U.S. labs spent millions to bolster Covid-19 testing — and they’re still struggling to keep up

Covid-19 testing capacity strained by surge in demand

13 min readDec 5, 2020

“It’s unimaginably gigantic, the amount that we’re doing, but it’s still insufficient compared to the demand,” one lab director said.

As Covid-19 cases surge across the United States, the outbreak is threatening to overwhelm the testing capacity at facilities that have spent months and millions of dollars to ramp up their capabilities, according to laboratory directors in six states.

Dr. Geoffrey Baird, who oversees all Covid-19 diagnostics as the acting chair of the University of Washington’s laboratory system, said he spent an estimated $30 million earlier this year to build up its labs, which now boast a total workforce of 1,500 — a tenth of that hired to focus on Covid-19.

But even that operation is now struggling to handle the surge.

“It’s unimaginably gigantic, the amount that we’re doing, but it’s still insufficient compared to the demand,” Baird said. “Lowering demand is honestly the most effective way to address supply.”

Lab directors in four states said that well-known suppliers of the devices and kits required for different testing platforms are manufacturing as much as their existing physical facilities allow, and so are limiting the allocations they can sell to individual laboratories.

Several also said these limitations were having a secondary impact on diagnostic tests for other diseases, too, thanks to an ever-changing picture for even the most basic testing materials, including chemical reagents and the plastic pipette tips used by the thousand in labs to guarantee consistent sample sizes.

The current supply and demand crunch for even these simple items of lab equipment is pushing the limits of their staff, testing systems and clinical care teams, the laboratory directors said.

“We’re seeing supply chain shortages around many of our tests,” said Dr. Robin Patel, director of the Infectious Diseases Research Laboratory at the Mayo Clinic in Rochester, Minnesota. “In many cases, not having anything directly to do with SARS-CoV-2 testing, which is complicated, and highly inefficient and also affecting patient care.”

Multiple lab officials said this has meant tests are carried out too slowly, or have been rationed for patients with several suspected illnesses, including gastroenteritis, sepsis, gonorrhea and chlamydia.

Dr. Kathleen Beavis, a professor of pathology and the medical director for quality at the University of Chicago’s laboratories, said the overwhelming number of tests recently meant some urine samples for patients with suspected sexually transmitted diseases had sat in her lab too long to be usable, while a component required to check for meningitis in children had been unavailable, causing a delay in diagnosis.

“I feel like it’s whack-a-mole,” she said. “And in all honesty, some things are falling through the cracks,” particularly as exhaustion sets in amongst her staff.

“We’re really suffering, I think, with morale and fatigue, and without the infrastructure that we normally have to combat some of this,” Beavis said. “I just wonder how much longer they can continue to do it.”

The fact that these supply shortages can curtail testing options is “definitely scary,” said Dr. Gary Procop, medical director for clinical virology at the Cleveland Clinic. “It’s not a pleasant life for a laboratory manager right now.”

He oversees Covid-19 testing for the Cleveland Clinic’s 1,200-bed flagship hospital, plus hundreds of other patients at hospitals and family health centers throughout the same system, most of them in Ohio. He said he had essentially built an entirely new second laboratory for the coronavirus, and must often ensure all six test platforms are humming at once just to keep up with demand.

But even his facility employs what Procop labels “test triage,” prioritizing urgent care patients over others for the fastest turnaround platforms, and minimizing testing access for asymptomatic patients.

And this agonizing form of triage — in a hospital’s laboratory rather than its emergency room — may prove increasingly necessary in the difficult weeks ahead, amid the repeated insistence from federal and state authorities that regular community testing is the only way to combat the crisis before vaccines arrive.

Several officials said that over the course of the summer, shipments ordered to their labs were reduced by manufacturers or redirected elsewhere to parts of the U.S. where facilities were facing even more pressure from Covid-19 patient requirements. And so as the national picture worsened, many laboratories introduced a form of test pooling — allowing multiple patient samples to be tested at once, to save burning through limited supplies too quickly.

But in areas with high Covid-19 prevalence, this kind of pool testing can become numerically inefficient.

“At a prevalence of about 10 percent, our pooling strategy breaks down because too many of the pools are positive,” Baird said.

That’s left Baird to make a difficult request, particularly of those displaying no symptoms who want to socialize with friends or gather with their families over the holidays.

“We’re asking folks now, you know, please don’t go get tested,” he said.

The mysterious neurological symptoms experienced by American diplomats in China and Cuba are consistent with the effects of directed microwave energy, according to a long-awaited report by the National Academies of Sciences that cites medical evidence to support the long-held conviction of American intelligence officials.

The report, obtained Friday by NBC News, does not conclude that the directed energy was delivered intentionally, by a weapon, as some U.S. officials have long believed. But it raises that disturbing possibility.

NBC News reported in 2018 that U.S. intelligence officials considered Russia a leading suspect in what some of them assess to have been deliberate attacks on diplomats and CIA officers overseas. But there was not — and is not now — conclusive intelligence pointing in that direction, multiple officials who have been briefed on the matter said.

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A team of medical and scientific experts who studied the symptoms of as many as 40 State Department and other government employees concluded that nothing like them had previously been documented in medical literature, according to the National Academies of Sciences report. Many reported hearing a loud sound and feeling pressure in their heads, and then experienced dizziness, unsteady gait and visual disturbances. Many suffered longstanding, debilitating effects.

“The committee felt that many of the distinctive and acute signs, symptoms and observations reported by (government) employees are consistent with the effects of directed, pulsed radio frequency (RF) energy,” the report says. “Studies published in the open literature more than a half-century ago and over the subsequent decades by Western and Soviet sources provide circumstantial support for this possible mechanism.”

While important questions remain, “the mere consideration of such a scenario raises grave concerns about a world with disinhibited malevolent actors and new tools for causing harm to others, as if the U.S. government does not have its hands full already with naturally occurring threats,” says the report, edited by Dr. David Relman, a professor in medicine, microbiolology and immunology at Stanford, and Julie Pavlin, a physician who leads the National Academies of Sciences global health division in Washington.

Aug. 2017: ‘Acoustic attack’ in US embassy in Cuba blamed for diplomats’ hearing loss
AUG. 10, 201702:32
In the last year, as first reported by GQ Magazine, a number of new incidents have been reported by CIA officers in Europe and Asia, including one involving Marc Polymeropoulos, who retired last year after a long and decorated career as a case officer. He told NBC News he is still suffering the effects of what he believes was a brain injury he sustained on a trip to Moscow.

A source directly familiar with the matter told NBC News the CIA, using mobile phone location data, had determined that some Russian intelligence agents who had worked on microwave weapons programs were present in the same cities at the same time that CIA officers suffered mysterious symptoms. CIA officials consider that a promising lead but not conclusive evidence.

The State Department and the CIA did not immediately respond to a request for comment late Friday. Russia has denied any involvement in the incidents.

The study examined four possibilities to explain the symptoms: Infection, chemicals, psychological factors and microwave energy.

“Overall, directed pulsed RF energy … appears to be the most plausible mechanism in explaining these cases among those that the committee considered. … The committee cannot rule out other possible mechanisms and considers it likely that a multiplicity of factors explains some cases and the differences between others.”

The report says more investigation is required.

Image: FILE PHOTO: Tourists in a vintage car pass by the U.S. Embassy in Havana
Tourists in a vintage car pass by the U.S. Embassy in Havana on Nov. 1, 2018.Alexandre Meneghini / Reuters
Electromagnetic energy, including frequencies such as radio and microwave, have been considered a leading possibility since the earliest days of the mystery. Early on, investigators also considered the possibility that sound waves, toxins or other mechanisms could have been involved, although no evidence is known to have emerged to support those theories.

Over the years, the FBI, CIA, U.S. military, State Department’s Diplomatic Security Service, National Institutes of Health and Centers for Disease Control and Prevention have investigated the incidents. None has come forward with any conclusions, and the State Department has quietly ceased using the word “attacks” to describe what happened, as then-Secretary of State Rex Tillerson and other top officials did in the early days after the incidents first came to light publicly in 2017.

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NEWS
Evacuated after ‘health attacks’ in Cuba and China, diplomats face new ordeals in U.S.
Starting in late 2016, U.S. diplomats and other government workers stationed in Havana began hearing strange sounds and experiencing bizarre physical sensations and then fell ill. The incidents caused hearing, balance and cognitive changes along with mild traumatic brain injury, also known as concussion.

More than two dozen U.S. workers who served in Cuba and a smaller number of Canadians were confirmed to have been affected, in addition to one U.S. government worker in China who was judged in 2018 to have experienced similar symptoms.

For some of the affected employees, those symptoms have resolved and the individuals have eventually been able to return to relatively normal lives. For others, the effects have lingered and posed an ongoing and significant obstacle to their work and well-being, according to NBC News interviews with U.S. officials who were assessed by the government to have been affected.

Sept. 2018: U.S. officials suspect Russia in mystery medical attacks on diplomats in Cuba
SEPT. 11, 201801:03
Cuba has adamantly and consistently denied any knowledge or involvement in the incidents. In late 2018, NBC News reported that U.S. intelligence agencies investigating the incidents considered Russia to be the main suspect, based on interviews with three U.S. officials and two others briefed on the investigation.

Some outside medical experts uninvolved in the investigation have speculated the workers might have simply suffered from mass hysteria. But doctors who evaluated the patients at the University of Pennsylvania, including through advanced brain imaging, found differences in their brains, including less white matter and connectivity in the areas that control vision and hearing than similar healthy people.

Secretary of State Mike Pompeo, asked in October about the investigation, indicated there was still no firm conclusion, although he bristled at the allegations that have been raised by many of the affected diplomats that the State Department took insufficient steps to protect them and ensure adequate care after they were injured.

“We’ve done a lot of work to try and identify how this all took place,” Pompeo said. “And we continue to try and determine precisely the causation of this while doing our best to make sure we’re taking care of the health and safety of these people.”

The report recommends that the State Department establish a response mechanism for similar incidents that allows new cases to be studied more quickly and effectively.

The pandemic has pushed millions of Americans to the cliff’s edge, with the ground crumbling at year’s end without further stimulus action by Congress.

When federal emergency coronavirus relief protections expire, some as soon as the day after Christmas, 13 million Americans will lose their jobless benefits. Many more face eviction, or will find student debt has come due.

Nine months in to the pandemic, the latest jobs report showed the economy in November gained a paltry 245,000 jobs out of the 10 million yet to be recovered, underscoring the need for swift remedy.

It “confirms we remain in the midst of one of the worst economic and jobs crises in modern history,” President-elect Joe Biden said in a statement released Friday, noting that the “grim” snapshot of the economy comes “before the surge in Covid-19 cases and deaths in December as we head into a dark winter.”

When the CARES Act was signed, there was enough money flowing so that workers could stay home while still paying their bills. It was an unusual sight: Amid the mass layoffs, people were still paying their rent and credit card bills and were protected from losing their home. That’s exactly what the bill’s signers calculated for. They knew how much money it would take to keep the economy on life support.

But with the coronavirus dragging on for longer than anyone had imagined, the appetite for protection measures developed inconsistently across America, and full bipartisan support for further spending withered.

Lawmakers hit an impasse earlier this year when Democrats pushed for $2.2 trillion in aid, while Senate Majority Leader Mitch McConnell, R-Ky., sought a smaller package of $550 billion.

“It’s another fiscal cliff when families have already gone over a fiscal cliff,” Diane Swonk, chief economist at Grant Thornton, told NBC News. “It really means we’re allowing the wounds triggered by Covid to fester and become scars.”

According to an analysis by the left-leaning Economic Policy Institute, if the pandemic unemployment insurance benefits were reinstated and the virus was brought under control, over 5 million jobs could be created or saved.

Half of America is working from home and insulated from the sight of wraparound lines at the food banks and growing homeless tent encampments in some parts of the country like Austin, Chicago, and Charlotte, that might normally stir their concern.

“With the vaccine coming, it’s going to be worse before it gets better,” Swonk said. “Anyone waiting for the economy to reopen, you can starve in that period.”

There have been some signs of support for a new $908 billion stimulus package. House Speaker Nancy Pelosi, D-Calif., said Friday that there is “momentum” on Capitol Hill to reach a deal on coronavirus relief, further optimism that legislation could be approved before the end of the year.

“I am pleased that the tone of our conversation is one that is indicative of the decision to get the job done,” Pelosi told reporters Friday.

The deal would provide for additional unemployment payments through March, but would not include another round of stimulus checks.

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Relief can’t come soon enough for millions of families.

Rachel Alvarez, 44, a single mother of three in Naples, Florida, was making $6,000 a month as a server. Laid off in March, her unemployment benefits — which expire on Dec. 26 — barely cover her rent. That leaves her scrambling daily in food lines to fill the fridge.

“We need that federal [supplemental unemployment benefit],” Alvarez told NBC News. “Here we are in the pandemic, highest numbers and death rates and no relief before the holidays? It’s crazy. It is not okay.”

Next month, if things don’t improve, Alvarez said she will have to seek restaurant work again, even though she hasn’t fully recovered from a recent bout of pneumonia and one of her sons has a lung condition.

“I’m worried I might be dead” from coronavirus, she said. “But I’d rather work and provide for my family and put myself at risk than not provide.”

Desperate families keep falling down the ladder, uncertain of what comes next, after the fumes they’ve been running on start to dissipate.

Kelly Ann Hotchkin from Hamilton, New Jersey, was out of work for 7 months and went back to work for a month and a half, only to be furloughed again. Her husband is out of work too. They have four kids from ages 2 to 13. She only gets $231 a week in unemployment.

“We’ve gone through every penny of our savings, my husband is going through the appeals process for unemployment now,” Hotchkin told NBC News in an online message. “I have zero ability to provide even one gift for our kids’ Christmas this year and apparently the government’s gift to us is to completely screw us the day after Christmas.”

The nationwide public health eviction moratorium implemented by the Centers for Disease Control and Prevention expires on Dec. 31. However, there has already been a surge of people living in their cars and tents, said Vanessa Brito, 37, a Miami political consultant who has voluntarily been helping thousands of people navigate Florida’s glitchy unemployment filing system. The eviction freeze still requires tenants to attempt to make minimum payments to their full ability using what government benefits they have.

“Imagine what comes Dec. 26. People are already living in their cars,” Brito said. “They’re going to be out on the street.”

Desperation has set in for many families, she said.

“We’ll take $100 extra. We’ll take anything. So please, sign off on something.”

U.S. labs spent millions to bolster Covid-19 testing — and they’re still struggling to keep up

Covid-19 testing capacity strained by surge in demand

Written by Pasoye