The demand for COVID-19 testing is surging — another challenge for overworked hospitals

As COVID-19 continues to circulate across Virginia, health officials are still grappling with the downstream effects — including a ballooning demand for testing.

In some cases, it’s created additional challenges for already overwhelmed hospitals. Last week, the Virginia Department of Health announced it would add another 170 testing events across the state this month “to help reserve our hospital emergency rooms and rescue squads for medical emergencies,” Dr. Laurie Forlano, the agency’s deputy commissioner for population health, said in a statement. 

Some health care providers, including hospitals and urgent care centers, have reported a “significant increase” in patients seeking testing, added Cheryle Rodriguez, a spokeswoman for the department. In Southwest Virginia, for example, Ballad Health processed a total of 9,004 tests between Aug. 29 and Sept. 4. The demand is almost triple what it was during the health system’s previous peak from Jan. 3 to Jan. 9, when it conducted 3,267 tests.

“Rapid tests may take as much as 48-72 hours,” CEO Alan Levine wrote in a series of tweets, adding that “you will NOT get a result faster by coming to the ER just for a test.”

In the first wave of Covid, we did 600 tests/day at our peak. We are now doing 1,800/day. So, rapid tests may take as much as 48-72 hours. We are working on this, and hope to have a solution by next week. You will NOT get a result faster by coming to the ER just for a test.

— Alan Levine (@alevine014) September 7, 2021

Hospitals aren’t the only providers reporting a spike in demand. Throughout June and July, before the rise of the highly infectious delta variant, there were often fewer than 10,000 tests a day conducted across Virginia, according to VDH data. Last Thursday alone, though, more than 29,000 people were tested.

CVS has also reported growing interest not only in rapid and drive-through testing at its pharmacies, but for the take-home kits available in stores. The demand is so great that the chain recently set purchase limits on three of the most popular brands.

“We’re continuing to work with our suppliers to meet customer demand,” spokesperson Tara Burke wrote in an email on Tuesday. 

Supply is still in a far better place than it was at the start of the pandemic, when state health departments were the only source for testing and set rigid criteria for which patients were eligible. Even when private labs began offering the service, turnaround times were sometimes a week or more, stymying the goal of quickly identifying and isolating new cases.

The variety and availability of testing options has expanded rapidly over the last year and a half, alleviating many of those early challenges. The average turnaround time for PCR tests in Virginia — still considered the gold standard for accurately diagnosing cases of COVID-19 — is between one and three days, according to Rodriguez. Burke said CVS’ rapid antigen testing typically delivers results in hours, and its drive-through tests come back within one to two days. But “high demand at the labs can lead to delays in turnaround times,” the company notes on its website. MedExpress, a chain of urgent cares with multiple locations in central Virginia, said results for PCR lab tests are currently taking two to three days to come back (though rapid antigen tests are generally finished during a patient’s visit, according to spokesperson Bridget Fare.) 

Many hospitals are experiencing that exact challenge. As the Mercury reported this week, emergency rooms across the state have been overwhelmed by the ongoing surge in cases, a trend that’s only compounded existing staffing shortages. “With ICUs being full, and our inpatient COVID volumes at more than 400 today, our team is doing the best they can to prioritize their time,” Levine wrote last week.

In addition to processing delays, the influx of testing requests can create headaches for nurses and physicians. One emergency room doctor from Northern Virginia said there’s been a surge in requests not only from symptomatic patients, but from people who are concerned about potential exposures.

“This testing has made operations complex because of the time needed for staff to don and doff [personal protective equipment],” the doctor added. With already-crowded ERs, it also means staff have to find an available space and spend time decontaminating the room if a patient tests positive. 

Some hospitals have streamlined their testing procedures in response, but many health systems are redirecting patients to nearby pharmacies and urgent cares.

“Emergency departments should be reserved for life- and limb-threatening situations, such as chest pain, severe injuries, difficulty breathing and stroke symptoms,” Ballad wrote in a news release last week. A spokesperson for Sovah, another nearby health system with locations in Danville and Martinsville, said it’s also been directing an “influx” of patients to primary care offices and other alternative settings.

Despite the COVID-19 surge, businesses and schools across Virginia — and the country — have largely returned to life as normal. Travel, work and education are continuing to drive the need for testing, Kaiser Health News recently reported, but the at-home kits, which can range from $10 to $40 per test, are too expensive for many people. That’s likely contributing to sustained demand for testing in more traditional settings, where health officials have frequently emphasized that it’s free for un- and underinsured individuals.

Some doctors also said patients are sometimes referred to hospitals for testing from primary care offices or urgent care centers. The Free Lance-Star reported that supply has increasingly become a challenge in those settings, with some urgent cares refusing to test patients unless they’re showing symptoms of the virus. And demand likely won’t slow anytime soon. Quest Diagnostics, one of the largest medical laboratory companies in the country, said Tuesday that it’s still “evaluating” a recent plan announced by President Joe Biden, who’s requiring all businesses with 100 or more employees to provide at least weekly testing for unvaccinated workers.

That includes considering the plan’s “potential implications” on testing services and “opportunities to scale our laboratory testing capacity and rapid antigen test inventory should demand increase,” a Quest spokesperson stated.

Emergency rooms, though, are seldom the right place to go for testing unless a patient is experiencing severe COVID symptoms — including difficulty breathing and chest pain. In many cases, routine testing might not even be available. Many hospitals, including LewisGale in Southwest Virginia, are only offering it to symptomatic patients or those awaiting surgery.

“But some people just default to emergency room care for everything,” said Ashlea Ramey, a spokesperson for Ballad. “It’s unfortunate, but especially in this part of the country, it can be a really hard habit to break.”