The anatomy of an 11-day Covid-19 test report

The test result finally came eleven days, almost to the hour, from getting swabbed at a mass drive-up testing site on July 2nd. Even then, the confirmation came not through the official portal, but rather via secure email from one of the several email, website response and telephone call queries I had been making for several days. I had been very sick for almost two weeks and my doctor wanted the Covid-19 test before seeing me again.

My Covid-19 test was negative; good news on one hand but that didn’t fully explain my illness. And it came on the day after a one-day-anywhere record of 15,300 positive tests were reported in my home state of Florida. And so, the question: If it took eleven days to get my test result, during a period when case counts have been growing at 5% PER DAY, then what is the real count of cases out there?

How can it be that this far into the coronavirus crisis, it takes eleven days to get the results of a test? Even well-connected Republican politicians and Fox News celebrities are finding that 7-day delays are common for their own families. The failure of the Trump Administration and some state governments to adequately ramp up testing will go down in history as one of key institutional failures of this crisis. This is my drill-down into just one way things can go very wrong in testing for coronavirus.

Heroes and yeoman’s duty

My first professional job long ago had me working on new computer-assisted ways to assemble automobiles at a higher quality level. These were the “exploding Pinto” years of the 1970s, and the American automobile industry was spending many millions of dollars trying to match Japanese levels of quality. An automobile assembly plant, when running well, is a marvel of systems engineering. I have also watched entire assembly lines come to a stop because somebody failed to do his (almost always his back then) job.

You may have seen some of the drive-up testing sites in Florida or the Southwest on the news recently. The complex logistics here remind me of those old assembly lines. In this Gulf Coast Florida location, National Guardsmen continue to manage traffic and supplies in the oppressive Florida heat seven days a week, while hundreds of sick or scared people are sitting in their cars, often for hours, snaking through the lines to the testing stations.

Covid Testing in Sarasota

Testing site in Sarasota, Florida (video by author)

At these stations, which are just tents without sides, PPE-garbed healthcare workers swab somebody nearly every minute once they get rolling, and it does not stop all day long. The scale of ordinary folk doing “yeoman’s duty” in awful conditions is mind-blowing.

From what I have discovered, some locations manage the basic logistics here better than others. The most common issue appears to be running out of tests, after people have waited for hours. Somebody likely knew that was going to happen long before the tests ran out. It only takes one. But none of these folks on-site are likely getting paid what they are worth in these working conditions. As a friend of mine liked to say, “God originally made Florida a swamp and God wants it back!” This is “swamp work.”

CDR Maguire, the emergency services firm that was contracted to run my testing site, has had its share of logistical breakdowns as they have ramped up Florida testing. I do have to say that they have been open and upfront with me about some of their issues with subcontractors in my personal contacts with them, and they helped track down my test in the end. I suspect, however, if Floridians ever do see the total bill for these emergency testing services, it will be staggering.

“You are the weakest link!”

A “big rig” truck assembly line I helped to plan in that early job was abruptly shut down one day for the lack of simple wood boxes. Some trucks to be later customized came off the line with no front seat, and had to be driven off the line while the driver sat on a simple box. Someone, somewhere, apparently said, “Why do these boxes I’m ordering keep disappearing?” and stopped ordering boxes.

The best efforts of all of these test site people, the time of all the people being tested, and all of this money spent, can grind to a halt in a similar manner. My research into my own test uncovered that test swabs from Thursday, July 2, through the weekend sat uncollected because no one had made arrangements to transport them over the Holiday. And so, none of the July 2nd tests from this site even made it to the laboratory until July 7, five days later! The subcontractor responsible for testing in Florida has assured me in a telephone conversation that each day’s tests are now being expedited out that same day for faster delivery. But that system failure alone cost almost five days out of the eleven that I and hundreds of others waited for our desperately-need results.

Failure point #2 in my case was caused by a very manual process for labeling the swab vials with identifying information. A National Guardsman will take your identification documents from you and fill out a form while you wait in the car line, as well as write down your telephone number. This information is then attached to the swab vial. If the Guardsman didn’t get your name, date of birth or other identifying information down correctly, or if a clerk later mistyped that information, then any of your subsequent attempts to use the laboratory’s website will be futile. There will be no “match” in the system. One of these transcription errors apparently happened to my swab vial. And so, once my test was finally processed on Day Nine, it sat somewhere in computer limbo, unmatched and forgotten.

Customer service hell

We have all been there. Telephone lines that ask you to “Press 1” and never take you to a human. In this case, the first telephone number given to me led to an automated message of “Your estimated wait time is two hours.” Calling back early the next day this number simply yielded yet another telephone number to call, this one for the laboratory itself, a company called GENETWORx. That number, after a long hold, went to a voice mailbox, but my messages/pleas were never answered by a human.

I managed a technical support hotline in the early days of personal computer software, and my excellent staff taught me how to appreciate the difference between an intent to actually help customers versus an attempt to get you to “Go away!” The Florida Covid test servicers are clearly in the latter camp. An email site that said to reply if your test was five days old was not answered until multiple emails over the next several days when at Day 11, it finally produced a response, the test result via secure email message.

And then there is the lab itself

In the middle of that logistical snafu chain was the base testing time of my sample, which was about four days and nine hours. I am not sure of the causes of delay here, other than most likely it was just a pure volume issue, where the massive quantities of tests are overwhelming available testing equipment and personnel.

Many labs are still reporting shortages of critical chemical reagents required to process these tests. The Trump Administration has explicitly made the acquisition of personal protective equipment, the tests themselves, and the chemical reagents a “local problem.” History will record well that this was exactly the time when a competent, top-down supply chain disaster response was justified. It did not happen.

The coronavirus curve is not yet beginning to bend in Florida and in much of the Southwest. And positive test result percentages are edging up in other states such as Iowa, portending more problems ahead. Week-long delays of test results for those who are sick can be life threatening. And out of experience I can attest that the delays are mentally excruciating for you and your entire family when you are not sure why you are ill.

Do you have a plan on where to be tested if necessary? Have you driven by to check the site out lately? Good luck. The government, unfortunately, does not have your back. You are on your own.

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