City Paper is not for tourists
Whitman-Walker Health sends its COVID-19 tests to LabCorp, a commercial lab headquartered in North Carolina. Since it began testing on March 16, Whitman-Walker has sent over 50 tests to the private lab and as of Wednesday, March 25, was waiting on the results of more than two-thirds of those tests, according to its chief health officer, Dr. Sarah Henn. Of the results that Whitman-Walker has received, just under half have come back positive.
Whitman-Walker has enough personal protective equipment to administer tests at the moment, Henn says, but health care personnel are using this equipment for an extended period of time to test multiple patients. Generally, protective equipment is meant to be used a single time and discarded, but Whitman-Walker is using extended wear protocol to conserve the amount of equipment.
“Our biggest struggle is just the turnaround time for testing right now,” says Henn.
It takes seven days to get results. Henn says LabCorp’s original goal was to turn around results in three or four days but that has not been the case. LabCorp is offering nationwide testing, so it’s not just serving the D.C. region. LabCorp did not immediately respond to a request for comment.
Henn says long wait times mean patients are left in limbo, anxiously awaiting their diagnoses. Not only does a quicker result mean a patient gets to breathe a sigh of relief earlier, but it means contact tracing can begin more immediately. This helps those who’ve been in contact with an infected patient get care faster and helps prevent further transmission of the virus. More immediate results also help a provider monitor a patient earlier. This is helpful in some cases where the disease worsens over time for a patient and they require more immediate care.
“We certainly know there are people who have milder disease and we can make presumptive diagnoses and tell people to stay home and self-quarantine,” she says. “But I think people are more likely to follow those instructions if they know they are positive than if they’re not sure.”
Whitman-Walker sends its swabs to a commercial lab over D.C.’s public health lab because the latter is prioritizing who they are doing tests for.
“The messaging that we’ve gotten from DC Health is that they’re prioritizing certain individuals: those health care workers, hospitalized patients, patients who may have exposed a lot of people to the virus, high-risk situations,” Henn tells City Paper. “The messaging we have been getting is that we need to pursue testing through the commercial lab for our patients.”
The people Whitman-Walker has been screening and testing are patients who demonstrate flu-like symptoms—fever, cough, and shortness of breath—and live in the community. It is not testing patients who are asymptomatic, but generally testing those with two of the three listed symptoms. These patients are typically younger.
The Department of Forensic Sciences says its public health lab has the capacity to process 150 patient tests per day and will be able to process 500 tests by Tuesday, March 31. D.C. has been able to ramp up its testing significantly because the Food and Drug Administration effectively expanded the lab’s options. Just because it has the ability to test more patients than it had been able to two weeks ago, when it was at 15 per day, doesn’t mean the public lab is doing so. Right now, the public lab is running 13 samples a day, on average, and has no backlog. Result turnaround time is within 48 hours.
“We can do more and we want to do more,” said Dr. Jennifer Smith with DFS, in a press conference on Wednesday, about testing. “I encourage hospitals and medical providers to proactively reach out to DC Health if they need testing support for their priority group 1 patients and other patients they deem necessary for testing.”
“Our public health lab is ready and eager to help,” she added.
DC Health released guidance naming its three priority groups on March 25. The three groups are the following:
Hospitalized patients and health care facility workers with COVID-19 symptoms
Patients in long-term care facilities with symptoms; patients over 65 with symptoms; patients with underlying medical conditions with symptoms; and first responders with symptoms
Critical infrastructure workers with symptoms; individuals “who do not meet any of the above categories” but have symptoms; health care facility workers and first responders; and those in detention centers and experiencing homelessness with symptoms
While testing capacity is expanding at the public lab and new drive-up locations, DC Health Director LaQuandra Nesbitt stressed on Wednesday that testing will continue to prioritize those at high risk. Given that, some hospitals have labs on-site, so they are processing results for the first priority group on their own campuses.
“I also want to underscore that we are making decisions about who to test if it’s going to change the clinical management or the public health management of that individual,” said Nesbitt. “So if you are going to have to self quarantine or self isolate while you are waiting for your test result, we recognize that it may be a high period of anxiety for you to wait a difference from 24 hours or seven hours. But if you have mild symptoms and you are going to remain at your home, we are asking for your patience during that period of time.”
“It’s very important for us to get timely results for those patients who are in the hospital, who may be critically ill, or it may actually impact the clinical management where they may need to get access to those compassionate care medications and where it may actually impact how and where we care for them in our hospitals,” she added.
Mayor Muriel Bowser in a community call on Wednesday also emphasized that a doctor’s referral is required for testing at any location, be it a standalone clinic or any of the drive-up locations that are expected to open in the coming week. When asked about “any plans for mass testing” from a Ward 8 caller, Bowser said D.C. needs to conserve protective gear and testing kits for those that need to be tested.
For the foreseeable future, Whitman-Walker still intends to send results to the commercial lab. “The messaging is still that providers should use commercial labs, unless they’re seeing someone who falls into one of these priority populations, in which case, they can contact the health department to pursue testing,” says Henn. But she emphasized that if D.C. wants to get this epidemic under control, there needs to be more and better testing.
“Where people have been successful in kind of reopening society, it’s been where they’ve been able to have lots of testing with fast turnaround time. So that as soon as someone who might be barely symptomatic tests positive, you are testing everyone they’ve been in contact with and you don’t have to go back weeks. You’re going back days,” she says.
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