When a stay-at-home order in March all but closed the revered labs of the gene-editing pioneer Jennifer Doudna, her team at the University of California, Berkeley dropped everything and started testing for the coronavirus.
They expected their institute to be inundated with samples since it was offering the service for free, with support from philanthropies. But there were few takers.
Instead, the scientists learned, many local hospitals and doctors’ offices continued sending samples to national laboratory companies — like LabCorp and Quest Diagnostics — even though, early on, patients had to wait a week or more for results. The bureaucratic hurdles of quickly switching to a new lab were just too high.
“It’s still amazing to me, like, how can that be the case, that there is not a more systematic way to address a central need?” said Fyodor Urnov, the scientist who oversaw the transformation of the Innovative Genomics Institute into a clinical laboratory.
The inability of the United States to provide broad diagnostic testing, widely seen as a pivotal failing in the nation’s effort to contain the virus, has been traced to the botched rollout by the Centers for Disease Control and Prevention, the tardy response by the Food and Drug Administration, and supply shortages of swabs and masks.
Yet one major impediment to testing has been largely overlooked: the fragmented, poorly organized American health care system, which made it difficult for hospitals and other medical providers to quickly overcome obstacles to testing.
Despite calls for more than a decade to create a national laboratory system that could oversee a testing response in a public health crisis, there is, in fact, little coordination among public and private health labs, said Scott Becker, the chief executive of the Association of Public Health Laboratories, an association of state and local government labs. An effort to create one 10 years ago withered away over time for a lack of funding, he said.
“We do not have a national laboratory strategic plan,” Mr. Becker said. “All of these things need to come together in an emergency.”
In recent days, President Trump has delivered a mixed message on testing, saying on May 11 that in ramping up, “we have met the moment and we have prevailed,” while a few days later, he suggested that testing was “overrated” and that the high number of cases in the United States could be traced to more prevalent testing.
The picture for testing is slowly improving. The United States is completing more than 300,000 tests a day, double the amount of a month ago, according to the Covid Tracking Project. A new, high-capacity test by the manufacturing company Hologic is being shipped to labs around the country, offering the potential to double testing capacity in many cases. Some states, like California, Rhode Island and Minnesota, have undertaken widespread testing of residents. And the federal government is beginning to distribute $11 billion to support state testing efforts, which was authorized by Congress in April.
When the Berkeley Institute didn’t get the expected influx of tests, it shifted to work with the city of Berkeley and other local groups to conduct the kind of blanket testing — of front-line workers and other at-risk groups — that many public health experts believe will be necessary to safely reopen society.
And companies like LabCorp and Quest, which were inundated with orders as the pandemic spiked in hot zones, have since cleared their backlogs. They, too, said they could be doing more testing, a mismatch that has complex causes, including an outdated sense by doctors and members of the public that the availability of testing remains scarce.
Still, the level of testing in the United States is orders of magnitude less than what many epidemiologists say it should be. The country should be doing at least 900,000 tests a day — and as many as 20 million — to yield an accurate picture of the outbreak, they say. The need for extensive testing is even more acute as many governors have reopened their states before the epidemic has crested.
Most testing is not done by public health authorities — whose labs have been chronically underfunded — but by hospital laboratories and major for-profit testing companies.
Some of the biggest industry players, including LabCorp and Quest, have consolidated their influence for years, buying up smaller competitors and negotiating exclusive deals with insurers and large health systems.
In many hospitals and doctors’ offices, ordering from major testing companies is built into electronic health records, making the request for test results from a leading company nearly as seamless as buying shoes from Amazon.
As a result, it is much harder for labs like the one in Berkeley to join the national effort to ramp up testing.
Representatives of other laboratories, including at the University of California, San Diego and the for-profit Eurofins Clinical Diagnostics, said they were surprised when they heeded the call to scale up testing in March but were not sent as many samples as they could manage, even as public health experts complained that the country was not testing nearly enough.
“There’s all this talk about doing more testing,” said Ryan Thomas, a co-owner of Centennial State Laboratory in Colorado, which quadrupled its staff in March and bought extra testing machines but has not received nearly as many tests as they have the capacity to process. “We are here, and we’re here to help.”
Dr. Deborah L. Birx, who is coordinating the White House coronavirus response, has made the issue of unused testing capacity a major talking point. A team from the Walter Reed National Military Medical Center recently sent a list of such labs to states. But the directors of several labs said they have not seen an uptick in requests since she highlighted the issue.
“We are now reaping what we sowed for the last several decades,” said Dr. Geoffrey S. Baird, the interim chairman of Laboratory Medicine at the University of Washington School of Medicine, which operates one of the biggest academic clinical labs in the country. “It’s not a six-week solvable problem. It’s not, buy more tests, get more swabs, and all of a sudden, we’re going to have a public health system.”
In normal times, scientists at the Innovative Genomics Institute at Berkeley spend their time advancing the gene-editing technology called Crispr that the lab’s founder, Dr. Doudna, is known for.
But after the pandemic shut down the institute’s research in March, Dr. Doudna called for volunteers to redirect most of the labs’ work to coronavirus testing. The country was clamoring for more tests, after all, and her lab was full of researchers with the technical skills to make it happen.
Unlike many other major research institutions, Berkeley does not have a medical school or run its own hospital. So Dr. Urnov reached out to others in the area, who were still ordering from LabCorp and Quest, despite lengthy delays in processing results at the time.
“We would come to these entities and say, ‘Hi, we hear you have problems,’” Dr. Urnov recalled. “And they said, ‘Well, you have to basically work with our EHR,’” the acronym for electronic health records.
Dr. David T. Pride, the director of the molecular microbiology laboratory at University of California San Diego Health, built a special lab to process the flood of coronavirus tests he expected to receive. But his lab is generally running 800 tests a day when it could do 1,200. He said competing hospitals have been reluctant to use his services or enter into the contracts required between major institutions.
“When things like this happen, where there’s a need to come together, there isn’t always the will for people to come together,” Dr. Pride said.
Eurofins, based in Europe, has 14 clinical labs in the United States. It started offering coronavirus tests to U.S. hospitals and doctors in March, but an executive said the labs were frequently operating at about half their capacity of 10,000 tests a day.
Frequently Asked Questions and Advice
Updated May 20, 2020
How many people have lost their jobs due to coronavirus in the U.S.?
Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Is ‘Covid toe’ a symptom of the disease?
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
Puzzled by the low volume, the executive, Dean Tassone, Eurofin’s vice president for payer services, said he wrote to a host of state and federal officials, including representatives of the White House coronavirus task force. He said he found it “bizarre” that so many governors have talked about a lack of available testing.
“The capacity is there, it’s simply not being utilized,” he said. “There’s this economic dysfunction that’s occurring.” Weeks after the company had reached out to New York officials, Gov. Andrew Cuomo’s office contacted Eurofins last Friday to assist with testing, the company said. Its labs will now provide testing for nursing homes in five of the state’s counties.
LabCorp and Quest, as well as other large players like BioReference Laboratories and Sonic Healthcare, have competed for years to win the loyalty of doctors and hospitals, and to make ordering a test as frictionless as possible. Large health systems, which often run their own labs, have also gotten into the game, requiring doctors in the practices they have bought to use in-house labs.
“They’re all trying to make ordering as easy and as paper-free as they can,” said Jondavid Klipp, the publisher of Laboratory Economics, an industry trade publication.
The biggest lab companies have also been buying up smaller competitors, and negotiating exclusive arrangements with major insurers like UnitedHealth and Aetna, part of CVS Health.
Even though federal legislation has required that testing for coronavirus be covered, with no out-of-pocket costs to consumers, Mr. Thomas of the Centennial lab said that doctors who order coronavirus tests also often send out for tests of other viruses, like the flu, at the same time. Many insurers require those tests to be done by in-network labs like LabCorp or Quest.
Adam H. Schechter, LabCorp’s chief executive, said in an interview that hospitals and doctors chose his company because “we’re a trusted partner and have been in this country for over 50 years now. We have a lot of longstanding relationships.”
The large companies said they do accept the overflow from some public health laboratories. And a spokeswoman for Quest said the company it is working on a plan to sending specimens to smaller, independent labs who could process extra tests.
Many of the smaller laboratories have since abandoned efforts to run tests for hospitals and doctor’s offices. Instead, they are focusing on broad-based testing of high-risk groups of people, like health care workers and nursing home residents, to help officials determine when it will be safe to permit residents to return to some semblance of normalcy.
Dr. Bob Kocher, a partner at the venture capital firm Venrock who is on California’s testing task force, said the state is in touch with the labs at Berkeley and San Diego. While the level of testing so far is a little more than half of the state’s lab capacity, he expects that will change as the state reopens and more people will need to be tested. “I think excess capacity today is ethereal and about to be used up,” he said.
The Centennial lab in Colorado is testing nursing home residents and employees of companies that are planning to reopen their offices. But Mr. Thomas said they could be doing far more.
“We have staff members willing to work the overnight, graveyard shift,” he said. “We’re here, and we have capacity, and we are available to do the testing.”