Private laboratories have joined public health facilities in testing for the new coronavirus in an effort to beef up screening capacity in New Jersey and nationwide. But the extra assistance doesn’t come without complications.
State officials have acknowledged they have limited information about coronavirus tests now being conducted by the two global companies collecting samples from medical providers in the Garden State and throughout the U.S. As of midday Wednesday, New Jersey had 23 residents who had tested positive for the related disease, COVID-19, including one who died early Tuesday.
While private labs are supposed to report testing results to the state’s Communicable Disease Service — which serves as a hub for all the coronavirus data — state officials aren’t automatically informed when medical providers submit coronavirus tests to these facilities. They also don’t have easy access to the patient histories and potential exposure information needed to determine how the person got sick and if the virus is spreading.
Until this week, New Jersey doctors and hospitals shipped all samples taken from individuals who met the federal requirements for coronavirus testing to the state’s public health laboratory services. But as of Monday, providers could also choose to have the swabs processed by LabCorp or Quest Diagnostics, the two private companies permitted to run the tests. (Patients should not need to pay out-of-pocket, thanks to state and federal actions to waive copays.)
State Department of Health Commissioner Judith Persichilli said Tuesday that, when private labs are involved, “that gives us limited ability to follow up on that case.”
‘Need to develop a closer communication’
The state may get basic results, she said, “but what we don’t know is all the background screening that the hospitals are now doing with any patient that now presents with respiratory symptoms and fever.” This includes critical information about travel history, work and social patterns, and exposure to others who might be sick.
“That’s why (with) the commercial labs, we need to develop a closer communication,” Persichilli said at the state’s daily briefing on the epidemic. As of Wednesday, New Jersey had recorded just one positive case processed in a private lab.
Ensuring that the state has quick access to accurate information about COVID-19 patients becomes more important as public health officials grapple with the likelihood of so-called community spread, in which the virus is transmitted among people with no exposure to a confirmed case or travel to an area where the disease is rampant. Identifying where patients contracted the virus will help the state plan its response and impact decisions to close schools or cancel large gatherings, like the upcoming St. Patrick’s Day parades, Persichilli said.
There is no vaccine or specific treatment for the disease, which results in mild, flu-like symptoms for most healthy individuals but can prove deadly to older people or those with compromised immune systems.
“Community spread indicates that the coronavirus is amongst us. And we have an expectation that that may be the case,” Persichilli said Wednesday, noting that officials had yet to identify a known source for two of the eight new COVID-19 cases diagnosed that day. More detail on these individuals’ history and travel should be available in 24 to 48 hours, she said.
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While the DOH awaits that information, state officials continue to leave most decisions about school closures and event cancellations to local leaders, but long-term-care facilities have been advised to assess visitors and restrict access to those that don’t pose any coronavirus risk to residents. Multiple New Jersey colleges have cancelled classes or required remote learning and Gov. Phil Murphy rescheduled a summit on gun safety planned for this week.
When to increase ‘mitigation strategies’
Persichilli said the state’s inter-agency task force on the coronavirus meets daily and key leaders talk multiple times during the day. “I don’t know where that turn is, but I know the epidemiologists will tell you we want to respond sooner rather than later and we will know when it’s time to take our mitigation strategies to the next level,” she said.
As of noon Wednesday, New Jersey had tested 80 people, with 57 returning negative results for the virus and 23 found as “presumptive positive”; 20 more are now being tested and another 37 people are considered potential candidates for testing, pending more detailed investigations into where they have traveled and how they might have contracted the disease.
The positive samples have been shipped to the federal Centers for Disease Control and Prevention, in Atlanta, for confirmation, but the CDC has yet to provide results or respond to officials’ questions about the delay. (CDC media representatives also did not respond to a request for information.)
The state DOH lab now has capacity to test roughly 400 people and has ordered kits for another 216 assessments from the CDC. Assistant commissioner Chris Neuwirth said tests take 24 to 48 hours to complete.
Once the results are in, the state lab notifies the doctor or hospital that ordered the test and the local health department in the patient’s community, which is responsible for conducting the follow-up screening that helps public officials identify exactly where the patient contracted the disease and where they might have spread the virus.
The corporate goal
But as of Monday, providers who determined someone met the testing requirements (either because of contact with someone infected, travel to a location where the disease is active, or a pneumonia with no known source) had the option of using Quest or LabCorp instead. Corporate representatives for both companies said their goal was to rapidly expand testing capacity in the U.S. to help protect public health, but it is not clear how much of their data — or the patient histories collected by the providers — is shared with any state, local or national health officials coordinating the response.
“Our team is proud to play an important role as part of an industry consortium that is working every day to meet the growing demand for national testing. Our utmost concern is for the safety of the public, patients, healthcare service providers, and our employees,” said LabCorp vice president and chief communications officer Pattie Kushner.
According to Kushner, LabCorp can now process “several thousand tests per day” at its North Carolina facility and is still increasing capacity there and at other sites. Results from the tests are reported to “ordering clinicians and public health authorities as may be required.” The process takes three to four days, she said.
Quest Diagnostics is processing samples from New Jersey and other states at its California headquarters, but hopes to expand to other locations soon. “We are scaling up capacity at this performing laboratory and anticipate we will have performed several thousands of tests for patients by the end of this week,” said Quest external communications specialist Rachel Carr.
Capacity should expand so that Quest can process “tens of thousands” tests weekly by the end of next month, Carr said. Results are available in three to four days, she added, but declined to address how these findings are communicated to public officials.