Vicky Amores, a New York City-based interior designer, is traveling to Florida for Thanksgiving to see her family. But first, she wants to get tested for Covid-19.
She trekked first to a CityMD urgent care location in midtown Manhattan, where she was told at around 10 a.m. on Tuesday that the location had already reached its capacity for the day. So she went uptown to another CityMD location on East 86th Street where the line stretched around the block with more than 60 socially distanced patients waiting to be tested.
Like many people, Amores wants to get tested ahead of the holidays. Others waiting in line said their workplace required regular screening. Another woman waiting at the same CityMD, Elizabeth Abelt, said she was going to dinner with a "very paranoid" friend Tuesday night who asked her to get tested beforehand. Abelt said she had waited for more than five hours to get tested.
With the holidays approaching, some companies calling workers back to the office and anxiety over the virus rising with the daily case count, demand for accurate Covid-19 testing is spiking. An average of 1.6 million Covid-19 tests were run every day over the last week, compared with a seven-day average of less than 900,000 in July, according to data compiled by the Covid Tracking Project, which is run by journalists at The Atlantic magazine.
The surge in demand is yet again stressing the supply chain for PCR molecular tests — the gold standard in Covid-19 testing — leading to long lines for testing, shortages in testing supplies and processing delays across the country.
"For months, our urgent care sites have been extraordinarily busy, seeing millions of patients for typical urgent care needs plus increasing numbers of people seeking medical evaluation and a COVID-19 test," CityMD said in a message to patients last week. "As you may have noticed, long lines are a daily fact at nearly every CityMD as we see a sharp rise in COVID-19 cases across the region."
It's not just CityMD locations. Labs nationwide can't get enough necessary testing supplies. The American Clinical Laboratory Association, an industry trade group, warned last week that its members are "facing delays or cancellations on orders for critical supplies, such as pipette tips."
"The surge in demand for testing will mean that some members could reach or exceed their current testing capacities in the coming days," the association's president, Julie Khani, said in a statement. "In cases where the number of specimens received exceeds an individual laboratory's testing capacity, there could be an increase in their average time to deliver results."
Quest Diagnostics, one of the largest clinical lab operators in the country, acknowledged Tuesday that it, too, is struggling to meet demand. Demand for Quest's molecular tests is up about 50% compared with the last week of September, the company said, adding that there's an industrywide shortage of testing supplies.
Quest's average turnaround time for molecular tests is now "slightly more than" two days for all patients, including high-priority patients who are already in the hospital or need a Covid-19 test to be cleared for surgery.
The current rise in testing demand is "modest," Quest said. But it expects cases and demand to rise "for the foreseeable future, which may cause turnaround times to grow," the company said in a statement.
LabCorp, another national operator of clinical labs, is also beginning to see a surge in demand that's pressuring turnaround time. On Wednesday, the company said its average turnaround time was more than a day, the longest it's been since the surge in July and August had people waiting several days or more for their Covid-19 test results.
"As the holiday season approaches, we are closely watching the trend, and we encourage everyone to wear masks, wash hands, socially distance, and follow local guidelines for group gatherings and keeping safe," the company said in a statement.
Quest also asked people to follow public health precautions to curb the outbreak, saying "we can't do it alone."
Deepak Nath, president of laboratory diagnostics at Europe-based Siemens Healthineers, said some labs might have the capacity to process more tests, but the stressed supply chain is constraining their ability to do so. He said the problems have shifted with time. Early on, lack of reagents, which are chemicals used to process the tests, were causing delays. Now they are short on swabs and other consumable supplies, he said.
With a high number of daily new cases not just in the U.S., but also across Europe, the supply chain could face some if its greatest challenges yet, he said.
"The supply chain is truly global," he said. "It's a very specialized industry, so it's not like there are many players."
Earlier this month, the American Society for Microbiology published the findings of their recent survey, which showed that 134 clinical labs reported running at an average Covid-19 testing capacity of 50.8% — meaning the shortage in supplies has them running at about half of their normal capacity.
The group said that "this data highlights that supply shortage is still an ongoing concern."
Dr. Patrick Godbey, president of the College of American Pathologists and the director of two labs in Georgia, said he's "very worried" about being able to meet the needs of his patients in the weeks ahead. He explained that PCR tests cannot be replaced by other tests in a hospital setting because clinicians need to confirm the diagnosis with a high degree of certainty to determine care.
"The quicker that we can do the test, which translates to the closer to home that we can do the test, the better for the patient, because you can make medical decisions much more quickly," he said in a phone interview. He added that his labs can always ship samples out to other labs, but that will take longer and the longer the test takes to return, the less helpful it is.
Godbey said that to focus supplies on Covid testing, some hospitals have stopped providing other diagnostic services in-house, such as sexually transmitted infections testing, which can have its own public health consequences. Still, he said, labs are running out of supplies, including pipette tips, nasal swabs, chemicals and even trained personnel, who are increasingly burned out from months of grueling hours.
"I do not have enough," Godbey said. "I'm very worried that as the cases go up, that I will not have enough reagents and I will not have enough consumables."