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Some call for faster — but less accurate — coronavirus tests as influx causes delays at TestNebraska

Some call for faster — but less accurate — coronavirus tests as influx causes delays at TestNebraska

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Lots of Nebraskans want to get tested for COVID-19, and that appears to be at least one factor slowing turnaround times for the state’s testing program.

TestNebraska has seen a dramatic increase in the number of swabs being conducted on a daily basis over the last month, according to Taylor Gage, a spokesman for Nebraska Gov. Pete Ricketts.

In addition, the Lincoln lab that processes those tests was shut down for a time for an audit, which it passed, Gage said.

As of early July, the lab had been averaging just short of 41 hours, from the time that nasopharyngeal swabs were collected at a drive-thru site until people received their test results. But during July, the average turnaround time was 57.9 hours.

And anecdotal reports in Omaha in recent days have included TestNebraska turnaround times of 70- and 80-plus hours.

Gage said the state’s team is aware of the elevated turnaround time and is working to resolve it, including adding staff and expanding capacity.

Ricketts has announced that the lab is in the midst of an expansion that will increase its daily capacity from 3,600 to 7,000 tests a day. Testing capacity nationally, too, has increased.

But delays in getting results, even temporary ones, have begun to raise questions in Nebraska and elsewhere about whether the testing currently available can quickly identify people who are infected with the coronavirus — a significant number of whom don’t have symptoms — so that they can go into isolation and their close contacts can be quarantined.

Nationally, delays of seven to 10 days — or more — in getting results have been reported at various times during the pandemic, particularly at times when cases have surged and testing materials are in short supply.

One concern is that people who get tested after having a close encounter with someone who’s positive may not wait for the results, particularly if they’re not ill and feel the need to get back to work or school.

Keeping teachers out of quarantine and in schools, for instance, is expected to be a key factor in whether schools can stay up and running this year in Nebraska. Avoiding close contact with infected people will be one important step for school staff.

But Millard Superintendent Jim Sutfin said Monday that testing also will play a role.

“We absolutely need rapid testing,” Sutfin said. “If we don’t come to a point where we have rapid testing, that might be what shuts the entire city down of every school district, because you cannot wait a week to get a test result on a teacher. You’re going to run out of people.”

In an opinion piece in The World-Herald on Wednesday, Thomas Murray, provost of Creighton University, backed a call by a Harvard epidemiologist and others for frequently screening larger populations using “faster, cheaper and acceptably less accurate tests.”

Antigen tests, like those commonly used in doctor’s offices for influenza, detect viral proteins in saliva or a nasal swab. They’re less sensitive than the gold standard test used by TestNebraska and many other large labs, which finds and amplifies the virus’s genetic material.

Murray also cited a modeling study published by a Yale researcher indicating that screening college students every two days using a rapid and less sensitive test, matched with strict behavioral interventions including mask-wearing, would dramatically limit the number of COVID-19 infections and permit the safe return of students to campus.

The aim, he wrote, would be to catch those who are most contagious. Those who are too early in the course of disease to be caught one day could be detected a couple of days later when their viral loads are higher.

Creighton will test everyone living on campus before they move in, using the gold standard method, known as RT-PCR.

But Dr. Steven Hinrichs, chairman of the University of Nebraska Medical Center’s pathology and microbiology department, said a less sensitive test could be considered dangerous in the current situation.

“If they are significantly less sensitive, individuals will be identified as negative when they are truly positive,” he said. “And falsely negative individuals could continue to spread disease.”

Hinrichs said he understands the desire for a fast, inexpensive test. But mask-wearing already provides an inexpensive means of preventing the spread of the virus.

An editorial accompanying the Yale study in JAMA Network Open also noted that the best-prepared campuses would use a layered approach aimed at reducing the influx of the virus from outside and limiting its spread on campuses, including masking and social distancing.

Hinrichs also said that getting test results returned rapidly is important.

The Nebraska Public Health Laboratory and a clinical lab jointly operated by UNMC and Nebraska Medicine continue to focus on returning results within 24 to 48 hours, he said, with a 24-hour turnaround the most common.

The public health lab continues to run about 450 tests a day. The clinical lab currently can run about 600 a day, about half of its capacity before recent cutbacks on tests from two large suppliers.

“I don’t believe a fast, wrong answer is better,” Hinrichs said. “The pressure needs to be back on the (labs) to get the turnaround time better, because it can be done.”

There’s little doubt TestNebraska has been busy. According to state data, the testing program averaged more than 1,700 tests a day in July, nearly 1,000 more than the next largest in Nebraska, the UNMC/Nebraska Medicine lab.

The state program’s turnaround time for the past two weeks averaged a little more than 3.5 days, a day or more longer than local university and health system labs but significantly faster than one national lab.

Still, some area residents already are seeking out the faster antigen tests.

TotalWellness in Omaha has been doubling the volume of antigen tests it conducts every week and is up to about 200 appointments a day, said owner Alan Kohll.

Results typically are sent to patients within 20 to 30 minutes. The testing platform, manufactured by Quidel, has an emergency use authorization from the Food and Drug Administration. “You’re not losing much in sensitivity by using the test,” he said.

Federal officials, in fact, have pledged to significantly ramp up the availability of such so-called point-of-care tests as early as fall.

Currently, the test costs $80. By Monday, Kohll said, the company will have the ability to verify and bill insurance companies.

The results of antigen tests are reported to and tallied by state and local health departments, said Gage, the governor’s spokesman.

Kohll said people come to TotalWellness because they want results right away. “That’s the whole point, is it should be convenient and fast to get the results,” he said.

After all, the quarantine time for the infected and those who come into contact with them isn’t short.

Those who were in direct contact, closer than 6 feet for 15 minutes or longer, with a COVID-19-positive person are advised to self-quarantine for 14 days, according to guidance from the Douglas County Health Department.

For those living with someone with the virus who can’t determine their last exposure, the clock runs out 14 days after the positive person ends their isolation, typically 10 days, for a total of 24 days.

World-Herald staff writer Joe Dejka contributed to this report.

TestNebraska drive-thru testing in Omaha

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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