It started with the “slightest of scratchy throats” for Mark Brody, a 53-year-old Mount Washington resident.
Despite having mild symptoms, he got swabbed for the coronavirus on July 3 after seeing a commercial advertising free drive-thru testing. He was told to wait a few days for the results.
But after experiencing nausea and lightheadedness to the point of collapse, Brody visited an emergency room on July 7 and got a positive test result within an hour. He did not receive the initial July 3 result until more than two weeks later — also positive.
“If you can’t get your test results within two weeks, you can’t even do anything with it,” Brody said. ”The whole thing’s pointless.”
Though “high-priority” patients — such as those in the hospital or showing severe symptoms — qualify for expedited testing, much of the population must wait several days for their COVID-19 results, a time frame that experts say does not help mitigate the spread of the virus. In Maryland, delays as long as five to seven days have become routine, which officials attribute to overwhelming demand at large commercial labs.
These lags come as states such as Maryland continue to make reopening decisions based on available data. But with results effectively a week or more behind, such judgments may not reflect what’s happening now.
In a statement, Maryland Department of Health spokesperson Charles Gischlar said results are generally returned within a week. However, some laboratories, including the health department’s and a repurposed research facility at the University of Maryland, Baltimore, can process tests within 48 hours.
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But with thousands of tests to process daily, those two labs do not significantly minimize the backlog created by national vendors.
To accommodate the demand for tests, labs run by the state, universities and private companies have opened throughout Maryland. Testing sites have emerged in parking lots, hospital garages, vehicle emission inspection stations, and even the Maryland State Fairgrounds and the Baltimore Convention Center. The hodgepodge of test sites, test types and test eligibility requirements has added to the confusion.
Republican Gov. Larry Hogan said this week that delays in obtaining timely results are “a big concern of ours.”
”As we’re seeing states across the country have serious spikes in infections, the demand for testing is ramping up dramatically. We’re seeing states that are sort of out of control,” the governor said Wednesday during an online meeting of the state Board of Public Works.
”And so, that is really slowing down many of these private labs. Most of our private labs are slowing down not as a result of anything happening here in Maryland, but as a result of that huge demand nationwide.”
Hogan said some labs were seeing a 10-day lag for results.
“The tests that come back that late are almost not even valuable,” Hogan said.
In a July 13 statement, Quest Diagnostics, one of the largest private clinical laboratories in the United States, said wait times for low-priority patients will average around seven days or more due to “the rapid, continuing spread of COVID-19 infections” across the country, as well as the overwhelming demand for tests.
CVS Pharmacy, which administered Brody’s swab, estimates its result turnaround at six to 10 days on its coronavirus portal.
Dr. Leana Wen, an emergency physician and public health professor at George Washington University, said results should be returned within 48 hours to be considered effective. But ideally, people should learn their result at the point of care, she said.
“The point of getting tested is to change how one would make decisions — for example, should you keep isolating?” said Wen, who previously served as Baltimore’s health commissioner. “Timely testing is the linchpin to COVID-19. If something comes back in five to seven days, it becomes too late to identify others.”
Wen said expanded testing and inconsistent national standards mean more people getting tested at the expense of the most urgent cases, such as those who live or work in close quarters or those who cannot afford to isolate without concrete evidence, like Kathleen Dickinson of Perry Hall.
“Some people just cannot afford to not work for a week because they’re waiting for the test results,” Dickinson said.
Dickinson, who owns a women’s boutique, said she had to go to work while waiting seven days to receive her test result. It was negative.
“With the delay in getting results, people have to weigh those options,” Dickinson said. “This should be a simple walk-in and you know your test results within 24 hours.”
Inconsistent testing rattled many Marylanders in the early days of the pandemic, as many were unable to get a test at all.
Since then, Maryland and the rest of the country ramped up testing capacity, but now some contend it has become too broad.
Jennifer Nuzzo, a senior scholar in the Johns Hopkins Center for Health Security, said the U.S. should develop a national strategy so that all states can adopt similar standards as to who qualifies for tests. She also said the country should conduct an audit to determine the cause of delayed results, so shortages in personnel, equipment or lab space can be remedied.
“The system can’t keep up unless we have a radically different approach,” Nuzzo said. “We never stress-tested the infrastructure we have. The causes of our testing troubles probably vary.”
Nuzzo, also the lead epidemiologist for Johns Hopkins University’s COVID-19 Testing Insights Initiative, said wait times of five to seven days limit states’ ability to encourage infected people to quarantine.
Some people, such as Brody, may no longer be contagious by the time they get their results back, but are capable of exposing their relatives and roommates in the interim, especially if they continue to work or live with others. (Brody’s wife, Robyn, also tested positive, and the two of them tried their best to isolate from their children in their four-bedroom townhome.)
Quarantining long term becomes difficult to justify with mounting pressures from work or obligations to family members.
Alex Greenspan, who works at a law office in Anne Arundel County, waited 13 days to find out he tested negative on July 2. He missed seven days of work, which meant his colleagues had to fill in on his behalf.
“I was worried about feeling like I was just taking off work frivolously because I didn’t have symptoms,” said Greenspan, 26.
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It also left him in a state of prolonged agony as he waited, fearing he had exposed his grandmother.
“All of us were kind of racked by guilt at the idea that we might have exposed her after her husband, my grandfather, had just passed away from COVID,” he said. “We just kept wondering how long it would take to hear back, and all the delay meant that we spent more time thinking about it.”
On Saturday, Greenspan learned that his friend who potentially exposed him to coronavirus received a negative antibody test, meaning the original test may have been a false positive, and that his 13 days of self-isolation had been “for nothing.”
Crystal Watson, another senior scholar in the Johns Hopkins Center for Health Security, said with the economy still in the early stages of reopening, some people may not feel comfortable taking extended periods of time off work to isolate. Some people need official documentation to take time off, she added.
Given the lag times on test results, Watson said the state should beef up its contact tracing program and begin the work as soon as a person goes for a test.
“These chains of transmission continue because we don’t have the proof that these events are occurring,” Watson said. “And for the people who were contacts of the case, if they were infected, they have likely gone on to develop symptoms or may have infected others.”
Baltimore Sun reporter Jeff Barker contributed to this article.