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Why Is COVID Testing so Hard to Scale?

Two full years into the pandemic, it’s almost impossible to believe how badly the U.S. has botched its approach to testing. Rapid antigen tests, while never widely available, have become nearly impossible to find—and if you do score one, you can’t be sure the results are accurate. For gold-standard PCR tests, people wait in hours-long lines, and then wait much longer for results—often a week or more.

As the Omicron variant rips across our country, outrage about testing has followed closely in its wake. America’s clinical laboratories are among the best in the world. So how have we failed this testing challenge so spectacularly?

The heart of the answer is policy: neither the Trump nor Biden administrations prioritized testing, and neither invested enough funding to build the massive infrastructure that would have been needed to absorb such enormous swings in demand. To make a real difference, significant funds would have had to flow, not only to clinical labs, but also to instrument and test manufacturers and developers of the chemicals, tubes, and other elements needed to run the tests.

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But even if testing had been given greater priority in the last two years, certain realities of how clinical laboratories operate would still have made it very hard to scale quickly enough to handle a situation like the one we’re in now with Omicron.

Capacity Limitations

There’s a reason clinical labs handle routine testing so well: it’s predictable. Lab managers know how many test kits they need for any given period, and their instrumentation is set up to handle the right volume. Testing is always more difficult for labs to manage when demand ebbs and flows.

Flu testing is a great example. Many clinical lab managers need to place their orders each year for test kits, chemicals, and other consumables by late summer, in order to prepare for the winter surge. During the 2017-2018 flu season, when flu rates in some areas were three times higher than usual, labs were brought to their knees. They needed more tests and more consumables than anyone predicted. But getting these scarce supplies, which must be produced in highly regulated manufacturing facilities, pitted labs against each other.

Sound familiar? A three-fold surge in demand crippled labs then; in the past six months or so of COVID testing, we’ve gone from a pre-Delta daily low of fewer than 200,000 tests to a recent Omicron one-day high of 4.2 million. That’s a 20-fold difference, and it may get worse. Expecting labs to handle this with existing infrastructure is like expecting a two-lane country road to handle the volume of rush-hour traffic in LA.