Experts fear longer Maryland COVID test turnarounds could contribute to surge

With coronavirus infections again rising, and many governments, businesses and schools requiring tests for those not vaccinated, more Marylanders are seeking COVID-19 swabs.

But residents are encountering a different testing landscape than during the last big surge over the winter. Pharmacies and doctors’ offices, and even pop-up clinics, have taken the place of expansive, largely state-run mass testing sites, resulting in widely varying turnaround times for results.

The combination has experts worried that, as the highly contagious delta variant continues to expand demand for tests, capacity at the state and national levels will be stretched thin and cause further delays, like those seen during previous waves.

They say access to timely results could be restricted to those who can afford to bypass testing centers by buying tests to use at home. Those left waiting for results from labs associated with centers may not quarantine. This could make the pandemic worse and produce unreliable data that could hamper efforts to counter it.

“My two main concerns are: Is access to testing constrained? I have a hunch that it may be, in many places. And, two: Is the test turnaround time fast enough to make public health decisions? I have a hunch that in many places, the answer to that question is, ‘No,'” said Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins COVID-19 Testing Insights Initiative at the Bloomberg School of Public Health’s Center for Health Security.

Nuzzo should know.

A few weeks ago, her daughter was exposed when a vaccinated teacher at her day care tested positive for COVID-19 — six days after her daughter had last seen him, Nuzzo said. Planning to see older relatives soon, Nuzzo sought tests for her immediate family.

She said it wasn’t easy. Two urgent care centers seemed like they would be too crowded. Eventually, she found a walk-in testing option through the Anne Arundel County Health Department that was open for another hour that day.

“It seems like to do that level of kind of searching and trying to figure out where to go, I could imagine that’d be off-putting for a lot of people, a barrier,” Nuzzo said.

On location, Nuzzo and her family got the swabs done swiftly. But afterward, she said, a health department worker told them results would take two to five days.

“I was like, ‘Oh, my God. We’re already on Day Six. If I don’t get my results back for five days, what was the point of this whole experience?’ The whole incubation period for my daughter was completely done,” said Nuzzo, referring to the time from exposure to COVID-19 to when symptoms emerge, which is slightly shorter for the delta variant than the original strain.

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Tests are recommended closer to three days past exposure, compared with three to five for previous strains.

In the meantime, Nuzzo purchased the BinaxNOW at-home COVID-19 tests, which came back negative. The more reliable polymerase chain reaction, or PCR, tests from the health department confirmed those results three and four days later.

More cases are prompting more authorities to ask for tests, for example, to enter a campus, office or school. Infections in Maryland have been on an upswing since early July, with 1,272 added Thursday. A dozen deaths were reported and 778 were hospitalized, the most since May.

Exactly how fast results are needed depends on the situation, said Gigi Gronvall, an immunologist and senior scholar at the Hopkins Center for Health Security.

“For people to isolate, the sooner the better,” she said. “However, the de facto standard for travel and other things has been 72 hours.”

She took her son, too young for vaccination, to be tested ahead of sleepaway camp during the summer and had him swabbed at two sites. The CVS test came back in 14 hours, while results from the state-run mass testing site at the Baltimore Convention Center came back in 74 hours, times she said show how “uneven and unpredictable” testing has become.

Gronvall said she plans more studies on testing times. For now, she’s expecting more people to turn to over-the-counter rapid testing. That could be a big potential cost for consumers and results may not be accepted for all purposes such as travel.

The at-home tests cost about $24 for a two-pack at CVS, which is out of stock online and limiting customers to six packs per order.

More affordable and widely available rapid and at-home tests could help fill the void of government testing sites and alleviate the burden of other testing facilities said Neil Sehgal, assistant professor of health policy and management at the University of Maryland School of Public Health.

But he said the tests, especially if used routinely, can be expensive.

“I don’t think the average Maryland resident has that in their budget,” Sehgal said.

Nuzzo said there shouldn’t be a two-tiered system where only people with means and knowledge of the tests have access to timely results.

And at-home tests raise another concern: If positive, are all of those cases being reported to public health officials who help formulate policies to protect their communities?

“While it was helpful for me to be able to make decisions for my family’s health and make decisions about putting others at risk, no health department knows about this,” she said.

Maryland doesn’t publish testing turnaround data, though Charles Gischlar, a spokesman for the state Department of Health, said the state’s contract labs offer results within approximately 72 hours.

CVS said the outside labs it uses across the country have been averaging a turnaround of one to two days. A national private lab company Quest, said it is maintaining a one-day turnaround.

That’s better than some times reported last summer that exceeded a week or two. But testimonials from about a dozen people in the Baltimore area suggest the wait time varies — from a couple hours to four or five days.

One thing is clear: The demand for tests has increased compared to earlier this summer, though it has yet to reach the levels of April or during the pandemic peak over winter.

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The average daily tally of tests reported by the state during the last week of August was 28,263, according to an analysis by The Baltimore Sun of state data. That’s about double from the 14,079 daily tests reported during the last week in June, but well below the average 41,379 daily tests reported during the last week of January.

The state health department said the numbers, reported on a state website, reflect PCR tests electronically reported to the agency “by labs and other clinical facilities,” which are required to report positive tests. Officials have not said whether results from testing programs at schools and universities, private business or other venues are included in the total.

David McCallister, a health department spokesman, said the state works with state-contracted labs on turnaround times.

“Generally, test results may be available in 48 to 72 hours,” he said. “However, turnaround time for test results may vary depending on laboratory testing demands and resources. Individuals who may have been potentially exposed should follow CDC guidelines regarding self-isolation.”

People may need the tests for travel, work or returning to school. Governments and businesses have instituted a variety of coronavirus vaccine requirements, some offering the option for regular testing instead of immunizations. And with infections among vaccinated people, called breakthrough cases, becoming more common, more people may be seeking tests when they have cold or allergy symptoms.

Sehgal said that officials had expected testing demand would decrease as more people got vaccinated. But the U.S. Centers for Disease Control and Prevention now recommends vaccinated people be tested after a being exposed to someone with COVID-19.

“Especially with delta and the amount of virus that people are putting out into the environment around them, because the delta variant replicates so rapidly once someone is impacted, timely access to test results are more important now than ever before,” Sehgal said.

Shortly after Baltimore County resident Kevin Opeth and his fiancee returned from a trip to Nashville, he started to feel sick. And, although the couple is fully vaccinated against the coronavirus, Opeth wanted to be tested before his fiancee had her upcoming bridal shower. The 34-year-old hurried to a local Walgreens and got himself tested for COVID-19.

That was around 3 p.m. Aug. 25, he said, but the results of his PCR test didn’t arrive until about 5 a.m. Aug. 28 — the morning of the shower. His results came back positive, prompting a scramble to obtain a rapid test for his fiancee.

“I expected to get it in two days, but it took close to four,” he said.

Thankfully, her test came back negative, and, after consulting with their doctor, the party went on as scheduled while Opeth isolated.

Baltimore Sun reporter Hallie Miller contributed to this article.