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Despite a network of testing options, COVID-19 test result wait times remain too high

Urgent care picks up the slack in testing but often at a higher price.

Health care worker, Antoinette Killing, prepares a COVID-19 kit  to be tested on a COVID rapid equipment/machine at the Vybe Urgent Care in Philadelphia, Pa. Friday August 21, 2020. Vybe urgent care recently started offering rapid 15-minute COVID tests at their centers.
Health care worker, Antoinette Killing, prepares a COVID-19 kit to be tested on a COVID rapid equipment/machine at the Vybe Urgent Care in Philadelphia, Pa. Friday August 21, 2020. Vybe urgent care recently started offering rapid 15-minute COVID tests at their centers.Read moreJOSE F. MORENO / Staff Photographer

If you need a COVID-19 test, how long will you have to wait for results?

One answer came from a new survey conducted by researchers at Rutgers University and others. They found that Pennsylvania and New Jersey both had test waiting times similar to the national figure, with the waits running three days and two days, respectively. The figure nationally was three days.

But Katherine Ognyanova, an assistant professor of communication at Rutgers who helped produce the report, pointed out that these numbers reflect only the median, or midpoint, of wait times, “so that means you have quite a lot of people who are waiting much longer.”

She said any waiting time beyond 24 hours renders contact tracing nearly irrelevant: “If you have to wait several days for your test, it’s more likely that you’ve come into contact with more people during that time.”

In Philadelphia, options for testing range from hospitals to public health centers to private businesses like urgent-care clinics. Each comes with different wait times, patient costs, and access.

Though COVID-19 tests must by law be covered by insurance, the telehealth or in-person assessments that may precede them generally are not. While those charges are less common in public or hospital-based options, those places tend to have fewer open slots. This has made room for urgent care facilities to grab a share of the market by providing longer hours despite higher out-of-pocket visit costs.

Carolyn Cannuscio, a University of Pennsylvania public-health expert, said inadequate testing can undermine the economy. “Imagine an employer says that in order to return to work, you have to show evidence of a negative test result,” she said. “The longer the results are delayed, the longer those people will stay out of work.”

The new survey also found that white respondents waited an average of 3.9 days for results, while Hispanics waited 4.6 days and African Americans 5. “That lack of equity demonstrates that there’s some misuse of available resources,” said Cannuscio.

James Garrow, director of communications for the Philadelphia Department of Health, said public testing is a good option for people without links to a hospital. “We don’t want to depend on just the private health-care system to do this,” he said.

But Garrow noted that the department’s partnerships with separate clinics across the city, like Sayre Health Center in West Philadelphia, makes it harder to impose centralized control. The current wait time for results is one to two days, he said, but those numbers vary based on which lab handles analysis.

“When there’s a delay, it’s really based on individual lab turnaround times, which is not something that we have much control over,” he said, “other than trying to help these sites identify other labs.”

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Lab availability is less of a problem for hospital systems like Temple University’s.

Tony S. Reed, Temple’s chief medical officer, said that Temple already had much of the equipment needed for polymerase chain reaction (PCR) tests — the most common test today — and that the cost was more associated with acquiring test chemicals.

“I have a total capacity of about roughly 3,000 tests per day, but given the supply chain limitations that are still happening, I’m limited to 1,000,” he said.

Reed said his sample collection capacity is lower than that, limited to about 150 patients per day at each of Temple’s three testing sites in the city. All patients must meet with a doctor, virtually or in person, to be approved for a test. That allows Reed and his lab to maintain a 24-hour-or-less waiting time for results.

“We have a more rapid turnaround time than commercial labs, but we also have a more limited capacity,” he said.

But those limitations can diminish access for those who don’t have existing relationships with in-network physicians to set up appointments. Public health options aren’t always a feasible alternative, as many testing sites operate on limited hours. Sayre, for example, operates from 9 a.m. to 12:30 p.m. and 1 to 3 p.m.

Urgent care centers aim to fill that gap. Vybe urgent care, which has 11 locations in the Philadelphia region, operates from 8 a.m. to 8 p.m. during the week, and 8 a.m. to 5 p.m. on weekends. Another local company, myDoc Urgent Care, with four centers across the city, also has weekend availability.

But urgent care options are often less affordable. Jing-Jing Cai, an administrator for myDoc, says the business requires anyone seeking a COVID-19 test to go through a telehealth visit first, to limit exposure. Those visits cost $49, and aren’t covered or reimbursed by many insurers, she noted.

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Test result wait times tend to be longer at urgent cares, too, since they have to send results to commercial labs. Cai said she’d seen some results come back in less than 24 hours, but the overall average is about three days. At Vybe, CEO Peter Hotz said the wait time has been hovering around two to five days.

He plans to change that with the recent introduction of a new antigen rapid test, using the Sofia SARS Antigen FIA kit from Quidel Corp.

Hotz said the tests will be able to detect the presence of the virus by analyzing proteins from nasal swabs, returning results within 15 minutes. Last month, Quidel reported that the test demonstrated accuracy similar to PCR tests within the first five days of the onset of symptoms.

The rapid tests are in shorter supply at Vybe, with only 24 available per day at each center. They aren’t covered by insurance either, costing $75.

Public and private providers want to speed up results. In Montgomery County, officials recently started sending patient samples to labs in North Carolina that promise a 36-hour turnaround. But some worry that prices could exacerbate the wait times across different social groups.

Shaun Ginter, president of the Urgent Care Association, said the current business model for testing isn’t ideal. Unlike public facilities, urgent cares don’t get government money to help make the rapid tests cheaper for everyone.

If states or communities require negative test results before people can return to work or travel, “but people can’t afford these tests, that’s going to be a real social issue,” said Ginter.

He also said that while urgent cares have stepped up to fill the testing needs for some patients, they shouldn’t be the only place people can turn to for timely results.

“This crisis really highlights that the American public needs more affordable access to health care,” he said. “And urgent care has been there to help pick up the slack.”