State officials took forceful steps months ago to ensure free COVID-19 testing for any Tennessean, regardless of symptoms. But, as the caseload surges by thousands, there is not a statewide approach to address issues that have surfaced as wait times for test results grows.
Tennessee health leaders want to see wait times at two days or less, but the surge in testing is "undoubtedly straining laboratories’ capacity," said state health department spokeswoman Shelley Walker.
Some residents have reported waiting more than 12 days for results.
Lags dramatically blunt the efficacy of Tennessee's testing, which has been the cornerstone of the state's strategy against the pandemic.
Officials rely on timely data to guide decisions about school openings, public gatherings and business operations such as opening of bars and restaurants.
Faster results give officials a clearer picture of the real-time impact of the virus, and give contact tracers time to slow the spread of the virus by tracking patients' interactions with the community.
Slower results exacerbate the challenge. It means people may unknowingly spread the virus as they wait to know they have tested positive. The delays leave officials in the dark as they try to make decisions that could save lives during the pandemic.
“Testing is great but you need that second part of it to really fight the battle,” said Dr. Alex Jahangir, chair of Metro Nashville's Board of Health and the Metro Coronavirus Task Force.
Some local officials and individual clinics are tracking turnaround times for tests, but the state is not tracking the overarching trends, even though the delays in getting results intensify fear and concern for residents waiting to know if they have COVID-19.
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The woman who helps care for Catherine Fleenor's children found out she had the virus five days after her test. Test administrators at a local CVS clinic, where Fleenor and her husband were tested, told Fleenor she might have to wait a full week to find out if they have the virus too.
That means Fleenor's family may have unknowingly spread the virus to others.
"I have not had a full night's sleep since the positive test came back," said Fleenor, executive director of a Nashville healthcare company and mother of two.
"Racing through my mind, along with the guilt of whether or not we exposed anyone, is that the delay in our test results could be causing them more anxiety."
'All competing for limited lab capacity'
Tennessee Health Commissioner Lisa Piercey said officials have discussed strategies to expand the state's capacity for processing tests, but she did not describe those efforts in detail.
"We're continuing to watch the lab turnaround time," Piercey said Tuesday during a news conference. "It's going to take a few weeks to get that under control."
City-run sites in Nashville changed testing labs recently after large batches of results were delayed for weeks. While city officials say their average turnaround time has improved to about three days, other labs are still seeing much longer waits.
At Neighborhood Health, a network of Middle Tennessee clinics doing private testing, the average turnaround time for result went from 2-to-3 days in May to 9-to-11 days in July.
“That is in no way unique,” said Neighborhood Health CEO Brian Haile, reflecting on struggles of clinics across the Southeast. “We’re all competing for limited lab capacity.”
While the process varies, tests are usually processed with machines that use chemicals to identify if the virus is present on swabs. It can take a few minutes to several hours to process an individual test, based on the equipment.
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The skyrocketing number of tests as demand intensifies nationally has strained the system. Turnaround time is dependent on the availability of chemicals, equipment and personnel needed to process the deluge.
Vanderbilt University Medical Center, which processes more than 900 tests per day, has seen its turnaround time fluctuate based on the available supply of chemicals, said Dr. David Aronoff, director of the division of infectious diseases at Vanderbilt University Medical Center.
'It has become an utter debacle'
Jahangir said broad testing still provides a valuable window into tracking the virus in Nashville and Tennessee. But he acknowledged regional supply chain issues remain a lingering problem.
“That’s where some anxiety comes for me," he said.
Gov. Bill Lee announced a widespread ramp-up of state-funded testing in April, with officials urging residents to opt for a test "when in doubt."
Dr. Aaron Milstone, a pulmonary critical care physician at Williamson Medical Center, said Tennessee's commitment to testing people regardless of their symptoms backfired. The deluge of testing has overwhelmed labs, he said, resulting in increasingly irrelevant test results.
"It has become an utter debacle,” said Milstone.
“The whole idea in the beginning was that we could keep the genie in the bottle," Milstone said. “Now the genie is out of the bottle and no amount of testing is going to make Lee’s problem go away.”
Broad testing is only useful, Milstone said, if the state gets results quickly and aggressively harnesses them to isolate positive cases. But with 750 contact tracers working for the health department across the state and 27,749 active cases Tuesday, that is an uphill battle.
“We would literally need the National Guard at this point to contact trace effectively,” Milstone said. “Testing widely and broadly is doing absolutely nothing to fight the pandemic. Absolutely nothing."
Aronoff, the Vanderbilt doctor, said testing remained a "vital" tool.
“While I agree that we can’t simply test your way out of this pandemic, we need the information that testing provides us to be able to develop action plans and do the things that are necessary to protect people from COVID-19," Aronoff said.
“When we have a combination of supply chain bottlenecks and increasing activity of disease, we need to be putting thought into how we prioritize who gets tested and who does not.”
Jahangir said Nashville still plans to continue with testing regardless of symptoms. In Nashville, he said, a team of about 140 contact tracers contacts about 80% of positive patients within a day of their results.
“We’re doing a lot of tests," Jahangir said, “and I think that is good.”
Jahangir said a national strategy is needed to improve the supply chain, alleviate broader testing delays and get rapid tests to vulnerable populations that need them the most.
But, as it stands now, people across the region are hitting numerous hurdles as they navigate the complicated web of testing options from public and private providers, all with different procedures.
Delays in results can extend past known contagious period
When Sara Heilwagen's grandmother passed away last month, she traveled to Illinois for the funeral. She brought four different types of hand sanitizer, a variety of masks, and remained on the breezeway outside the church during the service.
She wanted to honor and remember the grandmother who had been a beloved school bus driver who inspired Heilwagen to be independent and open to new experiences. But Heilwagen wanted to ensure she didn't come home with the coronavirus.
Then, after four days with family, on the drive home she started to feel a heaviness in her chest and her throat tickled with a light cough.
Two days later, she submitted an online request for an appointment at AFC Urgent Care in Smyrna. The office was supposed to confirm a time, but she didn't hear from them.
When she followed up by phone the next day, she was told the office had received more than 200 requests in a 24-hour period. They would call her when they had availability.
By Sunday, she was told she had to re-submit her request online.
She finally got her test on a Tuesday morning, a nasal swab that felt "like sucking in a nose full of dust." Results sent to LabCorp were supposed to be available in two to three days.
They still hadn't come back more than a week later.
"At this point, it's been 15 days since I first felt symptoms," she said. "I am past where I would have been contagious anyway. There's not a whole lot of good in getting my result anymore."
Milstone, the Williamson Medical Center physician, said the state has leaned too heavily on testing without taking simpler defensive measures like issuing a statewide mask mandate.
The result, Milstone said, has been a “patchwork quilt” of policies that sow confusion and fail to present a united front against the virus.
Vulnerable communities that needed fast testing to guide medical treatment and to cut off hot spots suffered because resources were being depleted indiscriminately for people without symptoms, Milstone said.
'The uncertainty is just too much'
Haile, the CEO of Neighborhood Health, said he wants to see public health officials invest more in targeted testing for at-risk communities.
Haile praised on-site testing for low-income housing units and public housing complexes in Nashville. But he said reluctance from property owners, undocumented residents and people struggling with homelessness have hampered the effort.
Haile said leaders at the Metro Public Health Department could improve the situation by speaking to three different categories of concern:
- Property owners worried their low-income housing units will be penalized if COVID-19 hotspots are discovered;
- Undocumented immigrants who believe getting tested could expose them to deportation or legal trouble; and
- People struggling with homelessness who have avoided testing because they fear being forced into a quarantine that mimicked lock-up.
"The leadership at the Public Health Department has an opportunity, and it's an opportunity that none of us can afford to miss, to deal directly with concerns from people," Haile said. “If Metro Public Health can speak squarely to those concerns it would make an enormous difference.”
Connecting those groups with fast test results was the next priority, Haile said.
Neighborhood Health, the network of Middle Tennessee clinics that provides care to thousands of uninsured Nashvillians, saw relatively short wait times of 2-3 days in the spring, Haile said. Today, it can take up to 11 days to get results.
Neighborhood Health got supplies for about 300 rapid test kits, Haile said, but when it comes to the thousands in need that was "a drop in the bucket."
"It's really easy to say: Assume you're positive, stay away from people and quarantine," Fleenor said. "But without a test result, when you think you've been exposed, the uncertainty of it is just too much."
Joel Ebert contributed to this report.
Reach Adam Tamburin at 615-726-5986 and atamburin@tennessean.com. Follow him on Twitter @tamburintweets and please support local journalism.
WHERE TO GET TESTED
The state of Tennessee has made free COVID-19 testing available for any resident, regardless of symptoms. The time it takes to receive results varies by location.
In Nashville, free state-run testing is available 7 a.m. to 1 p.m. for the three Metro sites: Nissan Stadium Lot N (1 Titans Way), Meharry Medical College (918 21st Ave N) and the former K-Mart parking lot (2491 Murfreesboro Pike in Antioch).
Testing is also available at many urgent care and walk-in clinics.
To find a testing site location anywhere in the state and its hours of operation visit: https://ift.tt/2RrTWSn
For non-health department sites, individuals should call the assessment site prior to going in person. Many locations do a phone assessment to determine if an in-person assessment or test is needed. They typically also require appointments.
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