day she came down with a fever. A few sick days and a negative result later, she’s back to her normal routine. A Philly truck driver, exposed to COVID-19 by a family member, waited in line for hours at a free clinic and he’s still waiting for the result. His employer won’t let him return to work without it.
One Lancaster grandmother shared her plan to ensure Thanksgiving went off without a hitch. Her grown children would be welcome so long as they tested negative and everyone would eat in separate rooms. Masks were to be worn except at mealtime.
But she soon realized her plan had a potentially fatal flaw: None of them could get rapid tests and, by Thursday, most of her family was still awaiting results from samples taken three, four, five days earlier.
“There’s some risk I’m willing to take — but not this much,” she said. “I’ve just thrown up my hands: Thanksgiving canceled. We’ll be eating turkey sandwiches ‘til Christmas.”
Pennsylvania isn’t seeing the 7-to-10-day delays that hampered its COVID-19 response during the spring and summer, when officials scrambled to secure basic supplies like nasal swabs and chemical reagents. Some supply chain concerns remain, particularly if the surge worsens amid holiday gatherings, but most labs are better equipped than they were earlier this year.
Marianne Downes, president of the American Society for Clinical Laboratory Science’s Pennsylvania chapter, said many labs now have several diagnostic tests at their disposal. If a hospital runs into a problem with one test — perhaps a shipment of that test’s chemical reagent is delayed — they can quickly pivot to a different test.
Instead, much of the problem now centers around the need for additional staffing to meet demand.
“With increased demand comes increased delays,” she said. “Where you had several thousand tests a day before, now people are demanding twice that.”
Downes said many facilities already shifted more lab personnel away from routine tests and toward COVID-19 testing. Likewise, many retired technicians have been pressed back into service. But as these technicians fall ill, there’s limited staff to replace them due to how specialized the skillset is.
“You can’t make people appear out of nowhere,” she said. “We do not have a large number of people out of work who can do laboratory diagnostics.”
There has been some movement to train people with no medical background as temporary lab techs working specifically on COVID-19, Downes said, but those efforts have their limits. For one, those people need additional supervision if they run into a problem on the floor they’re less equipped to deal with. For another, training newcomers requires taking an existing technician who could be processing samples out of the lab.
“When you’re training someone, you cut your own productivity in half,” she said. “You’re paying two people to do half the work.”
Despite all of the challenges, Pennsylvania has managed to increase its testing capacity.
The state Department of Health’s lab in Exton, for example, is now able to process about 1,200 tests per day, up from 750 in the spring. Statewide, meanwhile, the total number of daily tests increased from about 7,000 per day in April to about 58,000 per day now.
Even so, Pennsylvania currently ranks second-to-last (ahead of Puerto Rico) in the nation in terms of tests completed per 100,000 residents, according to Johns Hopkins University data.
Department of Health spokesman Nate Wardle said that statistic presents a distorted view of the state’s efforts to expand testing. For example, it excludes multiple coronavirus tests reported on the same person as well as antigen tests, which show whether a person has coronavirus antibodies from a previous exposure.
Likewise, the Johns Hopkins ranking reflects testing rates during the entirety of the pandemic whereas the greatest expansion of testing has come in recent months. In the last week alone, the state saw a 14 percent increase in tests performed.
Based on PennLive’s calculations, if repeat and antigen tests were included, Pennsylvania would have a testing rate of 41,653 tests per 100,000 residents — which would still place it in the bottom 15 of states and territories monitored by Johns Hopkins. And that ranking assumes the change in methodology would only improve Pennsylvania’s standing and not simultaneously lift all states uniformly.
There’s no clear reason for why Pennsylvania lagged so far behind the rest of the country in testing but it’s likely a combination of funding limitations, its geography and politics.
Federal funding distributed via the U.S. Department of Health and Human Services to states for testing and other COVID-19 responses in April wasn’t tied to population. North Dakota received the equivalent of $6 per resident compared to Pennsylvania’s paltry $1.95 per resident. North Dakota, perhaps to no one’s surprise, currently ranks No. 1 in Johns Hopkins’ ranking of testing by population.
Downes also noted that the state’s far-flung geography presents a unique testing challenge. People in more rural areas have limited testing options and those tests may take longer to transport to a laboratory for processing. The state has made strides on that front, partnering with private entities like Walmart to set up testing sites in parking lots and at pharmacies.
The final factor is a lot more difficult to quantify but public health officials are increasingly talking about the dangers of “pandemic fatigue” and the growing mistrust some residents show toward mitigation efforts — even among those who take the initial step to get tested.
That makes enforcing mandates designed to curb the spread of the virus, such as Gov. Tom Wolf’s order requiring those who travel out of state to get tested before returning, more difficult.
Michael Huff, the state’s director of testing and contact tracing, noted that 96 COVID-positive patients reached by contact tracers in the last week refused to quarantine themselves.
It’s not clear what consequences these people could face for willfully exposing an unknown number of people to the virus by not quarantining.
“If an individual choose[s] not to quarantine, we can force them to do so with a court order,” Wardle said, in a written statement. “However, that is not a step the department has taken. When we work to inform people of the need to take these actions, they typically will do so as part of their collective responsibility to protect Pennsylvanians.”
So far, just over 3 million of 12.8 million Pennsylvanians have gotten tested since the start of the epidemic this spring.
Huff said the goal is to ensure anyone who wants a test can get one, although he noted that the state is already prioritizing testing in counties with significant outbreaks — although that’s increasingly every county. The department now identifies 63 of 67 counties as having significant spread.
Starting next month, he said, the department plans to launch a mobile testing program in each county to expand its existing testing capacity.
It’s instructive to think of coronavirus mitigation as a three-legged stool with the legs being testing, contact tracing and public cooperation with masking, social distancing and other guidelines. As the first two components are increasingly strained by short-staffing, public health experts are increasingly calling upon residents to step up.
On Friday, Allegheny County Health Director Debra Bogen made that plain in an urgent plea for people to take responsibility for curbing the outbreak in their community.
“If cases continue to rise at this rate, modeling predicts our healthcare system could be overwhelmed within a month,” Bogen said. “We know that it can take two weeks for changes in behavior to impact the spread of the virus and for case numbers to decrease, which is why I am asking you to start now.”
Wallace McKelvey may be reached at wmckelvey@pennlive.com. Follow him on Twitter @wjmckelvey. Find PennLive on Facebook.
Read the ‘The hunt for Ray Gricar.’
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